Triage Federal minister of health in addis.pptx

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1. Triage FMOH 2013

2. Case scenario A 28years old young man arrived to the ED after 1hr of the incident. On arrival patient came on stretcher, non communicative, snoring, has edematous face, responding only to pain, RR is 20/min, BP 100/60mmhg, P120/min, oxygen saturation 80%, What is your triage score and code Where will be the patients disposition What are the next steps

3. Triage Triage, from the French word “trier”, literally means: “ to sort ” The aim depends on the situation of the event: Severity number of victims/medical or trauma and capacity of the facility or the state

4. Types of triage Multiple causality scenario – number and severity of the injuries or illness proportional or does not exceed to the resources and ability at hand to render care. Priority is given to life threatening conditions Mass causality scenario – number and severity of injuries does exceed the capacity of the facilities and staff. In this case, those with the greatest chance of survival with the least expenditure of time, equipment’s and supplies are prioritized

5. TYPES OF TRIAGE Patient to triage: when a patient appears relatively stable and is able to mobilize him/herself to the designated triage area. This will be the type of triage used in most of the cases . Triage to patient: here the patient is usually unstable. The patient is unable to mobilize him/herself to the designated triage area and should be transfer directly to the resuscitation room. Triage should be performed at the bedside and documented in retrospect. This type of triage will be used less often.

6. Principles of triage: Degree of life threat posed by the injury or illness Injury or illness severity Salvageability - consider likelihood of survival Resources available Time, distance and environment

7. Benefits of triage To speed up the delivery of time-critical treatment for patients with life-threatening conditions , To save life To save limb 2 . To ensure that all people requiring emergency care are appropriately categorized according to their clinical condition , 3. To improve patient flow

8. Triage benefit con… To improve patient satisfaction 5. To decrease the patient’s overall length of stay 6. To facilitate streaming of less urgent patients 7. To be user-friendly for all levels of health care professionals.

9. Triage officer   It is the responsibility of these men and women to quickly and accurately assess a patient's condition determine that patient's priority for treatment. Has to have Strong evaluation ability, Skill on quick and decisive judgment, and the ability to keep a cool head are all necessary skills needed to be a successful Triage officer.  

10. Activities at triage area Triage is the first point of clinical contact for all people presenting to the Emergency Department and the point at where care begins . Triage is a brief clinical assessment that determines: the clinical urgency of the patient’s presenting problem and ends with the allocation of an emergency category, which determines the time and sequence in which they receive emergency care.

11. Minimum standards for the triage practice and the triage environment   Standard 1: Clinical practice Undertake patient assessment and allocate the Triage Score category based on; a. Findings of the primary survey b. Risk assessment Initiate appropriate nursing interventions BLS and emergency interventions to improve patient outcomes and

12. Equipment and Environment The triage environment must provide safety for the public, the triage nurse, staff and patients of the Emergency Department and the hospital . The environment : a. Must be immediately accessible and well sign posted b . Must have access to an area for patient examination and primary treatment

13. Minimum standard con… c. Must be designed to maximize the safety of the triage nurse, staff and patients (e.g. threat alarms, access to security personnel ) d. Must be equipped with emergency equipment ( air way equipment, Gloves, face masks & other barrier protective devices, mercury thermometer, Electronic/ manual blood pressure & pulse analyze -Pulse oximetry , ECG, Dry dressings/ bandages, Finger prick ( glucotest & finger prick hemoglobin), Urine dipsticks & urine pregnancy tests )

14. Minimum standard con… e. Must enable care to be provided with due regard to standard and additional Precautions for infection control and prevention f. Should enable and facilitate patient privacy

15. Importance of Triage Scale The scale directly relates with a range of outcome measures (inpatient length of stay, ICU admission, mortality rate ) Resource consumption ( staff, supply, time, cost )

16. Triage Scale cont’d 3. It provides an opportunity for analysis of a number of performance parameters in the Emergency Department case mix, operational efficiency, utilization review, Outcome effectiveness and Cost    

17.   Table 1 TEWS: Triage Early Warning Score.

18. Emergent Severity Index (ESI)

19. Case 1: Patient with help = Respiratory rate = 18 Heart rate = 118 Blood pressure = 208/112 Temperature = 36.5 Patient Alert No Trauma What is the TEWS: (Triage Early Warning Score) Emergent Severity Index (ESI ) Disposition

20. Case 2 Patient arrived on stretcher Respiratory rate = 30 Heart rate = 130 Blood pressure = 90/60 Temperature = 36.5 Patient confused/reacts to voice = Has history. of Trauma What is the TEWS: (Triage Early Warning Score) Emergent Severity Index (ESI ) ? Disposition

21. Case 3 Patient in wheelchair = (With help) — scores 1 Respiratory rate = 18 (15-20) — scores 1 Heart rate = 118 (111-129) — scores 2 Blood pressure = 208/112 (>200) — scores 2 Temperature = 36.5 (35-38.5) — scores 0 Patient Alert = (Alert) — scores 0 No Trauma = Scores 0 TEWS: (Triage Early Warning Score )6 Emergent Severity Index (ESI )orange Disposition – next to red- resuscitation

22. Case scenario on Triage at the scene You reach to the mass casualty area after two heavy tracks clashed Describe your action plan What type of triage you are going to conduct and why?

23. Case study At the scene of the accident you found 5 pts 1 ST pt =35ys female, screaming for help, restless, complaining for pain urging for help, has lacerations on the head and extremities 2 nd pt = 20 year old man has some breathing difficulties, chest injury 3 rd pt.=40yrs old man unresponsive, snoring, has facial lacerations 4 th pt = 5 years old child no visible wound looks conscious but sleepy 5 th a women with big belly has big wound on the lower extremities and bleeding from the wound 6 th a 20 years old female screaming running here and there claming her mother is died …. how do you start your job at the scene

24. What is Q service Q - is provide an optimum services with the available resources and have an impact on morbidity, mortality, and permanent disability Thank you !!!