Emergency Department Triage System

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Emergency Department Triage System

• By
• Jamal Wahadneh Rn MPH and
• Ms Aida Salahat Rn
• Al-Makassaed Emergency department

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Objectives

• Define Triage
• Define Triage system
• Identify different systems
• Describe emergency severity index
• Function of triage system

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History of Triage

• Definition
• Origin
• Informal triage

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Goals of Triage

• Primary
• Secondary

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Category of triage

• In hospital triage
• Multi casualty disaster triage

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Types of triage methods

• Three level
• Four level
• Five level

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Function of triage

• Identify life-threatening conditions and
  determine acuity level of each patient

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Reassessment in triage

• Level 1 Continuous
• Level 2 every 15 min
• Level 3 every 60 min
• Level 4 every 60 to 90 min
• Level 5 every 2 hours

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Five level system

• Origin of 5 level
• Identify different levels

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Emergency Severity Index

• Definition
• Advantages
• disadvantages

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E M E R G E N C Y
S E V E R I T Y
I N D E X
Is patient dying ?
Yes
No
Level II, III, IV, V
Level I
Can patient wait ?
Yes
No
Level II
Level III, IV, V
How many resources ?
ONE Level IV

• TWO
• Level III

NON Level V
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What are resources ?
Resources Not resources
Labs HX and physical exam.
ECG-X-rays C-T MRI Point of care testing
IV Fluids /hydration Saline or Hep lock
IV /IM Medication PO. Medication
Specialty consult Simple wound care (dressing check /recheck) crutches ,splints,slings.
Simple procedure
Complex procedure
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Key concepts

• Acuity level change
• Choose higher acuity when in doubt

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Basic triage components

• Across the room assessment
• Triage history
• Physical assessment
• Triage decision

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Key concept

• Discontinue assessment and transport the patient
  immediately to the treatment area if immediate
  care is needed. Do not delay treatment to finish
  the assessment

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Triage process

• Establish priorities
• Scientific method
• Importance of time

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Nursing process in triage

• Assessment time
• Vital signs
• Pain scale
• Nursing diagnosis

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Key Concept

• Never assume the accident caused the presenting
  condition. The presenting condition may have
  caused the accident.

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Interview methods

• Open ended
• Close ended
• Communication style
• Use of five sense
• attitude

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How do I triage?

• Across the room
• General appearance
• Abcd
• Subjective and objective (AMPLE)
• Focused assessment
• Pains scale (Pqrst)

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Triage decision

• Step1- visual
• Step 2- chief complaints
• Step3- focused assessment
• Step 4- pose hypothesis
• Step 5- determine acuity
• Step 6- reassess the acuity

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Remember That

• Effective triage gets the patient
• To the right place.
• At the right time.
• With the right care provider.

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• Questions