Triage

4,638
-1

Published on

Published in: Health & Medicine, Business
0 Comments
6 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
4,638
On Slideshare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
180
Comments
0
Likes
6
Embeds 0
No embeds

No notes for slide

Triage

  1. 1. TRIAGE IN THE HOSPITALThe word "triage" is derived from the French verb "trier," to "sort" or "choose." Originally the process wasused by the military to sort soldiers wounded in battle for the purpose of establishing treatment priorities.Injured soldiers were sorted by severity of their injuries ranging from those that were severely injured anddeemed not salvageable, to those who needed immediate care, to those that could safely wait to betreated. The overall goal of sorting was to return as many soldiers to the battlefield as quickly as possibleGENERAL PRINCIPLESFunction of triageTriage is an essential function in Emergency Departments (EDs), where many patients may presentsimultaneously. Triage aims to ensure that patients are treated in the order of their clinical urgency andthat their treatment is appropriately timely. It also allows for allocation of the patient to the mostappropriate assessment and treatment area, and contributes information that helps to describe thedepartmental casemix. Urgency refers to the need for time-critical intervention - it is not synonymous withseverity. Patients triaged to lower acuity categories may be safe to wait longer for assessment andtreatment but may still require hospital admission.All patients presenting to an Emergency Department should be triaged on arrival by a specifically trainedand experienced registered nurse.The triage assessment and Triage Scale code allocated must be recorded.The triage nurse should ensure continuous reassessment of patients who remain waiting, and, if theclinical features change, re-triage the patient accordingly.The triage nurse may also initiate appropriate investigations or initial management according toorganisational guidelines.The triage area must be immediately accessible and clearly sign-posted. Its size and design must allowfor patient examination, privacy and visual access to the entrance and waiting areas, as well as for staffsecurity.The triage area should be equipped with emergency equipment, facilities for standard precautions (hand-washing facilities, gloves), security measures (duress alarms or ready access to security assistance),adequate communications devices (telephone and/or intercom etc) and facilities for recording triageinformation.That initial triage of patients occur within 10 minutes of arrival and Must include vital signs.If triage times extend beyond 15 minutes, an additional nurse Should be immediately called.Accurate triage is the key to the efficient operation of an emergency departmentEffective triage is based on the knowledge, skills and attitudes of the triage nursePaediatric patients should have their vital signs taken every 30 minutes when indicated and other patientsshould have an hourly triage reassessment where indicated.Triage is an essential function in Emergency Departments (EDs), where many patients may presentsimultaneously.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 butmay still require hospital admission.
  2. 2. Goals of Triage1. Rapidly identify patients with urgent,life-threatening conditions2. Assess/determine severity and acuity of the presenting problem3. To ensure that patients are treated in the order of their clinical urgency4 To ensure that treatment is appropriately and timely.5. To allocate the patient to the most appropriate assessment and treatment area6..Re-evaluate patients awaiting treatmentAdvantages of Triage1. Streamlines patient flow2. Reduces risk of further injury/deterioration3 Improves communication and public relations4 Enhances teamwork5. Identifies resource requirements6 Establishes national benchmarksTriage Acuity Determinants1. Chief complaint2. Brief triage history3. Injury or illness (signs & symptoms)4. General appearance5. Vital signs6. Brief physical appraisal at triageKey points in Triage in the emergency department1. The assessment/triage area must be immediately accessible and clearly sign-posted. Its design should allow for:patient examination means of communication between entrance and assessment area privacy 2. Strategies to protect staff will exist3. The same standards for triage categorisation should apply to all Emergency Departments (ED) settings. It should be remembered however that a symptom reported by an adult may be less significant than the same symptom found in a child and may render a childs urgency greater.4. Victims of trauma should be allocated a triage category according to their objective clinical urgency. As with other clinical situations, this will include consideration of high-risk history as well as brief physical assessment (general appearance +/- physiological observations).5. Patients presenting with mental health or behavioural problems should be triaged according to their clinical and situational urgency, as with other ED patients. Where physical and behavioural problems coexist, the highest appropriate triage category should be applied based on the combined presentation.6. The most urgent clinical feature identified determines the ATS category.7. Once a high-risk feature is identified, a response equal to the urgency of that feature should be initiated.
