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."

Literature & Research

Injured Children: A Population at Risk

In June 2006, the Institute of Medicine (IOM) released the "Future of Emergency Care" series of reports, focusing national and local media attention once again on the state of crisis under which many emergency departments in America operate on a daily basis. Included in the series is the report, "Emergency Care for Children: Growing Pains," which references a study that evaluated the stabilization and intervention in the emergency department of children who have been critically injured. (Note: All three IOM reports can be accessed free of charge by going to www.ena.org). The study, led by Elizabeth A. Hunk, MD, MPH, was conducted by a team of researchers from Johns Hopkins Children's Center in Baltimore and Duke University Medical Center in Durham, North Carolina.¹

The study evaluated 35 of North Carolina's 106 emergency departments with a "mock code" scenario using a life-sized pediatric mannequin. The mannequin was presented to triage as a 3-year-old, critically injured child in his mother's arms. None of the participating physicians or nurses involved in the direct care of the patient knew in advance that the mock code was going to occur. The hospitals in the study were chosen randomly and included community hospitals and Levels I–III trauma centers, with annual census ranging from 5228 to 107,499 visits per year.² Trauma remains the leading cause of death in children, which makes the results of this study even more unexpected and disturbing. Consider the following areas listed by the authors as "stabilization tasks most frequently in need of improvement":

Of the 35 departments evaluated:

• 34 failed to order the correct dose and concentration of dextrose
• 34 did not institute appropriate warming interventions
• 34 did not undress the child
• 33 did not assess the child for injuries to the upper extremities or shoulders
• 31 did not correctly order IV fluid boluses
• 28 did not assess or provide the necessary stabilization to the cervical spine
• 28 did not reassure the parents
• 20 did not use the Broselow-Luten color-coded tape correctly
• 17 failed to correctly estimate the patient's weight

Also revealed by the study is one of the most concerning results (although identified by the authors as "stabilization tasks most frequently performed well"): in seven (20%) of the emergency departments, the triage nurse did not take the child immediately to the treatment area trauma/resuscitation room.² This is particularly concerning because it is vital that the triage nurse recognize a critically injured child every time and take the child immediately to the treatment area. What about your hospital—would the triage nurses recognize a critically injured child every time?

References

1. Lewis S, Most ED's "fail": key tests in mock drills for pediatric trauma cases, ED Management, May 2006, vol. 18, no 5, 49-51.
2. Hunt EA, Hohenhaus SM, Luo X, Frush KS, Simulation of Pediatric Trauma Stabilization in 35 North Carolina Emergency Departments: Identification of Targets for Performance Improvement, Pediatrics, March 2006, vol. 117, no 3, 641-648.

Using Volunteers at Triage: a Solution or a Problem?

Most of us are all too aware of the complex problems that emergency health care in America is facing today. In seeking creative solutions, beware that you do not inadvertently generate new problems that could potentially jeopardize patient care and safety. Consider how one hospital addressed issues in its emergency department with the use of volunteers.

Journal of Emergency Nursing recently published the article, "Using Volunteers at Triage in the Emergency Department: One Successful Program," which delineates the steps one hospital has taken to address some of the issues specific to the triage arena and process. The article validated that the use of volunteers improved patient satisfaction scores and decreased their "Left Without Being Seen" (LWBS) rate—but there may be hidden dangers with such an approach.

Our scores are improving—so what's the problem??

The responsibilities of the triage volunteers described in the article include greeting patients and their families, providing directions as needed, and documenting the arrival time, patient's name, date of birth, and chief complaint.¹

Triage First takes the position that best practice is for the chief complaint to be obtained by an experienced registered nurse at triage. At the very least, the person obtaining chief complaints should be a medically trained employee with additional education in obtaining appropriate chief complaints and in knowing when to communicate that info to the triage RN immediately.

Hospitals put their patients (and themselves) at great risk when they make it the responsibility of a volunteer to recognize covert problems when patients present with atypical chief complaints. An example of this would be the elderly female who presents with the chief complaint of weakness and fatigue, but who is actually experiencing an acute myocardial infarction. Emergency nurses are also better equipped to understand that patients do not always recognize or communicate the most significant problem they are experiencing—such as the older patient with congestive heart failure who presents complaining only of ankle discomfort and swelling.

Some hospitals determine the order in which patients are triaged based on the reason for the visit stated by the patient. This can be problematic, especially when multiple patients arrive simultaneously or within minutes of one another and the chief complaints provided by the patients do not indicate the level of severity of their conditions. This was demonstrated at a facility by a gentleman in his 70s who presented to the desk complaining of a sore throat and feeling sweaty. Several other patients presented at about the same time, so the older man was sent to the waiting room to await triage. While waiting, he went into ventricular fibrillation because he was having an acute MI.

Note: It is appropriate to capture documentation of the patient's perceived reason for visit the ED. It is NOT appropriate to assume that statement to be the chief complaint and to prioritize care based on that assumption.

Many administrators are beginning to recognize that point-of-entry triage is a high-risk position that needs to be recognized as a specialty area within the emergency department. While volunteers can be an invaluable asset to the emergency department, obtaining and documenting the chief complaint should be the realm of the experienced, clinically astute, triage-educated emergency nurse.

References

1. Fortin I, Using Volunteers at Triage in the Emergency Department: One Successful Program, Journal of Emergency Nursing, 2006, 32: 340-342.

Copyright 2007 Triage First, Inc.