Would this work? If so, why hasn't it been done?

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Specializes in Corrections, Cardiac, Hospice.

Looking over the thread about ER being used as PCP's. I had to throw this out. Would it help the ER's to have a clinic inside them? Especially in the teaching hospitals. Why isn't there a 24/7 clinic staffed by residents to take on the cases of "oh, I fell down, nothing wrong, just fell" or the wonderful "I have had a cold for a week"? Then, when the patients are triaged, they can be sent straight to the clinic for a visit, or to the ER. Has this been done? Could it be done?

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It's being done, it's called a fast track clinic. Basically it's an urgent care attached to the ER, usually with PA's.

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Specializes in Critical Care, Emergency, Education, Informatics.

It's called Fast Track. And it's been tried just about everywhere. The problem is there is only so much space and staff. And I seem to recal that medicare wasn't going to pay for fast track anymore or at least change the reimbursment.

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Specializes in ICU/ER.

Yes it would work and the hospital I work for has done it. We have a Stat Care clinic right next to our ER. The Stat Care clinic is run by NP/PAs. If you go to the Clinic and the staff thinks you are in need of further care the ER is one door away. I have used the Stat care clinic many of times for my family, the cost to me is the same as seeing my Dr. So I have taken the kids there for sports physicals as well as sore throats and fevers. Twice we have been escorted over to the ER side.

It is perfect because we have access to lab and x-ray and pharmacy.

One thing that ours does is we do demand the co-pay up front. That is something the ER does not do.

So we have had patients go to use Stat Care and were told they had to either pay their co-pay or if they dont have insurance I think it is 80.00 and they just walked the ten steps over to the ER and were seen for "free" for them.

We are open from 4pm-11pm Monday-Friday and Saturday Sunday 9am-9pm.

We share the space with the corporate medical group. So during the work day there is a different group of drs/nurses in there. But that space was vacant after 4pm during the week and closed all weekend, so it is a good use of space.

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Yes it would work and the hospital I work for has done it. We have a Stat Care clinic right next to our ER. The Stat Care clinic is run by NP/PAs. If you go to the Clinic and the staff thinks you are in need of further care the ER is one door away. I have used the Stat care clinic many of times for my family, the cost to me is the same as seeing my Dr. So I have taken the kids there for sports physicals as well as sore throats and fevers. Twice we have been escorted over to the ER side.

It is perfect because we have access to lab and x-ray and pharmacy.

One thing that ours does is we do demand the co-pay up front. That is something the ER does not do.

So we have had patients go to use Stat Care and were told they had to either pay their co-pay or if they dont have insurance I think it is 80.00 and they just walked the ten steps over to the ER and were seen for "free" for them.

We are open from 4pm-11pm Monday-Friday and Saturday Sunday 9am-9pm.

We share the space with the corporate medical group. So during the work day there is a different group of drs/nurses in there. But that space was vacant after 4pm during the week and closed all weekend, so it is a good use of space.

I was going to point out that several ERs in our area have urgent care units in them that function just like you indicate. Also as you point out they are not opened 24 hours a day.

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It's called Fast Track. And it's been tried just about everywhere. The problem is there is only so much space and staff. And I seem to recal that medicare wasn't going to pay for fast track anymore or at least change the reimbursment.
If the Governor of Pennsylvania ever gets his way and get his "Cover All Pennsylvanians" insurance program passed, urgent care units will be one of the cost reduction corner stones of the program. That was one of the things that was pointed out to him, that co-pays are responsible for a lot of people not using these sort of facilities.
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I work in an urgent care that is connected to our hospital. We see upwards to 120 people per day we are open 8am-8pm. The sad thing is that most of the cases we see are things that could wait until the next day for the PCP. We also get people who come in wanting a physical (sports, yearly, etc.) they are not seen in our UC due to the time that it takes to see these pt. It is not like they just found out today they need a sports physical and I am sorry but that is not what UC and Stat clinics were designed for. We help them make an appt. Urgent Care and Stat Care is being used like convenient care. I understand how frustrated the ER nurses are when they get chronic problems coming in that should be seen by their PCP. We do not get the chart and we do not know the patient like their PCP but they will come to us even when the PCP has openings. When we were kids and even when my kids were little we did not run to the doctor all the time. We gave our kids tylenol for a fever. People will come into the UC and tell the provider exactly what they want for meds be it antibiotic, pain med, etc. then they get mad because they may not get an antibiotic. We also have people who will come in 2 or 3 days in a row knowing that we do not have the same providers every day and if one didn't give them what they wanted then maybe the next one will. Some of the things that people come in for are just plain stupid stuff i.e. I woke up an hour ago and have a fever. No I did not take anything for it. I need such and such drug because the fever is not going away. To that we just think "You can't fix stupid"

