Minimizing risk of provider in triage ...

[Guest ERCat]

Looks like my ER may implement a provider in triage for the really crazy days in the winter. It sucks, but it's a fact of reality. The job will be shared between the PAs AND the docs...

 

The liability, I feel, is huge. If the patient dies out in the waiting room, the first provider who saw them and order tests on them would probably be liable. Also, it's not realistic for the provider in triage to follow up on everyone's results. So if the patient leaves without being seen in the ER Buy a provider, and one of the labs ordered in triage comes back abnormal... isn't this a huge risk?

 

I realize the provider in triage thing totally sucks... but... Any suggestions on how to minimize our liability? Specifically I am thinking about having them implement a policy and a disclaimer in the medical screening exam note done by the provider in triage that alludes that they are simply ordering tests to facilitate quicker movement through the ER...

[Reality Check 2]

What is the strategy of having a provider in Triage?

Reduce door to provider metric times?

 

Start early intervention with CXR, labs, diagnostics?

 

Assign a triage level and give the nurses something to work with?

 

So, if a patient comes to triage with flu symptoms but low O2 sat, tachypnea, tachycardia - do they go to the front of the line and get O2 and a CXR?

How do you (as triage) know who will get the patient once behind the magic doors?

 

I see where there are lots of opportunities to have a patient fall through the cracks, decompensate, leave, etc.

 

Are there protocols or criteria that the nurses follow to bring people back? Is a provider expected to follow those?

 

It could be a positive or a giant pain in the butt as I see it. All depends on why it is done and if everyone cooperates to make it a viable idea.

[rev ronin]

* If the patient leaves AMA, they left AMA.

* You need to make sure there's a process in place for the treating provider to have access to everything the ordering provider ordered, including seeing labs or studies ordered but not back yet.

* If you're handing them off to another provider in a standardized fashion, it's not patient abandonment.

[DizzyJ]

I worked triage in the past and it was kind of nice.....I enjoyed having a little break from needing to handle everything from start to finish.  I screened the patients and ordered labs.  If a patient didn't needs labs and I could dispo them out the door in 2 mins, then I completed them.  Anyone who I considered more urgent then others went to the front of the line.  If a patient walked out before being seen, then they left.  It was not my fault.  If a lab was ordered and came back abnormal, then we documented the patient left and we tried to contact them.  I did not start an official note on the patient.  I only completed an internal note for the provider to see that picked up the patient.  

[anewconvert]

* If the patient leaves AMA, they left AMA.

* You need to make sure there's a process in place for the treating provider to have access to everything the ordering provider ordered, including seeing labs or studies ordered but not back yet.

* If you're handing them off to another provider in a standardized fashion, it's not patient abandonment.

Define AMA here.  You haven't advised a course of treatment to which they are making a choice to not follow.  If you have only triaged them, then they bail what advice have you given them that they have chosen to ignore?   

[jwells78]

We did this at my last job. They called it "RME; rapid medical evaluation"

 

-nurse and PA/NP handled each pt together; ordered tests, labs, xrays; turn around quick patients as able.

 

-primary concern was door to doc time; 15 minutes or less.

-documented a quick S/O/P note; if someone left, it was considered "before intentional discharge;" just dictated a quick note and done.

 

On a busy day with the right staff, you could really clean up the front, which is really about the only good thing I could see in it.

 

It is otherwise a horrible waste of time for a new grad, or anyone new to EM; you cant learn diddly squat up there. Plus, I found that our newer/slower providers tended to gravitate to it because they could just throw on auto-pilot and turn around 1-2 pts A SHIFT. (Waste of resources....?)

 

Its not a bad gig once in awhile if you arent actively trying to find your stride in this career field, but spending 3/4 of every shift up there for the last 6 mo of my career in EM ---stick a fork in me, Im done.

 

This was my experience with it; keep in mind I began this EM journey back in 1999, and my PA-C mentors never had to do it (lucky them!).

 

These metrics I dont see going away any time soon, so it doesnt surprise me to hear of (RME) popping up more and more everywhere I go.

-J

[DizzyJ]

Define AMA here.  You haven't advised a course of treatment to which they are making a choice to not follow.  If you have only triaged them, then they bail what advice have you given them that they have chosen to ignore?   

I am going to interpret the meaning of AMA as a general term implying the patient left.  The use here is probably also grouping in dispositions like "left without completing treatment" or "left without being seen" or "left before seeing provider".  It is implied that the ER staff does not want them to leave without officially being discharged and thus any form of leaving is against medical advice.