Emergency Room Triage Observation

14 million Canadians visit Emergency Departments (ED) every year, and also reported to having the highest use of EDs (Ontario Hospital Association, 2006). ED overcrowding in Canada has become an epidemic. ED overcrowding has been defined as “a situation in which the demand for emergency services exceeds the ability of an (emergency) department to provide quality care within acceptable time frames” (Ontario Ministry of Health and Long Term Care, 2014). This has been an ongoing problem across Canada. Ontario has developed an initiative to reduce ED wait times by implementing a variety of strategies and collaborating with other institutions. This paper describes the Emergency Room National Ambulatory Intuitive (ERNI), an

S (situation): Hi, my name Kelsey and I am a nurse in the emergency department. I am calling about Shannon O’Reilly’s most recent laboratory results.

Bedside reporting involves giving information or a report to the oncoming nurse in the presence of a patient. This method gives the patient an opportunity to ask questions and get clarification regarding his or her care. Bedside reporting increases patient satisfaction, quality of healthcare and nurse-to-nurse responsibility. Hospitals need to design a better handoff process that can easily reduce patient risks and increase patients’ involvement in their care. Emergency rooms shift reports usually take place at the nursing station of every patient care area. The departing nurse gives information verbally to the oncoming shift. Therefore,

Meanwhile, elsewhere in Habersham County, Tom was feeling slightly nervous as he exited the staff lounge and entered the hustle and bustle of County Hospital’s ER to begin his first shift as an RN. The first few hours of his shift passed slowly as Tom mostly checked vital signs and listened to patients complain about various aches, pains, coughs, and sniffles. He realized that the attending physician, Dr. Greene, who was rather “old school” in general about how he interacted with nursing staff, wanted to start him out slowly. Tom knew, though, that the paramedics could bring in a trauma patient at any time.

Additionally, the care environment developed a hazard when the patient population increased both in number and acuity with the admission of the acute respiratory distress patient and increasing patient load in the lobby without note of available back up staff being called in. Examples of errors from the flow chart comparison might include failure to assess and monitor when Nurse J initiates blood pressure and SpO2 measurements, fails to initiate ECG with respiration monitoring, fails to administer supplemental O2, and leaves the room without apparently noting the baseline of the patient2. Furthermore, there appears to be an error in the lack of communication collaboration between the RN and LPN regarding Mr. B’s post procedure status and monitoring needs, and there is a failure to rescue when the LPN notes the low SpO2 value, fails to respond, and instead re-initiates another blood pressure reading without noting the results. As Mr. B’s condition deteriorates and a code is called, an ACLS error is observed in the timeline when the patient is noted first to have absent pulse and respirations and that a monitor is next applied and the patient and displays ventricular fibrillation. Chest compressions appear to not have been the first action in this scenario, nor is end tidal CO2 monitoring noted as initiated to monitor the quality of compressions. These are examples of hazards and errors in the care of Mr. B and in an actual RCA the level of detail would likely turn up

Usually results delivered to unit clerk who could take long time in delivering the important message to medical staff.

Triage is the categorizing of patients by order of who needs to be seen most urgently. It can be broken into three stages; emergent, urgent, and non-urgent. Emergent is immediately life or limb threatening. An example of an urgent case would be a dog that ingested half a bag of grapes 45 minutes ago or a male cat with a suspected blocked urinary tract with no urination for the past 12 hours or more. Urgent needs to be treated but is not life threatening or limb threatening if left untreated for several hours. An example of an urgent case would be a puppy that jumped off the couch and is now lame on its front right leg or a bird that comes in with a broken wing after a brief scuffle with the household cat.. Non-urgent should be treated but time is not a factor. An example of a non-urgent case would be

