Medical triage: what hygiene and safety measures must be followed in the designated area?
Triage is part of the patient treatment prioritization process, ensuring that patients in serious condition are seen first by medical staff. Triage can be performed in isolation from streaming or completed after a patient has been initially streamed upon arrival. This process and model of care will depend on the capacity of each medical unit and the existing demand from the population.
When emergency departments are under pressure, triage can be used to help clinicians identify the order in which patients should be consulted, but it can also be part of normal activity to support patient flow within the hospital. Disinfection of triage areas is essential and mandatory for preventing the spread of infections.
The term triage comes from the French word "trier," which means to sort or select. Its historical roots for medical purposes go back to the days of Napoleon, when it was necessary to triage large groups of wounded soldiers. Over the centuries, triage systems have evolved into a well-defined priority process, sometimes requiring specific training depending on the setting or organization using the system.
Table of Contents
- What is triage in emergency medical units?
- What does medical triage consist of?
- The five triage categories
- Screening in the triage area
- When medical triage is performed
- Hygiene and safety measures in the triage area
- Patient flow in emergency departments
What is triage in emergency medical units?
Triage is a significant face-to-face clinical assessment that may include observations and the use of specific tools to support decision-making. It usually takes longer than streaming. The result is a priority assigned to the patient, thus helping to manage workload and ensuring that the sickest patients are seen first.
Triage must be performed by a clinician who is trained and competent in using the specific triage system applied. Its correct use ensures a robust and reproducible assessment. The triage process should begin as soon as possible after the patient arrives at the hospital, and if the patient has not already been streamed, the initial patient assessment will also take place.
Sufficient resources must be allocated to triage to cope with variations in demand (both in terms of number and time required to complete triage), not average demand.
Triage must be performed in an environment sufficiently private for the exchange of confidential information, but not isolated from the department. Disinfection of triage areas must be performed several times a day, at regular intervals, and whenever the situation requires it. The availability of resources is also taken into account during this process.
What does medical triage consist of?
As established, triage represents the process of rapidly examining sick people upon their first arrival to place them into defined categories, as follows:
- Patients with priority signs who should be given precedence in the queue so they can be rapidly evaluated and treated/moved/isolated without delay.
- Patients with emergency signs who require immediate treatment.
- Patients who do not have emergency or priority signs and are non-urgent cases. They may wait their turn in the queue for evaluation and treatment. Most people will not be prioritized and will not require emergency treatment.
The five triage categories
Triage category 1
People who need treatment immediately or within two minutes are classified as having a condition that is immediately life-threatening. People in this category are seriously ill and require immediate attention. Most would have arrived at the Emergency Department by ambulance.
Triage category 2
People who need treatment within 10 minutes are classified as having a condition that is imminently life-threatening.
People in this category suffer from a serious illness or exhibit very severe pain. People with severe chest pain, difficulty breathing, or severe fractures are included in this category.
Triage category 3
People who need treatment within 30 minutes are classified as having a condition that can be life-threatening. People in this category suffer from severe illnesses, are bleeding heavily from cuts, have major fractures, or are severely dehydrated.
Triage category 4
People who need treatment within one hour are classified as having a potentially serious condition. People in this category have less severe symptoms or injuries, such as a foreign body in the eye, a sprained ankle, a migraine, or an earache.
Triage category 5
People who need treatment within two hours are classified as having a less urgent condition. People in this category have minor illnesses or symptoms that may have been present for more than a week, such as rashes or minor aches.
Each hospital has its own triage system. They all create priorities for who receives care or is transported for care. The most common triage systems use color coding. Disinfection of triage areas is mandatory, regardless of the type of patients.
Screening in the triage area
Screening, or the analysis of the patient's health status, should take place at the entrance to the medical unit. Screening must be performed at all times, during all shifts, for all persons who arrive at the medical unit.
The screening area must always be stocked with:
- Thermometer
- Hand hygiene solutions
- Medical protective equipment (medical masks, gloves)
Also, disinfection of triage areas will be constantly ensured.
How to use hand sanitizer correctly
When medical triage is performed
Emergency rooms can be crowded with people who need immediate attention, plus people seeking treatment for less serious conditions. The emergency department may only have staff to meet the expected need.
When there are too many patients and not enough staff or resources, triage is used to determine who receives care first. This ensures that patients who need life-saving treatment are seen before those who have less serious conditions.
Triage can be a short-term necessity, for example when there is a vehicle accident with multiple victims requiring ambulance transport. Or, it can be a long-term need for a hospital that is often understaffed for the number of patients arriving at the emergency department.
Hygiene and safety measures in the triage area
The triage or screening area requires compliance with the following aspects:
- Well-demarcated area
- Proper ventilation
- Medical disinfectants
- Adequate distance between patients (> 1 meter)
- Protective equipment for medical staff
- Surface disinfectants
- Hand hygiene solutions for medical staff, patients, and accompanying persons
- Infrared thermometer
- Screening questionnaire
- Trash cans and access to cleaning protocols/charts
- Clear signage
- Information posters
- Disinfection of triage areas
Patient flow in emergency departments
The basic principle is that, upon arrival at the hospital, patients are directed to a treatment area or service equipped with appropriate healthcare practitioners to manage their clinical needs.
Patient arrival
Most patients arriving at emergency departments (ED) present themselves (they are unannounced). Since the COVID-19 pandemic, hospitals have changed the way patients access services due to increased infection prevention and control measures, including rapid testing of patients for COVID-19.
Announced patients
These patients have contacted a doctor beforehand, such as their family physician, and have been advised to go to the hospital. As a rule, this category of patients does not have serious emergencies.
Patients who are transported by ambulance are also announced.
The ambulance will pre-alert the emergency department staff if they are transporting a patient who needs to be received rapidly by a clinical team. These patients must be taken over by the appropriate medical team immediately upon arrival.
Handover of unannounced patients from an ambulance crew to the emergency department should be completed following locally agreed processes within 15 minutes of arrival. Responsibility for the clinical assessment and treatment of the patient lies with the hospital from the moment the ambulance reaches the department. Ambulance medics must return to their vehicle immediately after handover to prepare and become available for patients who need an ambulance response in the community.
Unannounced patients
This category includes patients who present themselves without prior contact with a clinician from another healthcare setting and those advised to go to the hospital by a specialist or family doctor.
Initial patient assessment
The main objectives of the initial assessment are as follows:
- to identify patients with life-threatening conditions and injuries to ensure that those with the most time-critical conditions are prioritized;
- to accurately assess non-life-threatening conditions and injuries so that these patients are appropriately prioritized and seen by the correct service within appropriate timeframes;
- prevents crowding of emergency centers and supports infection prevention and control;
- recognizing potentially vulnerable patients and taking steps to assist them.
Conclusion
Triage represents a mandatory stage in hospital emergency centers. Protocols for receiving, assessing, and directing patients are clearly established and target the level of danger each patient is in. Hygiene and disinfection measures are required in triage areas to prevent the contamination of patients, accompanying persons, and medical staff with potentially dangerous pathogens.
Sources:
https://media.tghn.org/medialibrary/2020/12/Webinar_week_2Triage_and_patient_flow_.pdf
https://www.england.nhs.uk/guidance-for-emergency-departments-initial-assessment/
https://www.health.nsw.gov.au/Hospitals/Going_To_hospital/Pages/triage.aspx
