SlideShare a Scribd company logo

Triage in Emergency Department

•Download as PPT, PDF•
•
Hasan Arafat
Hasan Arafat

Triage is the process of sorting patients based on the urgency of their condition to provide the right care to the patients who need it most. It involves an initial assessment of patients upon arrival to identify life-threatening issues and prioritize patients into categories based on need. The document outlines the goals and categories of triage in both emergency and disaster situations, with categories ranked from resuscitation to non-urgent based on the threat to life, limb, or function. It also describes the key components of triage including an initial across-the-room assessment and ongoing re-assessments to adjust patient priority as needs change.

1 of 27
Triage in Emergency Department Triage Waiting room Team leader
Definition of Triage • Triage is the term derived from the French verb trier meaning to sort or to choose It’s the process by which patients classified according to the type and urgency of their conditions to get the Right patient to the Right place at the Right time with the Right care provider
Triage Categories • Non 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.
Non disaster or E.D triage The primary objectives of an ED triage are to (ENA,1992, P. 1): 1. Identify patients requiring immediate care. 2. Determine the appropriate area for treatment 3. Facilitate patient flow through the ED and avoid unnecessary congestion.
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.
Disaster • Definition: 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 those who have little or no chance of survival. Correct triage is essential to accomplish this goal
Disaster The triage team Triage of Victims - first victims to arrive are frequently not the most seriously injured. Critical patients Fatally Injured Patients Non critical patients Contaminated patients
Triage levels 1- Resuscitation 2- Emergent 3- Urgent 4- Less urgent 5- Non urgent The Canadian E.D. Triage and Acuity Scale
Triage in Emergency Department
• He diagnosed the patient with atherosclerotic emboli by looking at his blue toes • He confirmed his diagnosis through the patient’s smoker facies, smoking is a risk factor for atherosclerosis • He concluded that the patient prognosis is poor, he want survive a surgery for his wound • “He will take an ambulance ride, a surgeon’s time and an ICU bed” • The patient was left in the field, he later died
TRIAGE LEVELS 1- Resuscitation -- threat to life/limb Time to nurse assessment IMMEDIATE Time to physician assessment IMMEDIATE • Cardiac and respiratory arrest • Major trauma • Active seizure • Shock • Status Asthmaticus
Triage levels 2- Emergent Potential threat to life, limb or function Nurse Immediate, Physician <15 minutes • Decreased level of consciousness • Severe respiratory distress • Chest pain with cardiac suspicion • Overdose (CONSCIOUS!) • Severe abdominal pain • G.I. Bleed with abnormal vital signs • Chemical exposure to eye
Triage levels 3- Urgent Condition with significant distress Time: Nurse < 20 min, physician < 30 min • Head injury without decrease of LOC but with vomiting • Mild to moderate respiratory distress • G.I. Bleed not actively bleed • Acute psychosis
Triage levels 4- Less urgent Conditions with mild to moderate discomfort Time for Nurse assessment <1h Time for physician assessment < 1h Head injury, alert, no vomiting Chest pain, no distress, no cardiac susp. Depression with no suicidal attempt
Triage levels 5- Non urgent Conditions can be delayed, no distress Time for nurse and Physician assessment more than 2h • Minor trauma • Sore throat with temp. < 39
• Triage is a dynamic process. The urgency (and hence triage category) with which a patient requires to be seen may change with time. • Placement in a triage category does not imply a diagnosis, or even the lethality of a condition • Patients in non-urgent categories may wait inordinately long periods of time, whilst patients who have presented later, but with conditions perceived to be more urgent, are seen before them.
Triage in Emergency Department
Basic component of triage • An “across-the room” assessment • The triage history • The triage physical assessment • The triage decision
An “ across the room assessment” To identify obvious life threat conditions General appearance Air way Breathing Circulation Disability (neurogenic)
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 area •If any patient doesn’t look right kindly but quickly interrupt any current interaction and go investigate.
Across the room assessment • Airway Abnormal airway sounds, strider, wheezing grunting Unusual posture e.g.. Sniffing position, inability to speak, drooling or inability to handle secretion • Breathing Altered skin signs, cyanosis, dusky skin, tachypneic bradypnea, or apnea periods, retractions, use accessory muscles, nasal flaring, grunting, or audible wheezes
Across the room assessment • Circulation Altered skin signs, pale, mottling, flushing Uncontrolled bleeding • Disability (neuro.) LOC Interaction with environment Inability to recognize family members Unusual irritability Response to pain or stimuli Flaccid or hyperactive muscle tone
Triage in Emergency Department
Role of triage nurse • Greet patients and identify herself. • Maintain privacy and confidentiality • Visualize all incoming patients even while interviewing others. • Maintain good communication between triage and treatment area • maintain excellent communication with waiting area. • Use all resources to maintain high standard of care.
Role of triage nurse • Teaching ----- use of thermometer, first aid ??? avoid lecturing. • Crowd control. • Telephone. • Communicate with team leader and seek feed back on decisions.
Importance of re-triage • Reassess the patient within 1-2 hours 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.
Triage in Emergency Department

