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Because every patient entering the emergency department needs to be triaged, it is imperative to ensure that every triage nurse maintains accurate clinical decision-making skills that support optimization of patient flow. While the Emergency Nurses Association (ENA) has historically recommended ongoing triage competency validation to ensure safe practice in the ED, the organization updated itsTriage Qualifications and Competency Position Statementin 2017 to place greater emphasis on the use of retrospective chart review as a means to ensure accurate clinical decision-making in triage.

In addition to the ENA recommendation, here are five more reasons retrospective chart review is an effective part of a triage competency validation process:

Intoxication! Talk about a red flag! Let’s consider two “flavors,” if you will. First, the patient with an actual chief complaint AND who happens to be intoxicated. Next, the patient who presents with apparent intoxication and no other immediately obvious issues. And for those of you who have not had a busy shift in an urban emergency department, the number of patients with altered mentation secondary to alcohol can be remarkable. Unfortunately, many of these patients get to be regular visitors; they are well known by the emergency providers and are often on a first-name basis.

When a patient presents with chest pain or chest-related symptoms, the role of the triage nurse is to critically evaluate the relationship of risk factors to outcome potentials to make the best triage decisions. The more risk factors a patient has, the greater the triage nurse’s concern for a potential high-risk scenario. In this blog, we will propose several triage questions for chest pain and consider several serious concerns that can prompt a patient to present with chest-related complaints, not all of which involve the heart:

The Maternal Fetal Triage Index (MFTI) tool developed by obstetric experts at AWHONN is a recent advance that deserves attention from all obstetric professionals. If you haven’t yet learned of it, stay tuned, because you will be hearing much about it as it goes “live” in the EMR of many institutions around the country.

Accurate triage of patients in an emergency department is critical to timely care and patient safety. 

Read these four clinical tips for triage nurses based on recent trends spotted by RSQ® Collaborative Triage Champion, Shelley Cohen, RN, MSN, CEN. 

Download these tips as a PDF.

Patients with mental health complaints are visiting emergency departments and urgent care centers at an increasing rate. It is imperative that triage staff are able to make rapid and safe decisions for these patients.

Rule #1: Make No Assumptions

Making assumptions in triage is dangerous. Our subconscious biases can lead to cognitive errors in the assessment of patients, particularly those who are agitated.

Over the last few years, many of our clients have expressed interest in demonstrating the impact that various system-wide performance improvement initiatives might have on patient outcomes or financial metrics. One of our colleagues from a large hospital system recently posed a similar question about triage. Like many initiatives, given there are so many variables in play, it is extremely difficult to pinpoint a cause and effect with triage; however, let’s explore four areas in which you could expect to see improvements with an efficient, safe triage process.

Triage is an essential part of any busy emergency department (ED), but one that is often taken for granted. While triage is not designed to determine the cause of the patient’s symptoms, it prioritizes the patient’s need to be seen by a provider. EDs often assume (possibly erroneously) that triage assessments are being performed correctly or that any errors in triage can be corrected when the medical screening is done. Both of these assumptions can lead to serious adverse patient events.

As leaders in the healthcare industry, we spend a great deal of time and resources analyzing patient outcomes and looking for areas of improvement. In triage, this typically translates to a leadership audit of triage decisions and a report back to staff on areas of improvement.

It’s important to periodically evaluate your audit process for effectiveness and sustainability. To evaluate your current process of triage record reviews, consider the following:

Are you prepared for surges in your ED patient volumes?

As we head into the peak of flu season, many facilities are already feeling the effects of increased volumes, such as:

• Longer waiting times
• Staff exposed to more airborne illnesses resulting in increased sick time
• A shift in perceptions of care resulting in lower patient satisfaction scores