Take Me First: The Triage System

Often times, when I read a medical scene in a fiction novel it generally covers treatment of a character’s injury/illness. That can be the extent of the scene. What other factors inherent to the ED can increase conflict for the character?

One of the first people you’ll come into contact with if you go to the emergency department is the triage nurse. Triage is a process of sorting patients so the sickest are seen first. Can anyone see potential areas of conflict during the triage process?

When I screen a patient in triage, I take their complaint, a set of vital signs, medical history, allergies, and current medications. For pediatrics, we get a weight because every drug dosage is based on their weight. Most likely, the parent explains why they brought their child in. I then assign them a level based on my assessment of how emergency they need to be seen. Different emergency departments will use different scoring systems but all ED’s have them. Some are three levels. The hospital I work for uses a five level triage system.

If I “level” you a one then you’re dying and need immediate resuscitation. A level two patient might be a fracture with obvious deformity that may have to be set using sedation or an infant that needs a septic work-up. A level three patient would be those requiring a work-up for their issue— like abdominal pain. A level four patient is generally a simple laceration repair or concern for fracture but not an obvious deformity. If I assign you a level five, then you could likely be seen by your doctor the next day without suffering any ill effects. This would cover things like getting a test for strep throat or having a doctor look at a rash. You can see as the “acuity” goes down (level one is the highest acuity), so do the number of tests and procedures. ED nurses are very good at anticipating what tests and procedures the doctor will likely preform.

If bed space is not an issue, patients are generally taken in order of arrival. People in the waiting room are excellent at keeping track of what order they’re in and they expect this to be maintained. However, when bed space becomes limited, then I want the doctor to see the patients who have the highest acuity first.

However, when you begin to pull people out of order, this is when tension begins to rise in the waiting room. At first, it may be subtle. I call a patient back and the ones that signed in before that one give me what I affectionately call the “evil eye”. The longer the wait, the more restless people/children become. Sometimes, sicker patients do have to wait. As a nurse, this is not an ideal situation but I also can’t place more than one patient/family in a room.

Often times, it is presumed that a patient that arrives by ambulance will automatically get a room in the department. However, if beds are tight and the patient’s acuity is low, I have triaged them to the waiting room. How happy do you think that patient is? I know this may come as a shock, but some people who call an ambulance are not having a medical emergency.

In the comments section, write a triage scenario that has high conflict in no more than five sentences. Can you do it?

***Contest reposted from February 9, 2011.***

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