Comments on: The “Fast Track”

By: Robert

Robert — Wed, 19 May 2010 21:21:27 +0000

Actually I am not in health care but I can think. I am sure I will be dimissed by a lot of you health care professionals and I am sure the smart ones will think about this. The hospital I use and I am there a few times a year because of a chronic condition, has a nurse practioner in the fast track and this forces the triage nurse to be more throough in assesment plus the Fast track doesn’t have beds they have those big chairs things that you sit in to give blood or have blood taken at a lab.

If you send a patient to the fast track who is beyond the skill level of the NP you have to start all over again. Mistakes will always be made if a more serious condition is the main cause but it seems to work well in this hospital. The big problem is the patients who are waiting and don’t understand how triage works an complain that someone went ahead of them as if they were at McDonalds.

By: Robert

Robert — Wed, 19 May 2010 21:14:32 +0000

Shawk

Did you read what he said? Why did you bother? You can not reason with a person like that. They are not reasonable.

By: Painless

Painless — Wed, 01 Jul 2009 23:22:47 +0000

What it sounds like everyone is missing is an experienced, trained triage nurse. They should be able to determine 95 – 99% of the time what truly is and is not an emergent condition or what might and might not be emergent. They should also be able to determine what fits FT criteria and what doesn’t. Kudos to the triage nurse and Charge nurse who don’t waste valuable resources when they are necessary – however it sounds like some of you have put yourselves at the mercy of the nurses in times past. I have been that triage nurse and frequently am a charge nurse, and I work WITH my physicians in the seldomly realized goal to provide the best care to my patients in the most expedient manner. I’m sorry, I do enjoy this blog immensely, but I notice that I tend to see some antagonistic tones prevail when talking about the nursing staff. In my career, there have been times when I’ve saved my physicians bacon, and there are times when they have saved my bacon. Believe it or not, I think the system works best when physicians and nurses have a symbiotic relationship, not an antagonistic one.

By: shawk

shawk — Thu, 18 Jun 2009 07:19:20 +0000

Wow,

You dont understand what is going on at all, do you? and you have some kind of chip on your shoulder for er docs, or all docs?

As an er physician, I see fast track as a necessary evil. remember, we are mandated to see ALL patients coming within about 200 yards of hospital property, give them a medical exam, and stabilizing treatment. Fast track is a good way to do this, and often we have mroe serious illness being picked up from the fast track clinic.

By: dr brenner

dr brenner — Mon, 15 Jun 2009 05:12:36 +0000

It does create a triage conundrum. On the one hand you have the sickest patients go back first to main ER. And the least sick go back second to the fast track. The middle category go last. It’s backa– triage, but more efficient to move through the waiting room patients.

I often admit my FT patients as they are often mistriaged. So again, not so fast. In your case, your nurses don’t view it as a fast track, they view it as a bed. and that causes the whole system to break down.

check out my website: http://drbrenner.blogspot.com

By: Amy

Amy — Sun, 14 Jun 2009 23:10:10 +0000

Fast track should be reserved for fast track type patients. Sending severe injuries to an area of the ED understaffed/underequipped to handle them is inappropriate. It sounds like FT wasn’t turning over much, and you probably ended up not having much to do for part of the day. If it were up to me, I would have suggested that the doc see some extra patients over in the ED, with occasional trips to FT to see/dispo a few patients over there. FT would have been slower, but patients would have been in an area appropriate for their complaint and you could have eased the burden in the main ED while dispo’ing FT patients as well. I guess a lot of that depends on how quickly you work, though. Most of my friends in FFS practice see about 3.5 pts/hr on the low end and stretch to 5/hr.

