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Triage Categories?

QUESTION:

Your customizable policy book how-to manual is incredible. Your hard work in the development of this tool has saved us countless hours! There have been questions from the nurses regarding the triage category of "urgent'. They interpret "urgent" as meaning the patient needs immediate assistance, period! Perhaps you could give me a little history on the current categories. Are these based upon national guidelines/standards etc? Thank you for all you have done. Your presentation this summer was exceptional

ANSWER:

Thanks for the positive feedback. It was a lot of hard work and I sometimes wonder if people who plan to write their own book from scratch realize what they're getting themselves into…

Re “Urgent”: This is just part of my general knowledge base. I was in ED management from '83-'95, and I really can't remember where I learned the meaning of those words. Those are the words that we traditionally used for triage (ER, field, etc). You'll find the traditional triage/ED literature replete with it. The ENA is now recommending a 5 tier triage category system, which I think would probably be overkill for the phone.

The traditional triage categories of “Emergent”, "Urgent" and “Non-Urgent” are generally well understood among triage professionals (ER people, EMTs, etc), but I can see how those words could be a little confusing for others because of the English definitions and connotations they carry. However, it's just semantics. Don't let your nurses get hung up on use of the words “Emergent”, “Urgent”, “Non-Urgent”. It might be better if you use the categories “Immediate”, “24 hour” and “Routine” because they're much more descriptive and no one can really get confused about what those words mean. Or “Red, Yellow, Green” would work also, as long as your policy book defines them and everyone has the same understanding. That's the key…

If you look at the Policy book, you'll see that section 3.3 speaks to the triage categories, and I defined “Urgent” as meaning potentially life threatening. Like I said, if you would rather call it “24 hours” instead of “urgent”, it's customizable, so have at it! Because of the potentially life threatening nature of these calls, they must be seen and evaluated promptly. It's up to the nurse's judgment, usually guided by decision support tools (aka, “protocols”) to decide how quickly within that 24 hour period. “Urgent” could mean within the hour, before the end of the day, or first thing tomorrow. Just be sure if you put someone off until tomorrow that you're confident they're stable. You don't want to “bet their life” and then lose.

If this doesn't answer your question, please contact me.