Thursday, September 11, 2008

Emergency department’s triage system takes team approach to improve care

Photo by Kristin Ellis
First Lt. Chelsi Genday, an emergency room nurse, administers a needle to James Laska, a Walter Reed paramedic. The ER sees about 50 patients a day and admits around 10.
With 50 patients coming through the doors of the Walter Reed Emergency Department and about 10 admissions a day, the staff has still found time to adjust and implement three major changes of administering patient care. The triage system is now a team approach to patient care, according to Christina Ferguson, head nurse of the ED. The six military nurses, 11 civilian nurses, and 22 medics are assigned rooms in groups to help provide the continuity of care.

What makes emergency medicine so unique is that you see everything, all kinds of injuries. Its like a puzzle you are trying to solve, she said. So, one discipline cant function without the other. Their role is just as important as everyone elses and this teamwork is vital to make the ER function.

The triage system has transformed from a three-level to five-tier system based on the emergency severity index (ESI). The ESI is a five-level emergency department triage algorithm that provides clinically relevant classification of patients into five groups, from 1 (most urgent) to 5 (least urgent) on the basis of acuity and resource needs. The ESI program helps the emergency department rapidly identify patients in need of immediate attention and better identify patients who could safely and more efficiently be seen in a fast-track or urgent care center rather than the ED.

It is definitely more specific compared to the old system, which was vague, Ferguson said. Its a much better system.

In addition, the inpatient electronic documentation system has been beneficial to both the hospital and patient by allowing multiple departments to track patients and streamline care. The Walter Reed Emergency Department also sees several civilian emergency appointments. If someone in the area [goes into cardiac arrest], the D.C. Fire Department may call. Wed bring them here on post and admit them if they arent stable.

Dr. (Maj.) Keith Sumey, chief of the ER, noted that caring for the wounded warriors at Walter Reed is both a privilege and the priority. Sumey served with the 86th Combat Support Hospital in Baghdad in 2005. Its kind of sobering to see the end result of wounds these Soldiers suffered and truly satisfying to see they get good care here, Sumey said.