Why FAST TRACK is wrong

Specialties Emergency

Published

EDs have x resources.

When we allocate any of those limited resources to treat those with conditions better treated in non-ED settings, we are 1. diverting limited resources away from more acute cases, and, 2. sending the message that EDs are for conditions other than emergencies.

Abolish the Fast Track. Treat each patient according to acuity. If that stubbed toe has to wait 16 hours to be treated because all the patients who came in after him were more acute, so be it. Screw Press-Gainey.

EDs, it's time to decide and focus: are you EMERGENCY DEPARTMENTS or PRIMARY CARE CLINICS?

It's time to stop trying to be all things to all patients.

Specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.
Long time ER nurse here, did phone triage for a year...

One thing I learned: people will call me (triage) or you (office) for advice, but 9 times out of 10 will do what they originally wanted to do (go to the ER @ 0200)

it'll NEVER change...

oh, and the medicaid patients in NO way have a hold on the 0200 ER visit for a rash...those patients come in ALL socio-economic statuses...Ignorance and stupidity have no financial ties...

I agree with all of that too.

However, the $50 or more co-pay a lot of insured folks have for ER visits does tend to keep some of them out of ER.

I did once have a mom with insurance and a $100 co-pay take a conjunctivitis to the ER for convenience.

I've done the telephone triage thing too. Some parents would call back more than once hoping for different advice from a different nurse. They didn't realize that not only were we working off standardized, computerized protocols, their previous calls were also in the system and would pop right up!

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Specializes in ER, Outpatient PACU and School Nursing.

speaking of fast track- I wanted to hear some input regarding your policy. we have once again started up fast track. we have assigned rooms- supposedly a PA and now a Medic. As nurses we have to give out the medications and sign the discharge papers. Some of us are unwilling to do this unless we have assessed the patient ourselves. I think it takes more time to do- instead of just assigning a nurse. we are told the paramedic cannot give out meds or sign the discharge papers. so doesnt that make us liable since we are signing the paperwork? some nurses feel comfortable letting the medic do everything and count on their documentation and sign it. some others say no- and pretty much have their assignment and take on the medics. One nurse voiced her concerns last week and refused to oversee triage- she was told if she refused- she would be sent home and considered insurbordinate. I wish we had a straight answer about this and I dont know why the PA cannot just cosign the chart with the medic since he or she is doing the assessment.

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Most docs won't even prescribe medications based solely on the diagnosis of another physician, much less the patient, himself. A history of a chronic condition is frequently not the cause of "exactly the same pain." Your doctor won't accept your diagnosis because he doesn't want to miss something other than your chronic condition which may be causing the pain. If your "migraine" turns out to be a massive hemorrhage, will your family release the doc from all liability? I doubt it. So does he. So does his liability insurance underwriter

And instead the poster gets to sit in an ER in the middle of the night for hours only to be asked a few questions by the ER doc, no tests because the pt says it's her typical migraine pain, and gets medicated and sent home.

If the migraine were a bleed then pain meds would not work. What's wrong with giving the poster a script for a breakthrough pain med with instructions to go to the ER if it doesn't work? The script could be for just one or two doses so that the poster wouldn't be tempted to "take a few more doses to wait and see."

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