jaygator76 Posted July 25, 2011 Author Share Posted July 25, 2011 who here incorporates this? what are the big negatives? getting ready to create a shift dedicated to triage. in short, responsibilities will be starting workups, decrease door to provider times and treating/streeting when able (suture removals, script refill, etc) Link to comment Share on other sites More sharing options...
jaygator76 Posted July 25, 2011 Share Posted July 25, 2011 who here incorporates this? what are the big negatives? getting ready to create a shift dedicated to triage. in short, responsibilities will be starting workups, decrease door to provider times and treating/streeting when able (suture removals, script refill, etc) Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 25, 2011 Moderator Share Posted July 25, 2011 done it. hated it. very efficient but very boring. lots of volume. no satisfaction of finishing a workup. lots of your colleagues mad at you because you under/over ordered things and didn't start a workup the way they would have. we did it for maybe 6 mo then dropped it. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 25, 2011 Moderator Share Posted July 25, 2011 done it. hated it. very efficient but very boring. lots of volume. no satisfaction of finishing a workup. lots of your colleagues mad at you because you under/over ordered things and didn't start a workup the way they would have. we did it for maybe 6 mo then dropped it. Link to comment Share on other sites More sharing options...
pahopeful Posted July 26, 2011 Share Posted July 26, 2011 We are doing a variation on this. Namely, we don't have a dedicated provider to do it. The 2 midlevels on have to just get it done. We are expected to greet the pt within 30 min of their arrival. I pretty much hate it, but can see some benefits. I dont think I would enjoy doing a triage shift like that mainly d/t the reasons E named. The person in triage invariably as to order too much or too little. The way we do it currently just about kills us because you have to see your reg volume, and manage things out front. I work at a 24k volume facility. Here in Texas it is getting to be standard to post your wait times on the website. One hospital even has it on a billboard! It seems to me to be a big PR thing for the hospital much more than an increase in the standard of care. Link to comment Share on other sites More sharing options...
pahopeful Posted July 26, 2011 Share Posted July 26, 2011 We are doing a variation on this. Namely, we don't have a dedicated provider to do it. The 2 midlevels on have to just get it done. We are expected to greet the pt within 30 min of their arrival. I pretty much hate it, but can see some benefits. I dont think I would enjoy doing a triage shift like that mainly d/t the reasons E named. The person in triage invariably as to order too much or too little. The way we do it currently just about kills us because you have to see your reg volume, and manage things out front. I work at a 24k volume facility. Here in Texas it is getting to be standard to post your wait times on the website. One hospital even has it on a billboard! It seems to me to be a big PR thing for the hospital much more than an increase in the standard of care. Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted July 26, 2011 Moderator Share Posted July 26, 2011 On my first ER rotation as a student, I saw precisely this kind of situation. That particular ER seemed to do it for 2 reasons- 1) They felt a midlevel would do triage "better" than a nurse, and it would help expedite ordering 2) This particular physician group had a policy of seeing every patient a midlevel saw The PA's/NP's who worked there didn't seem to enjoy it (they didn't hate it as much as you did, E :) ), but what was strange is that I saw a NEW PA also doing triage for the ER. With the benefit of hindsight and experience, I fundamentally disagree with having a brand-new PA being tasked with such a job. Nurses don't let newbies do triage- so why would a brand-new practitioner be put in that place too? BTW, PA Hopeful....do you work for a certain ER in the med center in Fort Worth? Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted July 26, 2011 Moderator Share Posted July 26, 2011 On my first ER rotation as a student, I saw precisely this kind of situation. That particular ER seemed to do it for 2 reasons- 1) They felt a midlevel would do triage "better" than a nurse, and it would help expedite ordering 2) This particular physician group had a policy of seeing every patient a midlevel saw The PA's/NP's who worked there didn't seem to enjoy it (they didn't hate it as much as you did, E :) ), but what was strange is that I saw a NEW PA also doing triage for the ER. With the benefit of hindsight and experience, I fundamentally disagree with having a brand-new PA being tasked with such a job. Nurses don't let newbies do triage- so why would a brand-new practitioner be put in that place too? BTW, PA Hopeful....do you work for a certain ER in the med center in Fort Worth? Link to comment Share on other sites More sharing options...
pahopeful Posted July 30, 2011 Share Posted July 30, 2011 No, True Anomaly, I don't work in Fort Worth. But I do work in the DFW area. :) The hospital where I work also as the physician "sees" every pt policy. I think that pt's like the provider in triage thing, but I don't think the providers do. Next thing it will be the docs up in triage taking a pt from start to finish. In fact MattM had mentioned a doc in triage system in an old post. This allows the PA to see pt without need for further f/u from physician and still bill at 100%. I have mentioned it around my workplace, and no docs are jumping at the chance yet! Link to comment Share on other sites More sharing options...
pahopeful Posted July 30, 2011 Share Posted July 30, 2011 No, True Anomaly, I don't work in Fort Worth. But I do work in the DFW area. :) The hospital where I work also as the physician "sees" every pt policy. I think that pt's like the provider in triage thing, but I don't think the providers do. Next thing it will be the docs up in triage taking a pt from start to finish. In fact MattM had mentioned a doc in triage system in an old post. This allows the PA to see pt without need for further f/u from physician and still bill at 100%. I have mentioned it around my workplace, and no docs are jumping at the chance yet! Link to comment Share on other sites More sharing options...
