Presentation on theme: "Triage in Emergency Department"— Presentation transcript:
1 Triage in Emergency Department Waiting roomTeam leader
2 Definition of TriageTriage is the term derived from the French verb trier meaning to sort or to chooseIt’s the process by which patients classified according to the type and urgency of their conditions to get the Right patient to theRight place at theRight time with theRight care provider
3 Triage CategoriesNon 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.
4 Non disaster or E.D triage The primary objectives of an ED triage are to (ENA,1992, P. 1):Identify patients requiring immediate care.Determine the appropriate area for treatmentFacilitate patient flow through the ED and avoid unnecessary congestion.
5 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.
6 DisasterDefinition: an incident, either natural or human-made, that produces patients in numbers needing services beyond immediately available resources. May involve a large no. of patients or a small no. of patients if their needs place significant demands on resources.The key to successful disaster management is to provide care to those who are in greatest need first and just as importantly, not provide care to to those who have little or no chance of survival. Correct triage is essential to accomplish this goal
7 Disaster The triage team Triage of Victims - first victims to arrive are frequently notthe most seriously injured.Critical patientsFatally Injured PatientsNon critical patientsContaminated patients
8 Types of E.D. triage system Type 1: Traffic Director (Non Nurse).Type 2: Spot CheckType 3: ComprehensiveTwo-tiered systems: intial screening by RN who greets each patients on arrival, perform a primary survey and determine whether the patient is able to wait for further assessment by a second triage nurse.Divide tasks among staff members, internal triage and external triage
9 Triage levels 1- Resuscitation 2- Emergent 3- urgent 4- less urgent 5- Non urgentThe Canadian E.D. Triage and Acuity Scale
10 Recommended reassessment Overview of three category triage acuity systemscategoryacuityRecommended reassessmentExamplesClass 1EmergentImmediately life or limb threateningcontinuousCardiopulmonary arrest, severe respiratory distress, major burns, major trauma, massive uncontrolled bleedingComa, status epil..Class 2UrgentRequires prompt care, but will not cause loss of life or limb if left untreated for several hours.Every 30 minutesAbdominal pain, non cardiac cp, multiple fractures, lacerations, renal calculi,Class 3Non urgentAnd treatment but time is not a critical factorEvery 1-2 hrsRash, chronic headache, sprains, cold symptoms
11 TRIAGE LEVELS 1- Resuscitation -- threat to life Time to nurse assessment IMMEDIATE Time to physician assessment IMMEDIATECardiac and respiratory arrestMajor traumaActive seizureShockStatus Asthmatics
12 Triage levels 2- Emergent Potential threat to life,limb or function Nurse Immediate , Physician <15 minutesDecreased level of consciousnessSevere respiratory distressChest pain with cardiac suspicionOver dose (conscious)Severe abdominal painG.I. Bleed with abnormal vital signsChemical exposure to eye
13 Triage levels 3- Urgent Condition with significant distress Time Nurse < 20 min, physician < 30 minHead injury without decrease of LOC but with vomitingMild to moderate respiratory distressG.I. Bleed not actively bleedAcute psychosis
14 Triage levels 4- Less urgent Conditions with mild to moderate discomfortTime for Nurse assessment <1hTime for physician assessment < 1hHead injury, alert, no vomitingChest pain, no distress, no cardiac susp.Depression with no suicidal attempt
15 Triage levels 5- Non urgent Conditions can be delayed, no distress Time for nurse and Physician assessment more than 2hMinor traumaSore throat with temp. < 39
16 Basic component of triage An “across-the room” assessmentThe triage historyThe triage physical assessmentThe triage decision
17 An “ across the room assessment” To identify obvious life threat conditionsGeneral appearanceDisability(neurogenic)Air wayCirculationBreathing
18 Across the door assessment The triage nurse must scan the area where patients enter the emergency door, even while interviewing other patient.The triage antenna should be seeking clues to problems in all people who enter the triage areaIf any patient doesn’t look right kindly but quickly interrupt any current interaction and go investigate.
19 Across the room assessment Air wayAbnormal airway sounds, strider, wheezing gruntingUnusual posture e.g.. Sniffing position, inability to speak, drooling or inability to handle secretionBreathingAltered skin signs, cyanosis, dusky skin, tachypnicbradypnea, or apnea periods, retractions, use accessory muscles, nasal flaring, grunting, or audible wheezes
20 Across the room assessment CirculationAltered skin signs, pale, mottling, flushingUn controlled bleedingDisability (neuro.)LOCInteraction with environmentInability to recognize family membersUnusual irritabilityResponse to pain or stimuliFlaccid or hyper active muscle tone
21 Characteristics of triage nurse Extensive knowledge to emergency medical treatmentAdequate training and competent skills,language, terminologyAbility to use the critical thinker processGood decision maker
22 Role of triage nurse Greet patients and identify your self. Maintain privacy and confidentialityVisualize all incoming patients even while interviewing others.Maintain good communication between triage and treatment areamaintain excellent communication with waiting area.Use all resources to maintain high standard of care.
23 Role of triage nurseTeaching use of thermometer, first aid ??? avoid lecturing.Crowd control.Telephone.Communicate with team leader and seek feed back on decisions.
24 Importance of re triage Reassess the patient within 1-2hours of initial triage and continue to re assess on a regular basis, patients who may have presented without cardinal signs of severe illness may develop them during long waits.Patients who appear intoxicated actually may have life threatening problems such as DKA, and should not be permitted to keep it off in the waiting room.
25 The last person in along line at triage may have a serious medical problem that requires immediate attentionPatient should wait no longer than 5 minutes for triageIf in doubt about a category, choose the higher acuity to avoid under triaging a patient