When "quick triage" doesn't work

ER Stories: “The trouble I see is that if the waiting room is packed with people not fully assessed, we might miss the occasional person who is there for back pain but really is having a AAA rupture!”

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ERMurse
Lots of problems with the system described but that has not stopped the bean counters and ED Physician group directors from thinking they can re-invent ED care by eliminating Triage. You’d think they just invented sliced bread when they claim the ED flow problems can be solved by shaving a couple of minutes at the front end. Attacking Triage and promoting programs like RME, Door to Doc, or Provider is Triage are Marketing based programs to promote ED Groups competing for contracts. Its not the front end that is generally the problem. Its the middle and back end process that leave patients in the ED for hours and impact flow.
The system described is a first come first served system. Thats fine if your first in line and get that last bed but not so good for the sick elderly patient with early sepsis who by the order of their arrival gets sent to the waiting room or by there inability to prioritize a chief complaint get sent to Fast Track and managed by a PA.
The obviously sick and obviously well are easy to classify. Its the ones in the middle, the very young and very old or complex medical histories with subtle presentations that need the experience and time of a Triage Nurse. ENA standards say Triage should be done in 3-5 minutes. If its consistently taking longer then there is a problem with the process, documentation tool, or physical layout.

When "quick triage" doesn’t work

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