dmdpac Posted March 5, 2016 Share Posted March 5, 2016 Do the EDs for which many of you work have a time goal for door to dispo of your fast track (ESI 4-5) level patients? Do you have any idea or information as to how they arrived at their goal time? Can you help point me to any material supporting or discouraging any particular time goal? The system for which I work has a door to dispo time of 60 minutes for their fast track patient population. For a variety of reasons, some systemic and some not within our control, our times have been increasing much to the dissatisfaction of the powers that be. We, as providers, have not been getting much push back as yet. Our provider patient contact to dispo times are still good. However, the conversation, as part of a larger ER management discussion, is becoming more frequent and louder. Nobody has been able to provide us with any information as to how the organizational goals were made. Thanks, in advance, for any help. Link to comment Share on other sites More sharing options...
Guest ral Posted March 5, 2016 Share Posted March 5, 2016 No push for times in my current hospital ERs, although they do keep track. About ten years ago, I worked at one hospital that opened the "fast track" side at 0900 daily (when the first PA/NP shift of the day started. Was only a doc on until that time of morning). It had twelve beds. Starting around 0800, triage nurses would hold patients for the fast track side. Promptly upon arriving at 0900, they would fill all twelve beds. The medical director called me into his office after the first few weeks, and told me that they had a goal of door to dispo being 1 hour in fast track. I questioned his math skills, pointing out that twelve patients all roomed at the same time, equates to six minutes per patient from the point I introduce myself, to the time the nurse signs them out of the computer. Not going to happen. Link to comment Share on other sites More sharing options...
nebero Posted March 5, 2016 Share Posted March 5, 2016 Do the EDs for which many of you work have a time goal for door to dispo of your fast track (ESI 4-5) level patients? Do you have any idea or information as to how they arrived at their goal time? Can you help point me to any material supporting or discouraging any particular time goal? The system for which I work has a door to dispo time of 60 minutes for their fast track patient population. For a variety of reasons, some systemic and some not within our control, our times have been increasing much to the dissatisfaction of the powers that be. We, as providers, have not been getting much push back as yet. Our provider patient contact to dispo times are still good. However, the conversation, as part of a larger ER management discussion, is becoming more frequent and louder. Nobody has been able to provide us with any information as to how the organizational goals were made. Thanks, in advance, for any help. Let me guess. You work for EmCare are HCA hospital. I have no idea how they come up with 60 minutes. I just do my best and time stump my chart when I pick up and discharge patients. I no longer worry about things beyond my control. If it takes one hour for xray or the RN takes another hour to actually discharge patient after I discharge, this is not my problem. Sent from my SM-G928V using Tapatalk Link to comment Share on other sites More sharing options...
jwells78 Posted March 7, 2016 Share Posted March 7, 2016 Door to doc times; door to discharge times, ect, ect I am still waiting for: door to sandwich tray times and door to norco times. ... ... We literally just instituted the latter at my facility. Because quality medicine isnt enough anymore everyone. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 7, 2016 Moderator Share Posted March 7, 2016 Door to doc times; door to discharge times, ect, ect I am still waiting for: door to sandwich tray times and door to norco times. ... ... We literally just instituted the latter at my facility. Because quality medicine isnt enough anymore everyone. yup, us too. door to pain med is new quality measure. trying to leave that job that you and I used to work together at in favor of all solo or double coverage rural positions. Link to comment Share on other sites More sharing options...
Reality Check 2 Posted March 7, 2016 Share Posted March 7, 2016 Put the patients on a conveyor belt and have everyone of the care team stand still and work 'em as they pass by. How fast can you do a pelvic on a moving target?..... Sorry, couldn't resist. Medicine is not McDonalds! Link to comment Share on other sites More sharing options...
dmdpac Posted March 7, 2016 Author Share Posted March 7, 2016 Put the patients on a conveyor belt and have everyone of the care team stand still and work 'em as they pass by. How fast can you do a pelvic on a moving target?..... Sorry, couldn't resist. Medicine is not McDonalds! This is actually pretty funny. Is it wrong to laugh? Link to comment Share on other sites More sharing options...
SHU-CH Posted March 8, 2016 Share Posted March 8, 2016 My experience in fast track was that many of the patients were there for minor procedures and tended to be fairly time consuming. Unless you have a lot of staff to help prep and cleanup even a simple procedure like putting two sutures in someone is going to tie up 10 minutes. And this is for an easy patient. Make it a screaming kid and you are trying to fish a bead out of some orifice and be prepared for a 20 minute wrestling match. There are also many threads on here that speak to Fast Track abuse. On institution I worked at would place essentially every backboarded patient in Fast Track. They would also put higher acuity patient in Fast Track "just to get them started." It sort-of defeated the purpose of having a Fast Track. In reality the Fast Track just became a satellite ER. Link to comment Share on other sites More sharing options...
dmdpac Posted March 8, 2016 Author Share Posted March 8, 2016 Thanks for the replies and humour. I am not employed by the above named organization. The group for which I work treats us well. We are not relegated to FT. While we PAs are solely responsible for the FT areas we do rotate through all acuity treatment areas of our ERs often times alternating the next up chart with the attending. The more I look the more I think the 60 minute time frame is fairly arbitrary. I also agree that medicine is not fast food. Or, as one of my colleagues recently referenced, "This is not Burger King. You don't always get it your way." Link to comment Share on other sites More sharing options...
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