CONCLUSION

CONCLUSION AND DISCUSSION

Only 12 (34.2 % ) of A/E departments in Ireland operate a triage system. No recommendations have been made by An Bord Altranais, the Department of Health or the Major Incident Planners, that triage be introduced into all A/E department. This is in stark contrast to the UK, where the Patient Charter (1992) obliges all A/E departments to operate some form of triage (3,4). In the USA some states have passed legislation requiring A/E departments to have triage 5). In a 1991 survey 95.6 % of emergency departments had triage in operation (5). When all the benefits of triage, both to patients and staff, are considered I believe that it is a basic necessity.

The larger the numbers of patients per annum in the A/E department the more likely it is that the department will have triage. 6 (75 % ) of the departments with over 40,000 patients per annum operate triage, but there still remains the 2 (25 % ) departments with a similar number of patients and no triage. Over 40,000 patients per annum is a huge amount of patients, with figures like that it is very likely that patients are delayed inappropriately. The figures are equally disturbing for departments with 30,000·40,000 patients per annum, with only 50 % of these departments operating triage.

I noted from my research that A/E consultants work only in A/E departments with more than 20,000 patients per annum. It is surprising that while 2 (28.5 % ) of departments with between 20,000 · 30,000 patients per annum have an A/E consultant, there is still 1 (16.6%) department with 30,000 ·40,000 patients per annum with no A/E consultant, I believe that an A/E consultant should be appointed urgently to this department.

Triage is provided on a 24 hour basis in only 5 (41.6 % ) of A/E departments that operate this system. To provide a continuously high standard of care for all patients triage should be extended in the other 7 (58.3 % ) of departments.

The number of triage categories used should be standardised nationally to ensure that staff moving from one hospital to another are already familiar with the system and to facilitate comparison of departments to be made easier. In the UK and Australia a 5 category triage scale has been recommended (3,4,6).

6 (54.5 %) A/E departments, with triage have no written triage policy. Written policies should be compiled to standardise and aid with patient sceening (1, 7,11). A survey in the UK in 1991 showed that 60.3% of A/E departments had no written policy on triage. (1)

Only 3 (25 % ) departments have a private area for triage. This should be remedied to enable the triage nurse to fully examine the patient and to discuss any details in confidence with the patient. Our figures of 3 (25 % ) of departments with private triage areas actually compares well with a survey in the USA in 1991 (5), in which 15 % of emergency departments had a private area for triage.

One of the most startling results is that 2 (16.6 % ) departments require no prior A/E experience to work in triage. This is in stark contrast to the recommendations by the American Emergency Nurses Association that 6 months experience and education with a preceptorship is required before working independently in triage (2). It has been recommended by a study in the UK that 2 to 3 years experience is necessary (1). I believe that at least 2 years A/E experience is necessary prior to working as a triage nurse.

I was surprised that only 2 departments required an A/E nursing course to work

in triage. But this compares favorable with a US survey where only 3 % of emergency

departments required that the triage nurse be a certified emergency nurse (5). I would

prefer an extension of the formal orientation course to all hospitals.

In 2 (16. 6 % ) departments the triage nurse could not initiate any investigations. In only 1 (8.3 % ) departments could all the listed investigations be initiated by the triage nurse. I was pleased to see that in 3 (25 % ) departments X Rays could be initiated by the triage nurse and this is to increase to 4 (33.3 % ) departments this year. I feel that the lack of a private triage area in 9 (75 % ) departments limited the investigations which could be initiated by the triage nurse, this then deletes some of the possible benefits of triage. I feel the skills of the triage nurse are being under·utilized.