ROUTINE TRIAGE IN OUR ED

Triage is an essential function in Emergency Departments (EDs), where many patients may present simultaneously. Urgency refers to the need for time-critical intervention – it is not synonymous with severity. Patients triaged to lower acuity categories may be safe to wait longer for assessment and treatment but may still require hospital admission.

Aims of Triage:

• To ensure that patients are treated in the order of their clinical urgency
• To ensure that treatment is appropriately and timely.
• To allocate the patient to the most appropriate assessment and treatment area.
• To gather information that facilitates the description of the departmental casemix.

Triage although an western concept has been introduced to India in last couple of years in certain pockets of excellence in Emergency Medicine. Majority of these departments have transplanted certain triage policies which has been evolved in either Canada, Australia, UK or USA. The South African triage policy (CAPE Triage) although very close to Indian setup cannot be applied to the diverse healthcare scenario in this country.

The challenges in corporate health care organizations in India are the following:
1. Patients refuse to wait when they pay for service.
2. VIP syndrome
3. Inappropriate utilization of emergency services by other specialties.
4. Inadequate training of heath care staff


At Max Healthcare we have introduced a three tire simple triage system which is easy to implement and a good policy to start with. However we have set up a committee along with our GWU faculty members to look into this complex issue from Indian perspective. We hope to improve further and come up with India specific triage policy.

At present time we feel happy to have achieved the first step of this mammoth project and be a part of the continuing improvement program.

ROUTINE TRIAGE POLICY

PRIORITY 1 (TIMELINE: IMMEDIATE )
1. ANY COMPROMISE IN AIRWAY, BREATHING AND CIRCULATION.
2. PATIENT IN CARDIAC ARREST
3. UNCONSCIOUS PATIENTS
4. PATIENTS WITH CHEST PAIN
5. PATIENTS WITH ACUTE STROKE
6. PAEDIATRIC PATIENTS ( AGE < 18 YRS)

PRIORITY 2 (TIMELINE: 10 MINUTES )
1. PATIENTS WITH POSSIBLE COMPROMISE IN AIRWAY, BREATHING, CIRCULATION.
2. PATIENTS WITH ACUTE PAIN OF ANY REASON.
3. PATIENTS WHO REQUIRES WORKUP FOR DIAGNOSIS OF POTENTIAL THREAT.

PRIORITY 3 (TIMELINE: 20 MINUTES )
1. PATIENTS WHO HAVE NO COMPROMISE IN AIRWAY, BREATHING, CIRCULATION.
2. AMBULATORY PATIENTS WHO REQUIRES OUTPATIENT TREATMENT FOR MINOR ILLNESS