Any nurses out there who think express care should not exist?

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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. :madface:

Specializes in ER, ICU, Infusion, peds, informatics.
there is no moral justification for having "fast track" areas within emergency departments. they exist because they make money. they are as wrong as having "vip suites". the hospital will assure the public that everyone is treated equally. we do not truly see the sickest patients first. hospital administrators and physicians would never be expected to wait to be seen in the er. am i right?

yes, part of the "allure" to admin is that they ("fast track" areas) make money.

but, they also have a separte, important (to admin) function: they decrease average los.

there is a nation-wide push to decrease er los. last i heard, fast track patients were supposed to be out in 60-90 minutes; "regular" patients were supposed to be out in

now, we all know that most abd pain pts won't be out in less than 3 hours. it takes at least 45 minutes for the ct to be done after the constrast is ingested, and it can take a couple of liters of fluid, plus some phenergan/zofran, before they can drink the contrast.

since chest pain patients usually need three sets of enzymes, at least 1 hr apart, there is no way they are getting out in 3 hrs.

since fast track patients don't take all that long (many can be treated with an rx only), having a fast track area decreases average los in two ways: one, the shortness of the fast track visit itself will decrease overall average los. second, these are patients that would be esi level 4 or 5, waiting the longest, so thus would most likely have the longest los without a fast track area. or at least a much longer los. without a fast track area, these patients would be contributing to a longer average los most days.

now, i'm not saying that i agree with all of this. i just wanted to point out that it isn't all about the money (though i agree, much of the allure [to admin] of these patients is that they usually have insurance).

part of the blame lies with the federal agencies that are setting these guidelines. and before someone asks, i admit that i don't know which agency is doing this. i want to say it is cms, but i'm not sure. i can ask someone at work, though.

personally, i think that we would be much farther ahead with a campaign to decrease inappropriate er use/abuse, rather than a campaign to decrease average los in ers. but that might just be me.

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Specializes in cardiology.
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 ...

Thank God we don't have an express care ....

I get irritated when half the patients I have, could have seen their PCP for treatment. I suppose I have the most fabulous pediatrician in the entire world, since no one else can seem to get into their kids' peds offices.

Here's a question .... do pt's really call their own doctors, or do they just come to the ER because there's a possibility that they won't have to pay for their treatment??

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Thank God we don't have an express care ....

I get irritated when half the patients I have, could have seen their PCP for treatment. I suppose I have the most fabulous pediatrician in the entire world, since no one else can seem to get into their kids' peds offices.

Here's a question .... do pt's really call their own doctors, or do they just come to the ER because there's a possibility that they won't have to pay for their treatment??

I would say of all my pediatric patients, 90% of parents do not call anyone (I know because I ask all me patients) they usually wait until they come home from work or after the ball game is over and come straight to the ED or they wait until friday or the day before the holiday so there sick child does not interfere with the weekend or holiday. The rest trully call their MD who says go to the ED. Our patients are illegal freecare and mass health (welfare) the free care and mass health want the convenience and the illegals give false addresses so do not have to pay.

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Specializes in Peds ED, Peds Stem Cell Transplant, Peds.
I would say of all my pediatric patients, 90% of parents do not call anyone (I know because I ask all me patients) they usually wait until they come home from work or after the ball game is over and come straight to the ED or they wait until friday or the day before the holiday so there sick child does not interfere with the weekend or holiday. The rest trully call their MD who says go to the ED. Our patients are illegal freecare and mass health (welfare) the free care and mass health want the convenience and the illegals give false addresses so do not have to pay.

Ditto here!!!!

And the new thing out in Chicago, is that many of the doctor offices have a $50 fee to call them after hours. Patients have to choose to pay a $50 fee to talk to a doctor. or pay a $50 dollar or nothing if they are medicaid. Thus that enhances the improper use of the ED.

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Ditto here!!!!