  3. 3. Examples of Triage Acuity Systems2 Levels 3 Levels 4 Levels 5 LevelsEmergent Emergent Life-threatening ResuscitationNon-emergent Urgent Emergent Emergent Nonurgent Urgent Urgent Nonurgent Nonurgent Referred• Level 1 Resuscitative• Level 2 Emergent• Level 3 Urgent• Level 4 Less urgent• Level 5 Non-urgentLevell II:: ResusciittattiiveLeve Resusc a ve• Conditions that are threats to life or limb (or imminent risk of deterioration) requiringaggressive interventions.Requires immediate attention of Nurse and DoctorLevell III EmerrgenttLeve Eme gen• Conditions that are a potential threat of life, limb or function, requiring rapid medicalintervention or delegated acts.Requires immediate attention of nurse and 15mts for Doctor’s attentionLevell IIII Urrgen tLeve U gen• Conditions that could potentially progress to a serious problem requiring emergencyintervention. May be associated with significant discomfort or affecting ability tofunction at work or activities of daily living.Upto 15mts for Nurse and upto 30 mts for DoctorLevell IIV:: Less UrrgenttLeve V Less U gen• Conditions that related to patient age, distress, or potential for deterioration or complications would benefit from intervention or reassurance within 1 – 2 hours) Upto 30mts for Nurse and upto 60 mts for DoctorLevell 5:: Non UrrgenttLeve 5 Non U gen• Conditions that may be acute but non-urgent as well as conditions which may be part of a chronicproblem with or without evidence of deterioration. The investigation orinterventions for some of these illnesses or injuries could be delayed or even referred toother area of the hospital or health care system.Upto 60mts for Nurse and upto 120 mts for Doctor
  4. 4. TRIAGE SCALE CATEGORY ACUITY(Maximum waiting time)PERFORMANCE INDICATOR THRESHOLDCategory – I Immediate 100%Category- II 10 minutes 80%Category - III 30 minutes 75%Category- IV 60 minutes 70%Category- V 120 minutes 70%Allocation of Triage CategoryPROCEDURE1. On arrival assess the patient. Balance the need for speed against the need to be thorough. All patients presenting to an Emergency Department should be triaged on arrival by a specifically trained and experienced registered nurse. The triage assessment should generally take no more than two to five minutes Measure vital signs at triage if required to estimate urgency, and if time permits. The triage assessment is not necessarily intended to make a diagnosis, although this may sometimes be possible.2. Determine the clinical urgency of the patient. Use a combination of the presenting problem, general appearance and possibly physiological observations to assess the patients urgency. Notify doctor on call of patients arrival and ATS category as required. Indicate urgency of doctors attendance.3. Allocate Triage Scale (I- V) : is a scale for rating clinical urgency so that patients are seen in a timely manner, commensurate with their clinical urgency.4. Take any patient identified as ATS Category 1 or 2 into the appropriate assessment and treatment area immediately. A more complete nursing assessment should be done by the treatment nurse receiving the patient.5. Meet any immediate care needs. Standing orders may apply6. As appropriate, initiate appropriate investigations (e.g. x-rays) or initial management according to hospital protocol. Waiting time is reduced and patient satisfaction is increase where nursing staff follow protocols and order tests and or management.7. Document details of the triage assessment on the record and Include at least the following details:Date and time of assessment Name of triage nurse Chief presenting problem(s) Limited, relevant history Relevant assessment findings MDC and BRIS code (if applic.) Initial triage category allocated Any diagnostic, first aid or treatment measures initiated. Use a trauma record form as appropriate8. Ensure continuous reassessment of patients who remain waiting. Re-triage a patient ifhis/her condition changes while they are waiting for treatment
  5. 5. additional relevant informationbecomes available that impacts on the patients urgency Both the initial triage and any subsequent categorisations should be recorded, and the reason for the re-triage documented.TRIAGE IN THE EMERGENCY DEPARTMENTThe Triage Scale: Descriptors for CategoriesThe clinical descriptors listed in each category are based on available research data where possible, aswell as expert consensus.However, the list is not intended to be exhaustive nor absolute and must be regarded asindicative only. Absolute physiological measurements should not be taken as the sole criterion for allocationto an ATS category.Senior clinicians should exercise their judgment and, where there is doubt, err on theside of caution.2The most urgent clinical feature identified determines the triage scale category.Once a high-risk feature is identified, a response commensurate with the urgency of that feature shouldbe initiated.Important time-critical treatmentThe potential for time-critical treatment (e.g. thrombolysis, antidote) to make a significant effect on clinicaloutcome depends on treatment commencing within a few minutes of the patients arrival in the EDCategory I – RESUSCITATIONImmediately Life-Threatening Condition- Immediate simultaneous assessment and treatmentConditions that are threats to life (or imminent risk of deterioration) and require immediate aggressiveintervention.Clinical Descriptors (indicative only)Cardiac arrest Respiratory arrest Immediate risk to airway - impending arrest Respiratory rate <10/min Extreme respiratory distress BP< 80 (adult) or severely shocked child/infant Unresponsive or responds to pain only (GCS < 9) Ongoing/prolonged seizure IV overdose and unresponsive or hypoventilation Severe behavioural disorder with immediate threat of dangerous violence
