Can someone explain how triage in emergency works?

[Astrid]

Just wondering if anyone here understands how triage in emergency works? Now I understand the concept of treating those of the greatest need first. I suppose I want/need to know how it is implemented.

Sometimes it is obvious to see why someone goes straight in or has less of a wait, but other times the whole waiting process seems to be backwards. I just don't get how a patient that is laughing, eating and moving well, can go ahead of someone in pain and almost collapsing.

Does anyone have first hand experience with triage who can explain? Thanks

[helle]

I'd love to know too.

[Babyluv]

Mmm who knows!

[Catastrophic]

I don't know much, I know there is 5 categories. 1 being the most serious, 5 the lowest...

Generally heart attacks, asthma attacks, car crashes etc those with life threatening illnesses are at a cat 1. They go in straight away.

I think 2 has to be seen in 15-30 mins. And it kinda goes like that.

Sorry cant really explain it too well. Hopefully someone else comes in

[delphmoon]

Whilst I completely understand what u are saying, there is a generic reply to this age old question.
People respond differently to pain/illness. Not all people in pain or not need of urgent care present with the typical symptoms. So the laughing smiling talkative patient could actually have a serious bowel obstruction or foreign object lodged in their head- I have seen it.
Also, these patients could have psych issues and are been seen too by psych rather than medical staff.
At my hospital we have 'fast track' where non urgent cases are seen too quickly compared to more complex presentations that usually require an admission or lengthy assessment like fractures and abdominal complaints.
Fast track deal with thing like migraines, food poisoning, wound dressings etc.
Anyway. This may not be the case at the hospital ur referring to


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[Astrid]

Thanks for that.

Make sense Delphmoon - just a pity things like that are not explained at the time, but then at the time it all sounds like an excuse when you need to be seen.

ETA: just saw your post about faking it. Pretty bad that it happens, but to an extent I understand it.

[nickle730]

Patients are also triaged based on potential or emergent illness. A simple example would be a 60 year old bloke comes to emergency complaining of chest pain. He has an extensive cardiac history. A 25 year old bloke comes to triage complaining of chest pain, he suffers no co-morbidities and has no cardiac history. He has had a nasty cold for the past week. The 60 year old will be seen before the 25 year old because there is greater potential that his chest pain is cardiac in nature.

Pain is subjective. Although the patient who presents with say, an isolated sprain or even a simple fracture of the ankle from playing footy will wish to be seen quickly, the fact is that he is not going to die from his injury and it does not have great potential to deteriorate. The laughing 60 year old with chest pain and a cardiac history will be see before the groaning ankle injury. Which is not to say that treating pain is not important, but it is less important than treating a patient suffering a life threatening injury or illness.

Basically, triage is a system which sorts patients in order from those who are actually sickest, those have the potential to become the sickest and those who need to be seen but are not time critical. (And then there are those who should have seen the local GP!) If the triage nurse is on the ball, and usually a triage nurse is highly experienced, it is a really good system. It is frustrating to have to wait if you present with a low acuity injury or illness but if you were seriously ill I'm sure you would be relieved to 'jump ahead' of all the less sick or injured patients.

[delphmoon]

Oh and to add- there are the smarties who know the system well and claim to have attempted suicide just so the are seen to mire quickly.


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[Butterfly Dawn]

In alot of asian countries you dont have GPs so every time you are sick you go to the hospital. When people immigrate this isnt explained to them, so when they are sick they go to the hospital ED and clogg up the system- simply because they dont know. Perhaps there could be little packs made by some Government dep to give to homestay familys/ english schools/ community centres that can explain the way things work in AU/NZ.- Just a random thought as Im getting ready to take DS2 back to hospital for outpatient IV for his cough.

[~TT40~]

Cat 1 = those reqiring cpr (active life support) must be seen instantly. Some major trauma too like loss of limbs etc
Cat 2 = those that could potientally become 1s eg chestpain (heart attack) asthma attack, major trauma. These must be seen in 10mins.
Cat 3 = things like abdo pains ..need to be seen in half an hr.
Cat 4 and 5 = arent really seen as emergency. I think cat 5 are within an hr?

When im at work next i can get you the exact deffinitions if you want

sent via my vortex manipulator

[~ Zarava Flutterby ~]

Cat 1 = those reqiring cpr (active life support) must be seen instantly. Some major trauma too like loss of limbs etc
Cat 2 = those that could potientally become 1s eg chestpain (heart attack) asthma attack, major trauma. These must be seen in 10mins.
Cat 3 = things like abdo pains ..need to be seen in half an hr.
Cat 4 and 5 = arent really seen as emergency. I think cat 5 are within an hr?

