In emergency medicine, triage nurses perform a critical function. When a patient arrives at the ER, the triage nurse is the first skilled provider to see them. “Triage” means “the medical screening of patients to determine relative priority of for treatment.” The triage nurse is vested with responsibility for determining patients’ acuity, the chief presenting complaint and, ultimately, the urgency and order in which patients should be seen by ER physicians. But what happens when a triage nurse makes a critical error?
The Agency for Healthcare Research and Quality (AHRQ) recommends using a triage tool called the Emergency Severity Index (ESI) in emergency medicine. The ESI is an algorithm or decisionmaking tree taught using a handbook and DVDs. When triage nurses fail to alert ER physicians about an impending crisis in the ER, or hospitals fail to adequately train their nurses to recognize important signs or symptoms, then a medical malpractice claim may exist under Ohio law.
Triage also takes place in non-emergency settings. Most of us have called a doctors office and received the pre-recorded admonition that “if this is an emergency, hang up and dial 911.” The recorded message assumes that laypersons are capable of triaging themselves and deciding whether borderline complaints, like transient dizziness or moderate chest discomfort, are worthy of a call to 911. When the patient remains on the line, they will speak with an office employee who should be trained in the basics of patient triage.
Our firm once handled a case where a patient called a physician’s office with classic symptoms of an impending heart attack. The receptionist failed to alert the patient to call 911. When he arrived at the doctor’s office, the office staff parked the patient in the waiting room without alerting the physician about the patient’s complaints. The patient went into full arrest in the waiting room and died. The receptionist’s actions were entirely unacceptable. During the course of litigation, we learned that the receptionist was not trained to handle such emergencies. The delay caused by her failure to properly triage the patient cost the patient his chance at being stabilized and treated for coronary artery disease. The resulting claim for medical negligence was settled for a confidential sum.