  6. 6. Category II – EMERGENTImmediately Life-Threatening Condition -Assessment and treatment within 10 minutes (oftensimultaneously)The patients condition is serious enough or deteriorating so rapidly that there is the potential of threat tolife, or organ system failure, if not treated within ten minutes of arrival or Very severe pain Humane practice mandates the relief of very severe pain or distress within 10 minutesImportant time-critical treatmentThe potential for time-critical treatment (e.g. thrombolysis, antidote) to make a significant effect on clinicaloutcome depends on treatment commencing within a few minutes of the patients arrival in the EDClinical Descriptors Category 2 (indicative only)Airway risk - severe stridor or drooling with distress Severe respiratory distress Circulatory compromise - Clammy or mottled skin, poor perfusion - HR<50 or >150 (adult) - Hypotension with haemodynamic effects - Severe blood loss - Chest pain of likely cardiac nature Very severe pain - any cause BSL < 2 mmol/l Drowsy, decreased responsiveness any cause (GCS< 13) Acute hemiparesis/dysphasia Fever with signs of lethargy (any age) Acid or alkali splash to eye - requiring irrigation Major multi trauma (requiring rapid organised team response) Severe localised trauma - major fracture, amputation High-risk history: Significant sedative or other toxic ingestion Significant/dangerous envenomation Severe pain suggesting PE, AAA or ectopic pregnancy Behavioural/Psychiatric: - violent or aggressive - immediate threat to self or others - requires or has required restraint - severe agitation or aggressionCategory III – URGENTPotentially Life-Threatening-Assessment and treatment start within 30 minsThe patients condition may progress to life or limb threatening, or may lead to significant morbidity, ifassessment and treatment are not commenced within thirty minutes of arrival . or Situational UrgencyThere is potential for adverse outcome if time-critical treatment is not commenced within thirty minutesorHumane practice mandates the relief of severe discomfort or distress within thirty minutesClinical Descriptors (indicative only)Severe hypertension Moderately severe blood loss - any cause Moderate shortness of breath SAO2 90 - 95% BSL >16 mmol/l Seizure (now alert)
  7. 7. Any fever if immunosuppressed eg oncology patient, steroid Rx Persistent vomiting Dehydration Head injury with short LOC- now alert Moderately severe pain - any cause - requiring analgesia Chest pain likely non-cardiac and mod severity Abdominal pain without high risk features - mod severe or patient age >65 years Moderate limb injury - deformity, severe laceration, crush Limb - altered sensation, acutely absent pulse Trauma - high-risk history with no other high-risk features Stable neonate Child at risk Behavioural/Psychiatric: - very distressed, risk of self-harm - acutely psychotic or thought disordered - situational crisis, deliberate self harm - agitated / withdrawn / potentially aggressiveCategory IV – LESS URGENTAssessment and treatment start within 60 minsThe patients condition may progress to life or limb threatening, or may lead to significant morbidity, ifassessment and treatment are not commenced within thirty minutes of arrival. or Situational UrgencyThe patients condition may deteriorate, or adverse outcome may result, if assessment and treatment isnot commenced within one hour of arrival in ED. Symptoms moderate or prolonged. orHumane practice mandates the relief of discomfort or distress within one hourClinical Descriptors (indicative only)Mild haemorrhage Foreign body aspiration, no respiratory distress Chest injury without rib pain or respiratory distress Difficulty swallowing, no respiratory distress Minor head injury, no loss of consciousness Moderate pain, some risk features Vomiting or diarrhoea without dehydration Eye inflammation or foreign body - normal vision Minor limb trauma - sprained ankle, possible fracture, uncomplicated laceration requiring I investigation or intervention - Normal vital signs, low/moderate pain Tight cast, no neurovascular impairment Swollen "hot" joint Non-specific abdominal pain Behavioural/Psychiatric: - Semi-urgent mental health problem - Under observation and/or no immediate risk to self or othersCategory V - Less Urgent-Assessment and treatment start within 120 minsThe patients condition is chronic or minor enough that symptoms or clinical outcome will not besignificantly affected if assessment and treatment are delayed up to two hours from arrival orClinico-administrative problemsResults review, medical certificates, prescriptions onlyClinical Descriptors (indicative only)Minimal pain with no high risk features Low-risk history and now asymptomatic Minor symptoms of existing stable illness Minor symptoms of low-risk conditions Minor wounds - small abrasions, minor lacerations (not requiring sutures) Scheduled revisit eg wound review, complex dressings Immunisation only