And the new thing out in Chicago, is that many of the doctor offices have a $50 fee to call them after hours. Patients have to choose to pay a $50 fee to talk to a doctor. or pay a $50 dollar or nothing if they are medicaid. Thus that enhances the improper use of the ED.

our place is starting a new fee for service for PCP who send there pt for nonemergency reasons. IE dressing change,TB reads, lab checks for chemo persons, suture removal. The only thing is the PCP although they were told the pt would get this charge they do not tell their patients and send them any way

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Specializes in ER, ER, ER.

I've worked in ER's that have a "fast track" and some that don't. I do believe that the non-urgent patients should be immediately, and publicly spanked for even thinking of using the ER as a first-line area of care (can we all say 'toothache'???). That being said, I am very appreciative that there is an area for the non-urgent patients to be treated in that is away from the real ER. Definition for real ER: Where I try to save your life, not try to fluff your pillow.

My point is, I believe that there should be 'Fast Track" areas; but they should be entirely separate from the ER. Separate staffing, billing, and waiting areas.

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Specializes in ER, ICU, L&D, OR.
Ditto here!!!!

And the new thing out in Chicago, is that many of the doctor offices have a $50 fee to call them after hours. Patients have to choose to pay a $50 fee to talk to a doctor. or pay a $50 dollar or nothing if they are medicaid. Thus that enhances the improper use of the ED.

why shouldnt they charge for after hours calls.

And if you had Universal Health Care then this would be mute anyway

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Specializes in Peds ED, Peds Stem Cell Transplant, Peds.
why shouldnt they charge for after hours calls.

It is called continuity of care, or the lack there of.

Universal health care would actually make matters worse. I for one do not want to wait six months to have a surgery to remove a tumor, and another 3 months for chemo. Nor do I want to pay 50% plus in taxes.

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Specializes in ER/EHR Trainer.

Not only is Express care (Fast track) needed, I wish we could double the size or ours! Sometimes I wonder how old the respondants are to these posts and whether they have children or sick family members. Maybe you are fortunate like I used to be to have a good dentist or doctor at any time. Those days seem to be long gone. I live in NJ, and you are lucky to get to the doctor in the same week you are extremely ill!! My sister lives in Massachusetts, it sometimes takes 3 weeks to see her doctor or pediatrician-most recently my 92 year old father in law was ill-his doctor doesn't even have an answering service any more! The doctor has plenty of patients and doesn't feel he needs to work after hours. (I did say doctor, not banker) Do I use the wild card that I am a nurse, YES..especially if someone is truly sick. At least I have that as a backup, what about the "REGULAR GUY".

Our ER is 55+beds, divided in medical, acute, pediatric and fast track. Everyone has someplace to go. Our beds are used for sick patients, when I work fast track and we are a little slow, I will accept patients to our FT area and work them up-at least their stuff is started.

Have you truly given any thought to having a toothache and no dentist or one who can't see you for a week. Or having abscesses that need to be drained because no surgeon will take medicaid and remove the sac that keeps filling, chronic pain, or how about the fact that physicians will not remove stitches, or even take care of their patients generalized needs anymore. (indigestion=MI, asthma=SOB and respiratory arrest, dizzy(hot)=TIA etc....) all afraid of malpractice. I am sorry if it bothers people to have simple complaints, but when you cant swallow or breathe, or sit, or walk you need medical attention just like everyone else! Maybe respondants hospitals should level the playing ground-any injury that comes in by ambulance is met by a doctor, there is no go ahead of the line unless it is active cp, stroke, or respiratory distress. Unfortunately, nausea and vomiting and pain is all lumped together in the waiting room. If I had my way, they would all be lined with iv fluids infusing-I feel the ER waits(at least my hospital) are directly caused by lack of beds on the floor, staffing, or discharges(all floor problems). Get rid of the backup and the ER will function properly. BUT, don't penalize the FT patients just because they don't require the million dollar workup! I sometimes wish we could do more for these people-THEY NEED IT!

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Specializes in Maternal - Child Health.
why shouldnt they charge for after hours calls.

