Role of the triage nurse
Tine triage nurse’s main role is the accurate prioritisation of patients, and this must be the prime objective. The triage nurse needs to become accomplished at rapid assessment — this involves quick decision making and suitable delegation of tasks. Long conversations with patients should be avoided as should exhaustive history taking. Clinical observations such as temperature/pulse, etc_ need to be delegated if they are not required to establish priority as they are too time consuming.
In small departments the triage nurse will sec all patients corning in the department. In others there may be separate nurses dealing with patients who come walking and on stretchers. The mode of arrival of the patient does not always concur with the seriousness of the illness. (Patients with trivial complaints call the Emergency Services and patients with MI arrive by ear) Therefore there must he close liaison between triage stall in order to place the patients correctly. The triage method outlined in this book should assist this process by standardising triage practice.
Rapid influxes of patients may require the triage nurse to seek assistance from another member of stalk the triage process is integral to the clinical management of most departments, and a variety of additional tasks may be undertaken.

First aid/analgesia
The triage nurse may need to provide or facilitate some first-aid treatment, and recognise the need to provide analgesics if required (see pain). Application of a sling or dressing will immediately improve the patient’s comfort and help Minimise further trauma and bleeding.

Patient information
The triage nurse is the first clinical contact for the patient. and talking the patient through the illness and probable course in the department alleviates much distress and anxiety. Patients appreciate knowing the waiting time, the probable time spent in the department, whether any investigations may be ordered and possible treatment. This information can be provided quite quickly for most common conditions.

Health promotion
The triage nurse (if times allows) can usefully act as a health promoter. The patient is quite receptive to health care advice when an adverse event has occurred. If possible brief advice about relevant topics such as locked cabinets, cycle helmets anti stopping smoking may be appropriate. It is helpful if patient information leaflets are available.


Disposition of patients around the department
The triage nurses will “lieu hive to decide where to place the patients in the department. This will depend on departmental facilities and policies. Patients who are distressed, in pain, bleeding or at extremes of age may be best placed in cubicles away from the general waiting room. Patients who need to be lying down for examination (for example those suffering from knee injuries, back complaints and abdominal pain) should be placed in an area where they can lie down. Ill patients may well walk into the department and may need to be placed in the appropriate area of the department. To achieve this, the triage nurse needs to be continuously aware of the occupancy of the department and the current disposition of patients.

Managing the waiting room
Emil they have been seen by a clinician, the patients’ main contact is the triage nurse. Further advice may be sought by these patients, and criticisms delivered. The triage nurse needs to keep the occupants of the waiting room informed of the current approximate waiting time. Constant observation and reassessment are necessary in order to spot those patients whose condition is changing. Triage is a dynamic process and the patients often need regular reassessment. This might occur after an intervention e.g. the administration of analgesic, or after an appropriate length of time. Patients may be dropped into a lower category after pain relief or brought forward if they deteriorate. No one can anticipate all problems and it is not a ‘failure’ id accurate assessment to change the triage category according to further developments in the patient’s condition, or indeed with further information that may be acquired. The waiting room should be considered to him a clinical area.

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