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Question: When I am working in triage as the only RN, how can I reasonably be expected to reassess everyone in the waiting room?

Answer: This common question reflects the frustration experienced by triage nurses who have to manage the waiting room with limited resources and less than optimal processes in place. The problem of patients sitting in the waiting room for hours without reassessments is complex and multifaceted. It requires careful consideration of many contributing factors including, but not limited to, annual census, staffing patterns, acuity mix, use of protocols, availability of beds in the treatment area, and length of time in the waiting room.

Not all patients require the same frequency of reassessment. Furthermore, many triage nurses function under the wrong assumption that reassessment always implies a full assessment with vital signs. This is not necessarily the case - a reassessment may be as simple as touching patients and asking how they are feeling in reference to their presenting complaint while you visually assess them. However, it cannot be stressed enough that your practice MUST reflect your ED's policy. If your policy states that urgent patient's must be fully reassessed every 60 minutes, and this does not occur with subsequent deterioration of a patient's condition, you are responsible for not following that mandate. There is a high risk of litigation when waiting patients deteriorate and have a bad outcome, especially if reassessments have not been done. If you are unable to reassess patients according to policy, that becomes a point of leverage for encouraging change to your system and the addition of needed resources.

One method of assisting with meeting reassessment criteria would be the use of "observation chairs." Urgent patients or any patient that you are concerned might need more timely and frequent reassessment would NOT be placed in the waiting area, mixed with the general or less urgent population. Instead, place them close to the triage area in view of the triage nurse for easier and even continuous observation.

Another method some hospitals use when the department is overcrowded and the waiting times are long is to assign a nurse specifically as the "waiting room nurse" or "reassessment nurse." This nurse is generally responsible for reassessments, assisting with comfort measures, and the initiation and follow-up of protocols.

Finally, when you are unable to meet the reassessment policy of your ED, are you notifying your charge nurse and documenting this somewhere in your department, such as in a 24-hour shift report or a log that tracks periods of danger at triage? (The inability to reassess patients waiting for bed placement is definitely a period of danger!) Always keep in mind the bigger question here: What is the standard of care that you would expect if it were your family member sitting in the waiting room?

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