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Traditional Nurse Triage: An Outdated Model?
LETTER
LETTER
TO THE
EDITOR
Submit all Letters to the Editor online at http://ees.elsevier.com/jen/
Traditional Nurse Triage: An Outdated Model?
Dear Editor: My mom and I recently spent a long afternoon shopping at the mall. I promised her we would meet my sister for an early dinner. At almost 90 years old, my mom was anxious to be off her feet; she was a little grumpy and needed something to eat. As for me, I needed a glass of wine! Upon our “early-bird” arrival at the restaurant, we asked for a table to wait for my sister. The nice young hostess firmly informed us of the restaurant’s policy that the entire party must be present to be seated. Unfortunately for me, my mom does not believe unescorted women belong in a bar. Forty minutes later, we were finally at our table and the busboy brought a basket of bread. The waiter eventually came by and began to recite a litany of dinner specials when my mother interrupted him, “I am starving and know what I want … please just give our order to the chef!” Admittedly cantankerous, my mom’s reaction to the obstacles of just ordering her dinner reminded me of the hoops patients must jump through upon their arrival to most emergency departments. As ED visits continue to increase across the nation, the ability to receive and efficiently process new patients is vital. Similar to customers who come to a restaurant for food prepared by a chef, patients come to the emergency department for definitive care by a provider (doctor of medicine/nurse practitioner/ physician assistant). They expect to be “treated” rather than triaged so they can “wait” to be seen. Patients want to be seen by someone who can assess them, initiate treatment, and discharge or admit them. Most emergency departments want to provide an exceptional patient experience but are unable or unwilling to shift their focus from a nurse- and hospital-centered process to a patient-centered approach. Over time, we have allowed organizational constraints to become insurmountable obstacles to actually getting the patient to a provider for treatment. Sick or injured patients do not
J Emerg Nurs2012;38:418-9. 0099-1767/$36.00 Copyright © 2012 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.
418
JOURNAL OF EMERGENCY NURSING
want to endure detailed assessments and a barrage of mandated screening questions that are often relegated to the traditional triage nurse process. Today, in many lowacuity cases, the triage interaction takes longer than the assessment and disposition by the provider. As an ardent supporter of professional nurse triage in the late 1970s, I remember many colleagues resisted the perceived clerical role of greeting arriving patients as not “real nursing.” I embraced this exciting new role of prioritizing patients and have implemented and taught triage programs for many years. Decades later, the role of the professional triage nurse has evolved into a highly respected and sophisticated position with specific expectations and standards of practice. As patient volumes rose across the nation, emergency departments came to rely on triage nurse assessments and experience to identify patients who required immediate care. Registered nurses became the sole proprietors of the triage process, and most emergency departments continue to revolve around this concept and process. Unfortunately, the triage role has also become an exhaustive and laborious process that often delays definitive provider management. The health care pendulum has shifted, and an ever-increasing number of people are using, and will continue to use, emergency departments as primary care providers. It is disingenuous to say that every patient must undergo a complete nurse triage process before he or she is deemed safe to be seen and treated by a provider. Not every patient requires a detailed assessment, and performing such assessments creates a risk for more serious patients waiting to be triaged. Triage is a process designed to sort patients to wait when there is no one available to treat the patient. Quality of care is a perception that belongs to patients and depends on whether they believed that their needs and expectations were met. It is time to cast off the albatross of in-depth professional nurse triage for every patient and embrace a multidisciplinary approach. An intake team dedicated to patient arrivals can assess, treat, and disposition patients (home, moderate care area, or critical ED bed) much more efficiently than the current traditional nurse triage bottleneck at most facilities.1 Emergency departments across the nation have embraced a variety of innovative strategies to improve the timeliness of the patient-provider interaction, such as provider at triage, immediate bedding, and triage teams. There
VOLUME 38 • ISSUE 5
September 2012
Shea
is no one solution that will meet the needs of every facility, but it is clear that we must explore new options to optimize efficiency and patient satisfaction with the patient arrival process. Let’s not continue to be mired in “metrics madness” and allow an outdated nurse-centered process of “triage” to impede our ability to actually treat our patients.—Sheila Sanning Shea, RN, MSN, CEN, ANP,
September 2012
VOLUME 38 • ISSUE 5
Emergency Nurse Practitioner, St Mary Medical Center, Long Beach, CA; E-mail: [email protected] doi: 10.1016/j.jen.2012.05.019
REFERENCE 1. Shea SS, Hoyt KS. “RAPID” team triage: one hospital’s approach to patient-centered team triage. Adv J Emerg Nurs. 2012;34(2):177-89.
