MD/NP in triage?

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Specializes in ER.

We are considering having one MD or NP in triage to evaluate if labs are needed, referrals required, a quick look and out the door, etc. Is anyone else doing this? If so, how is it working, what are the pros and cons, how are the logistics of this? Any input would be appreciated. Thanks

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Specializes in emergency nursing-ENPC, CATN, CEN.

I think it's great in helping weed out those that could be referred back to their FMD--the non-urgent/ clinic types. It would also cover the EMTALA screening exam requirement as well.

May help with implementing more triage fast protocols to help decrease through-put times as well.

Let the MD/NP focus on the hx of complaint and the various info required, utilize others to fill in the rest of the chart- VS, med list, allergies, etc

I think it's a great idea. Several of our local hospitals are using NP/PA's in this manner

I know there are studies out there comparing MD triage/ nurse triage--(not looking skills and/or accuracy-but improved ED wait satisfaction, etc)

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Specializes in ER, Trauma, ICU/CCU/NICU, EMS, Transport.

You say you know of some in your area, can you give some contact names for me, I'd like to speak with them directly.

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We use an MD at our triage, five days a week from 10 till 6. What happens is we complete our usual triage assessment (generally without interference from the MD) and then after the MD will review the chart, possibly speak with the pt for a moment if they feel the need and then order things that can be done from the waiting room - bloodwork, xrays, u/s, ct, etc. The idea is that by the time a room becomes available, the results will be back and the patient hopefully won't have to stay as long. We've had TLPs (as we call them - triage liason physicians) for about six months and while I haven't seen any official report on how it's going, the reviews around the department are mixed. It largely depends on the doc, of course, but from a nursing perspective, it hasn't seemed to have made as big a difference as I would have hoped. The ones who need to stay for treatment still need to stay and the others we would have fast-tracked anyway. Plus, there's always the chance of the 2nd ER doc who actually sees the patient wanting just that one other blood test or xray that the initial doc didn't order, thus making the pt have two blood draws or what not instead of one. The physicians are quite highly paid for much less work than they typically do on the floor - I've always thought it was a position much better suited for an NP. I think sometimes they think so too. They get bored a lot at triage!

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Specializes in ER/EHR Trainer.

We started doing ATP-advance triage protocol without a doctor/NP/PA. Anyone with CP that's been cleared by EKG and anyone with abdominal pain have standing orders.

CP-cbc, cmp, trop.....Abd pain-cbc, cmp, amylase,lipase, ua...obvious deformities to limbs-xrays......cough, and fever...urine hcg/cxray.

We can give breathing tx, toradol injection, tylenol or motrin, and sl zofran for nausea as standing orders.

We also call Dr if r/o dvt for doppler, r/o appy Ct scan, head injury/orbit injury ct scans, Abd KUB and anything else.

We also have a PA or NP in triage if our waiting room gets busy and to follow labs.

It really depends on the waiting room, the triage nurses, and the experience of all involved. It still is not seemless.

Maisy

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I would love and most of my colleagues would love to have some sort of filter for the ESI/EMTALA procedures we have to deal with on a daily basis. Having an NP would be awesome in triage.....we even have 3 triage rooms that would fit the bill for this kind of weeding out process. All over the US EMS is being forced by the cities they contract with to bring in whomever calls or a taxi ride to the ED. The system is outrageous.....and whenever I am at the command center and get an EMS call about enroute with a cough, wart, constipation, ESI4/5 I send them to triage where they wait to be seen based on acuity. Vitals stable.....they wait until an appropriate treat and street quick care bed becomes available. It's our triage skills that determine where a patient goes.......I use mine wisely and ethically.

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Specializes in Nephrology, Cardiology, ER, ICU.

Hey guys - what a timely thread.

I was just hired part time at a community hospital to be the triage APN! I will be developing the position with the idea that it would be available on evenings (when the census is the highest).

My experience is 10 years in a level one ER as a staff RN, charge, case manager.

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Specializes in Education, FP, LNC, Forensics, ED, OB.

Just wanted to tell you congratulations, traumaRUs!!!!!!!!

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Specializes in ER.
We are considering having one MD or NP in triage to evaluate if labs are needed, referrals required, a quick look and out the door, etc. Is anyone else doing this? If so, how is it working, what are the pros and cons, how are the logistics of this? Any input would be appreciated. Thanks

where I work, they just instituted this new plan, having PA's and NP's do a screening, and then deciding what they need as far as labs and tests. Then they either scoot them to the Main ER waiting or keep them in screening (which is now Urgent Care, really, since they closed the Urgent Care for Admitted holds). The only thing this new process expedites is the ordering of certain tests which require Radiologist approval here, CT's, Ultrasounds.... otherwise they're doing what the triage nurses have always done, with the exception of documenting everything. So when the patient gets to the final destination (in the Main ER or screening), the primary nurse still has to do the triage and ask all of the questions that might have been asked by the PA or NP, but was not documented. They don't put in the meds, the allergies, the hx. They just grab the info, make a quick note and determine where to place and what to order. It doesn't speed up the whole process at all. Like I wrote, the only advantage I see is that they can get Radiologist approval quicker for those tests that may take a while to order. It all still adds up to the same wait for patients.

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Specializes in ER.
We use an MD at our triage, five days a week from 10 till 6. What happens is we complete our usual triage assessment (generally without interference from the MD) and then after the MD will review the chart, possibly speak with the pt for a moment if they feel the need and then order things that can be done from the waiting room - bloodwork, xrays, u/s, ct, etc. The idea is that by the time a room becomes available, the results will be back and the patient hopefully won't have to stay as long. We've had TLPs (as we call them - triage liason physicians) for about six months and while I haven't seen any official report on how it's going, the reviews around the department are mixed. It largely depends on the doc, of course, but from a nursing perspective, it hasn't seemed to have made as big a difference as I would have hoped. The ones who need to stay for treatment still need to stay and the others we would have fast-tracked anyway. Plus, there's always the chance of the 2nd ER doc who actually sees the patient wanting just that one other blood test or xray that the initial doc didn't order, thus making the pt have two blood draws or what not instead of one. The physicians are quite highly paid for much less work than they typically do on the floor - I've always thought it was a position much better suited for an NP. I think sometimes they think so too. They get bored a lot at triage!

that's a bit overdone to have an MD out there where a triage nurse, PA or NP could do - the MD would be better to utilize their time and pay to see patients on the main ED and expedite from that end. We still order using protocols, so whatever a NP or PA may order (it's most often a la carte ordering), the nurse still adds to it based on their assessment (which usually winds up being ordered later by the ER MD that sees them anyway).

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Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.

I think what's happening is that some hospitals are not fully grasping the appropriate use of mid-level and higher practitioners in triage. If I'm understanding it correctly the purpose of having these kind of people in triage is to provide the EMTALA required medical screening not to hasten care that would be normally provided...that's what protocols are for. I would interpret this to mean that the NP/PA/MD would screen patients coming into the ED and those who did not require immediate care would be directed to follow up with their PCP/clinic or given the option to pay all or part of their emergency room bill up-front (with the hope that most of these people would go home). These people could not later claim that they "were not seen by a doctor" because they did actually receive the federally mandated medical screening. When utilized correctly this format could effectively decrease the overuse of emergency departments..that is until the usual abusers figure out a way to get seen anyway (the old I have chest pain scam).

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Specializes in Nephrology, Cardiology, ER, ICU.

FlyingScot - that is my understanding also. Where I'm going, it is a brand new role as they have no mid-levels in the ER.

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