The authors of a recent analysis examined 13 studies about nurse-ordered testing at triage. Ten studies were about length of stay or time to diagnosis. The authors of the other three compared tests ordered at triage with tests ordered by emergency physicians. There were some surprising findings.
Since 2015, when multiple international trials were reported showing clear benefit for mechanical thrombectomy in patients with large vessel occlusions, this treatment has been the standard of care. However, the speed of treatment remains paramount for good outcomes, and different models have been developed around the world in different geographic settings.
The tool is particularly effective at illuminating which patients are at both ends of the severity spectrum, which can be helpful to emergency clinicians as they make their disposition decisions. Still, it is up to clinicians to consider the information provided, and then use their clinical judgment.
Certain hospitals are including information on their critical care triage policies in admission packets to explain how care or supplies will be allocated if rationing becomes necessary. Some clinicians feel ethically obligated to inform everyone up front of the possibility. Others think it is better to do so only if and when it becomes necessary.
When preparing for any disaster, plan for a range of scenarios, including worst case. Determine where beds and staff will come from under the direst of circumstances. Use predictive modeling to anticipate daily care needs and identify alternative locations where patients could be relocated if the community demand reaches a boiling point.
At the Hospital for Special Surgery (HSS) in New York City, everything changed around mid-March, when the facility closed because of the COVID-19 crisis. The first four weeks since HSS closed to elective surgeries were a time of dizzying change.