Triage Today: More of a Process than a Place

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May 13, 2014  |  Delia Caldwell

When many people hear the term “triage,” they think of a place — a room or perhaps even a chair in front of an Emergency Department reception desk.

In this case, triage is a noun, a physical space where a patient goes for initial evaluation and vital assessment before moving on to see a nurse or other provider. You might call this the pit-stop model: whether it’s a room or a chair, this notion of triage is a pit-stop that patients must pass through before they can receive further care.

By framing triage in this way, however, many organizations have missed opportunities to improve the effectiveness of emergency department operations. In its most successful implementations, triage is more of a verb than a noun, more a process than a place.

Back to the Roots

Triage is derived from a French verb: trier, which means “to sift” or “to separate.” On the battlefields of World War I (and the Napoleonic Wars before that, according to some scholars), those transporting the wounded to medical care had to separate the injured into three categories:

  • Those who would likely survive whether or not they received immediate care
  • Those who would likely die whether or not they received immediate care
  • Those whose survival likely depended on immediate care

The evaluators would then make decisions about priority of care based on this assessment.

From these violent origins, triage has developed into its contemporary practice: an evaluation to determine priority of care. Yet by conceptualizing triage as a place, many providers have missed ways to make it as effective as possible.

Triage as Process

Today, many providers are looking back to the original definition of triage as they seek to achieve more efficient emergency department design.

Triage doesn’t have to be a dedicated space. At its core, triage is rapid evaluation by a very experienced clinical professional. Its core requirement is an operational design that facilitates the necessary evaluation.

Think about the moment a patient walks into an emergency department. Who do they interact with first? In a traditionally conceived process, the patient might first see a registration official before moving on to triage before moving on to receive care. This is a suboptimal process, however. Consider a conceptually simple change: designing an emergency department operationally so that in the receiving area, patients see a nurse first of all.

Now, an experienced clinician can immediately make a rapid visual assessment, provide a quick registration, and bypassing traditional registration staff .. A nurse may evaluate the patient’s needs at the outset, speeding up care and thus adding capacity for the emergency department.

This process-centric idea of triage is not a standard of practice yet, but innovative emergency departments across the country are implementing it to powerful effect. Whether taken alone or combined with other operational improvements such as protocol-based medicine and immediate bedding, this approach to triage can dramatically reduce patients’ timelines of care and improve performance for the emergency department as a whole.

 ABOUT THE AUTHOR     Delia Caldwell MBAoutcome_swarming_Delia Caldwell
Delia Caldwell works with clinical staff to put the systems and processes in place they need to improve care and save lives. Through simulation modeling, process mapping, and dashboard tools she helps departments reduce LOS, improve patient outcomes, and streamline operations. A skilled facilitator, Delia guides organizations through change, using data to demonstrate that her recommendations will improve productivity and efficiency. With more than 85 operational studies completed, her efforts have redefined the way that providers deliver care. Read more from Delia.

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