"express care guidelines"

core0 · Jun 13, 2008

I am an FNP and have a strong emergency background. I have been tasked with looking into setting up a fast track or express care concept in the emergency department. I am interested in getting others triage guidelines or patients evaluated in this type of system. Any help would be greatly appreciated...
If I could get actual guidelines I would greatly appreciate it
[PM Member]
David RN, MSN, FNP-C

I'm assuming you mean guidelines on who can be referred to urgent care?

Most hospitals use either the ESI system or the CTAS. For most places ESI 4 and 5 go to fast track (you can argue that most ESI 5's should just be sent home). Some places will allow select ESI 3's to be seen in fast track. For more on the ESI system:

http://www.ahrq.gov/research/esi/esi1.htm

David Carpenter, PA-C

das264 · Jun 13, 2008

I thank you for your response. I have just seen so many different examples of what is actually seen in these departments I was wondering if I could get my hands on some actual department guidelines. Some departments won't have lacerations sewn in fast track, some won't see vag d/c etc.. and then some do..

core0 · Jun 13, 2008

I thank you for your response. I have just seen so many different examples of what is actually seen in these departments I was wondering if I could get my hands on some actual department guidelines. Some departments won't have lacerations sewn in fast track, some won't see vag d/c etc.. and then some do..

Mostly because that depends on your resources. There are some Fast tracks that are set up like mini ERs for less sick people. They have easy access to labs, x-ray etc. Others are set up only to see minor medical illnesses.

Take you lac example. A simple lac is within the scope of most fast tracks. However, if you only have two rooms to work with you are going to tie up one of your rooms for a while and your only provider. Same with lady partsl exams.

Where I did my EM rotation fast track was 9 rooms with 2-3 providers. They did pretty much the full range of ESI 1-3. When I was in the Army fast track was 3 rooms and one provider. They only did medical issues. There was a separate suture bay where the medics sutured complex and simple lacerations.

First you have to define your resources then you can decide what you are capable of doing. Once you do that find out what the EM physicians are comfortable letting go of.

David Carpenter, PA-C