Two-Day Course
Comments

"Absolutely, positively awesome course!"

"The instructors are dynamite!"

"Their knowledge base, expertise, and professionalism clearly shine through."

"Triage First's course will greatly add to my nursing practice. I sincerely thank you for that!"

"Everything covered was nurse-driven – this class is for nurses, by nurses."

"Two-day course is real world knowledge – now I can't wait to go to the Triage Specialist Course."



2007 Workshops

St. Louis, MO
May 8-9

Washington, DC
June 19-20

More info



Triage First, Inc.

Email
info@triagefirst.com

Website
www.triagefirst.com

Call toll-free
(866) 369-8029



Triage Specialist Course Comments

"The Triage Specialist Course was a wonderful complement to the 2-day course...taking triage concepts to new heights."

"The best course I have ever taken – I have been a nurse for 39 years, 30 of them in the ED. At last we have a course that teaches a methodical method for triage!"

"I have spent 30 of the last 32 years in emergency nursing. I've learned more from this course than any other course I've taken."

"It offers practical situations and solutions to our real life emergency departments."

"I feel it will positively impact our practice."

"The course was excellent, realistic and applicable."

Case Presentation

In spring of last year, a 41-year-old male presented to a crowded emergency department complaining of shortness of breath and a "fluttery" feeling. The subjective history also noted chest pain with cough and chills. He had a history of hypertension, insulin-dependent diabetes, congestive heart failure, recent myocardial infarction with stent placement (2 weeks prior), and was on multiple medications. His triage vital signs were BP 104/63, HR 124, RR 36, T 97.7, O₂Sat 96% on room air. There was no objective assessment documented. The patient was assigned an urgent category using a three-level acuity scale and was sent to the waiting room following triage. Approximately 30 minutes later, the triage nurse was alerted to attend to the patient, who was found unresponsive with agonal respirations. Attempts at resuscitation were unsuccessful.

The patient, a heavy user of the ED, had been seen 4 days earlier for fever and general malaise and was discharged with a diagnosis of upper respiratory infection. The same nurse triaged the patient on both visits to the ED.

What Went Wrong?

Best-practice triage requires that a systematic approach be employed to determine the appropriate acuity, disposition, and intervention; it should include the following: across-the-room assessment; consideration of the worst-case scenario; subjective information; objective assessment; and the use of critical thinking skills to "connect the dots." This process was circumvented with this patient.

This patient's history along with his presenting chief complaint (cardiovascular complaint of chest pain with visceral symptoms) would define the patient as high-risk and should have earned him an emergent category on a three-level acuity scale (CTAS Level 2-Emergent / ESI-Level 2). His unstable vital signs further validated that category. However, since the patient was given an urgent acuity assignment and allowed to wait in the waiting room (rather than being taken immediately to a treatment bed and care provider), appropriate documentation and assessment at triage should have included (at the very minimum): mental status, respiratory effort, breath sounds, peripheral perfusion, and ability to ambulate. However, there was no objective assessment even documented. Two other factors may have also influenced the inappropriate acuity assigned to this patient: the patient was known by the ED staff as a "frequent flyer" and the emergency department was crowded when the patient arrived.

First of all, the state of the department should never influence a triage nurse to lower a patient's acuity. And, secondly, it is crucial that triage nurses avoid the temptation to dismiss the seriousness of patients who are heavy users of the ED. Every patient deserves (and the law requires) that we rule out the possibility of an emergency medical condition. And it is well documented that all patients who return to the ED less than 72 hours after a prior visit—and all frequent flyers—are at risk for serious illness or injury and must be given thorough and unbiased assessments. Protect your patients (and yourself): Use a consistent, systematic approach to triage...no matter what.




Copyright 2007 Triage First, Inc.