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SOPs/Patient-Care/SOP-UC-001-Triage-Protocol.md

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+# Standard Operating Procedure: Urgent Care Triage Protocol
+
+| Document ID | SOP-UC-001 |
+|-------------|-------------|
+| Title | Urgent Care Patient Triage and Acuity Assessment |
+| Revision | 1.0 |
+| Effective Date | [DATE] |
+| Author | [AUTHOR] |
+| Approved By | [APPROVER] |
+| Department | Urgent Care |
+
+---
+
+## 1. Purpose
+
+To establish standardized procedures for triaging patients presenting to urgent care to ensure appropriate prioritization, timely care, and identification of emergent conditions requiring ED transfer.
+
+## 2. Scope
+
+This procedure applies to all patients presenting to urgent care including:
+- Walk-in patients
+- Scheduled same-day appointments
+- Patients referred from other providers
+- Pediatric and adult patients
+
+## 3. Responsibilities
+
+### 3.1 Triage Nurse/Medical Assistant
+- Conduct initial patient assessment
+- Assign acuity level
+- Obtain vital signs
+- Identify emergent conditions
+- Initiate appropriate protocols
+
+### 3.2 Urgent Care Provider
+- Review triage findings
+- Evaluate patients per acuity
+- Make disposition decisions
+- Authorize ED transfers
+
+### 3.3 Front Desk Staff
+- Check in patients
+- Alert clinical staff to arrivals
+- Facilitate registration
+
+## 4. Definitions
+
+| Term | Definition |
+|------|------------|
+| Triage | Process of prioritizing patients based on clinical urgency |
+| Acuity | Severity of patient's condition |
+| ESI | Emergency Severity Index (reference scale) |
+| ED Transfer | Patient requiring emergency department level care |
+| Chief Complaint | Primary reason for visit |
+
+## 5. Triage Levels
+
+### 5.1 Urgent Care Acuity Scale
+
+| Level | Description | Examples | Target Time |
+|-------|-------------|----------|-------------|
+| 1 - Emergent | Life/limb threatening, requires ED | Chest pain, stroke symptoms, severe dyspnea | IMMEDIATE ED transfer |
+| 2 - Urgent | Significant symptoms, needs prompt attention | High fever, moderate dyspnea, severe pain | <15 minutes |
+| 3 - Semi-Urgent | Moderate symptoms, stable | Lacerations, minor fractures, UTI symptoms | <30 minutes |
+| 4 - Non-Urgent | Minor symptoms, stable | Minor cold symptoms, prescription refills | <60 minutes |
+| 5 - Not Appropriate | Outside scope, needs referral | Chronic disease management, specialist care | Redirect to PCP |
+
+## 6. Procedure
+
+### 6.1 Initial Contact
+
+1. **Patient Arrival**
+   - Acknowledge patient within 5 minutes of arrival
+   - Brief visual assessment
+   - Determine if immediate attention needed
+
+2. **Quick Look Assessment**
+   Rapidly evaluate:
+   - Level of consciousness
+   - Respiratory effort
+   - Skin color
+   - Obvious distress
+   - Visible injuries
+
+### 6.2 Triage Assessment
+
+#### 6.2.1 Chief Complaint
+
+Document in patient's own words:
+- Primary symptom
+- Duration
+- Severity (0-10 scale for pain)
+
+#### 6.2.2 Vital Signs
+
+| Parameter | Normal Adult Range | Action if Abnormal |
+|-----------|-------------------|-------------------|
+| Temperature | 97.0-99.0°F | Assess for fever source |
+| Heart Rate | 60-100 bpm | Assess for underlying cause |
+| Respiratory Rate | 12-20/min | Oxygen, escalate if distressed |
+| Blood Pressure | <140/90 mmHg | Repeat, assess symptoms |
+| SpO2 | ≥95% on RA | Oxygen, consider ED transfer |
+| Pain Score | 0/10 | Pain management protocol |
+
+#### 6.2.3 Brief History
+
+| Element | Document |
+|---------|----------|
+| Onset | When did symptoms start? |
+| Provocation | What makes it better/worse? |
+| Quality | Describe the symptom |
+| Radiation | Does pain travel? |
+| Severity | Rate 0-10 |
+| Time | Constant or intermittent? |
+| Medications | Current medications |
+| Allergies | Drug and other allergies |
+| Last meal | Time of last food/drink |
+| Medical history | Relevant conditions |
+
+### 6.3 Level 1 - Emergent (ED Transfer Required)
+
+**Immediate recognition and action for:**
+
+| Condition | Signs/Symptoms | Action |
+|-----------|---------------|--------|
+| Cardiac emergency | Chest pain, diaphoresis, SOB, arm/jaw pain | Call 911, ECG if available |
