Meeting the need for emergency care
May 14, 2018
When people think of a trip to the emergency room they often envision an ambulance – lights flashing and sirens blaring – pulling up to unload a patient from a gurney as hospital physicians rush to save the patient's life.
While this image is perfect for action movies or television dramas, the majority of emergency room patients actually walk through the department's front doors and are initially assessed by nurses in the triage area.
The triage area of an emergency room acts as a front line for patient care. The nurses who work there are charged with determining which patients need immediate care for life-threatening conditions; urgent care, for conditions that are not immediately life-threatening; or less urgent care for more routine issues.
At Dignity Health Sierra Nevada Memorial Hospital, the Emergency Department has been providing crucial care for western Nevada County for more than 60 years. As the regional patient population has risen from 15,000 to 35,000, caring for the growing number of emergency patients has become a challenge.
The first stop for most Emergency Department patients is a visit with a triage nurse who will record their vital signs, including measuring temperature, taking a pulse and evaluating respiratory rates and blood pressure.
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Triage nurses are also in charge of gathering a patient's medical history, as well as recording what medications they are on and if they have any allergies.
SNMH triage nurses see up to 55 patients a day. Sometimes they begin initial patient treatment such as covering a wound with a temporary dressing, applying a splint, or placing an ice pack on an arm or leg injury.
"The triage nurses are often the first members of our hospital team that patients coming through the ED encounter," said Emergency Services Supervisor Dot Mitchell, who has worked in SNMH's Emergency Department for more than 25 years. "Their role is important not only for assessing patient needs, but also for welcoming patients in a kind and compassionate manner."
SNMH uses a five-level algorithm called an Emergency Severity Index to sort the severity of patient needs. The ESI triage assesses patients' medical issues and the number of hospital resources their care is anticipated to require. Examples of resources include X-rays, blood tests, sutures and intravenous or intramuscular medications.
"The ESI system helps us expedite patient care. It allows us to sort through multiple patients quickly so that if life saving measures need to be implemented, we can quickly act. ESI allows us to assess individual needs, and rapidly get patients to care when needed," said Mitchell.
While the ESI system helps expedite care in the SNMH Emergency Department, hospital leadership recognizes more must be done in order to continue to meet the need for emergency care in our community. To that end, construction on a Rapid Treatment area is set to begin in November of this year.
The new Rapid Treatment project is in addition to the construction currently taking place to upgrade Emergency Department diagnostic imaging equipment. The Rapid Treatment medical exam rooms will be located near the Emergency Department patient lobby with the nurse triage area right next door.
A Physician's Assistant will be on hand to assess and potentially treat patients whose condition is less severe.
According to Mitchell, the goal of the Rapid Treatment area is to help non-acute patients get the care they need while simultaneously freeing up the Emergency Department for patients who are suffering from more life-threatening issues.
"Our goal is to always ensure our patients are getting the right care, at the right time," said Mitchell.
SNMH Emergency Services Director Cathy Currier says another component to improving emergency care is working with the community.
"Our ED physician group is educating the community on a regular basis through the newspaper and radio, as well as in person.
Heading into the summer, our ED nursing staff is educating the community on snakebite care, with our 'Stop the Bleeding' campaign, and on water safety. It's all part of meeting community need."
For more information on the SNMH Emergency Department transformation – which includes the addition of a Rapid Treatment area – please call 530-477-9700 or visit supportsierranevada.org/ourpromise.