Initial impression

So when we call a patient in from the waiting room, when does the actual triage start? Do you start at that point or do you start when you get him into the room? Talk me through how you actually start the all triage process and when it starts?

Really starts as soon as you look at their details on the screen, because there is always, is it either an ambulance hand-over sheet where there is some details on there, or when they were booked in, the reason why they are attending. So you have got a very, very brief indication of why they are here. So that is where it starts. And then you call them in, but that first call, of can they hear you? Can they recognise their own name? And then when they walk toward you, watch their gait, are they limping, do they have a leg problem problem, foot problem? A back problem? And as they approach you, you can pick up on their gait and as they approach you, you can begin to see the colour of their skin, the expression on their face.

Yes, so you have really started to do an assessment from the minute that you actually call the person from the chair, so you are looking at the way they stand, the way they have been sitting, the position they are in, their mental state, all of that sort of stuff plays a big part in your assessment. And you have not even got them the room at this point. Is that correct?

It certainly does, yeah. And as a point there, a triage nurse will always look, scan the waiting room and see if there is anybody acutely ill there. So they have got a good idea of who is where, calling the name identifies which patient is there, so you already know where they are and they are just identifying themselves.

Do you think this is a really important part of the triage? Does it tell you an awful lot from what people are doing prior to the assessment? In other words, if you stood in the waiting room and looked across the waiting room, do you think you could reasonably accurately pick out who was the worst and who was not so bad even before you called them into the room, just by the way they are sitting, the position they are sitting in, the way they look, the colour?

Well, yeah, one of the tasks of being a triage nurse is being aware of who is in the waiting room, scanning the patient, seeing if there is anybody who is in distress, really, and who does not look well, somebody who looks sick. That is the first indication that you have got, that somebody out there is quite ill, call their name and they come forward and that is that first impression you get off them.

So I would be correct in saying that you start the triage as soon as you call them from the actual waiting room. And then with your history, your signs and your symptoms that you are going to take following on from getting them into the room, that is where you are going to start to decide which pathway this patient needs to, whether it is a critical pathway or whether it is a minors, or even whether it requires anything at all. It is the whole package. You do not make those decisions from one single thing.

Correct, that is a whole picture.

And how long roughly should that take? Is there a time span on it, do you set a time span on it, is it something that should be done fast? What is your feelings on that?

Well, some triages can take a while. It depends how you do them. Really, you should know within 60 seconds what you are dealing with. If you ask the right questions, that is the skill of triage, asking the right questions, not interrupting or being rude to somebody, just asking the searching questions and also by their physical state as well.

So Mark, when you get the person actually from the waiting room into the assessment room with you, is there anything else you are particularly looking for with that patient now they are actually in front of you?

Okay, that is really where the A2E assessment comes in. Airway, breathing, circulation, neurological disability and exposure. So if somebody is in front of you and they are clearly choking, coughing, that is a big problem, so they would go in, they would go for immediate help. Breathing, are they breathing fast? Is the chest rising and falling in symmetry? Circulation, are they agitated, are they... Do you have good eye contact with, think around disability, neurological disability, good eye contact. Do they understand? Do they understand why they are here? Are they agitated? And exposure, you are just looking at the condition of their skin, really, are they pale? Clammy? Are they sweating? Are they bright red? Yeah, so it is the... That A2E process really is quick. Are they speaking in sentences?

So how long should this process take? If you were doing a proper triage, what is the sort of time span involved to do that triage properly?

Well, typically, it is usually 10 minutes. It should be no longer than 10 minutes. Some triage, particularly mental health triage, can take a little bit longer. Some triage can be really quick, it can take just two or three minutes, but usually by 60 seconds, you need to know really how sick your patient is in front of you and try to get them quickly on the pathway.

So I take it that it is not really a situation where you are having long conversations with somebody, you just want facts, you just want the exact history of what is going on and what they have come in with, that problem, and then that will give you the correct pathway to send that patient down to as fast as possible, so they get definitive care on the right pathway? Is that the case?

That is right, that is right, yeah. And in fact, when the patient comes in, I always say that I am the triage nurse, this is triage, it is your quick initial assessment.

Okay. Do you ever get your problems with people, do they think it is finished too quickly or... I mean, how does the patient feel? I presume you are trying to get the patient to feel comfortable, to relax and to understand that they have now started a path to better health, basically, so you have got to be seen to be cool, calm and understanding, but by the same token, you have also got to make things happen quite quickly, because that is the whole idea of triage, it is to speed up the process through the system to get the right care to the patient.

That is right, and it is... Of course, saying that this is a initial, quick assessment, it is also good to let the patient know when you have finished your triage assessment and now it is time to move further down the pathway, you have got to close it as well as to open it for the patient.

Wonderful. Thank you.