Anyone here work fast track/urgent care?

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Specializes in Med surg, cardiac, case management.

And what was your educational background?

You see, I work on a med-surg floor uses private physicians, so after hours the NPs from our fast track clinic (an alternative to the ER for less-urgent conditions) cover their patients. In the midst of a very bad shift I had a good experience working with one of the NPs from the fast track on a patient of a private physician who was going downhill.

Unlike some of the people I've graduated with, I'm not interested in going on and seeing dozens of patients in a primary care clinic (or worse yet, a community clinic). But I might well like what this fast track NP was doing.

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And what was your educational background?

You see, I work on a med-surg floor uses private physicians, so after hours the NPs from our fast track clinic (an alternative to the ER for less-urgent conditions) cover their patients. In the midst of a very bad shift I had a good experience working with one of the NPs from the fast track on a patient of a private physician who was going downhill.

Unlike some of the people I've graduated with, I'm not interested in going on and seeing dozens of patients in a primary care clinic (or worse yet, a community clinic). But I might well like what this fast track NP was doing.

If you don't want to see dozens of patients then you probably won't like fast track. The name of the game is churn. The whole principle is based on moving patients rapidly through the unit. The purpose is to prevent patients with relatively simple problems from clogging up the main ER. It also helps with patient satisfaction by getting these patient seen faster. Compared to the main ER it takes much less manpower and resources. Of course this is dependent on triage figuring out which patients are appropriate for fast track. I did some fast track shifts in school during my ER rotation. We saw evolving MIs, a ruptured esophagus, and a subdural hematoma all sent to "fast track".

The other problem I see with the system you describe above is what happens when there is an emergency and things are busy in fast track. What gets priority? On the other hand there are any number of hospitals where the only physician in house at night is in the ER. Its not unusual to have the ER staff (physician, NP or PA) stabilize patients until the attending can get there.

My main objection to fast track is that it has the disadvantages of ER (lack of patient relationship and continuity as well as patient population) with none of the advantages (ie interesting pathology). On the other hand there are a lot of PAs and NPs that have worked fast track for a long time and are very happy with the job.

David Carpenter, PA-C

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Specializes in Nephrology, Cardiology, ER, ICU.

I have worked prn in a community hospital ER - seeing the more minor issues.

My educational background: adult health CNS, now finishing (July 2010) peds CNS.

Nursing background: 10 years level one trauma center, 2 years ICU, 1 year med-surg and 2 years (LPN) LTC.

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Specializes in Med surg, cardiac, case management.
If you don't want to see dozens of patients then you probably won't like fast track. The name of the game is churn. The whole principle is based on moving patients rapidly through the unit. The purpose is to prevent patients with relatively simple problems from clogging up the main ER. It also helps with patient satisfaction by getting these patient seen faster.

Actually, I should have clarified: I'm not interested in seeing dozens of patients having only very simple problems...ie needing vaccinations, treatment of a cold, counseling for obesity or hypertension, etc...I had a classmate who excitedly told me that primary care NPs see 40 patients a day. Unless that includes a bunch of more serious problems I don't think that would excite me...

I know what you mean about fast track too. I know our fast track hasn't decreased the wait times in the ER, and the NP was telling me that they get some pretty acute patients there too.

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Specializes in allergy and asthma, urgent care.

I work urgent care and primary care in an urban community health center. I work 10 hour shifts and see about 24 patients a day, not 40. My patients tend to be a bit more complicated than the UTI, sore throat stuff you might expect to see in such a setting. Most of my patients are recent immigrants who have not had access to consistent health care, so we deal with alot of more chronic issues like diabetes, HTN, kidney disease, etc. We get lots of interesting derm stuff and I also do a fair amount of psych. We see evolving MIs, CVAs, and acute bellies fairly frequently. So......don't be so quick to think an outpatient setting is boring. I haven't been bored a day in the 9 months I've been there!!! Because I do both urgent care and have my own primary care patients, I do have the continuity and the chance to build relationships with my patients. It's a nice balance.

