Triage Decisions

It Takes More Than String to Fly a Kite: 5-Level Acuity Scales Are Effective, but Education, Clinical Expertise, and Compassion Are Still Essential

Adoption of a standardized 5-level acuity scale: Is it enough?

In a 1999 article entitled “What's Wrong With Triage,” Edwards² noted, “The process of allocating patients to categories has come to be seen as the sole purpose and end point of triage. This static and narrow perspective separates the responsibility for decisions on urgency from the responsibility to act on those decisions.” As desirable as the adoption of a standardized 5-level triage acuity scale is, it is not the definitive answer to many of the problems we hear about that are associated

Education

As we at Triage First have consulted with and educated thousands of emergency nurses and hundreds of physicians, we have discovered that most of them have not received formal education regarding the triage acuity scale in use at their own facilities. It also has been our experience that “MOST of the problems associated with a consistent triage performance and outcomes are due to lack of education regarding same.”⁶

We have found that a good number of emergency nurses are unable to describe their

Experience

An ENA position statement on requirements for triage nurses includes the requirement of being an RN with at least 6 months of ED experience. Some facilities require nurses to have as much as 2 years of ED experience before working at triage. Furthermore, although comprehensive triage education can be invaluable, certain things can only be learned through years of experience.

The triage nurse must be the “detective” at the front door; it is not the patient's job to tell the nurse what is wrong,

Empathy

In a 1999 article, Edwards⁸ comments, “Triage is not merely a gateway to care but one which brings therapeutic gains in its own right and acts as the critical first phase in the total process of care.” Regardless of the acuity scale in use, cynical nurses may not be able to provide the best care and may therefore allow their biases and prejudices to influence their triage decisions. Edwards⁸ also says, “Nurses operate on the basis of concern as well as clinical acumen. If triage is to be

The real solution

Reducing the incidence of mistriage will have a positive impact on patient satisfaction, patient safety, and, ultimately, the bottom line. To accomplish this goal, we obviously need a proven acuity scale, but we also need efficient processes, appropriate physical layouts, and supportive administrators. However, in our experience at Triage First, the most important key to alleviating the problem of mistriage is to have experienced, triage-educated, compassionate RNs assigned to triage.