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Augusta Health Triage Process

October 2008

Cecilia Carpenter, RN
Tiffany Painter, RN

The healthcare system in the United States has come under much pressure recently, especially its Emergency Departments. High numbers of uninsured patients, an aging population, and multiple other factors have caused many EDs across the country to close their doors. Other EDs have absorbed the overflow by seeing more and more patients each year with the same amount of resources. Augusta Health's ED saw 57,725 patients in 2007, and this number increases every year. In order to better care for our community, Augusta Health continually reassesses ways to streamline patient flow through the ED and provide excellent and safe patient care.

Triage, French for "to sort," is the process used by Emergency Departments to sort patients that are critically ill and need immediate treatment from patients that are non-urgent and can wait. Triage systems are one of the few things in health care that have not been standardized, so different triage systems are used across the country. Augusta Health has, until recently, used a 3-tier triage system. This system was subjective, and depended on the experiences and personal opinion of the triage nurse to make a triage determination. As a result, triage categories could be assigned incorrectly, which interrupted the flow of the ED and utilized resources inappropriately.

The Emergency Nurses Association and the American College of Emergency Physicians recently came out in support of a 5-tier triage system in an effort to better utilize ED resources and standardize care across the US. This system assigns an acuity to each patient; a priority of 1 indicates that the patient is near-death and needs immediate life-saving interventions, a priority of 2 indicates an emergent patient that should not wait, priority 3 indicates a patient that may be complex but that is able to wait, a priority 4 indicates a patient with a minor complaint that will not require multiple resources, and a priority 5 patient has a minor complaint that will require no resources. This 5-tier system was developed by ED physicians, is research-based, and is proven to be both reliable and valid. The 5-tier system sorts patients so that the most acutely ill patients are seen first, ED flow is improved, and resources can be used appropriately.

In order to comply with this new standard of care and to provide the best care possible for members of the community, Augusta Health recently implemented the 5-tier triage system. This change involved many hours of training for ED staff, computer systems changes, and collaboration between several departments. Augusta Health went live with the 5-tier system on February 4, 2008 at 7am.

At Augusta Health, every patient that presents to the ED is seen immediately by a Registered Nurse, 24 hours a day. That RN does a rapid assessment based on the patient’s complaint, obtains a brief health history, and determines that patient’s acuity based on that information. Depending on their condition and risk factors, patients may either be taken directly to an ED treatment room, or they may be asked to wait in the waiting room until other patients with potentially life-threatening illnesses are cared for. Patients are not seen in order of arrival, but rather according to the seriousness of their illness.

In order to expedite this process, patients should bring all of their medications with them to the hospital and be knowledgeable about their health problems. Patients should also know what medications they are allergic to. During busy times, patients and families should expect to wait. Sometimes this can be avoided by calling your family doctor prior to coming to the ED, as they may be able to see you in the office.

Augusta Health’s Emergency Department is open 24 hours a day, 7 days a week, and 365 days a year. The ED treats patients from all over the Shenandoah Valley and the state. It is our goal to provide excellent care to all of our patients, every day.