How are patients triaged in the LHSC adult Emergency Departments?
The Emergency Department is a space no one wants to find themselves in, but is there when urgent health care needs must be met.
As a patient, it can feel frustrating to wait, seeing others be called before you to be admitted to the department when you are not feeling well or have suffered an injury, but there are processes in place that help determine the order patients are seen in.
Registration
When you arrive at either the University Hospital or Victoria Hospital Emergency Department, you first register with a Registration Clerk.
You will be asked some screening questions related to violence and potential weapons as well as COVID-19, cold and flu symptoms. These are generic screening questions asked of everybody who enters the Emergency Departments.
If a person has one of the items that are listed as potential weapons, it will be secured by Security in a designated locker and it will be returned upon discharge. This is done for the safety of the patient, staff and other visitors.
Triage
The next person you speak to is a Triage Nurse.
This is where you share the reason for your visit and the nurse assesses your blood pressure, heart rate, oxygen, temperature and pain level.
Based off of your conversation and this assessment, the triage nurse will apply the Canadian Triage and Acuity Scale (CTAS) to help define a patient’s need for care.
The CTAS was developed for Canadian Emergency Departments and assists hospital staff to assign a level of acuity for patients based on the presenting complaint and the type and severity of their presenting signs and symptoms. The CTAS consists of five categories: critical, emergent, urgent, nonurgent and minor complaint.
Patients are triaged using CTAS to ensure that they are managed based on their need for care (e.g., sickest patients are seen first).
For some, the symptoms and reason for visit may fit within a medical directive, which is an advanced order from the physician, and allows the triage nurse to start bloodwork or take an x-ray before seeing the physician.
Confirmation of registration
After completing this assessment with the triage nurse, you will return to the registration clerk to confirm demographic information (such as name, address, contact information, next of kin, and primary care provider information) and complete your registration.
At this point you will return to the waiting room and wait in queue until an appropriate care space becomes available within the department.
Patient prioritization
Patients are prioritized by the level of severity of illness or injury. Triage nurses assess how quickly you need to be seen and in relation to the other patients already triaged. This is why someone who came in after you may be seen before you – their condition is worse and they require more immediate medical attention.
Once triaged, if you are in critical or emergent condition, you will be brought into the Emergency Department as soon as possible to see a physician. If your condition is not critical or emergent, you will be asked to wait in the waiting room until your name is called. Your wait time will depend on the severity of your illness or injury in comparison to other patients waiting and being triaged.
Reassessments do occur. If your condition changes while waiting in the waiting room, please tell a triage nurse and they will reassess you.
During your stay
Once there is an appropriate care space within the Emergency Department, you may be reassessed by the nurse while you wait to see a physician.
Once you are assessed by the physician there may be treatments ordered and/or further investigations that need to be completed. While you wait for the results, the nurse will continue to provide care.
Once the results are available, the physician will return to reassess you, review your results and discuss the best option for your care. This can include admission to the hospital, follow-up treatments, a referral or prescribe medication before you are discharged.
Why are other patients seen before me?
At triage, patients are assessed and sorted into groups according to the severity of their condition. The effect of a series of triage decisions is to identify those that need to be seen first and create a priority list by acuity level of those patients waiting for a care space and treatment.
Those with more acute conditions are seen first, in order to reduce the risk that their condition may deteriorate.
