Communication between the emergency department (ED) and the radiology staff is of high importance to ensure patient safety. Communication by telephone between the radiology staff and the primary registered nurse (RN) prior to patient transport from ED to radiology enhances departmental efficiency and improves patient care. Testing such as blood work, an electrocardiogram (ECG), and other diagnostic tests may be required prior to the radiologic procedure or exam. Acutely ill patients may need a nurse to accompany them to radiology to provide continuous assessment and evaluate cardiac monitoring, respiratory effort, and medication needs. The patient may require medication prior to transfer to radiology to control nausea, provide pain relief, or begin combating an infectious process with antibiotics. A number of reasons exist requiring the ED staff to delay transport to radiology such as tests requiring completion prior to the radiologic exam.
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Determining at triage whether a complaint is respiratory or cardiac in origin can be challenging, and more often than not, the answer may not come until after diagnostic testing. Since chest pain and shortness of breath often go hand in hand, a careful review of both the respiratory and cardiac emergency chapters can help prepare the nurse for assessing these patient populations. This chapter provides a foundation for potential high-acuity respiratory presentations that the triage nurse may encounter. It states worst-case scenarios of respiratory presentation. Some of the scenarios include anaphylaxis, epiglottitis, foreign body obstruction, inhalation injury, and Ludwig’s angina. The chapter lists triage questions related to a respiratory emergency and “red flag” findings of respiratory emergencies. Some of the red flag findings are: accessory muscle use, retractions, and/or nasal flaring; breath sounds unilateral or absent; confusion or restlessness; and respiratory distress or respiratory failure.
Working in triage can be overwhelming. The fast-paced environment, vast knowledge required, and the unpredictable nature of the triage area can leave even seasoned triage nurses feeling the stress. Emergency nursing leaders were asked to share their techniques for delivering quality care at triage, how they nurture themselves while in the triage role, and how they promote efficient departmental flow, all while keeping patient safety as the primary goal. This chapter includes tips, wisdom, and insights from nurses who have worked in the trenches and their suggestions for setting oneself up for success at triage. It helps the nurses to identify a minimum of three tips one can incorporate into their triage practice and reflect on their own triage success tips that one can share with other triage nurses. The chapter also helps the nurses to identify one method of sharing triage tips that can be incorporated in the facility.
Precepting an individual at triage is an opportunity to shape that nurse’s future practice. When the orientee begins practicing in triage on his or her own, this nurse may make potentially life-saving or life-altering decisions about your family members and friends. Therefore, giving the orientee the experiences and education that you would want every nurse to have at triage is crucial. This chapter covers essential skills required of the preceptor and provides tips for creating a positive experience for the triage orientee. It explains adult teaching principles. It helps the nurse to understand the impact of generational differences in the workplace and list recommended qualifications for a triage preceptor. It explains the benefits of precepting at triage and describes the components of the triage orientation. It provides tips for nursing leadership and nursing educators and ways to support preceptors.
Poor hand-off communication between the sender and receiver can result in a delay of care or, even worse, a sentinel event. Each organization makes decisions on a method that works to ensure effective communication to improve patient safety. The collaboration between the emergency department (
ED) and the radiology department is a critical part of this process. This chapter discusses the reasons why effective communication between the EDand the radiology department is important. It focuses on how a “ticket to ride” can improve ineffective communication and explains reasons for delays in turnaround time between the EDand radiology.
Patients with contagious illnesses who seek care may manifest a variety of signs and symptoms, often including dermal findings, which can be challenging to evaluate. The triage nurse’s role is not to diagnose the rash but rather to ensure that the patient’s airway, breathing, and circulation are intact and that patients with potentially contagious conditions are identified and appropriately isolated. This chapter focuses on many conditions that are a high priority for isolation in order to protect the patient, staff, and those waiting. It states contagious conditions such as chickenpox, impetigo, lice, measles, meningitis, rubella, and scabies. The chapter lists out triage questions related to a dermal presentation. It presents “red flag” findings of dermal presentations such as evidence of dehydration if immunocompromised, facial or tongue edema, mental status changes (confusion or decreased level of consciousness), and new-onset petechiae or purpura with or without a fever.
Overcrowding in EDs is a nationwide challenge. A new focus that links hospital reimbursement to customer satisfaction adds another element to the practice of patient care. These issues have prompted creative methods of resource utilization. One solution is to place a provider in triage to mitigate overcrowding challenges; reduce wait times; and rapidly and efficiently assess, diagnose, and initiate care for patients. This chapter offers ideas related to process and teamwork initiatives as well as communication tips that can help improve the communication and productivity of triage teams and enhance collaboration. It helps the reader to state the purpose of placing a provider in triage, discusses the importance of communication in triage, and lists out the tips for a provider in triage. Placement of a provider in triage serves a multitude of functions and offers numerous potential benefits that influence quality of care.
In healthcare today, patient satisfaction is more important than ever. Patient satisfaction is linked not only to high-quality clinical care but also to the customer experience. The success of an organization depends on its customers; thus, staff should recognize that both real and perceived experiences impact a person’s impression of the service rendered. Since you never get a second chance to make a first impression, making that first interaction a positive experience is essential. Staff training in the delivery of top-notch service is a key element to creating a customer-friendly environment that promotes patient satisfaction. This chapter states two key elements of providing an effective customer experience in triage nursing and lists two examples of the right words at the right time. It explains the importance of rounding and reassessments in the waiting room. Processes that enhance patient safety and patient satisfaction often improve staff satisfaction.
Synchrony between the emergency department (
ED) and radiology department ensures patient safety, efficient care, and the ability to meet core measure and time-sensitive treatment guidelines. Understanding what radiological diagnostic tests are commonly needed in the ED, and in how rapid of a manner, will help the radiology team to provide the highest level of care. This chapter focuses on how to identify four common radiological tests needed in the EDand how to recognize three core measure/time-sensitive medical conditions and discusses the guidelines that need to be met by radiology staff.
The abdomen contains many organs, both solid and hollow, that can manifest a wide range of possible abnormal findings. Utilizing key questions helps differentiate the patient with “gas” from one with a life-threatening perforation. When triaging patients, it is important to consider the worst-case scenarios and to identify not only patients who are obviously seriously ill but also those who might be. This chapter provides a foundation for potential high-acuity abdominal presentations that the triage nurse may encounter. It state worst-case scenarios of abdominal presentation. Some of the scenarios include abdominal aortic aneurysm, appendicitis, cholecystitis or cholelithiasis, and diverticulitis. The chapter lists triage questions related to an abdominal emergency. The chapter also lists the “red flag” findings of abdominal emergencies such as bloody or black stools; board like or rigid abdomen (from muscle contraction); coffee-ground or bloody emesis; acute colicky pain; pulsating abdominal mass; and rebound tenderness present.