  8. 8. Behavioural/Psychiatric: - Known patient with chronic symptoms - Social crisis, clinically well patientGENERAL PRINCIPLES1.1 Function of triage Triage is an essential function in Emergency Departments (EDs), where many patients may present simultaneously. Triage aims to ensure that patients are treated in the order of their clinical urgency and that their treatment is appropriately timely. It also allows for allocation of the patient to the most appropriate assessment and treatment area, and contributes information that helps to describe the departmental casemix. 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.1.2 The Triage Assessment The features used to assess urgency are generally a combination of the presenting problem and general appearance of the patient, possibly combined with physiological observations. The triage assessment should generally take no more than two to five minutes, obtaining sufficient information to determine the urgency and identify any immediate care needs. This does not preclude the initiation of investigations or referrals at this point. There must be a balance between speed and thoroughness. The triage assessment is not necessarily intended to make a diagnosis, although this may sometimes be possible. Vital signs should only be measured at triage if required to estimate urgency, or if time permits. Any patient identified as ATS Category 1 or 2 should be taken immediately into the appropriate assessment and treatment area. A more complete nursing assessment should be done by the treatment nurse receiving the patient. In Australasia, triage is carried out by emergency nurses. As triage is so important to both the smooth running of an ED and the outcome of the patients, it should be carried out by staff who are both specifically trained and experienced.1.3 Safety at Triage Triage is the first point of public contact with the ED. Patients with the whole spectrum of acute illness, injury, mental health problems and challenging behaviour may present there. Pain, anxiety and/or intoxication in patients or their relatives may provoke or magnify aggressive behaviour. These factors may create a risk of harm for the triage nurse and other reception staff. It is essential that all EDs plan for this potential risk by providing a safe but non-threatening physical environment, providing minimisation-of- aggression training to front-line staff, and having safe protocols and procedures for dealing with challenging behaviour. Where the safety of staff and/or other patients is under threat, staff and patient safety should take priority and an appropriate security response should take place prior to clinical assessment and treatment.1.4 Time to Treatment The time to treatment described for each ATS Category refers to the maximum time a patient in that category should wait for assessment and treatment. In the more urgent categories, assessment and treatment should occur simultaneously. Ideally, patients should be seen well within the recommended maximum times. Implicit in the descriptors of Categories 1 to 4 is the assumption that the clinical outcome may be affected by delays to assessment and treatment beyond the recommended times. Further research is still required to describe the precise relationship between the time to treatment and the
  9. 9. clinical outcome. The maximum waiting time for Category 5 represents a standard for service provision. The recommended performance thresholds represent realistic practice constraints in the clinical environment. However, there is no implied justification for prolonged delays for patients falling outside the required performance standards - all attempts should be made to minimise delays.1.5 Practicality and Reproducibility The primary and most important role of triage is clinical. Therefore application of the ATS must occur in such a way that ensures patient safety and maximises flow through the emergency department. While it is desirable to attempt to maximise inter-rater reliability for reasons of inter-departmental comparisons and for casemix purposes, it must be recognised that no clinical coding system achieves perfect reproducibility. Acceptable levels of inter-rater agreement have been defined which allow for a realistic balance between clinical practicality and classification.2. EXTENDED DEFINITIONS AND EXPLANATORY NOTES2.1 Arrival Time The arrival time is the first recorded time of contact between the patient and Emergency Department staff. A recording accuracy to within the nearest minute is appropriate. There should be no delay between the physical arrival in the ED of a patient who is seeking care and their first contact with staff.2.2 Time of Medical Assessment and Treatment Although important assessment and treatment may occur during the triage process, this time represents the start of the care for which the patient presented. A recording accuracy to within the nearest minute is appropriate: 2.2.1 Usually it is the time of first contact between the patient and the doctor initially responsible for their care. This is often recorded as "Time seen by doctor". 2.2.2 Where a patient in the ED has contact exclusively with nursing staff acting under clinical supervision of a doctor, it is the time of first nursing contact. This is often recorded as "Time seen by nurse". 2.2.3 Where a patient is treated according to a documented, problem specific clinical pathway, protocol, or guideline approved by the director of Emergency Medicine, it is the earliest time of contact between the patient and staff implementing this protocol. This is often recorded as the earlier of "Time seen by nurse" or "Time seen by doctor".2.3 Waiting Time This is the difference between the time of arrival and the time of initial medical assessment and treatment. A recording accuracy to within the nearest minute is appropriate.2.4 Performance Indicator Thresholds Where a patient has a waiting time less than or equal to the maximum waiting time defined by their ATS category, the ED is deemed to have achieved the performance indicator for that presentation. Achievement of indicators should be recorded and compared between large numbers of presentations.
