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One of the hallmarks of an emergency department (ED), compared with an urgent care, or a physician’s office, is that patients are seen by the clinicians in order of acuity, not arrival. When there are plenty of caretakers and few patients, determining the order is less important; everyone gets seen quickly. But when there are more patients than there are staff, some form of prioritisation is needed to prevent a critically ill patient deteriorating in the waiting room. Thus, triage is a critical need when there are not enough clinicians to go around. And as our departments become more and more crowded, our waits longer, there appears to be a greater and greater need for triage.
At the same time, triage itself, or at least the way we are told to practise it, also soaks up resources. In most EDs where emergency medicine is practised, one form or another of a multilevel triage scale is used to sort patients into three, four or five categories. Usually, only experienced nurses are allowed to perform triage, but only after special training. However, despite their extensive experience, these nurses are then asked to follow an algorithm rather than utilising their clinical judgement. Moreover, we hand to triage tasks that could be done by others: in some cases a quick registration, taking observations which could be done by a technician, or handling complaints from waiting patients, which would be better solved by a security guard, or, better yet, a kindly volunteer offering a cup of tea. Moreover, the nurses are asked to sort to a degree that at …
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