The basic meaning of the word triage is "to sort". Sort through stable vs. unstable patients. Triage almost always takes place in the waiting room, though sometimes it takes place in the parking lot. When a patient arrives at the hospital, we are called to the waiting room to triage the patient. Because we operate as a human ER does, we do not see scheduled appoitnments (obviously the other specialty departments do not operate in this manner).
In emeregncy/referral practice, our primary clients are the referring veterinarians. When area animal clinics close for the day/weekend they refer their patients to us for emergencies. We do not want to do anything that will hurt our relationship with our referring vets, so we don't provide vaccinations (except for the middle of the night bite wound of unknown origin), routine spays/neuters, or dentals. Suffice to say a good number of the people that arrive with their pets through the ER have never been to our facility before. That in itself is challenging, particularly if the animal is not stable. When I arrive in the waiting room to triage an unstable pet, I have a very short amount of time to gain the pet owner's confidence. I explain in simple terms what I am noticing about this person's pet.
"It appears that Fluffy is working pretty hard to breathe. Would it be okay if I took him to the treatment area to be evaluated while you fill out the paperwork?"
"I'm concerned because Rover's pulses are so weak, his heart rate is elevated and his gums are pale. I'd like for the vet to have a look at him immediately. Why don't you fill out some paperwork while we have a closer look at him and Dr Smith will be out to explain what's going on to you in a few minutes?"
It is not the job of a veterinary technician to diagnose, prognose, prescribe medication or perform surgery. To that end it is crucial to not offer up any diagnosis at the time of triage. So even though I often have a pretty decent idea of what is going on with a patient at the time of presentation, I keep my mouth shut - no matter what the clients ask me.
When a dog presents after being hit by a car and has major injuries requiring a strecher to get from the car to the building the client generally has no problem being separated from their pet for little while. When the patient is a cat that has been gradually declining in health for 2-3 weeks and is just being seen by a vet now - and is not stable - the owner can be surprised when I tell them my concerns and my desire to take the cat from them for a little while to be evaluated. Couple that with an emergency consent form that, if signed, gives us permission to spend a few hundred dollars in diagnostic work on the pet right away- and it can be enough to send a client over the edge. However, I think that, in general, people are aware of the high cost of veterinary care, and the even higher cost of emergency veterinary care.
I do empathize with clients over the amount of money that is required to fix some animals. Sometimes the bills are astronomically high. I could never afford to pay some of the bills I have seen. So I really appreciate it when a client does whatever it takes to fix their pet (financially speaking). This is, of course, when the animal can be fixed. Clients that spend crazy amounts of money to extend the lives of pets with long term, chronic, end of life type diseases are more difficult to stomach. However, I am not the judge, just the technician. It's my job to do what I can for both the client and pet, make everyone as comfortable as possible, and hope for the best. Even when the best option is euthanasia for a 2 year old dog that has been hit by a car and will require multiple days of hospitalization and surgery to fix. Money is tight, jobs have been recently lost and a baby is on the way - we can't afford to fix our dog. I get frustrated and feel sad for the dog - but that's the way our business goes.
Back to the actual topic - triage. It is a skill to triage well. I have been doing it for a number of years and I still make mistakes. Two weeks ago I triaged a golden retriever that presented to us after having been to 3 other referral hospitals in the area. The dog's heart rate was normal, though the pulses were not that great. Because all of the dog's other vitals seemed okay (normal respiratory effort, sounds, pink gums), and because I knew it would not be a long wait to see the vet (about 5 minutes) AND because the owner did not really want to part with his dog, I let the dog wait with his owner. My gut was telling me to bring the dog to the "back" (I hate that term), but I didn't go with my gut. Fast forward 3 minutes - reception calls for a stat triage, and lo and behold, this dog has collapsed on the waiting room floor. Come to find out he had bad heart disease - and I should have followed by instinct.
This seems to be a lesson I have to learn over and over again.
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