Emergency Departments Implement New Triage Form to Screen Patients for Actual Disease

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NEW YORK, NY – Myocardial infarction, subarachnoid hemorrhage, sepsis, diabetic ketoacidosis: these are examples of what the medical community regards as “real diseases.”  Unfortunately, our nation’s emergency department doctors and nurses are plagued with the task of sifting through legions of manipulative pretenders in order to find those patients that actually need help.

ER has never been more stream-lined

The Lancet of Emergency Medicine has recently published a triage form that accurately identifies patients that are actually sick.  The decision tool is called AYAS (Are You Actually Sick) and it is rapidly being implemented in many emergency departments.  The components of the AYAS decision tool are listed below.

Every “yes” answer is worth one point unless otherwise stated:

  1. Is the patient wearing sunglasses indoors?
  2. Does the patient request that his/her entire posse* be allowed into the ER room with them?
  3. Does the patient have >2 medical allergies?
  4. Does the patient have >2 piercings on non-auricular sites?
  5. Did the patient use the phrase “I KNOW my body!!”?  (Extra point if the patient snaps his/her fingers on the word “KNOW.”)
  6. Could the patient’s first name make a halfway decent stripper name?  (Examples include Amber, Destinee, or Misty.)
  7. Did the individual and a family member both check in as patients at the same time? (Extra point for each additional family member.)
  8. Did the fully-grown adult patient bring blankets from home to the ER?  (Extra point for a stuffed animal.)
  9. Did you know the patient’s name before he/she showed you a form of identification?
  10. Is the patient crying loudly despite lack of kidney stone, gonad torsion, active labor, penetrating wound, severe blunt trauma, or dislocated joint?
  11. Did the patient try to convince you of his/her high pain tolerance?

*posse: 2 or more non-related individuals that accompany the patient everywhere

After using the screening tool, the triage nurse totals the score.  The results are interpreted by the score chart.

0 Actual disease possible
1-3 Actual disease unlikely
4-6 No testing needed, offer them 20 Percocets to leave
6-8 Page psych
>9 Pretend to not understand English until the patient gives up and goes to another ER.  Consider having a pseudoseizure

So far, emergency department staff are thrilled with the results.  Elaine Dickenson, an ER nurse from Queens, says, “I was able to discharge 30% of the patents from triage! Our wait times have hit the floor!”

ER physician Michael Duncan agrees, “And it’s no surprise that there have been no bad outcomes from implementing this decision tool.  ER staff have known for decades that people that would score high on a decision tool such as AYAS are always full of bullcrap and are never actually sick.  This study is a God-send because it allows us to act on what we already know to be 100% true!”

Harvard, Johns Hopkins, and other pretigious medical programs are already working to validate a modified AYAS decision tool that adds 10 points if the patient has fibromyalgia, psychogenic seizures, or the nerve to mention a gluten intolerance as a legitimate allergy.

  • Show Comments

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    S. Weidner

    I think you should read the article again. I’m sure you’ll see how funny it is.

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    Dr Neeley

    I’m sure your attempts at evoking pity on a satire website are just as effective as your gluten-free is at treating your fibromyalgia.

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    This is hilarious. On the other hand I’m an ER nurse and have been doing so for over 2 years. I have more than my ear lobes pierced, and multiple visible tattoos. I can’t hate on that. Lol

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    Michael Brian Smallwood

    I always tell the docs I have a low tolerance for pain and thats why im crying like a little girl

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    S. Weidner

    But, are you aware that occasionally your patients can also roll off a list similar to the one you just gave? It is a bad idea to assume you know more than everybody else in the room.

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    Steve Perkins

    That’s why you only get one point. On the other hand, if you are allergic to toradol, tylenol, zofran, tramadol, and hydrocodone while, at the same time, happen to tolerate dilaudid and phenergan, then yes, you definitely get a point, maybe two.

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    Steve Perkins

    It’s something about that 8 years of formal education following high school followed by an additional 3-8 years of intense training in a 60+ per week role that lends itself to that arrogance. After finishing in the top 10% of college graduates and then being one of the about 10% that are accepted to medical school to go along with 12 years or so of post-high school education will do that to a person. Not a sleight to nurses, but even the bottom of the M.D. class is typically an incredibly bright individual, perceived otherwise or not.

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    OMG!!! Whre has this blog been all my life

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    S. Weidner

    This is so funny! Just can’t stop laughing. I knew you would all appreciate this as much as I did! http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3998848/
    What a riot.

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    Gomez Addams

    I agree with your assessment of fibromyalgia, sadly your snide comment about arrogance and nursing was unwarranted, untrue and over the top. I also am a nurse and I know lots of doctors that fit that bill just as well. Arrogance is not an occupational trait, however, doctors are far more likely to be perceived as arrogant than nurses. Where there is smoke there’s fire.

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    S. Weidner

    Sadly, I agree. It’s not funny. What I really want to say is that I hope that if you are a physician and that when someone comes to you and pays you for your professional knowledge that you can provide information to help them.
    The first time I had a physician who told me that my pain was somatic and that it was all in my head I was almost desperate for help. What was causing my bizarre reactions and pain? Did he know any mental health professionals who worked with people with somatic pain and could help me get my life back? I had already begun thinking that I probably needed a mental health specialist so I hoped to get a name or list of practices with a good reputation for successful treatment. Unfortunately, he just backed out the door mumbling what sounded to me like random phrases. Before I could ask what he was saying he was gone. When I left I requested information from the front desk in case he had a standard information sheet that he would ask them to include with the paperwork and that was why he hadn’t given me any information. Despite living near Johns Hopkins and some of the most respected medical practices in the country representing almost any field taught in med school, I have never had a doctor provide information to help me get this out of my head.
    Ok, I’m not going to the right places or asking the right questions. Do you keep this information on file? To whom do you refer your patients when they have symptoms commonly associated with fibro? If you want to get fancy with it you could even include relevant published papers for research nerds like me. When a patient comes to your door you have a wonderful opportunity to use your knowledge to help. What do you do with it?