[color=sienna]i don't have a problem with doctor's offices charging for after-hours calls. if they are providing a service, they deserve to be paid for it, and to have a reasonable expectation that patients won't take advantage of it.

and if you had universal health care then this would be mute anyway

[color=sienna]but i don't get how uhc would make this a mute point. uhc means that everyone would have access to coverage, not that everyone would have the right to free care at any time of the day or night.

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our place is starting a new fee for service for PCP who send there pt for nonemergency reasons. IE dressing change,TB reads, lab checks for chemo persons, suture removal. The only thing is the PCP although they were told the pt would get this charge they do not tell their patients and send them any way

Too bad we cant charge the PCP instead of the patients. I can't begin to tell you how many patients show up to our ED DURING the PCP's regular office hours saying, "My doc sent me down here to get a cat scan/x-ray/check my potassium." etc... Of course when you ask if they just have a slip for an outpatient test, "oh no, doc said I could get something for my abd. pain/headache etc...down here!" :angryfire

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Specializes in ER, ICU, Infusion, peds, informatics.
not only is express care (fast track) needed, i wish we could double the size or ours! sometimes i wonder how old the respondants are to these posts and whether they have children or sick family members. maybe you are fortunate like i used to be to have a good dentist or doctor at any time. those days seem to be long gone. i live in nj, and you are lucky to get to the doctor in the same week you are extremely ill!! my sister lives in massachusetts, it sometimes takes 3 weeks to see her doctor or pediatrician-most recently my 92 year old father in law was ill-his doctor doesn't even have an answering service any more! the doctor has plenty of patients and doesn't feel he needs to work after hours. (i did say doctor, not banker) do i use the wild card that i am a nurse, yes..especially if someone is truly sick. at least i have that as a backup, what about the "regular guy".

our er is 55+beds, divided in medical, acute, pediatric and fast track. everyone has someplace to go. our beds are used for sick patients, when i work fast track and we are a little slow, i will accept patients to our ft area and work them up-at least their stuff is started.

have you truly given any thought to having a toothache and no dentist or one who can't see you for a week. or having abscesses that need to be drained because no surgeon will take medicaid and remove the sac that keeps filling, chronic pain, or how about the fact that physicians will not remove stitches, or even take care of their patients generalized needs anymore. (indigestion=mi, asthma=sob and respiratory arrest, dizzy(hot)=tia etc....) all afraid of malpractice. i am sorry if it bothers people to have simple complaints, but when you cant swallow or breathe, or sit, or walk you need medical attention just like everyone else! maybe respondants hospitals should level the playing ground-any injury that comes in by ambulance is met by a doctor, there is no go ahead of the line unless it is active cp, stroke, or respiratory distress. unfortunately, nausea and vomiting and pain is all lumped together in the waiting room. if i had my way, they would all be lined with iv fluids infusing-i feel the er waits(at least my hospital) are directly caused by lack of beds on the floor, staffing, or discharges(all floor problems). get rid of the backup and the er will function properly. but, don't penalize the ft patients just because they don't require the million dollar workup! i sometimes wish we could do more for these people-they need it!

yes, they need care, but not in an emergency department.

these are things that need to be taken care of by primary care physicians in offices.

increasing the fast-track space isn't the solution. even though the visit is considered "minor" in our eyes, it is still considered an ed visit for billing purposes.

since ed visits are just about the most expensive way to receive care, this is an extremely inefficient use of limited resources (such as insurance company dollars). any wonder why our insurance premiums keep going up?

this is a problem that needs to be approached from the primary-care side, increasing access/availability of primary care providers, office visits, and appointments.

increasing fast track space only puts a band-aid on the problem. it makes people feel like something is being done to address the problem.

in reality, those people get seen, but there isn't any follow up. there isn't much by way of continuity of care. things get missed that way. little things that could be dealt with should proper follow up care be provided, can become big things.

ed visits just are a horrible substitute for primary care. (actually, they really arn't even a very good supplement to it, either.)

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