Rapid assessment and treatment (RAT) of triage category 2 patients in the emergency department

Abstract

Objectives: Our study aims to assess the effect of implementing direct verbal communication between the triage nurse and Emergency Department (ED) physician and providing Rapid Assessment and Treatment of Canadian Triage and Acuity Scale (CTAS) category 2 (RAT2) patients presenting to a tertiary care ED.Methods: This is a retrospective, pre and post RAT2 intervention study of periods in our ED using the Enterprise Reporting System and records from ED quality section. The data collected consisted of patient demographics, length of stay, waiting time (Door to Doctor Time), door to triage time, and triage to doctor time (physician initial assessment time) for CTAS category 2 patients, and any sentinel events reported during the study periods.Results: The total number of patients included in this study was 97,472 from which 10,024 were CTAS category 2 and 4,825 were post-RAT2 intervention. Using the T-Test, our results showed pre-RAT mean door-to-doctor time of 61.8 minutes (median: 61.5) and post-RAT time of 31.6 minutes (median: 32). This reduction was statistically significant (p<0.001). There was no significant difference in patient demographics, length of stay, door to triage time, or the door-to-doctor time for other category patients. There were no sentinel events reported during the RAT2 intervention period.Conclusion: Direct verbal nurse-physician communication with early physician assessment and treatment of category 2 patients reduces patient door-to-doctor time without delaying care of other patients or causing any sentinel events.

Rapid triage performed by nurses: Signs and symptoms associated with identifying critically ill patients in the emergency department

“…Based on rapid screening models commonly used in the prehospital setting, for example, the triage sieve, where the primary assessment identifies the victim's ability to walk, breathing and pulse (Smith, 2012), the ‘quick look nurse’ (Lauks et al, 2016), and in the effect of direct communication between triage nurse and emergency physician on reducing patient door‐to‐doctor and initial assessment time (Rahmatullah et al, 2017), this study's object will call the nurse's rapid assessment ‘rapid triage’. In other terms, rapid triage is a quick look from the nurse of an emergency patient's presentations when arriving at an emergency department (ED) with severe complaints reported by themselves or their companions (Moura & Nogueira, 2020).…”

A perception survey on the roles of nurses during triage in a selected public hospital in Kwazulu-Natal Province, South Africa

“…Similarly, the establishment of quick first aid measure usually prevents increased mortality rate. Furthermore, the first role of a nurse in charge of triage is to briefly assess the patients within five to ten minutes, in a case where there is no overcrowding, the nurse can reassess patients based on his or her discretion [ 18 ]. Conversely, the average length of time to triage a patient was five minutes but there is a significant increase in triage time when patients are triaged to a specialty, expected by a specialty, or were actively “seen and treated” in triage [ 19 ].…”

“…This same study also reveals that there are some volunteers that do perform triage in some developing countries [ 27 , 28 ]. Some other roles of nurses during triage include evaluation of patients' vital signs, asking questions about their medical history, being clinically experienced, showing determinations about the urgency of a patient's need, having good judgment and leadership, being calm under stressful situations, having ability to make quick and right decisions, being knowledgeable about available resources, having a sense of humour, being a creative problem-solver, being available and well-experienced, being knowledgeable of anticipated emergency unit patients, having a high level of listening and communication skills as well as extensive knowledge of warning signs and symptoms [ 29 ]. In support of this view, good assessment skill and establishment of good judgment while making decisions are essential roles that every nurse performing triage must do [ 29 , 30 ].…”