By: einstein

einstein — Sun, 14 Jun 2009 16:38:55 +0000

Freedom isn’t free. What the left doesn’t understand is that everything has an associated cost. How does this relate to the ER? Well, ER staff fall into one or both of two categories: 1. They wholeheartedly support the global ‘Medical Industrial Complex’ conspiracy and/or 2. They are your garden variety idiots.
Let’s examine the more benign variant first. The idiot’s position is: “I’m just stepping up to fill a void … I’m just trying to do the right thing for the patient in front of me.” !!! Loser !!!! I’ll paint a mental picture for the cognitively impaired: An F-16 based in Iraq is tasked to transit from one forward operating facility to another in preparation for an operation. The left wing bleeding heart liberal pilot says to himself “wow, what a waste of fuel … I’m destroying the planet with my exhaust stream … Al Gore would be so disappointed …. Hey, I’ll do my bit by loading my plane up with mail, spare parts, etc. to make the trip worthwhile — I’ll do more with less !!!! 50% over the allowed weight limit and cramped into a letter filled cockpit the pilot takes off. 20 minutes into the flight he is engaged by an Iranian MIG and he is blown out of the sky. Lesson ??? You can’t have it all — contrary to what Dr. Spock and Gloria Steinem would have you believe. Why don’t police officers provide social work services in between law enforcement calls [they know as much about social services as ER clinicians know about primary care medicine]? They don’t because it would blunt their ability to fulfill their intended responsibilities. Mission creep is dangerous … it resulted in our soldiers being dragged through the streets of Somalia. Would mission creep be possible without the complicity of weak minded front line troops who want to invaginate all the ills of society in an effort to ‘save the planet’? I think not !!
I’ll tackle the willful conspirators next. They saw the angle early on. America began as a land where hard work was rewarded and slackers suffered. Folks paid for what they needed / wanted. People rise to the level of expectation, so in the early days there were very few ‘bums’. Enter the 20th century. Medicine evolved, and hospitals took on their modern form. The dark ages, however, followed in short order … In an effort to efficiently provide a few life-saving interventions for patients while they waited for the OR team to assemble [to repair gunshot wounds, severed limbs, etc] the ER was born. The emergency ROOM worked well, initially. In the early days people had to pay for their emergency care …. Imagine that !!!! After some time it was decided that emergency care should not be withheld on the basis of ‘ability to pay’ — well intentioned, not a terrible move, but definitely a gateway drug. Enter the greedy, ambitious, ER lobby. They conceived a fantastic plan to get rich quick. “Now that the country is conditioned to pay for everyone’s emergency care …. All we have to do is group all medical care under the rubric of emergency care and ….. drum roll here …… we will have achieved back door ‘free healthcare’. “ The best is yet to come !!!! “We’ll give the people substandard primary care and charge them 20X what they would normally pay for it. We’ll get away with this because we’ll put the ‘emergency’ label on all our services …. We are as Gods !!!! Our pay, status, influence, and lifestyle will all skyrocket in a scant few years . Instead of relegating the dregs of our profession to the ER, in the future, doctors will be competing to be selected for the ER. We win 6 ways to Sunday on this !!!!!”
‘Emergency rooms’, my ass !!! They should be called third world clinics w/ a charged defibrillator on site
If ER clinicians had even a modicum of integrity, the door labeled ‘fast track’ would also be labeled ‘exit’.

By: Ryan

Ryan — Sun, 14 Jun 2009 14:51:53 +0000

Regardless of our feelings on low acuity and misuse of the ED, these are the (typically insured) patients that generate income for the hospital (and ultimately our paychecks). To keep them from walking out the door due to long waits, the fast track is there to get these people in and out. When ED’s are closing nationwide, you best believe that hospitals are going to do what they have to do to generate revenue, and if it means having 4-8 beds to handle BS so you can keep the other 20 open, so be it. The end justifies the means, in my opinion.

While I do think that the most acute patients need to be seen first, to place patients there that are big workups does more harm than good. Before everyone goes, “Well don’t the people who are really sick deserve beds first?!?!” acknowledge that when you do this, fast track patients end up in the Main ED getting ignored by their nurses and the big-workup patients end up in the fast track also being ignored, in the form of no cardiac monitor and a typically higher patient to nurse ratio.

Here’s an often little considered angle, though: If a patient codes in the waiting room or suffers a negative outcome, Triage and Charge will likely be held responsible. If a patient suffers a negative outcome in Fast Track, the nurse and doc back there will likely have to answer. So when push comes to shove, what would you do if you were Triage?

By: Joe

Joe — Sun, 14 Jun 2009 07:55:58 +0000

Huh. I thought the big win for the fast track was having a cheaper NP/PA work it rather than an expensive doctor. If the guy working it is qualified to handle the hard stuff, then I don’t see the point.

By: Rob

Rob — Sun, 14 Jun 2009 03:52:32 +0000

I think the bigger issue, isn’t patient placement, but whether a “fast track” should exist at all, it seems contrary to what an ED should be. If you’re not providing services for ED abusers, any chance they break their cycle. If a hypochondriac/frequent flyer had to wait 12 hours rather than being put in the fast track, does it deter their behavior? The only way to maintain a fast track, as a fast track, if you have to have one would be to make it a seperate department, not sharing staff, We’ve had to do that in a couple of sections of our lab. Our micro and blood bank departments had to be seperated and changed into individual entities to keep staff from being pulled. Anyway, I guess If the fast track is part of the ED then the most emergent case has to go first, if it’s a seperate entity then it should maintain it’s purpose to a quick in quick out cash machine for the hospital.

In all seriousness, does a hospital have to have a fast track area to remain solvent? Do you have to guarantee yourself that low reimbursement rate rather than let a patient sign in, sit and wait? I’m not real aware of the economic issues.