WWW.JENONLINE.ORG
419
LETTER
TO THE
EDITOR
Submit all Letters to the Editor online at http://ees.elsevier.com/jen/
Traditional Nurse Triage: An Outdated Model?
Dear Editor: My mom and I recently spent a long afternoon shopping at the mall. I promised her we would meet my sister for an early dinner. At almost 90 years old, my mom was anxious to be off her feet; she was a little grumpy and needed something to eat. As for me, I needed a glass of wine! Upon our “early-bird” arrival at the restaurant, we asked for a table to wait for my sister. The nice young hostess firmly informed us of the restaurant’s policy that the entire party must be present to be seated. Unfortunately for me, my mom does not believe unescorted women belong in a bar. Forty minutes later, we were finally at our table and the busboy brought a basket of bread. The waiter eventually came by and began to recite a litany of dinner specials when my mother interrupted him, “I am starving and know what I want … please just give our order to the chef!” Admittedly cantankerous, my mom’s reaction to the obstacles of just ordering her dinner reminded me of the hoops patients must jump through upon their arrival to most emergency departments. As ED visits continue to increase across the nation, the ability to receive and efficiently process new patients is vital. Similar to customers who come to a restaurant for food prepared by a chef, patients come to the emergency department for definitive care by a provider (doctor of medicine/nurse practitioner/ physician assistant). They expect to be “treated” rather than triaged so they can “wait” to be seen. Patients want to be seen by someone who can assess them, initiate treatment, and discharge or admit them. Most emergency departments want to provide an exceptional patient experience but are unable or unwilling to shift their focus from a nurse- and hospital-centered process to a patient-centered approach. Over time, we have allowed organizational constraints to become insurmountable obstacles to actually getting the patient to a provider for treatment. Sick or injured patients do not
J Emerg Nurs2012;38:418-9. 0099-1767/$36.00 Copyright © 2012 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.
418
JOURNAL OF EMERGENCY NURSING
want to endure detailed assessments and a barrage of mandated screening questions that are often relegated to the traditional triage nurse process. Today, in many lowacuity cases, the triage interaction takes longer than the assessment and disposition by the provider. As an ardent supporter of professional nurse triage in the late 1970s, I remember many colleagues resisted the perceived clerical role of greeting arriving patients as not “real nursing.” I embraced this exciting new role of prioritizing patients and have implemented and taught triage programs for many years. Decades later, the role of the professional triage nurse has evolved into a highly respected and sophisticated position with specific expectations and standards of practice. As patient volumes rose across the nation, emergency departments came to rely on triage nurse assessments and experience to identify patients who required immediate care. Registered nurses became the sole proprietors of the triage process, and most emergency departments continue to revolve around this concept and process. Unfortunately, the triage role has also become an exhaustive and laborious process that often delays definitive provider management. The health care pendulum has shifted, and an ever-increasing number of people are using, and will continue to use, emergency departments as primary care providers. It is disingenuous to say that every patient must undergo a complete nurse triage process before he or she is deemed safe to be seen and treated by a provider. Not every patient requires a detailed assessment, and performing such assessments creates a risk for more serious patients waiting to be triaged. Triage is a process designed to sort patients to wait when there is no one available to treat the patient. Quality of care is a perception that belongs to patients and depends on whether they believed that their needs and expectations were met. It is time to cast off the albatross of in-depth professional nurse triage for every patient and embrace a multidisciplinary approach. An intake team dedicated to patient arrivals can assess, treat, and disposition patients (home, moderate care area, or critical ED bed) much more efficiently than the current traditional nurse triage bottleneck at most facilities.1 Emergency departments across the nation have embraced a variety of innovative strategies to improve the timeliness of the patient-provider interaction, such as provider at triage, immediate bedding, and triage teams. There
VOLUME 38 • ISSUE 5
September 2012
Shea
is no one solution that will meet the needs of every facility, but it is clear that we must explore new options to optimize efficiency and patient satisfaction with the patient arrival process. Let’s not continue to be mired in “metrics madness” and allow an outdated nurse-centered process of “triage” to impede our ability to actually treat our patients.—Sheila Sanning Shea, RN, MSN, CEN, ANP,
September 2012
VOLUME 38 • ISSUE 5
Emergency Nurse Practitioner, St Mary Medical Center, Long Beach, CA; E-mail: [email protected] doi: 10.1016/j.jen.2012.05.019
REFERENCE 1. Shea SS, Hoyt KS. “RAPID” team triage: one hospital’s approach to patient-centered team triage. Adv J Emerg Nurs. 2012;34(2):177-89.
WWW.JENONLINE.ORG
419