while we don't have a doctor in triage, we do start our workup there. we have a list of protocols for most problems that need to be worked up, and as needed, we start iv's, draw blood, do ekgs while the patient is being triaged. the doc reviews the ekg, and if it is ok they can wait in the waiting room. blood goes to lab, and we can pull them out of the wr to a bed if anything comes back abnormal requiring immediate attention. then, when they get to a room, the basic work up should be back, allowing the doc to add what is needed or disposition as appropriate. the only part of the basic work-up that can't be done this way are xrays, because our xray dept won't take someone from the waiting room anymore. (by the way, we have a dedicated room just off of triage for the ekgs where there is privacy. it started this way because we somehow lost the monitor for this room, and that was one thing we could do with the space, but has really ended up working out well).
when i am in triage, i do warn people that i put an iv in that if they decide to leave and not wait any longer, they must have it d/c'd, or the police will be seeking them out to bring them back to either have it taken out or to verify that it has been removed. (and no, the police will not do the verification that it is out. they bring them back for us to verify it. people tend not to be very happy when this happens). often, if we are very backed up i will do just a vp rather than starting the iv to avoid this, unless they have really bad veins.
the last night i worked, we were extremely backed up for us, and two of the patients i triaged were older ladies with vague complaints and nothing significant on their ekgs. when the basic work ups came back, one had a crit of 20 and the other had a ddimer of over 1800. both got a room quickly when we got the labs back. others with similar c/o and nl labs waited over 8 hours, many went home, so it helps to get the people who truly needed to be seen back to a room.
is this common in other ers? things i've read on this board lead me to think it is fairly common, but i get comments all the time that "i've never had blood drawn in triage before."
while having a doctor in triage would lessen the glut in the waiting room, it really doesn't seem like a very good allocation of resources when what you really need is to do is get the people out of the beds in the back and dispositioned, to free up new beds. there is only so much you can do in triage/waiting room. and though this may sound callous, many of the people that would be discharged from triage will get up and leave anyway on a busy night, since they really didn't need to be there to begin with. why waste having a doctor see them? why waste your time having to discharge them from triage, one more thing to do up there? i really thought that having a doc in triage sounded like a good idea when i first read your post a while ago, but the more that i think about it, the more i think that it isn't the best allocation of resources.