VictoriaO Posted July 30, 2011 Share Posted July 30, 2011 This is interesting, I appreciate hearing the opinions from the seasoned EM PAs I'm seriously considering taking a position at a mid-sized rural ED with this set-up. The PAs work some or all of the shift in the main ED, part of the time up front in the RME (rapid medical evaluation) and swap places mid-shift. The PAs up front see every patient that comes in and starts the work-up. Haven't heard any complaints from the PAs and Docs I talked to at the facility. I'm very swayed by the fact that this is a big rural referral center, lots of interesting sick patients, docs and senior PAs who like to teach and the PAs in the main ED have great scope of practice and opportunities to do procedures and advance their skills. Plus the package is pretty great. Think I'll ask my PA contact about some of the issues you guys mentioned, thanks! Link to comment Share on other sites More sharing options...
VictoriaO Posted July 30, 2011 Share Posted July 30, 2011 This is interesting, I appreciate hearing the opinions from the seasoned EM PAs I'm seriously considering taking a position at a mid-sized rural ED with this set-up. The PAs work some or all of the shift in the main ED, part of the time up front in the RME (rapid medical evaluation) and swap places mid-shift. The PAs up front see every patient that comes in and starts the work-up. Haven't heard any complaints from the PAs and Docs I talked to at the facility. I'm very swayed by the fact that this is a big rural referral center, lots of interesting sick patients, docs and senior PAs who like to teach and the PAs in the main ED have great scope of practice and opportunities to do procedures and advance their skills. Plus the package is pretty great. Think I'll ask my PA contact about some of the issues you guys mentioned, thanks! Link to comment Share on other sites More sharing options...
jaygator76 Posted August 1, 2011 Author Share Posted August 1, 2011 thanks for the feedback all. we've actually tried this before but canned the idea mainly because didn't have the resources to make it flow (not enough techs, RNs). we're a 40 bed ER, seeing close to 80K/year. yes, the main reason for this is improved 'door to doctor times'. other negatives that i've thought of that maybe E you can help address are: patients leaving AMA after workup (we'll be able to order IVs, radiology studies) and how to encorporate RVUs into the whole thing since we are I think 20% RVU based salary. Link to comment Share on other sites More sharing options...
jaygator76 Posted August 1, 2011 Author Share Posted August 1, 2011 thanks for the feedback all. we've actually tried this before but canned the idea mainly because didn't have the resources to make it flow (not enough techs, RNs). we're a 40 bed ER, seeing close to 80K/year. yes, the main reason for this is improved 'door to doctor times'. other negatives that i've thought of that maybe E you can help address are: patients leaving AMA after workup (we'll be able to order IVs, radiology studies) and how to encorporate RVUs into the whole thing since we are I think 20% RVU based salary. Link to comment Share on other sites More sharing options...
polarbebe Posted August 9, 2011 Share Posted August 9, 2011 NES Healthcare Group, does this at my hospital. They have the "No Wait Guarantee" for walk-ins. http://www.neshold.com/ All the PAs/NPs work TTR (triage, treat & release) basically they see and treat fast track patients; triage everybody else to different areas of the ED depending on acuity to be seen by the ED attending. Link to comment Share on other sites More sharing options...
medic25 Posted August 10, 2011 Share Posted August 10, 2011 I've done a couple of these shifts now at my per-diem job (large inner-city community hospital); it's not bad for an occasional shift, but I could see it getting painful to do full-time. The nurse does the preliminary triage, and I either pick which patients I want to see, or the nurse asks me to see a particular patient. It does seem to have some benefit as far as getting workups started and speeding up dispos, but I haven't had any feedback from the folks behind me in the main ED about whether they like my workup or not. The real pain seems to come when volume is high and you can't move patients back to the ED. My first shift there was pretty benign, as we were able to move the patients through pretty quickly. My shift today was brutal, with 30-40 patients in the waiting room for most of the 8 hours and no open beds in the ED, which is pretty much impossible to keep up with. I think the process works best when you can get the patient moved back into the ED in a reasonable time, but by the end of my shift today I was admitting patients, discharging belly pains, starting IV antibiotics, etc, all on patients who still hadn't left the waiting room. You end up spending a lot of shift looking at angry patients and fighting for a room on the people you're really worried about; not how I'd want to spend every day at work. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 10, 2011 Moderator Share Posted August 10, 2011 yup, lots of fun to do the full workup from the waiting room. we end up doing that every now and then. folks sitting out there with labs done, IV's running, etc waiting for a hospital bed. a few yrs ago we had a waiting room to lifeflight case without the kid every getting a room. needed a peds subspecialist(ct surg-congenital heart kid going bad quickly) emergently and there was major constrsuction on the highway so we flew the kid 10 min away. Link to comment Share on other sites More sharing options...
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