When im at work next i can get you the exact deffinitions if you want

sent via my vortex manipulator

Wow thanks for that hun, i wonder if the hospital i went to with my gallstones attack is Teni's local?
I arrived by ambulance with chest pain, hard to breath etc they put me in a wheelchair and sat me in the ED with a baby (a friend bought DD1 in a car following us) and i waited there for over 3hrs.

[glenny_c]

I don't envy anyone working in an ED. If we need to go to the ED, we go to a private one now. You don't need PI, but you pay $150 and get seen straight away. Depending on the complaint you can end up getting most back from Medicare. I don't do this because I think they are any better than workers in public hospitals, but I think the public hospitals are so understaffed and overworked. I don't know how ED nurses cope with the constant complaints, I think they are amazing!

[Astrid]

Ok, so going by this, I should have been seen in 1/2 an hour, it took 4. I had people with stabilised fractures, who arrived after me and went through before me (they had xrays whilst waiting, so that is something sensible they do). I could go on, but I presented to the emergency department enough times with the girls, to know that something was seriously wrong with the system yesterday.

Thanks for the info.

[Freya]

I think the problem with triage lies not in the hospital's system but in who is going to the ER to be triaged in the first place!

Everytime I have been to the ER (usually with a very ill kid or a child with suspected concussion/head injur) I just sit and stare in wonder at who comes in with maladies that could be taken care of TOMORROW at a GP or by a quick trip to the chemist, while my 2yo with a mangled mouth and blood spurting everywhere gets chucked in the waiting room for 3hrs. Seriously (a teenage girl got through before us for...............conjunctivitis!) And the hospital cannot turn them away so they have to be added to the queue. Even more of a pain in the behind is when you know there is an after hours GP right there but they still insist on being in the ER.

I think whats most dangerous is, its got to the point now where I really hesitate at heading to the ER even when my instincts say its neccesary. Because I dont want to wait for hours and hours. Im sure Im not the only person who would think that and it could be the difference between life and death. I really feel for the ER staff.

[skybie]

When i was diagnosed with diabetes i was sent to emergency by my GP, i walked in talking, laughing ect, i was seen to immediately and had drips put in ect withn 5 mins of being there. i was DKA and the emergency dr was very suprised i was still concious given my ketone levels.
So just because someone doesnt seem 'sick' doesnt mean they arent hours away from life support! i was very very lucky

[Astrid]

Very true Freya. Some of them yesterday I did wonder why they had not gone to a GP, I did consider mine first, but realised I could not wait. The only good thing I could see was that they were treating children quickly, which was a nice change.

I will be making an appointment with my GP with regards to yesterday and will find out what to do if it happens again. The problem I find though, is the Doctors say one thing, but then reception does not comply, so I could call up/walk in as advised, but they could turn me away.

[Mrs P]

I found this quite interesting. When I was 30 weeks pg with DD I experienced leg pain/tingling for several hours, and since I have a blood clotting disorder, went to ER - thought it may have been a blood clot or dvt etc. Waited over 2 hrs to be seen, and one of the many people who went in before me had "something in his eye" that had "been there for a day or two".
At the time I was pretty unimpressed!!
My issue ended up being nerve tingling from DD's position (even though she had moved around it didn't go away for a while) so all ended well for me, luckily

[Me+him+bub]

I found this quite interesting. When I was 30 weeks pg with DD I experienced leg pain/tingling for several hours, and since I have a blood clotting disorder, went to ER - thought it may have been a blood clot or dvt etc. Waited over 2 hrs to be seen, and one of the many people who went in before me had "something in his eye" that had "been there for a day or two".
At the time I was pretty unimpressed!!
My issue ended up being nerve tingling from DD's position (even though she had moved around it didn't go away for a while) so all ended well for me, luckily

I have worked in ED at the Gold Coast of all places! and I as a nurse there was even upset about these situations, I am not justifying it but behind the scenes there are certain beds for certain categories of illness/injury, these areas are equipped with staff who can handle more needy scenarios and better machinery, closer to resus bay, theatre, etc, it may have been that the next bed free was in a basic area where there is just a bed and one nurse looking after 5 patients as opposed to where you should/would/could have been with dr's near by, more highly trained staff, etc. There is a system that works behind the scenes. one area in my old ED we called "cubes" was a few private type rooms where only women with miscarriages, sexual assault victims etc would go as opposed to being stared at by 6 other patients. And one nurse would have this to her self, another area was bay 1-5 where it was closest to ambulance bay and resus and would hold the sickest/worse off patients stroke/giving birth/physical assault etc, I could go on forever! the point being there is a lot that is unseen and if it didnt work this way there would be so much chaos for staff and patient's and life saving machinery would be all over the department and hard to get a hold of when needed. I have been on the other side waiting for hours with pregnancy bleeding and gall stones and few other things and boy it sucks waiting! the problem is if there was more staff and a few more beds then waiting times would be less.