1. Swipe screen to play
"TRIAGEDY"

2. Aims of the exercise
For participants to interpret & organise clinical observations for recognised clinical conditions
As a team develop a differential diagnosis
To synthesise data and using clinical reasoning, prioritise patients according to current physiology
To discuss escalation and action planning for the clinically unwell patient
To construct the ‘correct’ handover for each patient.

3. Triagedy!
Our Triage Nurse has assessed six acutely unwell patients and brought them through to Accident & Emergency.
Airway
Breathing
Circulation
Disability
Exposure
Depending on group sizes the participants should be paired up (working on one station per pair) or work in a small group to rotate through the separate stations.
Facilitator should have Perf Bowel, Sepsis, Asthma, Chest Pain, GI Bleed, Head Injury Cards in their pocket or on lecturn.
Stations should include:
Station 1: Flipchart 1 =ABCDE Patient A&B. (Red cards mixed up and spread across the chart) A Blank laminated NEWS Chart & marker
Station 2: Flipchart 2 = ABCDE Patient C&D (Yellow cards mixed up and spread across the chart) A Blank laminated NEWS Chart & marker
Station 3: Flipchart 3 = ABCDE Patient E&F (Green cards mixed up and spread across the chart) A Blank laminated NEWS Chart & marker

4. ----?Perforated Bowel?----
----Sepsis----
----Head Injury----
----?Perforated Bowel?----
Here are some example patients – remember these may not represent how the patient is looking right now! Ie. Whether they have a guedel in or not.
REMEMBER –Each Station has TWO of the SIX patients on them. It could be any two of these patients.
----Chest Pain----
----GI Bleed----
----Asthma----

5. Triagedy! Unfortunately the patient’s parameters have become mixed up!
In small groups try to build a clinical picture out of the observations in front of you.
You have a mixture of two patients observations per colour group.
For a bonus point attempt to match them to a
differential diagnosis!
Facilitator should monitor group work and support learners. This is a “game” of interpreting physiology, identifying clinical symptoms that associate with one another, and working as a team.
How the group interact, communicate and allocate tasks can be commented on later during the session.
Half way through the exercise (as the groups manage to start putting together a picture – the facilitator may choose to give them the two condition cards! This may then lead to further dicsussion and change of clinical symptoms according to the diagnosis.

6. Swipe to reveal clinical conditions
----Sepsis----
Swipe to reveal clinical conditions
----Head Injury----
----?Perforated Bowel?----
----Chest Pain----
----GI Bleed----
----Asthma----

7. ----?Perforated Bowel?---- ----Chest Pain---- ----GI Bleed----
----Head Injury----
----Asthma----
----Sepsis----
----?Perforated Bowel?----
----Chest Pain----
----GI Bleed----
Here are some example patients – remember these may not represent how the patient is looking right now! Ie. Whether they have a guedel in or not.
REMEMBER –Each Station has TWO of the SIX patients on them. It could be any two of these patients.

8. Which patient is your clinical priority?
IF PAIR WORK AT EACH STATION - ask them to identify the worst of the two in their own clinical opinion. They could possibly share this with the other groups.
IF SMALL GROUP ROTATING THROUGH ALL THREE STATIONS: they could identify their own TWO clinical priorities out of the SIX

9. National Early Warning Score NEWS
Using an NEWS Chart plot the parameters and score the patient according to the vital signs you have selected for the condition. Does the score support your clinical reasoning? What are the next steps for this patient?
An opportunity for Nurses and Doctors to familiarise themselves with NEWS – and discuss whether it is a good representation of clinical prioritisation.
Groups should plot their two patients onto an EWS chart – what is their score? Have they scored correctly? How should they escalate this patient?

10. The patients should all require further review by specialists, emergency care or possibly a crash call. In pairs identify the escalation plan and develop a handover appropriate for each patient. SBAR isn’t for every call!

11. Thank you for participating.
Please take a moment to discuss this workshop as an educational resource.
Swipe left to restart!