Tuesday, June 17, 2008

Fast What?

So I had the pleasure of working in fast track recently. Generally I enjoy fast track, because it is in and out and as the RN I can concentrate on one of the aspects of the job that I most love, which is patient education. The downside is the ridiculous amount of paperwork required given the speed with which patients come and go. In this 10 hour shift, we saw 26 patients, which may not seem so impressive until you take a moment to consider some of the patients that should never have been fast tracked (with the exception perhaps of the fish bone):

* The 16 month old with a 102 fever of unknown origin. Fast track course: straight-cath (2 attempts needed), IV line (3 attempts and 3 nurses needed), abbreviated sepsis workup, APAP, Rocephin, etc...

* The 39 year old with back/flank pain and fever. Fast track course: IV line, 2 liters Normal Saline, Percocet, Dilaudid, Zofran, etc...

* The 21 year old with a sensation of "something stuck in my throat" after eating fish the night before. Fast track course: throat x-ray to confirm that there was, indeed, a fish bone stuck in her throat, several telephone calls and mountains of paperwork to arrange a transfer to a higher-level facility with ENT surgeons on call and to schedule an OR

* The 45 year old with elbow cellulitis here for IV antibiotics. Fast track course: after initial consultation/secondary exam, ER doc brought in to review the case, finally IV line and 90 minute infusion ordered

* The 5 year old with severe cellulitis of the thumb with streaking up to the elbow. Fast track course: IV line, pain medicine, skin marking, Rocephin injection, etc...

Combined ER time of those five patients: north of 16 hours.

Four IV starts are about what I expect in a regular ER assignment where the patients stay for an average of 3-5 hours instead of 45 minutes.

It was a day. All I can say is thank goodness for ER Techs.

As an aside: I went through my scribbled notes and as near as I can count, more than 10 of the 26 patients we saw were smokers. Compare that rate of 39% to the state-average of 18% smokers.

5 comments:

Tracey said...

The ER is not a place that interests me at all. I give you tons of credit.

Nurse Practitioners Save Lives said...

Notice how certain types of disease processes happen in pairs or threes?
I used to see it all the time in the hospital on the med/surg floor too.
Nice blog.. I'll put a link up.

Kim said...

Holy cow - I don't work in an ER with a fast track, but is there no way to "de-fast-track" a patient if they turn out to be sicker than originally thought?

Braden said...

a patient can be sent to the main part of the ER, but that means getting the Doc to agree.

I would liken this to getting the Doc to agree to having all of their teeth pulled using only sutures and plastic straws. I suppose it's possible.

Deanna said...

Holy Cow! Our fast track is adult only, and the need for IV anything negates the fast-track status and sends them to urgent or acute. I give you tons of credit on that one!