Re-evaluating triage in the new millennium: A comprehensive look at the need for standardization and quality☆,☆☆
Section snippets
Assessment
Currently 96% of emergency departments use some type of triage system.5 The goal of any triage system is for the right person to be directed to the right place at the right time for the right reasons. Typically, the patient is seen by a triage nurse, who obtains brief subjective and objective information before making a priority decision. Thompson and Dains6 identified 2 types of triage systems that remain in use today in the United States: spot check and comprehensive triage. More than 25% of
Triage acuity systems
Most emergency departments in the United States use an acuity rating system to aid in prioritizing patients who come to the emergency department. Typically, a patient is seen by a triage nurse on arrival, the assessment is conducted, and the nurse assigns an acuity level. In the 1996 National Emergency Department Database Survey,9 ENA found a wide variety of triage acuity systems in use. Of 1373 respondents (approximately 27% of emergency departments in the United States), the most common
Competence
Triage nursing is a challenging position that requires special qualifications, education, and skills. Qualifications for the triage nurse role vary at different hospitals. Some hospitals require completion of specific educational programs, such as Advanced Cardiac Life Support or CEN certification. ENA (1995) has recommended specific qualifications for the triage nurse, including Trauma Nursing Core Course verification and CEN certification. We have found that many hospitals no longer fund the
Reproduction of triage data
Emergency nurses have been integral in recent national efforts to standardize the way ED data are collected.18 The Centers for Disease Control and Prevention coordinated a public-private partnership that developed recommended specifications for uniform ED data collection. An important aspect of the national Data Elements for Emergency Departments (DEEDS) is triage nursing data, such as chief complaint, first ED acuity assessment, and vital signs. The current inconsistencies in the way ED data
Conclusion
The rapidly changing health care environment has influenced the way in which the emergency department fits into the health care system as a whole. ED triage systems have evolved from clerks “eyeballing” patients in the 1950s to full comprehensive triage by RNs in the 1990s. In light of EMTALA, ED overcrowding, and shrinking budgets for nursing continuing education, we are challenged to find new ways to ensure accurate, expeditious triage of patients by competent triage nurses. As we enter the
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Competencies Emergency and Mental Health Nurses Need in Triage in Acute Mental Health Care: A Narrative Review
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2014, Journal of Emergency NursingCitation Excerpt :ED leaders must be confident that the right nurses are placed in the triage area to ensure patient safety and decrease liability. Gilboy et al3 and Schriver et al4 both concluded that ED nurses’ skills are crucial to accurately triaging patients, and McNair and Gurney7 suggested that education, experience, and empathy were important factors in triage. None of these 3 articles provided insight into years of experience that would exemplify triage competence.
Queueing Problems in Emergency Departments: A Review of Practical Approaches and Research Methodologies
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