Tuesday, March 05, 2013

triage is not for sissies

Triage. Every ER nurses nightmare.

Here's what triage is like:  Pretend you are at a carnival.  You sit at a booth.  There is a sign that says: HIT THE PERSON OVER THE HEAD, FREE OF CHARGE.  You are being paid to sit at the booth.  Being the reasonable person that you are, you assume that most people are nice enough to not hit you over the head. What surprises you is how many people are willing to hit you.  The first few times you are shocked. Then you get pissed.  I mean seriously, what is wrong with these people?  Hitting another human being over the head! The thing is, you can't leave, not if you want to get paid. You have to let them hit you.  Oh BTW, the owner of the booth wants you to have a big smile on your face while you are sitting at the booth.

There is a lot of emphasis on patient satisfaction these days. Reimbursement is starting to depend on it. So the goal is to make the patients happy. Noble goal. Triage is the gateway to the "patient experience". Triage is first contact.  It sets the tone.  Blah blah blah.  The triage staff needs to be polite, professional, etc.  More noble goals.

Reality: triage is difficult as shit. You are bombarded continually from all different directions:

patients presenting for care, sometimes all at once
ambulance phone calls
doctors phone calls
dealing with relatives, friends
you are an information desk for the whole hospital
   -looking up where patients are
   -directing everybody everywhere
dealing with unhappy people in the waiting room

People are impatient, angry, hysterical, anxious when they present to triage. They don't understand why they can't go right back.  Sometimes people act out in triage: crying, yelling, sometimes throwing themselves on the floor.  Often times there are people in back of triage in carts.  These are the people who can't be in the lobby.

Add to this the constant worry of the triage staff about putting people in the lobby who shouldn't be in the lobby.  In other words they are sick enough to go back, but there are no beds. Hopefully they'll be okay in the lobby.

In the middle of all this lies the triage nurse, trying to manage it all.  You are stressed in that role.  You are abused in that role.  You are sometimes overwhelmed in that role.  To expect nurses not to express their stress, frustration is unrealistic.  We who work triage are human. We are expected to be superhuman and do all of this with a continual smile.  Its not possible.

Whats the solution?

1) Eliminate as many phone calls as possible:
          -maybe ambulance calls can be handle in the main ER
          -put and end to doctors calling in about their patients
2) Have a  desk/person to field questions at the triage desk about directions, information, dealing with families.
3) Be realistic with patients about wait times.
4) Don't keep people in the ER for 4-5 hours at a time, backing up the waiting room.


jimbo26 said...

You must not use common sense in todays world . ;-)

Beth said...

Nice analogy. I always equate it to being the maitre-d at the most popular restaurant in town, and every person waiting for a table felt they deserved that table more than anyone else. It sounds from your post that your ER has only one triage nurse as well, no?

Thank god my ER is so dingy they haven't told us to be chipper and do all that customer service crap yet. Although we just got this new thing where people can "reserve a time" online and "skip the waiting room." Total BS.

Aesop said...

It gets worse.

Once you get control of triage, some dipshit-hasn't-worked-on-patients-for-20-years consultant comes along, and start yanking people out of the waiting room to beds BASED ON WAIT TIME RATHER THAN DOCUMENTED ACUITY.

Some people are alive simply because it's illegal to kill them, and not all of those people are patients. I've never come so close to shooting myself up with Ativan to keep from killing a staff member.

CarMG said...

I'm impressed!!!!
I read all that you wrote about Triage and thought "how is it possible?? I think exactly the same about it!!!"
But, there's a huge diference between our reallity: I work in Portugal!!!!!
And I had no idea it was the same oversea!!!!

I'll keep on reading :)