Our clinic based Urgent care is joining the ER..have some Q's?

  1. For three years I was the lead CMA ( yes CMA)in our clinic based Urgent Care. ( I am also an EMT). Our ER has been dysfunctional for the past 5 years due to having no permanent ER physician on staff. OUr clinic doc's take turn being on call and covering the ER. Well, whenever we had a complicated or severe patient come into the Urgent Care, the doc on call was so booked with clinic patients that it was like pulling teeth to get him to take the patient. Anyway, our little, but busy, urgent care is now joining the ER at the hospital we are connected to. We will provide urgent care coverage in the ER for clinic based stuff like ears and throats and broken fingers. We now have a full-time ER doc to take criticals. Has anyone else expereinced an ED/UC system like this? Our urgent care has always ran very effieciently, believe it or not, due to having two emergency med Physician Assistants on staff. The ER staff is very against us coming over there. I no longer work in the Urgent Care full-time, but fill in when needed. I, of course, won't be going to the ER with the urgent care because I'm nt an RN ( yet). Anyway, any suggestions on how to mix this system together without a diaster? I've never worked in an Ed that has it's own "urgent care" for non-critical patients. I think it's a great concept...but will it work? Any thought will be great!

    Lisa
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  2. 5 Comments

  3. by   Carla910
    We have a 6 bed urgent care unit next to our 19-bed ER Dept at a community hospital. We have been doing this for 3-4 years now. The urgent care used to be the castroom.

    We have specific criteria for patients that may bo to the urgent care area. The triage nurse makes the decision as to where a patient is placed.

    We see about 150 pts per day. Urgent care is part of that amount. We have a doctor, PCT, and a RN in urgent care, it hours are 11A to 11P 7-days a week. hope this helps.
  4. by   mikemw
    We had a 17 bed level 2 ER that expeirneced longer and longer waiting times for minor treatment due to a significant increase census. In Feb 01 we opened an 8 bed minor care unit adjacent to the existing ER, the minor care unit is staffed by 1 PA 2 RNs a unit secretary and an ER tech. The minor care unit is open from 1100-2300 daily, which are our peak patient volume times. The wait times for minor care has decreased from up to 3 plus hours in the lobby to less than 30 minutes in most cases plus the flow of critical patients through the main ER improved , The main problems we have encountered are: Medicare patients still must be seen by the ER MD who has to physically leave the main ER and come to the minor treatment unit. Also the temptation to use the minor treatment rooms for overflow of intermediate patients from the main ER, which slows the flow of minor care patients. All in all, we are very pleased with the results. Our patinets have been giving us very complimentary input since it has decreased the wait time in the lobby for nonlife threatening injuries and illness. THIS IS A WIN WIN SITUATION in my lowly opinion. Good luck with your implementation.
  5. by   ER_RN07
    I work in the Minor Emergency Care (MEC) unit of an ER. We have 8 beds. We are suppose to be staffed with 2 LPN's. But usually we run it with only 1 LPN. We have a triage criteria that nobody pays attention to. We often take patients that are classified non-urgent and occasionaly urgent patients. It all depends on how the day is going in the main treatment area! We often start IV's hang antibiotics or push meds (have to get an RN to push the meds!) and usually our patients are with us for more than 2 hours! We are starting a "reinventing" process which is sounding promising. We are trying to get a senior resident to be assigned to the MEC. Also we have started bedside registration and standing orders. For example last night I had a patient who had hand pain from slamming it in a door (ouch!) Went ahead and ordered the xray and the films were back before the MD went to see the patient. Also Xrays are now being sent over for the ER MD's to read. If they have a question they will bring it to the radiologist. This process saves probably about an hour! Sorry for the long post. If you have any questions let me know!
  6. by   CEN35
    most hospitals have an urgent care (i.e.e fast track/thru-care) in their er's. we have had one, but sometimes the minor stuff kept getting pushed back, due to the increased number of critical patients.
    well it's long in detail.....but the bottom line is, we now have 4 more rooms, giving us a total of 22. our erp coverage is differnt depening on the time of day. the uc area is open from 11-2300. the one problem that seems to be consistent, is people (i.e. triage nurse/uc nurse) having trouble deciding uc or er? my words have been, if they require a blood test/ekg and or iv (excluding iv ancef for deep laceration patients), they should stay up front in the er area. however, figuring this out seems to be an added problem trying to correct. if it is done right, it will be awesome. me
  7. by   LANA
    I work in a small rural hospital. We have one RN, working each shift, around the clock. One LPN for 12 to 16 of those hours. A clerk for 16 hours. (From midnight to 7 or 8 am, only one RN, who is registering, triaging, treating.) We have 4 beds, with another 2 to overflow for minor stuff. We average around 35 patients/24 hours. We are in the process of adding another full time RN because our pt load is picking up.

    The RN triages, juggles, treats RN requirements, & discharges. Our efficent LPNs get them in & out. We don't sit on them. Our physicians are staffed by an ER company. We expect the best out of our doctors. If they are incompetent or slow, the company is notified and they are no longer placed at our ER. We give out simple yes/no with comment section surveys, immediately upon discharge. They are anonymous and a box is provided. We do put the dates, so that we know who was working that day. This helps with providing backup for our complaints against doctors.

    We see a lot of clinic stuff, unfortunately. Should we get in a bind. The nurses request help from ICU and MedSurg, if need be. If we start backing up, we call in the local backup MD. We try not to back up with long stay IVs. We ask for admission to MedSurg for observation. We, also, have a manager, who will drop what she is doing and help (even if she is at home). I guess what I'm saying is that everybody works together.

    We rank among Columbia/HCA's top 10% for patient satisfaction.
    We get them in and we get them out. Keep them informed, if they have to wait. Don't be afraid to step on your doctor's toes. If you are a competent employee and they know it, they'll agree with you. You have to work together!

    Our policies, also, grant us permission to order x-rays or labs (within reason), when triaged, so as to speed up the process. Don't do anything outside of what your policies stipulate.

    I hope I have helped. Don't worry, the combined UC/ER will work out.

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