Triage 101

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2. Triage Nurse 101

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1. Telephone Triage is defined as 'making good clinical decisions under conditions of uncertainty and urgency' (Patel). Assessment by phone of an invisible patient, who is an untrained lay observer, complicated by the variability of symptom presentations, communications and process is challenging.
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Myself and the triage team

Priorto last week, Connaught had no functioning triage - a system used in the Accident and Emergency ward to determine the priority of patients' treatments based on the severityof their condition. Setting up a triage is amajor project of the Connaught Hospital Improvement Committee and King's hasbeen working with key staff from across the hospital and the Ministry to laythe foundations for this project. My background as a paramedic has (hopefully)placed me in a good position to work with hospital staff to prepare for itslaunch and help it get off the ground.

We decided to start with a pilot to allow us toresolve any issues before the wider training and implementation takes place. Inpreparing for the pilot we identified four nursing staff recommended byA&E Matron Kamara. It was also decided that it might be worth checking withthese staff that they actually wanted to do this, but following a brief meetingwith Dr Ahmed and I, all seemed to have a firm grasp of what triage would involveand supported the idea. It was encouraging to see how much enthusiasm there wasfor change and improvement.So far, so good.

TheSouth African Triage Scale (SATS) tool appeared to be relativelystraightforward (note to self, no triage system is straightforward), and with aday assigned for teaching later in the week a training package was puttogether, handouts printed and a plan for the day written. Anxious to avoid death byPowerPoint, the training included a walk-around of the new triage area of thehospital and some discussions around the practicalities of how the new systemwould work. We also wanted as much inputfrom the nursing staff as possible and for them to be involved in decisionsaround the way it would be used. It seemed important to spend timeensuring staff have a good understanding of the rationale for triage and itsimportance at Connaught rather than focus only on the minute details. But we still needed to cover how the SATStool functions. Let's be honest, it isn't really first date material, howeverenthusiastic we all are about it.

In a warm room with no air conditioning, an hour session was extendedto several due to a large number of questions and discussions. In a bid to liven things up, we recruited Senior Nurse Nyamato role-play a difficult patientwanting to know why she was not being seen in turn. Nurse Salamata was far better able to explainthe triage system than I had been able to that morning and Nurse Hajara faceddown any criticism of the system with a very succinct and direct summary of thereasons for waiting (which would be used by her again the following weekto excellent effect). It was beginning to feel that with this level of engagement andenthusiasm, we could make this work.

Our triage students .

Withthe training started, the building work complete and the Facilities andMaintenance staff (Willie and Abdul, you know who you are, even if we rarelyknow where you are) working very hard to repair and clean the necessaryequipment and areas, 3rd March was confirmed as a start date for the triagepilot. The Friday before the Monday that the pilot was due to start, we hadvery little equipment but we did have a desk. And we had a lot of phone callsand many more promises of equipment to be delivered yesterday. The list was notlong, but it was important. Given that we had no blood pressure cuff,stethoscope and clock with a second hand, the whole process would beimpossible.

Withso many people having worked so hard to get to this stage, we had to get it right.Enter Dr Ahmed Seedat, medical doctor and troubleshooter with an impressivemedical CV that also includes sourcing equipment, knowledge ofplumbing,tiling, grouting and tireless negotiation. Ahmed soon helped smooth out thosefinal few details just in time for Monday launch.

The final preparations for the triage room are made

Settingup a triage takes time and contributions from many people, and I'm happy to saythere was no reluctance from anyone to step up and help. With set up complete,now we just needed to start….

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Agenda

Date

Saturday, January 21, 2017

Time

9AM – 12PM
Registration: 8:45 AM

Location

Registration

Seating is limited. Please register as soon as possible.

Questions

info@TriageCancer.org or 424.258.4628

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