  10. 10. 2.4 Documentation Standards The documentation of the triage assessment should include at least the following essential details: o Date and time of assessment o Name of triage officer o Chief presenting problem(s) o Limited, relevant history o Relevant assessment findings o Initial triage category allocated o Retriage category with time and reason o Assessment and Treatment area allocated o Any diagnostic, first aid or treatment measures initiated2.5 Re-triage If a patients condition changes while they are waiting for treatment, or if additional relevant information becomes available that impacts on the patients urgency, the patient should be re-triaged. Both the initial triage and any subsequent categorisations should be recorded, and the reason for the re-triage documented.3. SPECIFIC CONVENTIONSIn order to maximise reproducibility of ATS allocation between departments, the following conventionshave been defined:3.1 Paediatrics The same standards for triage categorisation should apply to all ED settings where children are seen - whether purely Paediatric or mixed departments. All five triage categories should be used in all settings. This does not preclude children being seen well within the recommended waiting time for the ATS Category if departmental policy and operational conditions provide for this. However, for the sake of consistency and comparability, children should still be triaged according to objective clinical urgency. Individual departmental policies such as "fast-tracking" of specific patient populations should be separated from the objective allocation of a triage category.3.2 Trauma All victims of trauma should be allocated a triage category according to their objective clinical urgency. As with other clinical situations, this will include consideration of high-risk history as well as brief physical assessment (general appearance +/- physiological observations). Although individual departments may have policies that provide for immediate team responses to patients meeting certain criteria, these patients should still be allocated an objective triage category according to their clinical presentation. Again, departmental "fast-tracking" policies or systems should occur separately to the objective allocation of a triage category.3.3 Behavioural Disturbance Patients presenting with mental health or behavioural problems should be triaged according to their clinical and situational urgency, as with other ED patients. Where physical and behavioural problems co-exist, the highest appropriate triage category should be applied based on the combined presentation. While some acutely-disturbed patients may require an immediate clinical response (perhaps combined with a security response) to ensure their safety, it is recognised that some individuals entering an emergency department and posing an immediate threat to
  11. 11. staff (eg brandishing a dangerous weapon) should not receive a clinical response until the safety of staff can be ensured. In this situation, staff should act so as to protect themselves and other ED patients, and obtain immediate intervention from security staff and/or the police service. Once the situation is stabilised, a clinical response can take place as (and if) required, and triage should then reflect clinical and situational urgency.4. CLINICAL DESCRIPTORS4.1 Source The listed clinical descriptors for each category are based on available research data where possible, as well as expert consensus. However, the list is not intended to be exhaustive nor absolute and must be regarded as indicative only. Absolute physiological measurements should not be taken as the sole criterion for allocation to an ATS category. Senior clinicians should exercise their judgement and, where there is doubt, err on the side of caution.4.2 Most Urgent features Determine Category The most urgent clinical feature identified determines the ATS category. Once a high-risk feature is identified, a response commensurate with the urgency of that feature should be initiated.AUSTRALASIAN TRIAGE SCALE: DESCRIPTORS FOR CATEGORIES Response Description of Category Clinical Descriptors (indicative only)ATSCategoryCategory 1 Immediate Immediately Life- Cardiac arrest Threatening simultaneous Respiratory arrest Conditions that are threats to life (or imminent risk of assessment and deterioration) and require Immediate risk to airway - treatment immediate aggressive impending arrest intervention. Respiratory rate <10/min Extreme respiratory distress BP< 80 (adult) or severely shocked child/infant Unresponsive or responds to pain only (GCS < 9) Ongoing/prolonged seizure IV overdose and unresponsive or hypoventilation Severe behavioural disorder with immediate threat of dangerous violence
