While performing triage in the ED, the nurse determines which patient should be seen first

Triage: How the First Stop at the ER Determines Patient Priority

Triage is the process of sorting and prioritizing patients for care. Because the process determines a patient’s place “in line” at the ER, it is important to understand and pay attention to your triage score.  
What Does Triage Mean?  

The term refers to the sorting of sick or injured patients according to their need for emergency medical attention. Triage is thus the method hospital emergency departments use to determine who gets care first.  

How Does It Work? 

When a patient arrives, an ER nurse performs a brief, focused assessment and assigns the patient a triage acuity level, also known as a “triage score.” The acuity level is a proxy measure of how long the patient can safely wait for medical evaluation and treatment. Because the score can determine how fast a patient is seen by a doctor and even what type of care the patient receives, a triage nurse must accurately assign, document, and report the patient’s acuity level.  

What are the Triage Acuity Levels? 

 The Emergency Severity Index (ESI) stratifies patients into five acuity groups: 

Level 1 (resuscitation) requires immediate, life-saving intervention. Level 1  includes patients with cardiopulmonary arrest, major trauma, severe  respiratory distress, and seizures. 

Level 2 (emergent) requires an immediate nursing assessment and rapid  treatment. Level 2 includes patients who are in a high-risk situation, are  confused, lethargic, or disoriented, or have severe pain or distress, including  patients with stroke, head injuries, asthma, and sexual-assault injuries. 

Level 3 (urgent) includes patients who need quick attention but can wait as long  as 30 minutes for assessment and treatment. Level 3 includes patients with  signs of infection, mild respiratory distress, or moderate pain. 

Levels 4 and 5 are considered “less urgent” and “non urgent,” respectively.  

What to Do?  

The accuracy of the acuity level is critical because it determines the care the patient subsequently receives and the urgency with which it is provided. Sometimes ER nurses just get the triage score wrong. As a result, patients get placed further back “in the line” than their condition requires.  

If you have the misfortune of finding yourself at the ER, you should ask for your triage score. If the score seems “off,” ask the nurse about the basis for the score, and if necessary, double-check with the charge nurse or with the attending physician. 

The Bell Law Firm represents clients who have suffered death or catastrophic injury in medical malpractice and other personal injury cases.  

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When patients report to the Emergency Department of UPMC Western Maryland, our staff uses a method called triage to determine who needs to be seen first. What this means is that we evaluate the severity of patient symptoms rather than take patients back to a room in the Emergency Department based on the order they checked in.

We understand this can feel frustrating for those who have waited a long time for care. However, it is standard practice in hospitals across the country because it is the most efficient way of treating people. It’s also important to understand that we only use the triage system when the demand for emergency services is greater than the staff we have on hand to treat everyone. If you walk in and no one else is waiting, you will receive prompt treatment regardless of the severity of your injury or illness.

What Does the Word Triage Mean?

The word triage originated in the French language and means to select or sort. The French trace the meaning and use of the word back to the days of Napoleon when it was necessary for medical workers to determine who to see first in cases of mass injuries among wounded soldiers. The system has developed over the years to include several levels of determining priority to ensure that all patients receive the best possible service.

Emergency Department Patients Will First See a Triage Nurse

If you arrive at the UPMC Western Maryland Emergency Department by any method other than an ambulance, you will check in with a registrar and then take a seat in the waiting room. A triage nurse will call your name shortly, but this doesn’t mean that you’re going back for treatment just yet. It’s the job of the triage nurse to evaluate each patient to determine the severity of his or her symptoms. This will typically include the following:

• Ask you several questions about your illness or injury, including your most troubling symptoms and when they started.
• Take your vital signs such as temperature, blood pressure, pulse rate, and respiratory rate.
• Communicate with patients and other medical personnel regarding symptoms as well as provide updates to any family or friends who came with you.

The job of a triage nurse is not an easy one. He or she must be able to make quick decisions, often times with little information to base them on. We expect our triage nurses to use excellent communication skills with all parties and effectively handle the stress of multitasking that comes with the job. A triage nurse must have a college degree, pass a state licensing exam, and have certification in several emergency-related areas such as cardiopulmonary resuscitation (CPR).

Telephone Triage

Some patients prefer to call UPMC Western Maryland before making a trip to our Emergency Department. They may not feel certain if they’re experiencing a true emergency, have issues with transportation, or have another reason for calling instead of presenting in person. A telephone triage nurse has a different role from a regular triage nurse because he or she only speaks with people on the phone and doesn’t have the benefit of viewing the symptoms caused by the illness or injury.

If you speak to a telephone triage nurse, he or she will help you decide if you need to come in for immediate treatment. The person in this position may also be able to help you find other resources that would not require you to visit our Emergency Department. This role is essential because it helps to reduce wait times for people who have already presented for services.

The Triage System in Action

While most hospitals follow a similar process for evaluating clients, each has a unique system for assigning a color, numeric, or other type of code to patients depending on the level of severity. The categories below are the most typical assessments that we use when triaging patients here at UPMC Western Maryland.

• White: No illness or injury detected.
• Green: Injury or illness detected but symptoms are less serious and not life-threatening. The patient will require help eventually but can wait for others with more serious needs to receive treatment first. Additionally, patients in this category may have waited several hours to report to the hospital after the original onset of symptoms.
• Yellow: These patients have serious injuries or have presented with several symptoms of a significant illness. They need immediate attention and may sometimes go back for treatment before people with even greater injuries or illnesses because their chance of recovery is higher.
• Red: Patients at this level have a life-threatening injury or medical attention. They require immediate transport to a hospital room for medical intervention.
• Black: The patient has already died or has a mortal injury that will cause death. Because there is little that medical staff can do to intervene, patients in the red or yellow categories will typically take priority.

UPMC Western Maryland Emergency Department Contact Information

If you have general questions or wish to speak to a telephone triage nurse, please call 240-964-8500. You can also call our Patient Experience department at 240-964-5673 if you have any concerns about past care you have received at the UPMC Western Maryland Emergency Department.

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