[JessicRN]

It has become increasingly apparent that express care is a totally abused dept now. Why is it fair that the pt with a mosquito bite that he wants to be checked should be seen faster then the pt with abdominal pain. I always thought express care should be for those who really should have come to the ED but need less extensive treatment. (A laceration that needs sutured, a sprain that needs xrayed.) not non emergencies that should be treated in a clinic (that lump you noticed for 9 weeks and thought you should get it checked, or that sore throat for a week) I honestly feel these people should be made to wait hours and hours and maybe they will go to there own doctors or at least it would even up the playing field. I hate that I have to tell the patient with a possible appendicitis that he has to wait hours for a open bed because he is more serious then the pt with the toothache. No they do not understand and rightly so why should they have to. What happened to ESI 1-5 where appendicitis is a 2 and a toothache is a 5 and the 2 should be seen first. There must be a better system out there.

[Altra]

Chiming in to agree with you ... I think the concept is flawed.

The potential fix is a system that I've seen discussed here at allnurses -- after a medical screening exam, patients with nonurgent complaints are advised of a fee to continue treatment. In my ideal world, this would minimize express care to x-raying & splinting extremity fractures, suturing lacerations and little else.

All the other stuff we do in express care, gyne exams, pregnancy testing, Tylenol/Motrin for fever and malaise, IVF for patients w/2 episodes of vomiting, endless meds for back pain/neck pain/leg pain/toe pain/headache just encourages ER abuse.

[meownsmile]

I thought that was the idea of triage. I realize people abuse this care because they dont have a personal physican. Most people that go in for things like that are the same ones who complain about drs in the first place. I agree they should wait however long it takes if someone else with more acute symptoms comes in. And if they dont have insurance and are self pay and come in for some meanial annoyance they should have to pay the fee up front before being seen. Of course if it is life or death it is different, but for those who abuse it with their bites, fevers for a week etc, yep pay up front.
Most edodontists, oral surgeons and drs like that have to have payment up front or arrangements for payment before they will do any work, why not the hospital.

[Altra]

Originally Posted by meownsmile

I thought that was the idea of triage.

This is where express care subverts the triage process. Picture my ED's waiting room ... the ER and express care share a waiting room. When it's crazy busy, the patient with abd pain sits and waits while 5 or more express care patients are in & out, prescriptions for Motrin, Tylenol, Vicodin or Percocet in hand ...

[tridil2000]

i agree with you completely. it even uses up valuable resources from the main ed that could help more critical pts.

however, it's a huge money maker and that's what drives it. it can be staffed with a np or pa and turn over 10 or more pts an hour.

ching... ching...

[bill4745]

Totally agree. I have 14 years of ED and ICU experience, and at least one shift every two weeks my experience is wasted giving people motrin and cleaning lacerations, not to mention eight ED rooms. Meanwhile, the GI bleed and a chest pain wait two hours to get into a room. Nonsense.

[Kidrn911]

I may be wrong, but in my personal experience it is the medicaid patients that often miss use the ER as a doctors office. Thus I believe there should be a $5 co pay for them on nonemergent complaints that they could have seen thier PCP the next day. Another thing, we also need to STOP handing out OTC scripts, Tylenol, Motrin ie for them too. They walk in with their Gucci bag, cellphone, $200 shoes, with public aid card and whine about not having any money for tylenol for their baby, thus they get it free.

[ashleyjean3]

We fast track those pts.....they see a np.......their chart never crosses an MD desk. The fast track is staffed so that these pts can be seen without disrupting regular ER function. We have 15 dedicated fast track rooms. It works really Well for us.

[NRSKarenRN]

My DS and I had to wait 5hrs in ER with Kidney Stones as first time Dx.

NOT FUN but ambulances kept arriving....

[teeituptom]

I love express care, or minor care or fast strack, or slack track whatever you want to call it. Keeps the minor stuff from cluttering the major side.