Wednesday, March 19, 2014

how to make everybody happy 101

Hey I have this scathingly brilliant idea: an IV station at triage.  I would say about 90% of the people we see end up getting IVs.  This would save a lot of time and trouble.  Put the new nurses out there to practice. They would be experts in a day.

ER docs philosophy these days seems to be: Everybody could use a liter of saline so why not give them one.  It will make them feel like we are really doing something.  It gives them something to concentrate on while we wait for the myriad of other unnecessary tests to come back.

The patients can play it off with thier accompanying relatives or friends and tell them: See I told you I was sick! I have an IV! I am so sick I need an IV...

This is a win-win-win-win scenario:

1) New nurses get practice startings IVs.
2) Patient is happy.
3) Doctor can bump up level of care and make more money.
4) Nurses in back don't have start all of the IVs. They can run, not walk, to the pyxis to get all those meds like zofran, dilaudid, ativan... Patient is in la la land faster.  Everybody is happy.

Yeah I think I'm onto something here....


Kate said...

We do have this!

Our ER works like this:

2 triage nurses
1 waiting room charge nurse
1 waiting room procedure nurse
1 waiting room lab tech
1 waiting EMT/tech
1 waiting room MD

If an EKG is indicated,they get it done in the waiting room in front of an MD.

If the patient can't be roomed right away, we have recliners for these people. They get initial order written by the waiting room doc, IV lines, rainbow set of labs, istat blood gases, troponins, etc... pain meds, IV fluids, whatever...

So if you guys are busy, the starter workup has already been done in the unit.

girlvet said...


Anonymous said...

We're not quite that sophisticated but we do have protocols that allow a triage nurse to start the IV, do EKGs, send labs and give meds in limited circumstances(toradol, ondansetron). We can give fluids in the WR after talking with a doc but don't do it a lot. We'll also send them off for the most common radiological studies from the WR. I'd say that 90% of the people who end up with an IV during their visit, get it during triage. Mind you, we also have 2-3 triage teams going at a time.

Anonymous said...

The reason why everyone gets an IV is so the patient can't leave.