More Related Content

Triage in Emergency Department

  • 1. Triage in Emergency Department Triage Waiting room Team leader
  • 2. Definition of Triage • Triage is the term derived from the French verb trier meaning to sort or to choose It’s the process by which patients classified according to the type and urgency of their conditions to get the Right patient to the Right place at the Right time with the Right care provider
  • 3. Triage Categories • Non 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): 1. Identify patients requiring immediate care. 2. Determine the appropriate area for treatment 3. Facilitate 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. Disaster • Definition: 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 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 not the most seriously injured. Critical patients Fatally Injured Patients Non critical patients Contaminated patients
  • 8. Triage levels 1- Resuscitation 2- Emergent 3- Urgent 4- Less urgent 5- Non urgent The Canadian E.D. Triage and Acuity Scale
  • 10. • He diagnosed the patient with atherosclerotic emboli by looking at his blue toes • He confirmed his diagnosis through the patient’s smoker facies, smoking is a risk factor for atherosclerosis • He concluded that the patient prognosis is poor, he want survive a surgery for his wound • “He will take an ambulance ride, a surgeon’s time and an ICU bed” • The patient was left in the field, he later died
  • 11. TRIAGE LEVELS 1- Resuscitation -- threat to life/limb Time to nurse assessment IMMEDIATE Time to physician assessment IMMEDIATE • Cardiac and respiratory arrest • Major trauma • Active seizure • Shock • Status Asthmaticus
  • 12. Triage levels 2- Emergent Potential threat to life, limb or function Nurse Immediate, Physician <15 minutes • Decreased level of consciousness • Severe respiratory distress • Chest pain with cardiac suspicion • Overdose (CONSCIOUS!) • Severe abdominal pain • G.I. Bleed with abnormal vital signs • Chemical exposure to eye
  • 13. Triage levels 3- Urgent Condition with significant distress Time: Nurse < 20 min, physician < 30 min • Head injury without decrease of LOC but with vomiting • Mild to moderate respiratory distress • G.I. Bleed not actively bleed • Acute psychosis
  • 14. Triage levels 4- Less urgent Conditions with mild to moderate discomfort Time for Nurse assessment <1h Time for physician assessment < 1h Head injury, alert, no vomiting Chest 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 2h • Minor trauma • Sore throat with temp. < 39
  • 16. • Triage is a dynamic process. The urgency (and hence triage category) with which a patient requires to be seen may change with time. • Placement in a triage category does not imply a diagnosis, or even the lethality of a condition • Patients in non-urgent categories may wait inordinately long periods of time, whilst patients who have presented later, but with conditions perceived to be more urgent, are seen before them.
  • 18. Basic component of triage • An “across-the room” assessment • The triage history • The triage physical assessment • The triage decision
  • 19. An “ across the room assessment” To identify obvious life threat conditions General appearance Air way Breathing Circulation Disability (neurogenic)
  • 20. 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 area •If any patient doesn’t look right kindly but quickly interrupt any current interaction and go investigate.
  • 21. Across the room assessment • Airway Abnormal airway sounds, strider, wheezing grunting Unusual posture e.g.. Sniffing position, inability to speak, drooling or inability to handle secretion • Breathing Altered skin signs, cyanosis, dusky skin, tachypneic bradypnea, or apnea periods, retractions, use accessory muscles, nasal flaring, grunting, or audible wheezes
  • 22. Across the room assessment • Circulation Altered skin signs, pale, mottling, flushing Uncontrolled bleeding • Disability (neuro.) LOC Interaction with environment Inability to recognize family members Unusual irritability Response to pain or stimuli Flaccid or hyperactive muscle tone
  • 24. Role of triage nurse • Greet patients and identify herself. • Maintain privacy and confidentiality • Visualize all incoming patients even while interviewing others. • Maintain good communication between triage and treatment area • maintain excellent communication with waiting area. • Use all resources to maintain high standard of care.
  • 25. Role of triage nurse • Teaching ----- use of thermometer, first aid ??? avoid lecturing. • Crowd control. • Telephone. • Communicate with team leader and seek feed back on decisions.
  • 26. Importance of re-triage • Reassess the patient within 1-2 hours 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.

Editor's Notes

  1. مريض عنده احتشاء في القلب لازمه معالجة على السريع (ideally the patient should be referred for thrombolysis within 30 minutes of presentation) مشكلة قلب؟ رئة؟ جهاز هضمي؟ مريض خلص ومفش اشي زيادة تعمله، أخرجه، مريض لازم يطلع على القسم اطلعه
  2. لازم تشوف كل مريض بدخل الطوارئ، مريض اعطيته دوا ونتيجته بتبين بعد وقت او راح يعمل فحص وبتستنى ليرجع تنساهوش اذا المريض لازم يتحول على مستشفى اكبر او أخصائي حوله طمن المريض واهله
  3. † Registered Nurse: someone who is certified in nursing administration
  4. Based on Gustillo classification, type IIIC is associated with high amputation rates
  5. *For example a middle-aged man who hobbles in with an inversion ankle injury is likely to be placed in triage category 4 (green). If in the waiting room he becomes pale, sweaty, and complains of chest discomfort, he would require prompt re-triage into category 2 (orange). * an elderly patient with colicky abdominal discomfort, vomiting, and absolute constipation would normally be placed in category 3 (yellow) and a possible diagnosis would be bowel obstruction. The cause may be a neoplasm which has already metastasized and is hence likely to be ultimately fatal.