Physicians in the Triage Room

[Kath]

Hello All!

I've been a nurse for 16 years ; 11 ICU and the past 5 in ER. We are trying institute having a Physician in the Triage Room with the Triage Nurse during peak hours 11a-11pm. We are trying to work out some of the glitches before we go LIVE in April. We use IBEX as our computer Triage/Nursing Documentation which means that the Triage Nurse has to have the triage in before the doc can start his writeup on the patient. We anticipate that this will be a great idea for those that don't need to spend more than a few minutes with a doc ie: wound care check, nurse maid elbow, simple stuff. We have to figure out how to keep the flow particularly when it comes to Registration.Knowing that insurance info cannot be asked before obtaining health info , we are "stuck here." Any ideas would be appreciated.

[fairoasis]

The facility I currently work in implemented a similar plan just this year. Initially, at the front desk, the patient fills out a "QER" form with name, address, PMD, and chief complaint. A registration person checks the system to see if they have a MR # on file and if not, generates a record number. After the "QER" (quick ER) is entered, the patient is taken to a triage room by the registration person, the QER is placed in a holder on the door, and the last name is placed on the board. The triage nurse goes in the room, triages the patient and if it's a "quickie" notifies the MD. If it's a TRUE emergent situation, the patient is taken to the main ER and registered by the clerk there. If it's a 'fast track/no quickie' they are registered in the triage room and placed in the waiting room. Registration goes in and completes the registration process on the 'quickies' when the MD is done and while the nurse is giving Motrin/Tylenol/etc and discharging the patient. Luckily our facility had individual rooms not in use in an area of the ER that facilitates this plan. A monitor and keyboard were placed in each triage room for registration use and for nursing to enter RAD and LAB orders as needed. In order for this to work you have to have a crew that understands the plan and works well with others. As with any plan it has its flaws, holdups, and glitches. That's what ER is all about...the unexpected. You will definitely put in your 'road work' walking from room to room.

[bluenosern]

The hospital I am working at now has the Dr see the pt in triage and in my opinion it is NOT working. Pts can wait, in peak times, for hours before being triaged! With the North American standard of 15 minutes to have the pt seen by a RN I feel this hospital is setting themselves up for trouble. A "customer sevice rep" is the the first staff that sees the patient and is the one that oversees the waiting room.
The hold up is in the triage rooms that pts wait in to see the Dr. The doc then decides if pt is to go to fast track or the main ER. The doc also does the orders there ie lab, xray then the pt goes back out to the waiting room for registration

[jillofalltrades]

Sounds like you need a fast track. That works the best but can be difficult to find space for in an ER already sqeezed for space. We just opened a brand new 20 bed ER. It is fantastic. We had been squished in a department 1/4 the size with 10 beds for the past 5-6 years. It was miserable. New ER is doing great...bad thing is they only added one nurse with the 10 extra beds..they say they will add more nurses as the census proves we need them..Yeah, right. At night from 2am to 10 am they only have two nurses. One of those has to triage..it gets impossible sometimes...we are going to kill someone one night.. they have a tech all night too, but it does get interesting. The thought of having the patient see the ER doc at triage is an interesting idea. How does your triage system work?? We built 3 separate booths/rooms. The patient is directed to one by the admitting rep who gets their name, dob and chief complaint. they enter that into our patient tracking system...Ontrack(used to be Logicare). They triage nurse is called..she gets more info..may do vital signs if necessary...ranks the patient on a 5 steps system, then steps out. The admitting clerk then steps in and admits. We do the moving...the patient stays in one place. We do pretty good. But it can get crazy. Most patients are fully triaged within 15-30 minutes. Usually less. Having patients wait for hours to be triaged is scary. Think of the patients that might leave and could go home and get really ill...Why can't you triage the patient then send him to a separate area for the MD to assess.. He should have his own booth or something like that.. sounds scary for the nurses too...your butt is hanging out there. Hope you find a better method soon.
Laura