 |
 |
I researched the availability of triage in the A/E departments of Ireland. I sent a 16 item questionnaire to the sisters‑in charge of the 36 A/E departments in the country. 35 (97.2 % ) replied.
I expected to find that triage is mainly available in the large A/E departments, who also employ consultants in A/E medicine and are mostly situated in Dublin. I also wondered if the availability of triage would be influenced by the department being in a teaching hospital.
Indeed triage is only available in 12 (34.2 %) of A/E departments in Ireland. 11 (91.6 %) of these Accidents and Emergency departments have over 20,000 patients per annum, are situated in a teaching hospital and employ a consultant in A/E medicine. 25 % of the A/E departments in Ireland are situated in Dublin. Yet 66.6 % of A/E consultants and 50 % of triage facilities are in Dublin.
Of the 22 (64.7 %) of A/E departments without triage 2 (9 %) thought it was unnecessary ‑ 1 of these departments had less than 10,000 patients per annum, while the other had between 10,000 ‑ 20,000 patients per annum. The remaining departments gave the following reasons for lack of triage facilities.
_ lack of staff and space 12 (52.1 % )
_ lack of staff only 3 (13.0 % )
_ lack of space only 6 (26.0 % )
I realize that most departments, 15 (65.1 %) would need an increase in staffing levels, but as triage is such an important area with huge benefits for patients and staff, that management should be strongly urging the Department of Health to approve staff for this area.
I find it worrying that only 12 (34.2 %)
of A/E departments in Ireland have triage and only 2 (8.6%) of the A/E departments
without triage are looking into establishing triage. It is difficult enough
to treat patients with the "usual" complaints on an "ordinary"
day and not have an ill patient waiting inappropriately in the waiting room,
but in the event of a major incident I shudder to imagine the scene in the
A/E department without triage. The staff will be forced to triage patients
probably for the first time in their careers. To be efficient at triage you
need not only knowledge and A/E experience but also prior triage experience.
An A/E department during a major incident is not the place to get this experience.
Of the 12 (35.2 %) A/E departments who do
provide triage only 5 (41.6 %) departments have 24 hour cover. The evening
and night shifts seem to be the areas lacking triage. This is often the busiest
time with the least staff, when triage would be of most value.
2 (16.6 %) A/E departments require no prior
A/E experience to work in triage. This is extremely serious, as I would consider
this a basic requirement. Indeed 2 ‑ 3 years experience has been recommended
by a group in the U. K. (1) and 6 months is required by the emergency Nurse
Associations in the USA (2). Personally I feel that 2 Years experience is
a "must".
Educational requirements varied. Only 2
(16.6 %) departments required an A/E Course, again something I feel is essential.
5 (41.6 %) had informal training for triage. Without the foundation of education
how can a triage nurse make an informed decision?
The tests initiated by the triage nurses
varied hugely with triage nurses in 2 (16.6 % ) departments unable to initiate
any tests. Only in 1 (8.3 %) department could the triage nurse initiate all
the tests listed. Except for X ray examinations, these tests were fairly ordinary
and I fail to see why they cannot be initiated by experienced triage nurse.
In today's health care environment, where "quality of care" and "quality assurance" are the buzz words, why is triage not a requirement for A/E departments. Triage has been shown to improve the standard of patient care and after all isn't patient care our basic role. (1