TRIAGE CONCEPTDr. Aehtoosham bin Suleman.

TRIAGE To Seive and Sort. To prioritise patient.

BOLEH SAYA

BANTU?

Mak saya tu, demam dah sebulan….

Dah sebulan baru la ni nak

mari..

Aku dah nak pitam ni, tak de yang nak tengok

WHY TRIAGE ? A war happen and a lot of casualties

and patient affected by the war. Problem in actually returning back the

soldier back to the front line to continue involve in war.

French surgeon Baron Dominique Jean Larry first person creating triage.

Triage concept then is to sort who could be treated early and send back to war.

WHY TRIAGE AT ED? Number of patient usually exceed the

capabilities of the emergency department thus we need to prioritise the patient who needs the medical attention first.

If we serve the patient first come first serve then we would not save life but will ended up having multiple casualties.

SO THE CONCEPT IS :prioritizing patients

provide immediate critical care

do the most for the most

Aku tak kena triage

ker?!

OBJECTIVEEnsuring that unstable patients get immediate medical attentionEnsuring that potentially unstable patients receive prompt medical attentionIdentifying patients who require time-related interventions ( pain, poisoning)Ensuring that those who are not likely to deteriorate can wait safely for care (with regular reassessment)

TYPE

• 3 Tier System (International Civil Aviation Organisation)– RED Urgent– YELLOW Semi Urgent– GREEN Non-Urgent

• 5 Tier System ( Manchester Triage Group )– RED Immediate – ORANGE Very Urgent– YELLOW Urgent – GREEN Standard– BLUE Non-Urgent

MALAYSIAN TRIAGE SYSTEMCatego

ryColor code

Condition Emergency action

Priority

1 RED Life @ limb threatening; death if

no intervention. Injuries affecting

ABC

IMMEDIATE

TOP

2 YELLOW Serious but stable injuries; not

immediately life threatening. May

deteriorate without Rx

URGENT SECOND

3 GREEN Non serious, minor stable injuries.

Deferrable

NON URGENT

THIRD

4 BLACK / WHITE

Dead, decapitated, mutilated, severed, apnea, pulse less,

incinerated; unsalvageable

DELAYED LOWEST

MALAYSIAN TRIAGE CATEGORY 2011

RED TRIAGE

YELLOW ZONE

YELLOW ZONE

GREEN ZONE G1

GREEN G2

GREEN G3

NUMBERING BASE ON TRIAGE

GREEN (TRIAGE AWAY)

PROSES TRIAGE

BILIK MAYAT

BUKU BID

PUTIH

PENDAFTARAN

RESUS

MERAH

PENDAFTARAN

IMMEDIATE CARE

KUNING

BILIK OSCC

BILIK ASTHMA BILIK RAWATAN

LALUAN TERUS

(FAST LANE)

KECEMASAN (G1) KECEMASAN (G2)

RUANG MENUNGGU

BUKAN KECEMASAN

(G3,G4)

TRIAGE SEKUNDER

PENDAFTARAN

HIJAU

TRIAGE PRIMER

IN HOSPITAL TRIAGE1) Primary triage2) Secondary triage3) Surveillance triage

Retriaging patients in waiting area

4) Online triage .5) Definitive Triage.

PRIMARY TRIAGEa) Proactive triage

Outside department Determine the mode of transportation

into dedicated zone

b) Static triage At the counter

PRIMARY TRIAGE Based on power of observation. Base on 5 senses smell, look, touch,

hear,taste. Chief complain and observation will

decide either yellow red or secondary triage.

PRO ACTIVE TRIAGE

STATIC TRIAGE

SECONDARY TRIAGERemember ‘S-O-A-P’ by Larry-Weed Subjective

Patient’s (subject) main complaint(s) and the brief event history

Objective Your (object) physical findings and vital signs

Apply (Assessment) Apply the triage category based on your

assessment Plan

Decide a plan for the patient:1. intervention or treatment2. obtain full set of vital signs3. preliminary diagnostic testing

SECONDARY TRIAGE1) Vital signs assessment

Temp, BP, HR, RR/SPO2 & Pain score

2) First aid Wound dressing / cleaning Immobilization – armsling, rigid immobilizer

3) Simple treatment Pain killer – mild to moderate PCM – watch out for contraindication Tepid sponging

4) ECG / DXT5) Blood investigation

FBC, BUSE UFEME, UPT, X-RAY

SURVEILLANCE TRIAGE Triage di tempat menunggu. Pesakit yang sedang menunggu akan

diperhatikan jika ada perubahan pada kondisi penyakit dan akan di uptriage jika perlu.

DEFINITIVE TRIAGE Triage and Rapid sequence examination done

at the various zone of patient management

Quality Standards of TriageStudy of Triage Error

Categories1. Mild Error

-among non-critical causes G1,G2,G32. Moderate Error

-Between Treatment zones-not affecting patient’s well being

3. Severe Error-Affecting patient’s stability

4. SENTINEL-Severe mistakes causing death, serious morbidity

Quality Standards Targets

1.Sentinel -zero error

2.Severe -<1%

3.Moderate -<5%

4.Mild -<10%

5.Zero Complaint

6.Appreciations

ART and Personality of Triage Core Components

Voice tone–soft & gentle

Correct word & accent Empathy –feeling ,

sensitivity Body language Facial expression Behavioural patterns Sitting position Care

Static (Counter) Triage1) At the Counter

2) To Stand up when talking to Patient (show respect)

3) Appropriate Facial Expression

4) Low Volume Voice

5) Appropriate Behaviour

Challenges in pediatric triage

• Different from adult:a) Anatomy & physiology b) Presentation –

unable to tell symptoms Rely on mother’s history Must see & touch the child –

active running around Weak / lethargy Dehydrated

2 patients – child & the parent

Triage is designedto get the right

patients,to the right place,at the right time,

with the right care provider!

…time is essence!

CONCLUSION Triage adalah pintu kemasukkan pesakit

di jabatan kecemasan. Silap triage maka silaplah management

patient. Image jabatan dilihat di triage, kalau

bagus triage dan pengalaman semasa di triage, biasanya tiada komplain selepas itu.

ADASOALAN

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