MD/nurse team in ER triage to improve flow

[gamegirlkimmy]

I have been reading alot of articles about how having an MD in triage increases the flow in the ER. The article states that most ERs overcrowd due to each step being dependent on the previous i.e. triage, registration, waiting room, rooming, MD eval, labs/xrays, MD re-eval, ect..... An alternative scenerio is this: Registration generates a "quick chart", The MD is present as the triage nurse gets the chief complaint and history and then gets the process started from triage with labs, Xray, or possibly even discharging pt from triage. According to the articles I have read patient flow is greatly improved, Door to seen by MD times are drasticly decreased, patient satisfaction improved, and JACHO is happy!

Anybody out there use anything similar to this? I would like feedback and any data you might have that would or would not support this.

[nickola]

I worked ER in a level 2 in FL, and the RN could order x-rays, labs, etc. sometimes we'd have to run back to ER & find one of the docs to double check. Then we expanded & used a 'fast track' where we kept 2 RNs & a PA, simple suturing, colds, flu, clinic type complaints were seen there. It worked really well w/a PA & fast-track- we all rotated so we all got to work in the back w/the more serious cases too. The triage included phone triage as well. We never kept a doc in triage, only a PA- and they were awesome!! If we were crazy busy in the back we'd have to close triage for a while sometimes, but overall it worked great & patients were much happier!!

I have been reading alot of articles about how having an MD in triage increases the flow in the ER. The article states that most ERs overcrowd due to each step being dependent on the previous i.e. triage, registration, waiting room, rooming, MD eval, labs/xrays, MD re-eval, ect..... An alternative scenerio is this: Registration generates a "quick chart", The MD is present as the triage nurse gets the chief complaint and history and then gets the process started from triage with labs, Xray, or possibly even discharging pt from triage. According to the articles I have read patient flow is greatly improved, Door to seen by MD times are drasticly decreased, patient satisfaction improved, and JACHO is happy!

Anybody out there use anything similar to this? I would like feedback and any data you might have that would or would not support this.

[PedsERRN]

I work in a level 1 facility. We trialed MD in triage and found that it slowed down our triage times. We are often 10-20+ backed up with three nurses triaging. We expect 5min or less per pt, and with an MD it was more like 10. We also tried to let him take over the third room, leaving 2 nurses triaging and shunting appropriate pts to him. That worked a little better, but didn't seem to improve flow/wait times incredibly(sp?). We also have a Fast Track area, an can order extremity Xrays, rapid streps, and urines from triage.