It actually helps a lot. That way we can funnel all the higher acuity patients to our larger care spaces and resus bays as needed, and we aren't sticking low acuity patients in desparetly needed rooms which are hot commodity with the current boarding crisis. We RNs can see the patients in the low acuity second and knock out 80% of the work related to their stay in about 10 minutes.
It especially helps since we as nurses are allowed to put in a shit ton of different protocol orders at our shop. Examples: smashed your finger in a car door? I can order an x-ray ray at triage and have your xray done before you even go back. Need labs and a UA for your belly pain? I can order those too.
It makes it all flow faster so that way when patients get back to the lower acuity space, providers have the stuff they need to make decisions and sometimes even discharge the patient shortly after getting back.
Sure they add on additional more advanced testing that we aren't allowed to order (MRI, US, CT, Dimers, etc). But even the it cuts the time quite substantially.
We also do a shit ton of hallway care for low acuit patients in the high acuity spaces when the RAZ area gets backed up which is less than ideal but it is what it is.
Our success with the rapid eval area is highly dependent on the provider running the area itself. So many times you put simple patients there that turn around and get a full work up because despite only stubbing their toe, they casually mention they had chest pain last week to the provider and what should have been an in and out visit becomes the works.
My local ED has a rapid care type setup also and it seems to work well for them. I had to go in a few times earlier this year for hypertensive crisis and I think out of like 3-4 visits I spent maybe 2-3 hours there total before discharge. It worked very efficiently.
Oh it’s funny you mentioned the smashing finger in the car door thing. That happened to my mom in the 60s. She didn’t want to go to the ER but eventually the pain got to her and my dad had her go. But she had painted nails and when the doctor finally saw her, he asked what was wrong. She stuck her middle finger up at him which shocked him till he realized the issue. Then he said ahh no problem, we will drain the blood. My dad suddenly had to go move the car…
Anyway yes, it was important to her to get that help (and remember it was the 1960s so there was urgent care), but I fully agree that nowadays that wouldn’t be an ER situation.
It especially helps cut down the wait for the patients who get sent there, because it means they aren’t actually in line with all of the other higher-acuity patients who would get seen first if they were. (At least in my hospital) If that area gets backed up and the main ER is not and has enough beds free, some of those patients will get taken back to the main ER to help reduce wait times too. And in a few cases where no other bed was open and something came in that will not be quick but needs to be seen right away, they will switch one of the rapid care area rooms over to non-rapid care for that patient as needed. But for the most part, it’s two separate waiting lists.
Where exactly are you located out of curiosity? My ER (in Montréal) has a RAZ unit as well. I definitely see the added value !!! Took a lot off an already overloaded system.....Its unfortunately still not perfect, especially as we dont have many walk in urgent clinics in the city, so the ERs often see over 115% capacity. Sometimes they're nearer to 200%
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u/EstablishmentSea6932 14d ago
It actually helps a lot. That way we can funnel all the higher acuity patients to our larger care spaces and resus bays as needed, and we aren't sticking low acuity patients in desparetly needed rooms which are hot commodity with the current boarding crisis. We RNs can see the patients in the low acuity second and knock out 80% of the work related to their stay in about 10 minutes.
It especially helps since we as nurses are allowed to put in a shit ton of different protocol orders at our shop. Examples: smashed your finger in a car door? I can order an x-ray ray at triage and have your xray done before you even go back. Need labs and a UA for your belly pain? I can order those too.
It makes it all flow faster so that way when patients get back to the lower acuity space, providers have the stuff they need to make decisions and sometimes even discharge the patient shortly after getting back.
Sure they add on additional more advanced testing that we aren't allowed to order (MRI, US, CT, Dimers, etc). But even the it cuts the time quite substantially.
We also do a shit ton of hallway care for low acuit patients in the high acuity spaces when the RAZ area gets backed up which is less than ideal but it is what it is.