Triage

The emergency department is ridiculously busy; some days, it feels like an endless stream of patients. One attending saw 160 patients over an 8 hour shift. Although medicine in America is often practiced at speeds of 10 minutes a patient, it's neither easy nor ideal. Some days, that's what things feel like. The problem is sorting the wheat from the chaff. As mentioned in the previous post, the majority of patients in the "emergency department" don't have true medical emergencies. Some have a "layman's definition of an emergency" - symptoms where it is entirely appropriate to go to a hospital. But some have absolutely nothing; they need refills on medications, they have their usual chronic pain, they need a meal and a place to sleep. The volume of these patients can be so overwhelming that it's hard to identify those who need immediate attention. For example, I've had many, many patients with foot pain, and most of the time it's nothing - an ankle sprain, musculoskeletal strain, plantar fasciitis. But today, I saw a woman with foot pain, and on exam, I couldn't feel a pulse. It turns out that she has atrial fibrillation and threw a clot down her leg, a surgical emergency. Sorting out the true emergencies from the rest is not easy.

We rely a lot on the triage process by which someone determines the order in which patients are seen. For the most part, the most acute cases are easy - strokes, heart attacks, difficulty breathing. And some of the nonemergent stuff is easy to identify as well - young patients with a minor cut, constipation. But a lot falls in the middle - fever, abdominal pain, vomiting. These are the patients in which making an accurate determination of the acuity helps us sort out who needs to be seen first.