Introduction
Emergency care and medical services are offered to play an important role in the life of every person, who is in need of professional medical help. The way how emergency care is offered in special rooms may define the quality of life and even the future of human life. As a rule, all emergency departments have to follow a particular triage system based on which medical workers can gain control over patient crowds and improve the emergency care in regards to the level of care urgency (Melon, 2012). Patients are usually directed to a special registration clerk to identify what kind of help and what kind of a doctor is necessary in a particular case. This is why the concept of Emergency Room (ER) triage has to be properly analyzed, its characteristics need to be identified, and the description of the process should explain its worthiness and importance.
Such researchers like Endacott, Cooper, Sheaff, Padmore and Blakely (2010) underline the importance of triage reinstatement in the sphere of nursing management, and Saghafian, Hopp, Desmond, and Oyen (2011) explain that an American triage system has to be improved by the ability to collect the most crucial information in a short period of time and determine the methods of the information usage.
Aims and Purposes
The current paper aims at providing a conceptual analysis of ER triage, defining its meaning and characteristics, and explaining how a particular ER triage system can work under a number of circumstances. The purpose of the work is to develop the understanding of the concept of ER triage and offer a model case that demonstrates how triage is tied to the other medical processes organized in the Emergency Room.
Significance to Nursing
According to Rodgers and Knafl (2000), concept analysis helps to develop the knowledge basis about nursing and the services that have to be offered by nurses. ER triage is the process that predetermines a number of further activities that have to be done by nurses, this is why it is so important for nursing and medical care in general. With the help of ER triage, nurses become aware of what services should be offered and to what patients they have to pay their attention at first. It may happen that the presence of one patient may lead to the development of health problems among the other patients. In this case, evacuation may be needed. A patient may be in need of some urgent palliative care, and ER triage can underline such importance. In fact, triage helps both, the medical staff and patients to achieve the best outcomes of medical care.
Definition of Concept
Triage is a French word that means “to sort” (trier) (Saghafian et al., 2011). Many researchers offer their own ideas of how to define the triage concept using different conditions at different periods of time. For example, in the Oxford English Dictionary (OED), there is no definite explanation of what ER triage actually means. However, it is possible to find how the dictionary defines the concepts of “emergency room” and “triage” separately and unites them to comprehend what ER triage can mean. In the OED, the emergency room is defined as a hospital department that provides immediate treatment for patients with injuries and pain or a casualty department; triage is explained in two ways: as (1) the process of sorting in regards to the quality or (2) the evaluation of levels of urgency in regards to illnesses or injuries to choose the most appropriate order and method of treatment. The combination of such common definitions helps to create the following explanation of the ER triage concept that can be applied in nursing: Emergency Room triage is a process of sorting and prioritizing patients in regards to the level of their injuries in order to choose the most appropriate treatment and address the necessary doctor.
However, the OED is not the only source that can be used to define triage. There are many researchers, who make successful attempts to elaborate triage’s characteristics and explain how and why the process under organization is organized. For example, Saghafian et al. (2011) define triage as the process that is organized by means of streaming or prioritizing information about patients, and North (2004) underlines the fact that any kind of development in hospitals requires certain financial support, this is why ER triage is considered to be an important financial concept that cannot be neglected. Melon (2012) introduces ER triage as one of the most crucial interfaces for patients, who enter the existing care system, that aim at determining access to diagnosis and intervention. Aacharya, Gastmans, and Denier (2011) offer an ethical understanding of ER triage: it is identified as “a classic example of distributive justice, which addresses the question of how benefits and burdens should be distributed within a population” (p. 2).
All these definitions of the same concept turn out to be a unique opportunity to understand what ER triage is and how it should be evaluated by society. Nurses and other medical staff are not the only ones, who should know about triage.
Defining Characteristics
The identification of the characteristics that are associated with the concept of ER triage has to be based on the appropriateness of these characteristics to the purpose of the concept’s exploration. Taking into consideration this principle, the following characteristics of Emergency Room triage can be identified:
- ER triage is usually performed by a qualified registered nurse;
- ER triage is the process that helps to organize an acceptance of patients;
- ER triage promotes sorting patients in regards to their health problems and conditions;
- ER triage requires from nurses the following qualities:
Good communication skills:
- General awareness about illnesses;
- Abilities to define the level of injury within a short period of time;
- Abilities to make fast and thoughtful decisions;
- Knowledge about behavior in stressful or urgent situations;
- Understanding of cultural/ethical/racial concerns.
ER triage requires the necessity to improve overall education in the sphere of nursing:
- ER triage is the process that depends on the current technological progress.
ER triage may be of different levels:
- Urgent;
- Less/non urgent;
- Resuscitative
- Emergent.
ER triage is the process that consists of several steps:
- General evaluation of a patient and situation;
- History of a patient;
- Physical analysis of a patient;
- Decision.
ER triage presupposes the ability to act in accordance with a number of factors:
- Weather;
- Electricity;
- Communicative means;
- Availability of a necessary doctor.
ER triage requires constant improvements in regards to patient needs and expectations.
All these characteristics define a quality of the ER triage process, its effectiveness, and necessity in nursing management and the work of a hospital in general.
Model Case
Mr. Ballot is a white 35-year old driver of a limousine driver, who is admitted to a hospital in a result of an accidental crash caused by poor weather conditions. He has serious injuries on his body because of the inability to gain control over the car as soon as a black man appears on the road. His breath is stable, still, he loses his consciousness several times.
A registered nurse, Mrs. Curly, has to accept this patient. She is able to evaluate the whole situation, take into consideration weather conditions and a threat of power outages, and even chooses a white doctor in order to avoid possible personal reactions of Mr. Ballot on the black doctor due to the recent accident. During the ER triage process, she also considers the history of the patient, discovers that she has an allergy to certain sedative and soporific drugs, informs the doctor, and informs his family about the accident. Mrs. Curly looks confident and even calm completing all these steps. She also asks Mr. Ballot about his conditions from time to time not to make him get unconscious again. Within a short period of time, the doctor comes to the patient and starts treatment on the basis of the information offered by Mrs. Curly in a printed form.
In this case, Mrs. Curly demonstrates the qualities, necessary for an ER triage nurse. She stays calm and reacts on any change properly. She also considers the possible changes of weather and the possibility of problems with electricity, so, she prints all information and makes it available to the doctor anyway. The case follows certain attributes of the concept under analysis as the triage process is organized in accordance with the patient’s condition and his personal history. The story shows how Emergency Room triage works and influences the work of other departments in the hospital.
References
Aacharya, R.P., Gastmas, C., & Denier, Y. (2011). Emergency department triage: An ethical analysis. BMC Emergency Medicine, 11(16), 1-13.
Endacott, R., Cooper, S., Sheaff, R., Padmore, J., & Blakely, G. (2010, June 26). Improving emergency care pathways: an action research approach. Emergency Medicine Journal, 28(3), 203-207.
Melon, K.A. (2012). Inside triage: The social organization of emergency nursing work. University of Calgary Theses. Web.
North, L. (2004). Mind the gap in see and treat. Emergency Nurse, 11(10), 16-18.
Rodgers, B.L. & Knafl, K.A. (2000). Concept development in nursing: Foundations, techniques, and applications. London: Saunders.
Saghafian, S., Hopp, W.J., Desmond, J.S., & Oyen, M.P. (2011). Complexity-based triage: A tool for improving patient safety and operational efficiency. Michigan Ross School of Business. Web.