This ad is for fire sprinklers.
Notice the quick and efficient nurses executing the hospital fire evacuation plan.
I guess they are waiting for the patients to become victims so they can then put their “quick plans” into good use.
The one on the far left looks like she has comes from a “dreaded harsh toilet tissue” ad.
The next one looks like she is eating an ice cream cone.
Hard to do in a fire, don’t you think?
I mean, it melts and all.
Then we have two with so much air in their heads they have risen spontaneously like human helium balloons.
The enthusiastic professional on the right is just counting the minutes until her shift is over.
I thought automatic sprinkler systems were a more recent invention.
Sure would wreck havoc on a nurse’s cap.
In my department, the designated Charge Nurse is the triage nurse.
This can be tough on hellacious shifts because one cannot be in triage 100% of the time and really know what is going on in the department itself.
This is not as big a problem in my ED because, well, basically everyone is so experienced and self-sufficient there is no need of any major interventions. The Charge Nurse gets involved if there is a patient complaint, a problem with getting a patient upstairs or re-arranging patients if a specific ED room is needed.
I love triage, but don’t like being in charge.
In the huge tribe of health care I am an excellent Indian with no aspirations to the position of Chief.
There are three theories to how triage should be handled.
- The Down and Dirty Doorway Destination Decision
- Pass the triage room and go directly to Park Place, meaning you park your derriere immediately in a place on a gurney.
- Chest pain, severe dyspnea, CVA symptoms or hemmoraging at the secretary’s desk gets you this designation. Throwing up on the secretary’s desk can, on some occasions, also facilitate your entry into a room.
- You usually meet 90% of the ED staff within one minute of arrival as they all converge to get you “settled” (an IV, blood draw, EKG, portable chest and monitors all over your body, foley or CPR if you’re unlucky). Then they all disappear.
- Surf ‘em and Turf ‘em
- A one sentence chief complaint, multiple hash marks in a few boxes, allergies and half a set of vitals as you visually surf the patient.
- Then you turf ‘em to the waiting room to wait for registration.
- The Triage Trifecta
- A complete history of the present illness with focused assessment.
- Past medical history including surgeries, last period, pregnancy status (yes/no), Gravida/Parida, and immunization status including last DT when appropriate.
- A full set of vital signs including pain scale, weights on pedi patients and head circumference on infants (don’t get me started on that one)
There is no problem with the first system – emergent patients are emergently treated and that is universal.
So how far should you go when triaging a patient? How much information is too much information? Can you ever have too much information about a patient?
For the record, I’m a “Teresa Trifecta”. Every inch of that triage sheet is filled, checked, slashed, listed and signed. I ask about previous surgeries. I send families home for the medications or the list they forgot if the chief complaint warrants it.
I’ve been told by a colleague that, in her opinion, I’m too thorough. Spit ‘em out faster is her philosophy (a full triage with a patient that speaks English takes me 5 minutes, a child slightly longer).
I’ve had physicians tell me they love my triage notes, that they know what to expect when they go to see the patient.
How can you just “spit ‘em out faster” when some EDs require that tetanus boosters and fever control medications be given at triage? Along with the usual ice, elevation and the occasional pressure dressing or splint? Or the extra time it takes to get rectal temps on small children? Or the writing of 15-20 medications for the elderly?
It’s a catch-22. You are supposed to move faster because there are more people to see, but every year more information is required from each patient at the point of intake.
I say that the more information you collect up front the better. Some will say otherwise and as long as we do the mandated check marking, it gets by quality control.
But 5 years from now, I don’t want to be sitting in a courtroom with a practically blank triage note blown up for a jury with my name on it.
So “Teresa Trifecta” I shall remain.
When you’re dealing with someone’s health, there is no such thing as too much information.