25945578 triage in emergency department

7/31/2019 25945578 Triage in Emergency Department

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Triage in Emergency Department

TriageWaiting

room

Team leader


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Definition of Triage

Triage is the term derived from the Frenchverb trier meaning to sort or to choose

Its the process by which patients classifiedaccording to the type and urgency of their

conditions to get the Right patient to the

Right place at the

Right time with the

Right care provider


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Triage Categories

Non disaster: To provide the best care for

each individual patient.

Multi casualty/disaster: To provide the most

effective care for the greatest number of

patients.


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Non disaster or E.D triage

The primary objectives of an ED triage are to

(ENA,1992, P. 1):

1. Identify patients requiring immediate care.

2. Determine the appropriate area for

treatment

3. Facilitate patient flow through the ED and

avoid unnecessary congestion.


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4. Provide continued assessment and

reassessment of arriving and waiting patients.

5. Provide information and referrals to

patients and families.

6. Allay patient and family anxiety and

enhance public relations.


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Disaster

Definition: an incident, either natural or human-made, that produces patients in numbers needingservices beyond immediately available resources.

May involve a large no. of patients or a small no.of patients if their needs place significant demandson resources.

The key to successful disaster management is to

provide care to those who are in greatest need firstand just as importantly, not provide care to tothose who have little or no chance of survival.Correct triage is essential to accomplish this goal


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Types of E.D. triage system

Type 1: Traffic Director (Non Nurse).

Type 2: Spot Check

Type 3: Comprehensive

Two-tiered systems: initial screening by RN whogreets each patients on arrival, perform a primarysurvey and determine whether the patient is able to

wait for further assessment by a second triagenurse.

Divide tasks among staff members, internal triageand external triage


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Overview of three category triage acuity systems

category acuity Recommended

reassessment

Examples

Class 1 EmergentImmediately life or limb

threatening

continuous Cardiopulmonary

arrest, severe

respiratory distress,

major burns, major

trauma, massiveuncontrolled bleeding

Coma, status epil..

Class 2 UrgentRequires prompt care, but

will not cause loss of life orlimb if left untreated for

several hours.

Every 30

minutes

Abdominal pain, non

cardiac cp, multiple

fractures, lacerations,

renal calculi,

Class 3 Non urgentAnd treatment but time is

not a critical factor

Every 1-2

hrs

Rash, chronic headache,

sprains, cold symptoms


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TRIAGE LEVELS

1- Resuscitation -- threat to lifeTime to nurse assessment IMMEDIATE

Time to physician assessment IMMEDIATE

Cardiac and respiratory arrest Major trauma

Active seizure

Shock

Status Asthmatics


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Triage levels2- Emergent

Potential threat to life,limb or function

Nurse Immediate , Physician


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Triage levels

3- UrgentCondition with significant distress

Time Nurse < 20 min, physician < 30 min

Head injury without decrease of LOC butwith vomiting

Mild to moderate respiratory distress

G.I. Bleed not actively bleed

Acute psychosis


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Triage levels

4- Less urgentConditions with mild to moderate discomfort

Time for Nurse assessment


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Triage levels

5- Non urgent

Conditions can be delayed, no distress

Time for nurse and Physician assessment

more than 2h

Minor trauma

Sore throat with temp. < 39


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Basic component of triage

An across-the room assessment

The triage history

The triage physical assessment The triage decision


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An across the room assessment

To identify obvious life threat conditions

General appearance

Air way

Breathing

Circulation

Disability

(neurogenic)


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Across the door assessment

The triage nurse must scan the area wherepatients enter the emergency door, even while

interviewing other patient.

The triage antenna should be seeking clues toproblems in all people who enter the triage area

If any patient doesnt look right kindly but

quickly interrupt any current interaction and goinvestigate.


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Across the room assessment

Air way

Abnormal airway sounds, stridor, wheezing grunting

Unusual posture e.g.. Sniffing position, inability tospeak, drooling or inability to handle secretion

Breathing

Altered skin signs, cyanosis, dusky skin, tachypnic

bradypnea, or apnea periods, retractions, use

accessory muscles, nasal flaring, grunting, or

audible wheezes


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Across the room assessment Circulation

Altered skin signs, pale, mottling, flushingUn controlled bleeding

Disability (neuro.)

LOCInteraction with environment

Inability to recognize family members

Unusual irritabilityResponse to pain or stimuli

Flaccid or hyper active muscle tone


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Characteristics of triage nurse

Extensive knowledge to emergency medicaltreatment

Adequate training and competent

skills,language, terminology Ability to use the critical thinker process

Good decision maker


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Role of triage nurse

Greet patients and identify your self.

Maintain privacy and confidentiality

Visualize all incoming patients even whileinterviewing others.

Maintain good communication between triage andtreatment area

maintain excellent communication with waitingarea.

Use all resources to maintain high standard of care.


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Role of triage nurse

Teaching ----- use of thermometer, first aid

??? avoid lecturing.

Crowd control.

Telephone.

Communicate with team leader and seek

feed back on decisions.


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Importance of re triage

Reassess the patient within 1-2hours ofinitial triage and continue to re assess on a

regular basis, patients who may have

presented without cardinal signs of severeillness may develop them during long waits.

Patients who appear intoxicated actually

may have life threatening problems such asDKA, and should not be permitted to keep it

off in the waiting room.


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The last person in along line at triage may

have a serious medical problem that requires

immediate attention

Patient should wait no longer than 5 minutes

for triage

If in doubt about a category, choose the higher

acuity to avoid under triaging a patient

25945578 triage in emergency department

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