Emergency Department Triage System

ByJamal Wahadneh Rn MPH and

Ms Aida Salahat RnAl-Makassaed Emergency department

Objectives

• Define Triage• Define Triage system• Identify different systems• Describe emergency severity index• Function of triage system

History of Triage

• Definition

• Origin

• Informal triage

Goals of Triage

• Primary

• Secondary

Category of triage

• In hospital triage

• Multi casualty disaster triage

Types of triage methods

• Three level

• Four level

• Five level

Function of triage

• Identify life-threatening conditions and determine acuity level of each patient

Reassessment in triage

• Level 1 =Continuous• Level 2 = every 15 min• Level 3 = every 60 min• Level 4 = every 60 to 90 min• Level 5 = every 2 hours

Five level system

• Origin of 5 level

• Identify different levels

Emergency Severity Index

• Definition

• Advantages

• disadvantages

Is patient dying ?

Level II, III, IV, V

Can patient wait ?

How many resources ?

Yes No

Level I

Yes No

Level II

EMERGENCY

SEVERITY

INDEX

Level III, IV, V

ONELevel IV

TWOLevel III

NONLevel V

What are resources ?Resources Not resources• Labs • HX and physical exam.

• ECG-X-rays C-T MRI •Point of care testing

• IV Fluids /hydration • Saline or Hep lock

• IV /IM Medication • PO. Medication

• Specialty consult • Simple wound care (dressing check /recheck) crutches ,splints,slings.

• Simple procedure

• Complex procedure

Key concepts

• Acuity level change

• Choose higher acuity when in doubt

Basic triage components

• Across the room assessment

• Triage history

• Physical assessment

• Triage decision

Key concept

• Discontinue assessment and transport the patient immediately to the treatment area if immediate care is needed. Do not delay treatment to finish the assessment

Triage process

• Establish priorities

• Scientific method

• Importance of time

Nursing process in triage

• Assessment time

• Vital signs

• Pain scale

• Nursing diagnosis

Key Concept

• Never assume the accident caused the presenting condition. The presenting condition may have caused the accident.

Interview methods

• Open ended• Close ended• Communication style• Use of five sense• attitude

How do I triage?

• Across the room• General appearance• Abcd• Subjective and objective (AMPLE)• Focused assessment• Pains scale (Pqrst)

Triage decision

• Step1- visual• Step 2- chief complaints• Step3- focused assessment• Step 4- pose hypothesis• Step 5- determine acuity• Step 6- reassess the acuity

Remember That:

Effective triage gets the patient • To the right place.• At the right time.• With the right care provider.

Questions