A call came at 10 saying that there was no need for an additional doctor yet because of how slow the emergency room was that day. We were eventually told to come in at 12:00 though, but the fact that the amount of time you're made to work directly correlates to how busy the E.R. is was a weird concept to me. The way the emergency room is laid out is with a central station of desks with a wall separating the two haves. Surrounding the desks are the patients room. As a doctor, you simply wait until a patient is set up in a room by nurses and then claim the patient in the system. Each patient has a description of their pain complaint in the computer along with a ranked emergency level. After claiming the patient, the doctor go to see them in there room. When a Doctor visits a patients room, they do exactly what one thinks they would do— they ask questions. It was interesting to note how differently my father and Dr. James went about these interviews. Dr. James was more of a talking, “why don't you tell me what the issue is” kind of doctor. She let the patients talk but gently guided the conversations. She was very nice and would explain exactly what she meant in basic, social terms. On the other hand, my father was computer-like efficient in his investigation. He would always ask the same set of specific questions in each case no matter what the problem was. He would always be the one in charge and almost a bit callus in his method. That’s not to say

Patients are triaged by a nurse, skilled in using the triage scale tool (Australian Government department of

In this country patients cannot be turned away from receiving treatment due to legislation implemented by Congress in 1986 known as The Emergency Medical Treatment and Active Labor Act (EMTALA). EMTALA is a non-discrimination statute which states “no patient who presents with an emergency medical condition, actual or perceived, and who is unable to pay may be treated differently than patients who are covered by health insurance” (CMS.gov, 2013, p. 1). The statute prevents hospitals from rejecting patients, refusing to treat them, or transferring them to charity hospitals or county hospitals because they are uninsured or unable to pay for services. The ED provides care to uninsured patients (guaranteed through EMTALA) and for which it is never reimbursed (CMS.gov, 2013). Patients improperly assigned acuity levels tie up resources, lengthens the time in the ED, and increases unreimbursed costs to the emergency department. Inaccurate triage acuity levels can be costly (Gilboy et al., 2011; Bitterman, 2009). Providing the correct initial triage acuity levels decreases wait times and deterioration of a patient’s condition and, therefore, decreases

My perfect academic path seemed set until October of my Second Year. After Reading Days and about two weeks of ignoring severe pain in my abdomen, I finally went to the UVA Emergency Room. After many tests over the course of the night, doctors revealed the unexpected: at nineteen, I had two 18 cm tumors on each of my ovaries. The shock was almost comical at the time; nevertheless, I had major emergent surgery in Norfolk the next morning. I exhibited naivety about the recovery time, but my parents, doctors, and association dean told me the best thing I could do academically was to withdraw from the University. Aside from the five W's on my transcript, there is no record that I was ever at UVA that semester.

Information that is missing in this particular case in the lack of education to the medical staff

A paramedic facing a mass casualty situation or in the example illustrated, multiple casualty incident, is always expected to make the “right” decision given the circumstances surrounding the event. Fortunately, first responders have a tool at their disposal called triage. In this case, paramedics might employ the S.M.A.R.T. model (Simple Triage and Rapid Treatment), essentially a set guideline on orders of priority. EMS personnel employing this system, would in theory, have absolved themselves of all moral obligations regarding the decision taken. However, as human beings, we are hard wired to second guessing outcomes of such profound consequences affecting another living being. Unless you’re a Sociopath that

Case management in the emergency department, constantly works to find the right data in a patient’s record to ensure that they have the correct insurance coverage and can be admitted or discharged at the appropriate time and place. Even when the smallest amount of essential information is not documented, this otherwise straight forward process turns into a scavenger hunt for who has seen the patient, interventions that were done and for what reasons, and at what time all of these things took place. ED case manager Veronica Kountz (personal communication, March 20, 2015) states that the inadequacy of documentation can lead to insurance companies not covering patient costs, which the hospital then has to absorb. Before a patient can be admitted or discharged, the right

Several existing problems precipitated the creation of the triage system implemented by Kathryn Angell in an effort to deliver improved medical care. The main problem was a lack of coordination in service delivery. This lack of coordination caused excessive wait times on the order of anywhere from 23 to 40 minutes to see a nurse, 40 to 50 minutes to see a doctor, and as long as 55 minutes to get a prescription filled. The practice of all nurses being involved initially in seeing all patients caused duplication of efforts, including repeating questions and examinations, and resulted in procedural bottlenecks. Additionally, there were inconsistent levels of service and extreme variation in treatment because of the different experience