+| Stroke | Facial droop, arm weakness, speech difficulty | Call 911, note time of onset |
+| Respiratory failure | SpO2 <90%, severe distress, cyanosis | Oxygen, call 911 |
+| Anaphylaxis | Airway swelling, hypotension, urticaria | Epinephrine, call 911 |
+| Severe trauma | Major bleeding, altered consciousness | Stabilize, call 911 |
+| Sepsis | Fever, tachycardia, hypotension, AMS | IV access, fluids, call 911 |
+| Active seizure | Convulsions, unresponsive | Protect, time seizure, call 911 |
+
+**ED Transfer Protocol:**
+1. Call 911 immediately
+2. Notify provider
+3. Initiate stabilizing measures
+4. Document time and interventions
+5. Provide EMS with clinical information
+6. Send documentation with patient
+
+### 6.4 Level 2 - Urgent
+
+**Requires provider evaluation within 15 minutes:**
+
+| Condition | Characteristics |
+|-----------|----------------|
+| High fever | >103°F adult, >102°F child <3 months |
+| Moderate respiratory distress | SpO2 92-95%, increased work of breathing |
+| Severe pain | 8-10/10 |
+| Significant bleeding | Controlled but significant |
+| Dehydration with vomiting | Unable to keep fluids down |
+| Acute abdominal pain | Severe, localized |
+| Altered mental status | Confusion, not baseline |
+| Syncope | Recent loss of consciousness |
+| Diabetic emergency | Hypoglycemia, ketoacidosis symptoms |
+
+### 6.5 Level 3 - Semi-Urgent
+
+**Provider evaluation within 30 minutes:**
+
+| Condition | Characteristics |
+|-----------|----------------|
+| Lacerations | Requiring sutures, bleeding controlled |
+| Possible fractures | Deformity, point tenderness, stable |
+| Moderate pain | 5-7/10 |
+| UTI symptoms | Dysuria, frequency, no fever |
+| Ear pain | Moderate, no fever |
+| Minor burns | <5% BSA, superficial |
+| Sprains/strains | Ambulating, stable |
+| Rash with mild symptoms | No systemic symptoms |
+
+### 6.6 Level 4 - Non-Urgent
+
+**Provider evaluation within 60 minutes:**
+
+- Upper respiratory symptoms (mild)
+- Minor sore throat
+- Minor skin conditions
+- Medication refills
+- Minor eye complaints (non-trauma)
+- Minor injuries not requiring sutures
+
+### 6.7 Level 5 - Redirect
+
+**Outside urgent care scope:**
+
+- Chronic disease management
+- Routine physical exams
+- Mental health crisis (redirect to crisis line/ED)
+- Dental emergencies (redirect to dentist/ED)
+- Specialty care needs
+- Workers' compensation (per facility policy)
+
+### 6.8 Pediatric Considerations
+
+#### Age-Specific Concerns
+
+| Age | Automatic Elevation Criteria |
+|-----|------------------------------|
+| <3 months | Any fever ≥100.4°F → ED |
+| <2 years | Fever >103°F, lethargy, poor feeding → Urgent |
+| All pediatric | Respiratory distress, dehydration, altered behavior → Urgent |
+
+#### Pediatric Vital Sign Norms
+
+| Age | HR | RR | Systolic BP |
+|-----|----|----|-------------|
+| Infant | 100-160 | 30-60 | 70-90 |
+| 1-3 years | 90-150 | 24-40 | 80-100 |
+| 4-6 years | 80-140 | 22-34 | 90-110 |
+| 7-12 years | 70-120 | 18-30 | 90-120 |
+| >12 years | 60-100 | 12-20 | 100-120 |
+
+### 6.9 Geriatric Considerations
+
+- Lower threshold for escalation
+- Atypical presentations common
+- Consider polypharmacy
+- Falls assessment
+- Cognitive baseline consideration
+
+## 7. Documentation
+
+Complete FRM-UC-001 Triage Assessment including:
+- Time of arrival and triage
+- Chief complaint
+- Vital signs
+- Allergies and medications
+- Brief history
+- Assigned acuity level
+- Interventions initiated
+- Provider notification time
+
+## 8. Re-Triage
+
+Re-assess waiting patients:
+- Every 30 minutes for Level 2
+- Every 60 minutes for Level 3-4
+- Immediately if condition changes
+- Document all re-assessments
+
+## 9. Quality Metrics
+
+| Metric | Target |
+|--------|--------|
+| Time to triage | <10 minutes |
+| Appropriate acuity assignment | >95% (audit) |
+| ED transfers identified at triage | >99% |
+| Patient complaints re: wait time | <5% |
+
+## 10. References
+
+- Emergency Severity Index (ESI) guidelines
+- Emergency Nurses Association guidelines
+- Pediatric Assessment Triangle
+- State nursing practice acts
+
+---
+
+## Revision History
+
+| Rev | Date | Description | Author |
+|-----|------|-------------|--------|
+| 1.0 | [DATE] | Initial release | [AUTHOR] |