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    Your histrionic screed is wearisome. Try to be pithy next time, Sparky. Maybe it will help your fibromyalgia.

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    S. Weidner

    Truly you are a physician with great healing power! I am certain that your patient files are stuffed full of the lucky few who have come only once or twice to your office looking for relief and have never returned – proving that you have cured them.
    Do they gather beneath your window every Christmas to sing carols? I know that after reading your brilliant, insightful notes I was inspired to improve the song O Come! Emmanuel.
    Oh come! Oh come, ye fibromyalgians
    And thank our great physician.
    We came thinking that we were in pain
    When he cured us by calling us names!
    Ye fibromyalgians
    Our cure was here in this physician.

    Wow! Satire IS fun!

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    Kath Hancock


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    811Lilly .

    While I agree with many of the things listed, I do have a concern. I do have medical allergies and carry an epipen. I don’t go to the ER unless it’s necessary. While I understand that an allergic reaction does not constitute an illness, if I ever do get sick with a disease, it’s going to be considered unlikely that I have a disease just because I have allergies? I’m sorry, but I don’t think that having legitimate allergies is a reason to rule out the presence of disease in the future.

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    Thanks, “real nurse” if your real name happens to be Guest. This is a SATIRE site, so lighten the hell up. It sounds like your mother was suffering from something other than fibromyalgia, and was misdiagnosed. It’s pretty easy to do, since it’s a junk term. The old term for fibromyalgia was “malingering” and it is characterized by psychological disorders such as anxiety and depression, which in the case of fibromyalgia have been internalized. Hence, the squirrel diagnosis. The best treatment? Getting busy and focusing on other things, such as a job or volunteer work. Like I said, your mother sounds misdiagnosed and heavily undertreated, and since you’re a nurse, I’m pretty sure your arrogance far exceeds your knowledge base.

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    Amy Gallagher

    I certainly hope that you are not actually in the medical field. Your lack of knowledge and compassion about fibromyalgia is astonishing and shameful. My mother suffered from fibromyalgia for over 20 years before she received a diagnosis. And no, she didn’t take narcotics, and no, she didn’t take “benzos.” In fact, the strongest thing she ever took was Tylenol. I remember watching her step into the room every morning as if she were walking on glass, her hands twisted up like claws because they were too painful to use. I remember her dropping things (like a full casserole dish) and saying, “It just slipped out of my hands.” I also know that her symptoms greatly improved when her sleep apnea was treated (and no, she wasn’t overweight by any stretch of the imagination). So, fuck you and every other know-it-all asshole who has the luxury of not suffering from something that science and medicine have yet to “catch up” with. And unlike you, you obnoxious cretin, I am NOT afraid to use my real name, because unlike you, I happen to be a REAL nurse.

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    Fibromyalgia is also known as “Acorn Storage Deficiency” or “ASD” because the sufferers are all squirrels. Symptoms are temporarily alleviated with benzos, also known as “Acorn Juice” or “AJ” for short. Our Hispanic patients suffer from “Ardilla Loca” Syndrome, or “AL”. Please note the feminine gender of the noun.

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    Wow. This is truly satire that’s art imitating real life. ROFLMAO

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    Lisa Mason

    If only this was real…

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    Joker J

    “Do you know who I am?” “Why, have you forgotten?”

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    Felicity Alice

    Bronwyne Rankin

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    Margie Watson

    In addition to the ESI Triage Screen!

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    Helen MacPhail

    Don’t put good looking doctors in ER. Result

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    Ernestine Rose

    My only prob is with question 4. No need to hate on the piercings. Multiple visible tattoos OTOH…

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    Rissa Stackhouse

    It is so sad how friggen true this is? I LOVE you guys for making me laugh in spite of it all…..

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    Veronica Khauv

    Saatchi Patell died laughing

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    John Mckinney

    If this were implemented we would hear crickets in the waiting room..

    Mark D. Wright

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    Diane Prysizney

    CTAS “6”!!! Lol

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    Giselle Dutcher

    Yes please!

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    When prestigious hospital like Harvard, Johns Hopkins and others have taken up and working to validate a modified AYAS decision tool. This is a positive development and will be looked forward with curiosity.

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    Sharon Monheim Yager


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    Billy Haley


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    Robin Fahringer Mitchell Machajewski

    Heehee! *snork!”

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    Chris Ricketts

    So true! Can we add “my body temp is usually 96.0, so 98.9 is a REALLY high temperature for me”.

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    Victoria Morgan

    Whatever. the five second glance from an er nurse in triage has been shown to be a better predictor of outcomes. have only met a handful of us who can’t accomplish this.

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    Chris Melcher

    Margie , we need to implement

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    Amanda Cobb

    Lol love it

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    Rusty Correia

    This is way better than ESI!!!

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    Natalie Martin


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    Gabby Woods

    Natalie Martin

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