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Redrawing the Boundaries: Conceptualizing Emergency Medicine as a Complex Communication System
Unformatted Document Text:  12 agitated state of mind. Once the door has been located, parking is adequate and easy to find. For a few months during this study, the hospital experimented with a valet parking service for emergencies, but abandoned it once they found that most people who did not arrive by ambulance were well enough to park their cars. There are two sets of automatic doors at the entry-way, and once inside the triage area is about ten feet straight ahead. A security guard sits to the left of the entrance, but is hidden behind one-way glass and not visible to the visitor. The triage desk, however, is not clearly identified and “triage” is not a term known to the typical ED patient at CHC. Etymologically, “triage” is derived from the French “trier,” meaning to pick or to sort (Carvel, 2000). Today, triage is almost always conducted by an experienced nurse who--using the distinctions of emergent, urgent, and non-urgent--classifies patient acuity (Adams & Fontanarosa, 1996). A small sign near the glass window of the triage area instructs visitors to fill out a form and take a seat in the triage waiting room. Another sign reads, “Please do not enter while other patients are being triaged. Patients are seen in the order of seriousness or injury. Your understanding is appreciated.” But individuals are often too emotionally upset to read these signs and desire instead to speak with someone immediately. Some look around helplessly for a few seconds, while others poke their head into the triage area and ask what to do. Triage nurses see this as intrusive, ignorant behavior (i.e., “Didn’t they see the

Authors: Eisenberg, Eric., Pynes, Joan. and Baglia, Jay.
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12
agitated state of mind. Once the door has been located, parking is adequate and
easy to find. For a few months during this study, the hospital experimented
with a valet parking service for emergencies, but abandoned it once they found
that most people who did not arrive by ambulance were well enough to park
their cars. There are two sets of automatic doors at the entry-way, and once
inside the triage area is about ten feet straight ahead. A security guard sits to
the left of the entrance, but is hidden behind one-way glass and not visible to the
visitor.
The triage desk, however, is not clearly identified and “triage” is not a term
known to the typical ED patient at CHC. Etymologically, “triage” is derived
from the French “trier,” meaning to pick or to sort (Carvel, 2000). Today, triage
is almost always conducted by an experienced nurse who--using the distinctions
of emergent, urgent, and non-urgent--classifies patient acuity (Adams &
Fontanarosa, 1996).
A small sign near the glass window of the triage area instructs visitors to
fill out a form and take a seat in the triage waiting room. Another sign reads,
“Please do not enter while other patients are being triaged. Patients are seen in
the order of seriousness or injury. Your understanding is appreciated.” But
individuals are often too emotionally upset to read these signs and desire instead
to speak with someone immediately. Some look around helplessly for a few
seconds, while others poke their head into the triage area and ask what to do.
Triage nurses see this as intrusive, ignorant behavior (i.e., “Didn’t they see the


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