Fast Track Education

DayDreamin ER CRNP · Jun 3, 2018

I think your idea of an info card is a good start. In my experience, however, no one reads them and they end up on the floor. If they do read it, they will have 8000 questions about why they don't get a "bed" in the back. There is a weird perception that if they aren't getting a BED they aren't been properly seen. Not all patients feel this way but we all know there is always that "one guy."

I think having a personal conversation with the patient while he/she is still in triage is best. I say something like, "We are going get an X-ray / XYZ test while you are waiting to get the process started. From there, we will work on getting you a chair in our Fast Track area and can get you seen and treated and out the door a bit quicker. Sound good?"

In our ED, the FT area is run by the NPs but a doc still has to lay eyes on the patient. While a priority 4 patient is usually a FT'er, someone needing suture or an I&D may go on our "procedure" bed but still treated like a FT chair. Clear as mud?

JKL33 · Jun 3, 2018

Hi Everyone! My facility is working on improving our Triage/Fast Track process and area. We have a high acuity department with complex patients. Our Fast Track volume is hit or miss. Those we do see in our Fast Track area have the "I paid for the ER but got Fast Track Service without the cheaper bill" mentality. We get many complaints about not getting a "bed", being "left in waiting room" and not seeing "a real doctor". We do have a small 2 bed fast track area for quick evals, treatment and discharge. We have a small fast track waiting room with 6 chairs and a main waiting room. We have tried our best to verbally educate on the Fast Track process. I am considering a Fast Track passport or post card to educate about Fast Track and our goal to evaulate and treat rapidly. I also considered having a place for the Triage/Fast Track Nurse to handwrite their name and the Mid-level working with them, along with a couple check boxes for planned testing. Does anyone here have something they use? What works at your facilities? Thanks for any advice.

All else aside for the moment, it's not an unreasonable thought. This whole shebang is a convergence of expectations, regulations, and the need to actually provide emergency care for sick people.

I would start with seeing what cost-effective physical modifications you can make to the area that would send the message that these patients are being placed in a treatment area, not a waiting room.

Discuss at staff meetings some verbiage (not scripting) that may be useful under the circumstances, e.g.:

"We should be able to take care of your problem quickly today, so I'll show you to what we call the "fast-track" area..."

as opposed to

"Have a seat [in the same seat you were waiting in] and we'll get some things going."

I do think you should make up some cards. Yes, they'll end up on the floor, but word will get around.

Sorry, I have to say this - - - I would practically cry real tears, beg and implore you to not make a bunch of extra stuff for staff to do because of people's complaints about a system. It is overall a problem that is kind of unwinnable, no reason to make good people hate life itself. I'm being a bit facetious there, but YKWIM.

AnnieOaklyRN, BSN, RN, EMT-P · Jun 7, 2018

I would say to the patient, "so would your rather get the "bed" you think you are paying for and wait for hours OR would you rather get a chair and a mid level provider and be in and out in a half hour, pick one. "

I love how patients are so entitled. So frustrating!!

Annie

Kuriin, BSN, RN · Jun 7, 2018

Why not utilize a billboard or something near registration that says something like, "You may be placed in our FastTrack area which is a rapid evaluation, treat, and discharge area if you are not ill enough." -- though, that in itself could be an insult. Especially for parents bringing in their children.