Emergency Department Triage
Triage is an essential element of providing care to patients who present at a hospital emergency department. Triage is defined as a brief clinical assessment that determines the time and sequence in which patients should be seen in the emergency department. During triage, an emergency department nurse interviews a patient or the patient's representative about the medical problem causing concern, makes a brief evaluation of the patient, and takes the patient's vital signs. Based on the triage nurse's assessment, the patient will be assigned a priority of emergent, urgent, semi-urgent, and non-urgent. Based on the priority assigned to the patient, the patient may be brought immediately into the emergency room for treatment or be asked to remain in the waiting room until it is his or her turn to receive medical evaluation and treatment. After a patient is triaged initially, it may be necessary for the triage nurse or other emergency department personnel to "re-triage" the patient to determine whether the patient's medical condition has deteriorated to the point where the patient needs to be seen sooner. The failure to properly triage a patient who presents at a hospital emergency department can be the basis of a malpractice action. Because all hospitals are required to have triage protocols in place, a triage nurse is required to comply with the hospital's triage protocols. Failure to comply would be evidence of the nurse's negligence. A hospital's failure to have proper triage protocols can be the basis of liability for the hospital. Likewise, a hospital's failure to have supervisory procedures in place to monitor the triage process can be the basis of hospital liability.
The word "triage" is derived from the French verb "trier," to "sort" or "choose." Originally the process was used by the military to sort soldiers wounded in battle for the purpose of establishing treatment priorities. Injured soldiers were sorted by severity of their injuries ranging from those that were severely injured and deemed not salvageable, to those who needed immediate care, to those that could safely wait to be treated. The overall goal of sorting was to return as many soldiers to the battlefield as quickly as possible.Changes in the health care delivery system forced U.S. emergency departments to consider alternative ways of handling an increase in the number of incoming patients during the 1950s and early 1960s. In the late 1950s, physician practice began to change. Physicians moved away from solo practice; the days of house calls and the family doctor became nearly obsolete. Physicians formed office-based group practices that offered regular office hours with appointments. Emergency departments became the principal provider of primary medical care when doctors' offices were closed, principally during evenings and weekends. At the same time, more physicians entered specialties rather than general practice. Emergency departments started to experience a large increase in volume. The increased volume was a result of use of the ED by patients with lower acuity problems. Emergency departments recognized they needed a method to sort patients and identify those needing immediate care. This provided the impetus to put ED triage systems into place. Physicians and nurses who had used the triage process effectively in the military first introduced triage into civilian EDs. The transition of the triage process from the military to U.S. emergency departments was extremely successful. The emergency nurse triages each patient and determines the priority of care based on physical, developmental and psychosocial needs as well as factors influencing access to health care and patient flow through the emergency care system. Triage is to be performed by an experienced ED nurse who has demonstrated competency in the triage role. The goal is to rapidly gather "sufficient" information to determine triage acuity (ENA, 1999, p. 23)....
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