A 25-year-old male presents to an emergency department at his local community hospital with abdominal pain. The department is at its peak time of patient flow, and every bed is filled. The patient is called to the triage area; the nurse assesses him and assigns a triage level decision to his chart. His triage nurse must consider the following:
- Is his abdominal pain a potential for demise?
- How long will he wait to be seen by a provider?
- Is there anything that can be done to expedite his care?
What would be some key points of your triage assessment? Do you have enough information to assign a triage level according to your ED triage policy? During volume surges, how long will this patient have to wait for his triage assessment?
A rapid sorting system that quickly identifies patients with potential for demise from an injury or an illness is crucial in an effective patient flow process for the ED. Common challenges, however, may impede a triage nurse from rapidly sorting and triaging this patient:
- Several other patients have arrived ahead of him; they are also waiting for a triage assessment.
- A family member of a patient waiting for triage is verbally acting out and demanding to be seen next.
- The patient currently being triaged has a full typed page of medications that the triage nurse must enter into the electronic record.
Suppose the 25-year-old male with abdominal pain is preceded by these patients:
- A 2-year-old girl with diarrhea
- A 72-year-old man who “just doesn’t feel good”
- A 27-year-old woman with a foot injury
- A 12-year-old boy with an eye injury
Assuming no language barriers for these patients, how long on average would it take your department to triage them? The average time will dictate how long this abdominal pain patient will have to wait until he is triaged. If, for example, you require 5 minutes on average to complete your triage process, it would be at least 20 minutes before you assessed this patient.
Note that this average time does not account for any of the following obstacles that might impact total triage time:
- How long it takes to get the 2-year-old girl to cooperate for a temperature reading
- How long it takes to remove the 4 layers of upper clothing from the 72-year-old man in order to get a blood pressure
- The time it takes for the 27-year-old woman to remove her shoes and multiple sock layers to check a pedal pulse
- How far it is to take the 12-year-old boy for a visual acuity assessment
Challenges occur daily in triage, and while many of them cannot be controlled, they must be considered when reviewing current triage practices. The examples above are another reminder that the best interest of the patient is served with rapid sorting.
If the patient experiencing abdominal pain must wait at least 20 minutes for a triage assessment, is the triage system in place effective? Has there been a rapid identification and sorting of this patient?
Consider the following and how they relate to your own department:
- What is the average time to triage a patient currently?
- Is the triage process clearly defined in writing?
- Do the nurses and providers speak the same triage language?
- Does the triage system truly sort patients rapidly?
- Do triage levels reflect the severity of the patient presentation?
- Are triage decisions adapted or adjusted based on demand?
- Is there a quality review process in place to assure that triage decisions are correct and meeting practice standards?
All of these are measures by which you can gauge the efficiency and effectiveness of your triage process, which ultimately dictates patient flow.