Content area
Full Text
Traditionally the first point of contact for ambulant patients attending the accident and emergency (A&E) department was the reception desk. In recent years there has been increasing recognition of the importance of nurse triage, 1 with the development of standardised triage categories, guidelines 2 and national targets 3 for times to triage. The need to prompt early assessment by a triage nurse has led many departments to direct ambulant patients to the triage area rather than reception.
This approach has been adopted by the Northern General Hospital (NGH) A&E department for several years. Patients arriving at the A&E department entrance are guided by signs to the triage assessment area where they are assessed before booking at reception. However, staff noted that many patients seemed to disregard the signs and present themselves to reception first. It was therefore suggested that the arrangement be changed to prompt patients to attend reception first. This suggestion raised concerns that patients attending with time critical complaints might be inadvertently delayed at reception.
To resolve the issue we undertook a comparative study of the two different protocols-patients to attend triage first or to attend reception first. We aimed to answer the following questions-which protocol resulted in most rapid assessment overall, which protocol did patients follow appropriately, which protocol did patients prefer, and could receptionists recognise patients ultimately triaged to emergency categories.
Methods
The NGH A&E department is the only department serving the city of Sheffield, although ambulant patients may attend a minor injuries unit at the Royal Hallamshire Hospital. A total of 75 000 patients attend the NHG A&E each year. Ambulant patients attend by a separate entrance from the ambulance borne. Both reception and the triage area are adjacent to the entrance. The triage room is separated from the waiting room by a door that directly faces the entrance. This door is kept open except when patients are being examined. Reception opens onto the waiting room via desks that face perpendicular to the entrance. Signs immediately in front of the entrance direct patients to the appropriate area. Patients are triaged into standard, nationally recognised categories, 2 according to local guidelines.
The study took place over two consecutive four week periods in October and November 1999. During the first phase patients...