UK should copy New Zealand's approach to triaging patients
Emergency nurse Grace McDonald compares the triage process in New Zealand with the UK
In a UK emergency department (ED), a presenting patient is first met by a receptionist who enrols the individual in the system and asks them to fill out a form. Only after this will the patient meet a triage nurse.
I was, therefore, surprised when the first port of call for a patient in my Auckland ED was me – the triage nurse. During a 2-5 minute assessment with the patient, the presenting complaint is gauged and I decide where to allocate the patient.
In the UK, the triage nurse completes a triage score and initial assessment, including vitals. This is supposed to take place no more than ten minutes after the patient has presented in the ED but the reality of department demands means this does not always happen.
In my Auckland ED, the triage nurse sits at a desk behind a pane of glass. Initially, I found this very off-putting, as if a barrier was keeping me from making my triage assessment. However, I quickly realised that the triage nurse is able to determine efficiently where a patient needs to go without a receptionist and in spite of the pane of glass.
As a triage nurse, I make the initial decision and if a patient is asked to remain in the waiting room an assessment nurse takes a more in depth account of the problem, ordering X-rays, taking blood tests and providing analgesia, if required.
When I questioned whether it would be more useful for the triage nurse to carry out additional tests or take a fuller patient history, my charge nurse asked: ‘Would those tests change your decisions?’ Initially, I thought they would, but on reflection and through experience I have changed my mind. An unwell patient is easily identifiable, as is a well patient.
At first, this approach to triage challenged my practice and my perceptions but now I believe the UK should adopt the same techniques.
Making the triage nurse the first port of call for presentations makes sense for patient care and flow. And if I was a poorly patient, I know exactly who I would rather speak to first on my arrival at an ED.
About the author
Grace McDonald is an emergency nurse who relocated to Auckland, New Zealand a year ago