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Specializes in Home Care, Hospice, OB.

one thing that ours does is we do demand the co-pay up front. that is something the er does not do.

so we have had patients go to use stat care and were told they had to either pay their co-pay or if they dont have insurance i think it is 80.00 and they just walked the ten steps over to the er and were seen for "free" for them.

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with the cold they've had for three weeks, and their hangovers, and the million other items on the "stupid reasons to go to the er " thread...:banghead:

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I work in an urgent care that is connected to our hospital. We see upwards to 120 people per day we are open 8am-8pm. The sad thing is that most of the cases we see are things that could wait until the next day for the PCP. We also get people who come in wanting a physical (sports, yearly, etc.) they are not seen in our UC due to the time that it takes to see these pt. It is not like they just found out today they need a sports physical and I am sorry but that is not what UC and Stat clinics were designed for. We help them make an appt. Urgent Care and Stat Care is being used like convenient care. I understand how frustrated the ER nurses are when they get chronic problems coming in that should be seen by their PCP. We do not get the chart and we do not know the patient like their PCP but they will come to us even when the PCP has openings. When we were kids and even when my kids were little we did not run to the doctor all the time. We gave our kids tylenol for a fever. People will come into the UC and tell the provider exactly what they want for meds be it antibiotic, pain med, etc. then they get mad because they may not get an antibiotic. We also have people who will come in 2 or 3 days in a row knowing that we do not have the same providers every day and if one didn't give them what they wanted then maybe the next one will. Some of the things that people come in for are just plain stupid stuff i.e. I woke up an hour ago and have a fever. No I did not take anything for it. I need such and such drug because the fever is not going away. To that we just think "You can't fix stupid"

I completely understand the part about some pt. coming in 2 to 3 days in a row trying to get what they want. We don't have an urgent care so our small rural ER is the after hours clinic! We have this one pt. that will call the ER before they come in to find out which doc is working, if it's one that won't admit them or give them the pain med of choice, they will wait until the next night and call back until they get a doc they aren't familiar with, the only thing they don't seem to understand is, that even though we have several different docs work the ER, the same ER nurses are here time after time and will give the docs a heads up when this certain pt. calls or comes in. It's got to the point it would be laughable if it didn't cost the tax payer so much when said pt. calls 911 to be transported by ambulance when there is really no need.:banghead:

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I have a question... Do the nurses that triage the patient ever find out what the dx is after the ER visit is done? I'm curious because I had a horrible stomach ache for 48+hrs. I had cramping in my back, n/v, and nothing that I took helped. I DID go to urgent care but they sent me to the ER because she couldn't figure it out. My wc was elevated just a bit (11,000 I think).

So anyway... the triage nurse was extremely rude to me. And I felt like she was irritated because I was coming in with a "tummy ache".

I have posted the things she said to me on another thread, so I won't bore you with the details...

But in the end, I had to have my gall bladder out the next day. The wall was inflammed 5x the normal size and I later found out it was gangrenous.

Now... I'm just wondering if she went home that night and said to her husband... "I had this girl come in with a tummy ache today.. can you believe it?"

Do they find out what goes on after you are behind closed doors?? I'm just curious if she behaves that way to everyone or if she just didn't like me??!!?? :cry:

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Specializes in Gerontological, cardiac, med-surg, peds.

We have an "urgent care rural health clinic" practically next door to our ER (very small community hospital). It has significantly cut down on the "stubbed toe" type patient visits. One large teaching hospital in my area of the state has three sections to its incessantly chaotic ER - one section is basically for the "clinic" patients.

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