PART 3 / CH 4
Triage in the APS
Alexa Bagnell and Chris Finn
Triage is both a place (located in the front of the ER in the glass- enclosed area) and a state of mind (the decision about where to put a patient).
1. Answer page quickly and get patient’s name to see if APS has gotten a referral.
2. Go to triage immediately. If available, bring nursing staff with you. Decisions to be made at triage include:
Triage to APS or Medicine?
Reasons to triage to medical service: Any acute medical problems? Severely intoxicated (e.g., at risk to aspirate)? Overdose? Change in mental status of unclear etiology?
Where should the patient go?
(i.e., Would I be worried if this patient left without evaluation?) All patients sent on section 12 should be held in a secured area until evaluated by an MD.
3. Useful questions to be asked at triage (if circumstances allow):
- suicidal/homicidal ideation
- last use of drugs, EtOH
- last hospitalization (where and when)
- name of outpatient treaters
MGH triage options
| Location | Inclusion criteria | Exclusion criteria |
|---|---|---|
| APS clinic waiting room (day) Minor waiting room (night) | (does not meet criteria for commitment) - not suicidal - not homicidal - in good control | (“would you be worried if this patient left?”) - agitated - intoxicated - suicidal - homicidal - acute medical issues, - s/p overdose |
| Holding room | - suicidal - psychotic, needs a quiet/safe place; in good control - needs restraints | - acutely suicidal (needs monitoring) - risk of withdrawal - risk of seizure |
| Secured waiting room | (must consider acuity of other patients in area) - mildly intoxicated - suicidal - in good control | -agitated -violent -s/p overdose -acute medical issues |
| Major multipurpose (generally in restraints) | - intoxicated - active medical issues - s/p overdose - actively suicidal, agitated, violent - overflow from APS holding rooms | - safe in less restrictive environment - victim of trauma or violence (avoid restraint if possible) |
| Pediatrics | age<18 | see Acute Mgmt of the Agitated Child |