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Hoping I can gain some perspective here! I have been working in a mid-sized urban ED for almost 2 years now, and feel like I have not grown in knowledge/skills as a provider. Over the past year, our ED has been decreasing the number of PA shifts in the higher acuity pods and making us work more triage shifts, where we sit next to the registrar and document a quick note for walk-in pts. Sometimes taking vitals when the triage nurse is out. We aren't allowed to order labs/tests. Just to write a brief liner or two on why the pt is here. (By doing this, apparently the hospital can still bill pts that walk out but were not officially seen). Lately, I've been doing more of these triage shifts than even fast track, let alone being in the main pods. It's a little disappointing to see us being used this way, and I'm worried if this is the general direction city EDs are moving towards.... or maybe it's time to relocate or even change specialities. 

Appreciate any thoughts on this. Or if anyone has had similar experiences at the ED you work at, please share 

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You might want to speak with the medical director about granting PAs to initiate the workup during the triage process.

My PRN job doesn't have a PIT provider and the efficiency of the ED is abysmal. The PAs see levels 3-5 in the fast track and main ED areas and they are burned out.

The ED I travel to has a PIT provider that meets the patient with the triage nurse and interview/asses the patient, put the orders in, order the meds, imaging, and first set of serial labs etc. all of this gets done within 10-15 minutes and the patient is placed back in the waiting room. Patients even get discharged from that said triage room if they do not require a room anymore because all labs and imaging are done and by the time they're re-assessed, they can be safely discharged. This has been the most efficient ED I've worked in. In the main ED the PAs/NPs see levels 1-5 but cannot run a code/intubate. 

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