Rising to the Challenge of ED Triage

Challenges are mounting for emergency departments (EDs) across the nation. The AHA News reports that the annual number of ED visits rose by 16.8 million from 1997 to 2004, while the number of hospitals with 24-hour EDs fell 12%. Along with increased patient visits and fewer EDs, the nursing shortage in some areas of the country may help account for the fact that the average ED wait to see a physician jumped from 22 minutes to 30 minutes—and from 8 to 20 minutes for patients with myocardial infarction (MI).

According to renowned triage expert, Jeff Solheim, RN, BRE, CEN, CFRN, “The nursing shortage is making it difficult to fill positions with experienced nurses. Increasingly, less experienced nurses are being slated to work in triage, one of the most demanding areas in the ED.”

“Inexperience affects the entire department by leading to undertriage or overtriage. Both can be dangerous.” Without an in-depth understanding of triage and illnesses, a nurse may undertriage, especially when faced with an atypical presentation, such as an MI without left-sided chest pain. If the nurse assigns an acuity level that’s too low, the patient must wait longer and the condition can deteriorate, requiring far more care and having potentially fatal results.

Or an inexperienced nurse may overtriage, filling ED beds and stretchers with patients who don’t need immediate care. This overwhelms the system. Then ED physicians and nurses face major obstacles to optimal care because there are too many patients for the limited resources. And acutely ill patients may not get the beds they need.

Experience and Knowledge Are Key

Solheim believes “Experience is the best preparation for emergency nursing triage.” With ED experience, nurses know what conditions do—and don’t—deteriorate rapidly, which lets them prioritize patients appropriately. They can anticipate what patients need and expedite their care.

Solheim adds, “Besides experience, a truly effective triage nurse needs a strong knowledge base.” However, the nursing shortage may prevent some facilities from sending staff for classroom training in triage. Others may not have the money or time to provide it.

So Solheim recommends an alternative to classroom teaching, such as the online course Emergency Nursing Triage authored by the Emergency Nurses Association. Unlike other programs, which provide generic instruction, Solheim says, “This course provides typical and atypical patient presentations to help prevent undertriaging and overtriaging. It also has exercises that nurses can print and review with preceptors so that it’s applicable to each individual institution.”

According to Solheim, “Nursing organizations can help rise to their ED challenges by providing nurses with the knowledge they need to triage expertly. And one of the best ways to do that is through Emergency Nursing Triage.”

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