Triage
450 Administrative and Legal Issues
3 Therefore, adopt the following strategies to minimize your medicolegal risk:
(i) Always ask more senior ED staff for advice when you are unsure.
(ii) Never stereotype a patient, trivialize their complaint, or jump to
an easy conclusion.
(iii) Follow the guidelines above for good ED record keeping.
(iv) Become an excellent communicator – with the patient, your
medical colleagues, nursing staff and with the GP.
(v) Be a team player and use the supports available to you.
4 Notify the senior ED doctor and contact your MDO immediately if an
incident occurs that you believe could turn into a complaint or claim. Include
the following situations:
(i) Missed or delayed diagnosis.
(ii) Adverse outcome.
(iii) Communication breakdown.
(iv) Angry or disgruntled patient.
(v) ‘Gut feeling’ that something is not quite right.
5 Your initial reaction to an incident can help ameliorate the likelihood of a
claim subsequent ly being lodged or pursued. Ma ke sure you:
(i) Be honest, open and concerned – never defensive, evasive or
dismissive.
(ii) Talk the problem through with the patient in lay-person’s
language.
(iii) Express regret and empathy for an adverse outcome, including
saying sorry.
(iv) Continue to liaise with medical colleagues to ensure proper
follow-up.
(v) Document meticulously – never backdate, alter or delete a
medical record.
(vi) Contact your MDO early, while events are fresh in your mind.TRIAGE
1 Patients presenting to an ED are sorted or triaged on arrival, usually by an
experienced, specially trained ED nurse in order to direct resources to the
more seriously ill first.
(i) The triage nurse allocates an acuity category from the relevant
National Triage Scale following assessment of current physiological
disturbance and the risk of serious underlying illness or injury.
2 The triage category answers the question: ‘This patient should wait for
medical assessment and treatment no longer than ...’, an ideal time period
embodied in t he treatment acuit y (see Tables 17.1 and 17.2).