how does your triage work?

Published

I am doing some research for HCMC in Minneapolis, we are looking to streamline our triage process, and are looking at how other busy hospitals do things. We are a level one trauma center, and triage about 200 or more people a day. We presently have 3 nurses at triage during the day, a secretary or an aide in the center putting in names, ect. We are getting extremely backed up with interviews, Sometimes there is a 40 minute wait to interview patients. A 3-4 hour wait with 40 plus patients in triage is not unusual. Also we triage express care (urgent care) patients before sending them over there. We are so busy trying to place patients, sometimes just finding them, and also directing a great deal of traffic that comes to the ED that doesn't necessarily belong there.Our triage area is open, there is a security desk at the door but when they enter they first see the nurses desk with windows but also wide openings, so people are constantly in your face asking questions or how long or if you called their namewhile you are interviewing other patients, although there is a sign saying to start in the middle. We only have 2 closed rooms in triage to allow patients to lie down or to get EKG's. Our ED has 14 acute monitored beds, 12 semi-acute beds with 2 pelvic rooms and 4 designated ortho rooms as well as a couple of monitored rooms, and a 12 bed pediatric area which is also used for less acute adults also. We have a 4 bay stabilization room for traumas and critical cases. And to top it all off we have a 12 bed (or more if the hallways are full) area for intoxicated patients. Beds are usually all full, patients waiting for admits have to be moved to the hall frequently to accomodate ambulances or stat placements.Our computerized system is EPIC.At our busiest time of day we have 20 nurses and 5 or 6 nursing assistants in the department.Charge nurse is far too busy to take an assignment but tries to help out when able. We are a teaching hospital. Did I leave anything out? Also, any ideas about how to page patients for interviews or room placement without violating HIPPA? I welcome any info about how hospitals anywhere in the country do things...... Thanks!

Up Vote Up Vote ×

Well, we normally only see about 100/day so we have 1 nurse out front (people in the back triage those coming in from EMS in the rooms) unless "the bus comes in" then we send someone else out there to help (we have float nurses). When the pt initially comes in the door we ask what their symptom is, and if it is something like a controlled laceration, stable cough, etc, then we let them fill out an initial contact sheet with info about their SSN, birthdate, S/S, etc, and call themback in the order of their need. If they are having chest pain, etc, we bring them right back and they are triaged in their room. For those who "don't necessarily need to be there" we have a "Q room." These people still get triaged in, but then are placed in the Q room for a physician to see. If the MD decides that they do not need to be in the ER then they have the choice of paying $250 up front and being treated or leaving. If the MD decides that the toothache or whatever does need to be treated, then they upgrade them. This has also helped with the education of the people around the hospital as to when you need to go to the ER and when you can go see your PCP or walk-in clinic. We also have a fast track/non-emergent side where those who just need a couple stitches, etc, go. Hope this helps! God bless. :)

Up Vote Up Vote ×

HI,

Re: HIPPA and calling pts, we just started using raffle tickets; we keep one part and the pt gets the other, then we call them by the last 3 numbers. Of course, now pts think they get a prize with their visit. I guess the next thing is to provide them with a halloween mask so that they don't get recognized in the waiting rm. Gotta love HIPPA.

Up Vote Up Vote ×
Specializes in Trauma/ED.

When I call people back I use their first name then as they come to the door I quietly ask them their last name to make sure I have the right person, this maintains privacy well.

I like the idea of the "Q-room", that would be very helpful in my ED.

Up Vote Up Vote ×
Specializes in ER, Pedi ER, Trauma, Clinical Education.

Worked in an ER which saw 70,000 to 80,000 pts a year. So, we had plenty of days where we reached the 300 pts a day mark. How did we handle triage? We had three triage nurses at all times, unless the waiting room was caught up. If the triages were current, then one of the triage nurses would go to the back and work as a float nurse to help expediate pt flow in the back. This ER also used EMT/Paramedics, so this was an invaluable asset. In triage the EMT (or paramedic - I will use EMT from this point just for expediency purposes) does several things. First, they can help the secretary get pts registered in the computer, but they are able to keep an eye and ear out for "high risk" or emergent pts. If they see someone who falls into that category, then they can immediately start on that pts vital signs and notify the triage nurses that they are starting the vitals on a high risk pt. Then after the vitals are done, the nurse looks at the vital signs, gets the triage info and then can direct the EMT to perform an initial intervention such as an EKG, or assist the pt to a room in the back (if one is available). EMTs can also get the vital sign portion of the triage initiated while pts are waiting on the nurse to obtain their history. If the EMT has an out of range VS, or something of concern, then they can alert the triage RN. Basically, our key to running multiple pts through triage is a bare minimum of 2 triage RNs, with 3 the preferred staffing, and an EMT to help keep an eye on the waiting room, facilitate pt flow through triage, and alerting the triage RNs of any high risk pts.

Up Vote Up Vote ×

Lovvvvvve hippa- maybe we could get our own type of witness protection program at triage...

Up Vote Up Vote ×
Lovvvvvve hippa- maybe we could get our own type of witness protection program at triage...

For the staff? :lol2::lol2:

Up Vote Up Vote ×
Specializes in Emergency Dept, ICU.

Hey!

Get a copy of this months' ENA Journal... an article in it has all the triage streamlineing process improvement stuff you could want.

Up Vote Up Vote ×
Specializes in ED staff.

The way our triage works is this... patient comes in fills out a fast registration form that tells their name, social, address and what the chief complaint is, gives to registration clerk. Clerk registers the patient, name and complaint come up on my computer. I call the patient into the office. We use T sheets, they really streamline the process, takes approx 5 minutes to talk to the patient and get their vitals. If I have someone come in who is too ill to be triaged by me, I send them straight back. I usually have a tech working with me to get people out of cars and take the patient to their ER bed. Sometimes patients who come in by ambulance get triaged by me if their acuity is low enough. I have read about some hospital in LA (I think) that the patient enters all their information via a touch screen computer at a kiosk in the lobby. They enter their information, including their medications. Sometimes it takes me 10 minutes to write down all the pills a patient takes. If I am sending someone back who is really acute, I call the back and talk to one of the nurses to let them know what to expect. I would really love to have the patients register themselves. I had a young hispanic guy come in the other morning. The clerk registered him as having an altercation. He'd been stabbed 5 times with an ice pick which would have really been good to know since he registered at the same time 6 other people did and I took a few of them before this guy. He ended up having a hemo-pneumo thorax, had to get a chest tube and stay in ICU for a few days. I think the key to doing triage is to have someone assigned to do triage that that's all they do, in other words don't rotate the nurses through triage. The only way you can become quick at doing it is if you do it all the time. You also learn how to read people, be able to tell how sick someone is just by looking at them, be able to tell who is lying and just wants drugs etc.

Up Vote Up Vote ×
Specializes in ED.

We see 50,000 pts. We have a "greeter", physician, 2 medics (or 1 medic & 1 LPN) and an ED tech in Triage. Labs, EKG's, IV's, CT Scans, venous duplex studies, etc. are done in Triage. Meds are ordered by the Triage MD but only given if there is room in the triage area to monitor the pt. Sore throats, simple UTI's, back pains, tooth aches are are usually discharged from triage. We document using the HealthMatics ED computer system. The only drawback to the system is entering the numerous home meds, doses, etc. When the dept. gets busy, Triage will back up & pts. wait. It does help that the pt. was seen and had a quick initial evaluation by a physician.

Up Vote Up Vote ×
+ Join the Discussion