When considering putting a MD in Triage and a vertical process the “requirement” for a complete nursing assessment makes it impossible for us to see, treat, and discharge without this causing another bottleneck. Any comments and suggestions?
This is definitely a challenge and needs a coordinated effort. The way we do it at UCSF Fresno is basically: -Patient walks in and checks in at registration window -Patient goes one station over to get CC and vitals input by RN -Patients get called to one of 5 "cubicles" where a doc or APP does the rapid medical exam, also staffed by an RN. They get their labs drawn and EKGs in this area. -Patients triaged by provider to low acuity then go to a second lobby ("vertical" area b/c sitting in chairs) -From this lobby they get called back to smaller areas either for examination rooms or to see a nurse to start medications, IVs, etc. Otherwise they wait here for imaging and to see a provider.
The bottleneck tends to be for patients waiting in the vertical area to see a provider. We figure, at least they have been briefly seen at this point and labs/imaging is started. Sometimes the bottleneck backs up to the cubicles.
I'm not sure that this is the answer, but this is how we have been doing it.
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Robert M. H. - May 8, 2018 1:54 PM
When considering putting a MD in Triage and a vertical process the “requirement” for a complete nursing assessment makes it impossible for us to see, treat, and discharge without this causing another bottleneck. Any comments and suggestions?
Thanks in advance,
HutHut
Jess Mason - May 11, 2018 10:18 AM
This is definitely a challenge and needs a coordinated effort. The way we do it at UCSF Fresno is basically:
-Patient walks in and checks in at registration window
-Patient goes one station over to get CC and vitals input by RN
-Patients get called to one of 5 "cubicles" where a doc or APP does the rapid medical exam, also staffed by an RN. They get their labs drawn and EKGs in this area.
-Patients triaged by provider to low acuity then go to a second lobby ("vertical" area b/c sitting in chairs)
-From this lobby they get called back to smaller areas either for examination rooms or to see a nurse to start medications, IVs, etc. Otherwise they wait here for imaging and to see a provider.
The bottleneck tends to be for patients waiting in the vertical area to see a provider. We figure, at least they have been briefly seen at this point and labs/imaging is started. Sometimes the bottleneck backs up to the cubicles.
I'm not sure that this is the answer, but this is how we have been doing it.