My ED can't decide what it wants to be.

rjflyn, ASN, RN · Jan 27, 2007

No what needs to be done is if your going to have a fast track it needs to have a separate waiting area. The best I ever saw though was the hospital owned an urgent care clinic that was basicly across the parking lot from the ER. In fact it was staffed by the same physician group. They had a EMTALA waiver that allowed them to send the pts their after triage.

Rj

nursebrandie28, BSN, RN · Jan 27, 2007

is you management aware of priorty according to sickness?? Non-urgents are just that--- NON-URGENT.... i agree, they need to decide if they are an emergency room or a fast track!! Good Luck

Brandie

chip193 · Jan 27, 2007

Your fast track should be seeing about 60-75% of the patients that present to the ER - at least that's what the two fast tracks that I worked with see.

Can you imagine the waits if those patients were in the general population?

No one wants the non-urgents to be in the ER. If primary care were functional, then they wouldn't be there. But, let's face it - it's not, and won't ever be. So we need to see them as fast as possible and not gum up the works for the sick patients.

That's how Fast Track works.

Email4KH · Mar 7, 2007

Your fast track should be seeing about 60-75% of the patients that present to the ER - at least that's what the two fast tracks that I worked with see.
Can you imagine the waits if those patients were in the general population?
No one wants the non-urgents to be in the ER. If primary care were functional, then they wouldn't be there. But, let's face it - it's not, and won't ever be. So we need to see them as fast as possible and not gum up the works for the sick patients.
That's how Fast Track works.

Here's an idea: Why not guarantee payment to primary care providers for all patients, and reserve the right to refuse ED treatment for non-emergent cases; referring them to their primary care providers instead? It seems that it'd be much cheaper than treating non-emergent cases in the ED.

BBFRN, BSN, PhD · Mar 7, 2007

You can't refuse to treat in the ED. Can you imagine the lawsuits that would culminate from this?

I agree with Chip. I helped to start nursing services in a fast track, and we quadrupled our throughput after it was implemented. We did get a separate waiting room, and that was very effective. I would go get through the triage sheets, pick out the applicable patients, and call them back to the fast track on the overhead. No need to deal with those in the waiting room. The emergent patients were seen faster as a result. The fast track patients were seen by a NP or PA, while the doctors tended to the emergent patients.

Quite frankly, it's none of anybody's business why another patient gets seen before them. I would just say that privacy laws prevent you from discussing another patient's status, end of story. Emergency care is not a first-come-first-serve business.

Email4KH · Mar 7, 2007

You can't refuse to treat in the ED. Can you imagine the lawsuits that would culminate from this?
I agree with Chip. I helped to start nursing services in a fast track, and we quadrupled our throughput after it was implemented. We did get a separate waiting room, and that was very effective. I would go get through the triage sheets, pick out the applicable patients, and call them back to the fast track on the overhead. No need to deal with those in the waiting room. The emergent patients were seen faster as a result. The fast track patients were seen by a NP or PA, while the doctors tended to the emergent patients.
Quite frankly, it's none of anybody's business why another patient gets seen before them. I would just say that privacy laws prevent you from discussing another patient's status, end of story. Emergency care is not a first-come-first-serve business.

I think the law actually says that you can't refuse to evaluate in the ED. I don't think an ED is required to treat.

The idea about the separate waiting areas would be great for avoiding waiting patients' perception that less-acute patients are being treated before more-acute patients! True, one patient's condition is not any other patient's business, but also true is that most patients can identify and do resent when they're not being treated in order of acuity (or order of arrival!). It's not anybody's business, but patients don't understand why obviously less-acute patients are treated before them (I completely agree), and, like it or not, patient perception is a key component of patient satisfaction. Those PAs and NPs who are seeing non-emergent patients could be treating more acute patients, couldn't they? There's no way aroung the fact that fast tracking diverts that resource and others from more-acute patients. Besides all that, it's just plain wrong for a less-acute patient to be treated first. It's a violation of the concept of triage. Not first-come/first-serve, but most acute/first-serve. Fast track violates that principle.

I'm not sure how emergent patients are seen faster when limited resources are being diverted to treat non-emergent patients. Maybe you can clarify!

BBFRN, BSN, PhD · Mar 7, 2007

Sorry- you are correct about the evaluate vs treat subject. But, it does take time to evaluate- sometimes more time than it takes to treat. Fast track does not violate the principle of triage. You're just diverting those patients to an area involving less acute care.

The NPs and PAs were brought in to take care of the non-emergent patients, and the fast track was built for that purpose only. It didn't take away resources. We were a teaching hospital, so the residents and attendings were freed up to take care of the more emergent patients. I've seen it work. You are fighting a losing battle if you think you can turn away all non-emergent cases. There are many reasons more and more people are using the ER as their primary, but that's a whole other thread.

I have admitted more than my share of those who came in as non-emergent, and ended up staying a few days for workups, etc. The emergent cases still got priority in admissions, BTW. They also got priority on the radiology lists, etc. Our ed had their own radiology dept. separate from the main hospital, though. Our whole thing was set up to help get the emergent cases seen faster, without those taking the emergent cases having the non-emergents thrown in, taking up their time and resources. This way, the nurses who had the trauma room didn't have to leave Joe Bob with the flu-like symptoms without a nurse for 2 hours. Joe Bob would be treated and streeted, without having to wait until that nurse wasn't tied up any more. Thus, that bed was opened up for another patient to be seen.

It might be helpful to post a sign in the waiting room stating that non-emergent cases will be treated in the fast track area.

Add to that, the fact that when the fast track was slow, we would float over to the main ER or triage and help out if needed.

Your facility is looking at numbers. If the numbers show a higher throughput, they are not going to get rid of the fast track. If Joe Bob is not taking up that bed for the 2 extra hours that his nurse was in the trauma room, that's 2 more hours of an open bed for other patients.

Uptoherern, RN · Mar 8, 2007

I can empathize with the original poster. The NP in our fast track area wanted me to triage a person who came in for a suture removal. The problem with this is there were many who came in before him; some with serious complaints. Triage is triage; and triage is getting more time consuming every day (we are required to ask weight/height, smoke? drink? been out of the country in last 30 days? Pain #, precipitating factors, do you live alone.......ad nauseaum). I refused to triage him first.