Triage Protocol guidelines 14.2.23.pptx

The triage protocol creates an objective process to guide healthcare professionals in making the difficult determination of how to allocate resources to critically ill adult and pediatric patients when there are not enough critical care resources for everyone.

1. Dr.Anjalatchi Muthukumaran Vice principal cum nursing supt Era college of nursing , ELMCH Era University-226003 Emergency department Triage Protocol 2023

2. Introduction

3. What is the Colour code for triage? RED : (Immediate) severe injuries but high potential for survival with treatment; taken to collection point first. YELLOW : (Delayed) serious injuries but not immediately life-threatening. GREEN : (Walking wounded) minor injuries. The mnemonic “ ABCDE” stands for   Airway, Breathing, Circulation, Disability, and Exposure . First, life-threatening airway problems are assessed and treated; second, life-threatening breathing problems are assessed and treated; 

4. Triage protocol as per institutuion

5. Advanced Triage System Chart

6. Definition of Triage “ Triage is the term derived from French verb trier meaning to sort or to choose .” The term comes from the  French  verb  trier , meaning to separate, sort, shift, or select It is the process by which patients classified according to the type and urgency of thier conditions to gets the Right patient to the Right place at the Right time with the Right care provider . "Structured triage" was introduced by Holy Roman Emperor  Maximilian

7. Identifying the patient A  triage tag  is a prefabricated label placed on each patient that serves to accomplish several objectives: identify the patient. bear record of assessment findings. identify the priority of the patient's need for medical treatment and transport from the emergency scene. track the patients' progress through the triage process. identify additional hazards such as contamination.

8. Concept of triage system

9. Type of triage Simple triage Advanced triage Continuous integrated triage Reverse triage Under triage or over triage Telephone triage

10. 1. Simple triage It is usually used in a scene of an accident or “mass-casualty incident” (MCI), in order to sort patients into those who need critical attention and immediate transport to hospital and those with less serious injuries.

11. 2. Advance triage In advance triage, doctors and specially trained nurses may decide that some seriously injured people should not receive advanced care because they are unlikely to survive, in order to increase the chances for others with higher likelihood.

12. 3. Continuous integrated triage It is an approach to triage in mass casualty. It combines three form of triage with progressive specificity to most rapidly identify those patients in greatest need of care while balancing the needs of the individual patients against the available resources. Continuous integrated triage employs- a. Group triage b. Individual triage c. Hospital triage

13. 4.Reverse Triage - Early Discharge Usually , triage refers to prioritizing admission. A similar process can be applied to discharging patients early when the medical system is stressed. This process has been called "reverse triage ". Reverse triage- This process of triage can be applied to discharging patients early when the medical system is stressed. • During a “surge” in demand, such as immediate after a natural disaster, many hospital beds will be occupied by regular non-critical patients. • In order to accommodate a greater number of the new critical patients, the existing patients may be triaged, and those who will not need immediate care can be discharged.

14. Under triage and over triage 5.Under triage  is underestimating the severity of an illness or injury. An example of this would be categorizing a Priority 1 (Immediate) patient as a Priority 2 (Delayed) or Priority 3 (Minimal). Historically, acceptable undertriage rates have been deemed 5% or less. 6. Over triage  is the overestimating of the severity of an illness or injury. An example of this would be categorizing a Priority 3 (Minimal) patient as a Priority 2 (Delayed) or Priority 1 (Immediate). Acceptable over triage rates have been typically up to 50% in an effort to avoid under triage . Some studies suggest that over triage is less likely to occur when triaging is performed by hospital medical teams, rather than paramedics or EMTs

15. 7. Telephone triage In telephone triage, decision makers over the phone must effectively assess the patient's symptoms and provide directives based on the urgency. This should be done in a timely fashion while meeting standard guidelines in order to prevent symptoms from worsening

16. Australasian Triage Scale (ATS)

17. Adaptive Triage Protocol

18. Five Level Triage systems

19. CTAS - CANADIAN TRIAGE ACUITY SCALE

20. Triage Assessment Evolution

21. The German triage system also uses four, sometimes five colour codes to denote the urgency of treatment .

22. Triage Assessment level categories TRIAGE LEVELS 1- Resuscitation -- threat to life/limb Time to nurse assessment IMMEDIATE Time to physician assessment IMMEDIATE Cardiac and respiratory arrest Major trauma Active seizure Shock Status Asthmaticus Triage levels 2- Emergent Potential threat to life, limb or function Nurse Immediate, Physician <15 minutes Decreased level of consciousness Severe respiratory distress Chest pain with cardiac suspicion Overdose (CONSCIOUS!) Severe abdominal pain G.I . Bleed with abnormal vital signs Chemical exposure to eye

23. Triage levels 3- Urgent Condition with significant distress Time: Nurse < 20 min, physician < 30 min Head injury without decrease of LOC but with vomiting Mild to moderate respiratory distress G.I. Bleed not actively bleed Acute psychosis

24. Triage levels 4- Less urgent Conditions with mild to moderate discomfort Time for Nurse assessment <1hrss Time for physician assessment < 1hrs Head injury, alert, no vomiting Chest pain, no distress, no cardiac susp . Depression with no suicidal attempt Triage levels 5- Non urgent Conditions can be delayed, no distress Time for nurse and Physician assessment more than 2hrs Minor trauma Sore throat with temp. < 39

25. Emergency centre triage teaching hospital protocol

26. Categories of patient to be assess as per condition

27. Documentation • Date and time of assessment • Name of the DOCTOR / triage nurse • Chief presenting problem(s) • Limited, relevant history • Relevant assessment findings • Initial triage category allocated • Any diagnostic, first aid or treatment measures initiated

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