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How Triage Works

        Health | ER

Pros, Cons and Future of Triage
Dominique-Jean Larrey was surgeon in chief in Napoleon's army and invented the idea of triage. He also created "flying ambulances" to immediately transport the wounded to base hospitals nearby.
Dominique-Jean Larrey was surgeon in chief in Napoleon's army and invented the idea of triage. He also created "flying ambulances" to immediately transport the wounded to base hospitals nearby.
Liszt Collection/Heritage Images/Getty Images

The concept of triage is definitely a worthwhile one – help the people who need it the most, while also managing the flow of patients in and out of the emergency department or other triage situation. "From the provider standpoint it gives us a way to see the sicker kids first," says Dr. Batchelor of Children's Healthcare of Atlanta at Scottish Rite. "They need more attention, more time, more tests and more intervention."

By the same token, though, triage can inadvertently upset less critical patients. "Some parents don't understand the process, so they see a kid come in after theirs and get taken back sooner, not realizing that the kid is much sicker," Batchelor explains. "Parents get upset about that." Sometimes, patients in an overcrowded setting who are classified as "less urgent" wind up with lengthy wait times, causing them to become disenchanted and even leave without being seen. Other critics of triage find it unethical to delay treating patients, pointing to the possibility for rapid and unforeseen deterioration.

Many health systems address these concerns by constantly tweaking the process to reduce wait times, especially those with exceptionally high patient volumes. A study conducted at Kaiser Permanent South Sacramento Medical Center employed Lean thinking principles, a Japanese business methodology, to reduce waste and improve efficiency. For instance, under the old system, after the initial triage, the less-sick patients were sent to a separate waiting room where they waited again to be seen by a doctor. Under the new system, for minor injuries, a doctor does the examination in the waiting area or in a small room close by, rather than waiting for an open bed in the main patient area (though patients still have that option to wait for, if they wish.) Researchers found that the LWBS ("left without being seen") rate fell from 4.5 percent to 1.5 percent, and the time to be seen by a physician fell almost in half [source: Murrell et al.].

Although the core practice remains the same, the way triage is done has changed since the days of Napoleon, thanks to improvements in technology, medicine and efficiency. This trend is poised to continue because of the near-constant contributions being made by research and technology. "Telemedicine is coming out, smart phone apps and devices that take vitals will all make an impact," says Batchelor. Napoleon and his chief surgeon may have been visionaries in their own ways, but I doubt either of them could have ever seen that coming!


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