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Book Review:

 Emergency Nursing - 5-Tier Triage Protocols

Authors: Julie Briggs, RN BSN MHA & Valerie G. A. Grossman, BSN RN CEN
Publisher: Lippincott Williams & Wilkins
ISBN: 158255-371-8  
Reviewer: Tom Trimble, RN CEN

          The science of the art of triage is clearly organized and arrayed in this wire-bound handbook for a five-level acuity system, with an eye for consistency and compliance, in 86 protocols covering 120 conditions, and 20 appendices of reference material within 258 pages. In tabular form, it teaches discernment in assigning acuity levels by urgency, helps avoid missed questions, and provides room for notes. Training exercises and an assessment tool will help the preceptor develop critical thinking in the trainee.

           It is topically arranged alphabetically by "meat and potatoes" common complaints. This generic approach makes it a little awkward to look up problems by system, or to cluster them for teaching. Body Art Complications are included, but complications of patients with transplants or immune-deficiency problems, sickle-cell disease, cancer emergencies, or end-stage kidney or liver problems, or multi-system problems, for example, are not treated with a guide to assessment of those problems in context. This makes it more suited for community hospital problems or as a launch point for the mentored novice triage nurse, to systematically and repetitively use the structure to estimate how critical the patient is needing priority in care and his level of risk.  Some of this information can be found in appendices, thus "differential diagnosis of chest pain" includes transplant rejection and infection, yet cardiovascular aneurysm doesn't mention sudden onset or disproportionate pain but "differential diagnosis of abdominal pain" does for abdominal aortic aneurysm.

           Thus, strength and weakness (if that), are one. The focus is on quickly assessing severity. A quick-reference lie-flat-on-the-desk handbook will not and cannot bring all the data points and experienced judgment of a seasoned triage nurse with good clinical understanding to its pages. It is complaint-driven rather than diagnosis making. Method is key in this book with consistent application of "who needs help now; who can wait; how long can they wait in relation to their complaint." It is for the mentor or motivated self-learner to facilitate clinical correlation in reviewing each case encountered. Stronger cross-listing in the index would be useful: renal calculi are listed but not kidney stone or nephrolithiasis. Going to the Abdominal Pain protocol or the appendix will get you there, but think categorically.

            The authors not only encourage data gathering, they emphasize the qualities of personal interactions, courtesy and sensitivity, and consideration to upgrade triage category when history is hampered by youth, age, impairment of faculties, or language ability that might otherwise conceal potential problems. Psychiatric problems, abuse, intoxications, sexually-transmitted disease, foreign bodies, all find an approach within. Appropriate treatments to initiate at triage are indicated where needed. Always, reassessment of those who wait is recommended.

            This book puts forward a practical way of coming back to basics and helps categorize priority for patients. It does so in the format of the currently most-studied triage system type. As an educator or manager, I would feel confident that, with it, my nurses are being prepared to make safe decisions with an accurate program that reflects current thinking in triage strategy. As a book buyer, I would feel that I am getting full value for money for myself or my institution in using it as an aid to learning the triage decision-making process.

Date of Review: January 2006
Tom Trimble, RN CEN, is an experienced Emergency Nurse, Instructor, and the Editor & Publisher of this website. The opinions expressed are his own.

Disclosure: ENW! receives sample books for impartial review under its GUIDELINES. ENW! has no financial arrangements with publishers or authors. Where present, a purchase link is provided by ENW! as a convenience to its readers. The non-obligatory use of these links sometimes provides a small fee to ENW! (if from which provides no significant portion of operating costs for the website. ENW! is non-profit and dedicated solely to the interests of the Emergency Nursing specialty for which it is operated in trust. This page, as all others of the website, and the opinions of reviewers are subject to our DISCLAIMER.


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