Wednesday, October 13, 2010

Triage (defined)

Triage: a process of prioritizing patients based on the severity of their condition

Now I not only have to contend with patients who challenge my 30+ years of triage experience, now I am having to defend them to people I work with. In my small facility, there is a triage process as it pertains to the order in which patients are registered by the secretarial staff. In a perfect world, it would be first come first served. This would be followed by the ones with the biggest mouths, the most dramatic, or the most whiney.

ER patients and outpatients alike must register with the same secretarial staff. There are two until 5 PM, then there is only one. Helen, lord love her, is thorough but slllllllllllllllooooooooooooooowwwwwww. The lab and xray outpatients are sometimes bumped for registrations, appropriately, for patients who need to be seen in the ER sooner rather than later. Sometimes the docs are just antsy to see patients; sometimes we just want to get them in and out because we can.

Yesterday, I triaged a pale 6 year old with a head bump; he had vomited several times. Aside from a mildly elevated heart rate, he looked about as OK as he could. Still, I didn't feel I wanted him to sit in the waiting room while Helen registered several outpatients. As I exited the triage area, Helen intuited that I needed this child registered without delay and kicked the outpatient xray in front of her back to the waiting room.

Several minutes go by; Lee,the xray tech was in my face, abrupt and inappropriate as usual; "Do you ever think about how the patient might have felt? He was already seated. I know we are supposed to give preference to the ER patients, but do the outpatients always have to be bumped for every dental pain and boo-boo?"

Whoa, back off there. I waited for my blood to stop boiling, took a deep breath, calmly looked up as she loomed over me, then let her have it

"Lee, I understand your frustration. I am sure you got endless shit from the outpatient; not to mention it makes your numbers look bad, so I am sure there is a certain amount of self-preservation here. The reality is, it is my decision and mine alone when it comes to the order in which patients are registered; it is based on my clinical judgement. It is my license but more importantly it is based on doing what is right for patients who need care sooner rather than later, as well as common sense which you seem to be lacking today. Before you stick any more of your foot in your mouth you should know that this kid is head injured, pale and vomiting, which handily trumps your outpatient. That's all you need to know. Don't you ever question my clinical judgement again; you will lose, I assure you. Now get out and go fill in some forms or something".
She left sputtering but firmly in her place.

The Talker had heard the whole thing; "Wow", he said, "Well done".
Yeah, see definition.