[MPHkatie]

In our er, we all rotate through different areas, main, peds, the chest pain unit, fast track. I was in fast track yesterday and started to wonder about who the heck was in triage first, and then about how fast is fast track. During the day I took care of numerous people who had the various bumps, bruises, sprains, strains. I also ruled one guy out for an MI, one other one for Anurysm (yeah, I can't spell), admitted a patient with a SLE flare, did a chemical eye burn, etc. and a conscious sedation! three of these patients stayed for well over 8 hours and really required a lot of treatment(the sedation took the only RN, ME working that area totally out of circulation for about 1.5 hrs). We don't have a physician in our fast track area- a PA or NP, so they are often going to consult with the attending on the more complicated situations. So most of the patients were very delayed in treatment, and stayed for over 4 hours. Whats your fast track like? Are you able to triage dislocated shoulders/hips and complex fractures there, or is my ER just gone nuts. I know I am venting a bit, but I think that actual fast track pts- stitches, sprains, strains, etc coudl get in and out a lot faster if I wasn't also coordinating EKG's and CT scans over there. What do you think?

[traumajunkee]

Hi Katie.
We have a list of patients that can and cannot be triaged to Minor. Dislocations requiring conscious sedation is NOT a fast track patient. You need to set down with your supervisor, PA 's, and docs and set some standards. We do not even take back pain with radiculopathy. Now the chemical burn would be in minor. If the patient becomes an admit then they are transferred to major. Our minor is too busy to become bogged down with 4hr patients.Good luck!
Debs

[CEN35]

We actually keep track of it. At one point it was 124 minutes average. The last I remember was 81 minutes average. We are getting there, but not where we want to be.


me

[teeituptom]

Howdy yall
from deep in the heart of texas

We have a 9 bed fast track, dedicated to minor stuff. It sees between 40 to 50 pts a day. Its only open 12 hours. Noon to midnight. With a turnaround time of about 65 to 75 minutes. Not to shabby. But its staffed with a family practice doctor, 1 RN, and 1 tech. It stays fairly active there. Boring, but active. Its definitely a no brainer to work, but I see some of the younger nurses get a little stressed there. Its all about time management. But it works well enough.
Katie, sounds like your managers need to keep in mind what fast track is. However like everything else in the wonderfull world of ER, sometimes when it is hitting the fan, you may have to anticipate being flexible. What can you say, welcome to ER, we love or we hate it.

keep it in the short grass yall

teeituptom

[traumaRUs]

We too have fast track which is also overwhelmed. However, we don't put conscious sedation pts up there (its physically located two floor up from ER). Its staffed with two RNs, two MDs (one attending and one resident). Our LOS is over 120 minutes there.

[Jen911]

We have a 6 bed Fast Track (5 beds plus an eye room).. We take lacerations, fractures, ear infections, and other simple stuff like sinus infections, obvious UTI's, etc...anything that's not going to get "involved".. If it's going to be something that needs to be majorly worked up with labs, CT scans, stuff like that, it needs to go to the ER, not fast track. Our fast track is staffed by two PA's for the busy hours, 1 PA when it slows down, 1 ortho tech, and 1 RN.

The thing that slows our patients down the most is waiting for radiology to take X-rays. They're busy with ER patients. We're apparently supposed to get a dedicated X-ray tech eventually for Fast Track in the future, which would be nice, since we take so many ortho patients when it's busy.

Patients can come and go rather quickly, I don't know the exact figures, but I'd venture to guess an average of about 50 miinutes would be on the long end of a patient stay..... Last night we were rolling quite fast, I had a patient come in, needed sutures for a finger lac, was in, sutured, tetanus given, and discharged within 20 minutes! (blowing the smoke off my gun)..

RN's take turns working fast track, it's a nice break from working in the ER. Some people like working fast track, some hate it. I personally like it. Our PA's are great to work with, since they know how to really appreciate the RN's (and they actually dig in and will even discharge a patient if we're busy, too!)

The once nice thing about working fast track is, if we have a patient at any time who needs to be moved over to the ER, we're able to do so... For instance, if we have an ortho patient who we find will need sedation for a reduction, we'll need to put them on a monitor.. Or those patients who we've found just need a little more workup than the PA's feel comfortable with, no problem, we can move them and let the ER handle it from there as soon as a bed is available.

Our fast track has been a huge success, we get a lot of patients in and out of there, and it takes a lot of stress off the ER, keeping our monitored beds open. Plus, it gives my tired brain a break.. .5cc TD IM... .5cc TD IM... .5cc TD IM... .5cc TD IM ... LOL

[MPHkatie]

Something is definitely not so hot with our "fast" track. I did mention it in passing to my Manager, but with all the crud going on I doubt she will rememebr. She is great, but there's a lot going on. I think everyone makes a mistake or two when triaging- I mean, sometimes patients seem straightforward and turn into long drawn out rule outs for this and that, but it seems to be happening more and more often... Thanks for the input everyone.

[Tiiki]

We are supposed to have a "fast track" but the reality of the situation is we don't. We have 4 small cubicles with curtains and a separate waiting room for the "fast trackers" Well, you get a bit of this, a bit of that in there. Someone may start out in corriders (cubicles) but has stablized enuf (most likely we need the bed) and will be send to rm 18 (our fast track area). We have also had possible CVA's, MI's, you name it. You land where there is space. So when patients ask about fast tracking...we are honest..we say.."sorry, no such thing here."


JO-ANNE

[teeituptom]

Howdy yall
from deep in the heart of texas

Our fast track is pretty good, but it so boring to work, yuck