There is a difference between absolute clinical priority as defined using the method in this book, anti relative priority within and between triage categories. In overview the process of triage as outlined here is quite simple —patients are assigned to a triage category and then managed in order of priority mid time of attendance. However there are many other factors apart from clinical priority which may from time to time influence how the patient is handled within the Emergency Department. This chapter outlines these factors and discusses their importance. Clinical priority and the findings that determine it are dearly very important, but failure to recognize other factors can be detrimental to both departmental function and quality of care for individual patients.

Type of patient
There are a number of issues about the nature of individual patients that affect their management in addition to their clinical priority. These are summarized below.

Children
Children may need special management, especially in Emergency Departments without special pediatrics facilities. They are always accompanied by someone else (usually a parent but teachers, relatives or social workers may also he present), as well as siblings and friends who, although well, need entertaining. Children have very short attention spans and get bored, frightened and tired very easily. They may get very distressed and agitated because of communication and understanding difficulties, and this makes later handling more difficult.
Children who can be happily entertained by a play leader or in a separate waiting room with play facilities probably do not need any special attention other than frequent reassessment. It is helpful if child friendly food and drink e.g. snacks and drinks in cartons, bottles, etc. are available (provided the carer of any child who may need a general anaesthetic or sedation is aware of the need to keep the child nil by mouth).

It may be worthwhile having a special policy for children who present late in the evening or at night. The child who is very tired may prove impossible to examine and treat, so a relatively early examination may be considered.

Elders
Relative immobility can cause increased discomfort in the waiting room and may cause difficulty in reaching the toilet or going for refreshments. A per- son who is normally able to cope well in familiar surroundings may become quite confused and disorientated in the Emergency Department even it only slightly injured. The elderly are often set in a routine and become anxious if unable to meet their normal time table. There may be carers at home who have responsibilities who would need to be informed about the elderly patients’ attendance. The elderly are very prone to pressure damage to tissues which can develop after only half an hour on a hospital trolley. If they cannot be seen quickly for treatment they need frequent nursing attention. They may have problems with continence which if not anticipated may lead to embarrassment. Memory problems may lead to them providing little information. Practitioners should be aware of these issues and consider the relative needs of this group of patients.