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Specializes in STICU/NICU/CCU/ER.

40 patients a day is an exaggeration or you are obviously working 20 hrs a day or not offering good care. Be realistic please.

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Specializes in Med surg, cardiac, case management.
40 patients a day is an exaggeration or you are obviously working 20 hrs a day or not offering good care. Be realistic please.

40 patients a day is what I heard from a classmate who's in an NP program.

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40 patients a day is an exaggeration or you are obviously working 20 hrs a day or not offering good care. Be realistic please.

10 hour shift pt every 15 minutes. 40 patients. It really depends on if you really get true fast track patients or not. For example Medicare says you should spend around 10 minutes on a 99212 and 15 minutes on a 99213. If you are getting a lot of new patients its still 10 minutes for a 99201 and 20 minutes for a 99202. In reality most people being seen in urgent care are generally well (or should be) and are presenting with self limiting illness or trauma. Even minor trauma can be seen quickly. For example finger lac

Examine finger neuro check no tendon joint involvement basic history 5 minutes

Soak finger

See other patient

Dry off finger and numb it up 5 minutes

See other patient

Suture finger and place dressing 5 minutes

Total 15-20 minutes (max) over 30 minutes or so

During that time you could have seen a couple of other patients or at least gotten things going.

The key to fast track is flexibility and multitasking.

David Carpenter, PA-C

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40 patients a day is an exaggeration or you are obviously working 20 hrs a day or not offering good care. Be realistic please.

um... I doubt you are a NP because 40pts/day can be very realistic in many parts of the country. I have interviewed for many jobs where the patient load is expected to be 40-50/day in an 8 hour shift!

This is not how I practice, I came from a school that was anal about charting and I have this paranoia so I document everything and and overly thorough, I listen to heart/lungs on practically every patient, even if only a OM or laceration...

Regarding the question,

I come from 3 years Peds RN in a level 1 Trauma Center.

I currently do locum tenens and most of my work has been Urgent Care type work. My last job was in a rural ER staffed with one other Physician who saw the "real" ER patients and I saw all the patients that shouldn't be in the ER, (okay some needed care but for the majority, it was pts who lacked a PCP and TONS of drug seekers)

For me that was the major negative about this ER, I reviewed all the charts of "toothache" and "back pain" because after a few days I figured out they were all liars!

I do like procedures though and got to do a ton, which takes more time, especially if you have something complicated to suture, I only have 2 years experience and for me it takes some time, but I figure it should be okay because they can bill higher.

Anyways, I saw about 32pts in a 10 hour shift and usually with 5-10 procedures, I&D's, speculum exams, suturing, stapling, etc..

Occ with some more complicated patients that ended up being admitted such as COPD or CHF.

In Urgent Care 8 hours I would see probably 15-20 but that was only because the clinic was slow or I could/would have seen more.

I think average is about 15min/patient hopefully including paperwork but not always, depending if you have pts or not.

Personally I really like ER/UC type work.

If I ever take a perm position I think I would prefer Peds ER because they are not likely to be drug seekers and usually have a legitimate problem and not back pain for the past 20 years which they now want me to wave my magic wand in the ER to magically cure....

Overall its pretty fun, depends on what you like to do. I DON'T like to manage chronic disease, I DO like to do procedures and learn new things, so for me its a good environment.

Plus I think it usually pays higher and I think you are expected to see more patients in primary care because the billing is usually lower.

I should also add, in the ER I never got even a 5 minute lunch break, I never saw the Doc's take a break and rarely saw them eat either. I usually just brought a few sandwiches an tried to take a bite between each pt.

In the UC I always got a lunch, could have taken an hour, but I was paid hourly so I only took 30min which was enough.

I'm not sure if its like that in every ER as this is the 1st I've worked in.

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