The experienced triage nurse often discovers subtle signs that can lead to diagnosis of a serious health problem, therefore triage cannot be operationalized in such a way that just anyone can safely perform this critical duty. Triage assessments are brief and systematic. Assessment always includes a brief patient history, vital signs, and if possible a brief physical examination keeping in mind to ensure patient modesty and privacy. Knowledge of mechanisms of injury, injury assessment, and a wide range of disease processes is essential to prioritize patients properly. Professionals who excel in the triage use the skill of intuition.
Intuition develops with experience, sensitivity, and the use of observation.
Triage is done by categorizing patients into different acuity levels. Triage Level 1 are patients that must be seen immediately. Examples are respiratory distress, cardiac or respiratory emergency, severe hypo and hyperglycemia, anaphylaxis, and imminent childbirth. Triage Level 2 patients are those that can wait twenty minutes to two hours. Examples could include abdominal pain, elevated temperature, and persistent nausea.