Gail:
California has a regulation that states in essence that a triage nurse can
have no other duties. They can assist in some other functions but must be
immediately available to triage. That said, I work for the Kaiser Hospital chain
in northern California. What we have adopted for use as a triage tool is the
Emergency Severity Index (ESI) and utilize it quite religiously with great
result. As we have clinics both on and off-campus, we triage -actually MSE -
many patients in the 4 and 5 categories to our clinics directly or, when they
are closed, to the waiting room until we can get them.
With the exception of the night shift which utilizes the charge nurse to
MSE/triage, we have a dedicated triage nurse whoose sole function is to
medically screen everyone who comes in the door. We also have an additional
nurse, for when the volume picks up (usually a charge nurse as they don't take a
patient assignment) who will do the ESI which, if you aren't acquainted with the
system, gauges the patient's complaint to the number of resources may be needed
to deal with it, the lower the number the greater the number of resoucres and
sicker the patient. If we have the room in the department, anyone with an ESI of
1, 2 or 3 are brought back into the department and a complete bedside triage/MSE
is performed by that patient's nurse. Anyone with a 4 or 5 ESI is informed to
have a seat and the MSE nurse will get to them, perform the complete eval and
then send them on to our clinics.
We are usually able to screen away conservatively 70% of those that present
to the window when the clinics are open (1AM). Our goal is an ESI within 5
minutes and complete MSE within 30 or less. We have the highest satisfaction
scores in our region.
Given your situation, it would strike me that hiring an EMT or paramedic to
be your concierge would be more cost effective. They are more than capable of
performing a basic ESI triage (if trained) and would allow you the ability of
pulling the RN devoted to that task into a full time triage nurse. ESI does not
meet the requirements set forth in EMTALA for a medical screening exam which
requires the MSE be performed by either a MD or qualified RN but it does allow
you to move people quickly, utilize your resources more appropriately and
frankly, save some money.
Hope that answers your question.
Dave
----- Original Message -----
From: northeastlnc
To: emergency-nurse@yahoogroups.com
Sent: Thursday, October 02, 2008 5:03 PM
Subject: [emergency-nurse.org] Triage question


Question for all you talented ER nurses.
I work in a small rural ER (70 bed hospital). We have a "concierge"
at the entrance to the hospital (RN position). She is mostly for the
ER, but also helps direct pts to other areas of the hospital. At this
point, when a pt comes in for the ER, she asks them their chief
complaint after walking them into the waiting room, and trying to
provide a little privacy. This is written on a paper and brought
into the ER. THen the triage nurse goes and brings the pt in, or the
paper is hung if the triage nurse is busy. Other nurses take this
patient in to a room if they have an availabe. If it is a pt that
needs to come right in, ie chest pain, stroke symptoms etc, the
concierge brings them into a room or stands at the nursing station
until someone takes the pt in.....

Management wants to change this so that the concierge is not so
involved in the ER, and more as a greeter. I am on the comittee as an
ER nurse.

We do not have enough staff to have a triage nurse sit in triage, and
I have pointed out that we rely heavily on the concierge to be our
eyes and ears.

Can you email me privately how the process works in your ER
(especially smaller ER's). We are a coastal ER, and the summer are
SWAMPED, but in the winter things slow down a bit.
Thank you so much.

Gail Hendrickson
northeastlnc@...
I am fighting to keep this RN more for the ER, or we need to increase
our staff to have a nurse always in triage.





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