Hello,
Just wanted to touch bases with other ER Nurses to see how they are addressing the above patient populations (e.g. patients discharged from the lobby or immediately after being Triaged in our dedicated Triage Rooms):
Of course, all "walk in pts" or EMS pts brought to Lobby/Waiting Room will receive a MSE or Medical Screening Exam by a qualified Medical Provider (MD, PA-C, or NP).
Does your facility have a policy where: "To mitigate boarding and high volume challenges, the patient may be discharged by the medical provider after the MSE in lieu of a complete Nursing Assessment being completed?" OR do you possibly follow this policy for lower acuity pts such as ESI 4 or 5? (e.g. Triage Note, D/C Note, Home Med Reconcilation, and an entry on the flowsheet about General Appearance/Neuro Status, Resps , Vitals and Pain only?)
The policy also does say, "For Adult Pts and Pediatric Pts NOT D/C'd by Medical Provider after the MSE, these pts will receive BOTH an Initial Assessment (Primary & Secondary) with a focused assessment appropriate to the reason for visit" AND Clinical Screening (Abuse/Neglect, Sepsis, Stroke, Skin, Behavioral, Isolation/Infectious Disease status, Immunization status. Are you completing the entire Initial Assessment in addition to the items listed above for these patients?)
Lastly, what Vital Sign parameter do you use prior to D/C and the pt actually leaving? 1 Hr for adults and 30 mins for Pediatric pts?
Your Feedback is greatly appreciated as I am currently assessing and evaluating some Standards of Care and Policies and Procedures. Thank-you.
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Gloria-Fe Warling MSN;RN;CEN;CPEN;CCRN
MSN, RN, CCRN, CEN, CPEN
California State Council
Simi Valley CA
(818) 885-5396
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