Emergency department triage protocol

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To reduce long waits in the emergency department (ED), our hospital begins workups in the lobby waiting area (e.g., ECG, CT scans, labs). These tests are ordered with limited patient history and evaluation. Many patients leave after learning the results even though they have not yet been properly evaluated. Is it better to not tell the patients anything until a formal evaluation in the ED occurs?—THOMAS R. WALSH Jr., PA-C, Brookline, Mass.

Individual emergency-medicine departments generally set these policies. Many departments are seeking legal counsel regarding these protocols. It's one thing if a triage nurse is simply following an algorithm/protocol and quite another if the medical provider is reading the electronic medical record while the patient is still in the waiting area and ordering additional tests. Where I work, diagnostic studies are often ordered at time of triage to facilitate timely evaluation, but I am not aware of EDs that give the results prior to evaluation by the clinician. Generally, acting on results of diagnostic studies is most appropriately done in concert with history and physical examination findings.—JoAnn Deasy, PA-C, MPH (137-14)

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