Triage without an office

[LilgirlRN, ADN, RN]

This may have been asked and answered but I'm lazy and don't wanna look at all the ER stuff to find out. I work in an ER where we see about 150-200 folks a day. The ER doctors don't work for the hospital, they work for an ER MD staffing company. The old company's contract was up and they hired this new company, which hired some of our old docs from the company that had staffed us before. 3 months ago we had a triage office just like any other hospital however now the patients are brought to a room by a tech before they're even registered.This means if you're the triage nurse you have no control over what kind of patient goes where because someone else (the tech) is making that decision for you. Let's say we follow what usually happens every afternoon... people get home from work and decide they're too sick to go to work tmorrow or get home and find one of the kiddies sick and off they go to the ER. This means sometimes as many as 10 people may show up at once and if we have empty rooms they all come straight back. So now 10 people that have not been triaged are in rooms and I don't know what's wrong with them but I'm still responsible for getting them triaged in order of acuity?!? Our ER nursing director agreed to do this before the staffing comapny was given the contract, they requested this. They told the hospital head-honchos tat they could promise more revenue because fewer people would leave without being seen. We have ONE triage nurse and ONE tech for a 30 bed unit. Anyone else doing this and if you are how is your ER handling it? I feel like there is a disaster waiting to happen and I'll be the one (cause I'm triage more times than not) to blame. Hoping someone has a great idea for me. Thanks :)

[EmergencyNrse]

MANY are taught to "pull 'till full".

The ENA has bought into this and I don't agree with this practice.

You put the patient in the room and go straight to assessment. Registration happens @ bedside. What you lose isn't so much triage and sorting but allocation of your resources.

Not every ER room is set up identically to provide the same level of care therefore you end up with conscious sedation/reductions taking up pelvic beds. Abdominal pains in your ortho/splint bay, headaches in your tele beds, and bull$#!t patients in your trauma room... freakin' people all over the place. And then the ER slows to a crawl because all your equipment is tied up inappropriately.

Oh sure, there's the "musical beds" game but not everyone has a bed when the music stops. Then there is the mess of reporting off to another nurse who gave up her pt just so she can get yours. It's a laugh riot.

Everyone moving, nobody actually treating anything... everyone's too busy giving & receiving report. ALL because there wasn't someone actually doing triage.

Don't worry though there will be more BRILLIANT changes coming soon to an ER near you.

[LoveMyBugs, BSN, CNA, RN]

My ER is similar in size we see an about 130-200, 30 bed unit

The way my ER works, is the triage RN and a tech, plus a registration staff all are at the front, that way the RN sees everyone who walks in the door, all the vitals are taken at the desk. The nurse then decides if they need a bed or if they can be sent through our rapid medical exam area

If there are rooms open in the back the traige nurse calls the charge to see where to send which pts. The tech then takes the pts back to the rooms, while the RN stays at the front.

When the rooms are full, then the pts start to pile up in the waiting room, then the triage nurse gets the vitals and everyone gets sent to the fast track area, where they can be quickly evaluated by a provider and we can get orders started while they wait for a bed.

Pts that are waiting for a bed are then sent back to the waiting room, where they are revitaled and asses every hour untill they get to the back.

As far as computer charting goes our "triage" charting can be lengthy so if they are getting a bed in the back the nurse for that room completes the charting and if they are sent through fast track then that nurse completes the computer charting, the actual triage nurse does not do a lot of charting, mainly vital signs and sending them where then need to go.

When I first started working here, they used to have a CNA sit at the front desk and hand the RN the chart to call people back to triage, where they would sit and go over the long computer triage form, however now having a RN at the front desk they can make those calls that this person can not wait for a bed and take them right back.

We were also underconstruction for 3 years so we had a lot of left without being seen. Now that we have a new system in place to go with the new building there are days that go by where no one leaves without being seen. Could be the new system, could be that remodel is finally done.