  12. 12. Category 2 Assessment and Imminently life- Airway risk - severe stridor or treatment within 10 threatening drooling with distress minutes The patients condition is Severe respiratory distress (assessment and serious enough or treatment often deteriorating so rapidly simultaneous) that there is the potential Circulatory compromise of threat to life, or organ system failure, if not treated within ten minutes  Clammy or mottled of arrival skin, poor perfusion Or  HR<50 or >150 (adult)  Hypotension with Important time-critical haemodynamic effects treatment  Severe blood loss The potential for time- Chest pain of likely cardiac critical treatment (e.g. nature thrombolysis, antidote) to make a significant effect on clinical outcome Very severe pain - any cause depends on treatment commencing within a few BSL < 2 mmol/l minutes of the patients arrival in the ED Drowsy, decreased responsiveness any cause or (GCS< 13) Very severe pain Acute hemiparesis/dysphasia Humane practice Fever with signs of lethargy (any mandates the relief of very age) severe pain or distress within 10 minutes Acid or alkali splash to eye - requiring irrigation Major multi trauma (requiring rapid organised team response) Severe localised trauma - major fracture, amputation High-risk history:  Significant sedative or other toxic ingestion  Significant/dangerous envenomation  Severe pain suggesting PE, AAA or ectopic pregnancy Behavioural/Psychiatric:  violent or aggressive  immediate threat to self or others  requires or has required restraint  severe agitation or aggressionCategory 3 Assessment and Potentially Life- Severe hypertension treatment start Threatening within 30 mins Moderately severe blood loss - The patients condition
  13. 13. may progress to life or any cause limb threatening, or may lead to significant morbidity, if assessment Moderate shortness of breath and treatment are not commenced within thirty SAO2 90 - 95% minutes of arrival BSL >16 mmol/l or Seizure (now alert) Situational Urgency Any fever if immunosupressed There is potential for eg oncology patient, steroid Rx adverse outcome if time- critical treatment is not commenced within thirty Persistent vomiting minutes Dehydration or Head injury with short LOC- now Humane practice alert mandates the relief of severe discomfort or Moderately severe pain - any distress within thirty cause - requiring analgesia minutes Chest pain likely non-cardiac and mod severity Abdominal pain without high risk features - mod severe or patient age >65 years Moderate limb injury - deformity, severe laceration, crush Limb - altered sensation, acutely absent pulse Trauma - high-risk history with no other high-risk features Stable neonate Child at risk Behavioural/Psychiatric:  very distressed, risk of self-harm  acutely psychotic or thought disordered  situational crisis, deliberate self harm  agitated / withdrawn potentially aggressiveCategory 4 Assessment and Potentially serious Mild haemorrhage treatment start within 60 mins The patients condition Foreign body aspiration, no may deteriorate, or respiratory distress adverse outcome may result, if assessment and treatment is not Chest injury without rib pain or commenced within one respiratory distress hour of arrival in ED. Symptoms moderate or Difficulty swallowing, no prolonged.
  14. 14. or respiratory distress Situational Urgency Minor head injury, no loss of consciousness There is potential for adverse outcome if time- Moderate pain, some risk critical treatment is not features commenced within hour Vomiting or diarrhoea without or dehydration Significant complexity Eye inflammation or foreign body or Severity - normal vision Likely to require complex Minor limb trauma - sprained work-up and consultation ankle, possible fracture, and/or inpatient uncomplicated laceration management requiring investigation or intervention - Normal vital signs, low/moderate pain Tight cast, no neurovascular or impairement Humane practice Swollen "hot" joint mandates the relief of discomfort or distress within one hour Non-specific abdominal pain Behavioural/Psychiatric:  Semi-urgent mental health problem  Under observation and/or no immediate risk to self or othersCategory 5 Assessment and Less Urgent Minimal pain with no high risk treatment start features within 120 minutes The patients condition is chronic or minor enough Low-risk history and now that symptoms or clinical asymptomatic outcome will not be significantly affected if assessment and treatment Minor symptoms of existing are delayed up to two stable illness hours from arrival Minor symptoms of low-risk or conditions Clinico-administrative Minor wounds - small abrasions, problems minor lacerations (not requiring sutures) results review, medical certificates, prescriptions Scheduled revisit eg wound only review, complex dressings Immunisation only Behavioural/Psychiatric:  Known patient with chronic symptoms  Social crisis, clinically well patient

×