Currently, the Fast Track (Super Track) area consists of beds 20A, 20B, Chairs 1-5, and beds 21, 22, 23, 26, 27, 28.  Hours of MD staffing is from 12p-10p.  Staffing for this area consists of 1 physician, 1 PA, 3 nurses, and 1 tech.  The primary goal of Fast Track is to see the quick patients and to discharge patients quickly.  The secondary goal is to help decompress the ER.  The physician should see at least as many patients independently as the PA.  It is a collaborative process.  

Here are some "rules" that will help when you work in FT:

1. Have triage assign your name to every single patient that comes into FT, including the ones being seen by the PA.
2. Make sure triage DOESN'T assign patients to the PAs automatically.  Instead, make sure the PAs put their name on a patient one by one only as they are about to go see them.  This prevents them from stacking up patients but not see them immediately when you can just see them quicker.
3. If you don't like getting flu swabs or Rapid Streps on everyone or CXR on everyone who coughs, make sure you tell the PAs ahead of time so they don't waste time getting them.
4. Make it easy for the PAs to come to you early with management questions so that they don't run too far on their own and ride a patient for hours.
5. Your most important role is to manage the flow of not just FT but the waiting room and the main ER.  That means constantly looking at the board and figuring out how to decompress the FT, the waiting room and the main ED.  If there is a predominance of FT patients out in the waiting room, then prevent the charge nurse or triage from putting in sick patients in your more acute beds.  If there are few FT patients in the waiting room and the main ED is overwhelmed, then pick up a few of the sicker patients (but only those that can be admitted quickly or the differential diagnosis is not too broad).  If the main ED still has some empty beds, then don't let them put main ED patients in FT just because you also have a few beds empty.   FT is FT and you'll get busy soon enough.
6. Absolutely no psych or homeless patients in FT unless you're absolutely positive you can get them out quickly.  Even then, don't do it.
7. At 8pm, start giving the sicker patients that goes to beds 22, 23, 26, 27 to the main ED docs if you don't think you can get rid of them before the end of your shift.
8. Continue to see the quick FT patients until close to 10pm.
9. Talk frequently to the charge nurse and triage when things get busy and coordinate the movement of beds.  The main ED docs don't have time for this but it should be your job to do this whenever you see a bottleneck somewhere that can be fixed.
10. Have the PA do RPM if you feel that it is more efficient for them to do this.  I personally feel that the only time when RPM is necessary is when there is a predominance of higher acuity patients in the waiting room and there are absolutely no main ED beds available in the near future.  In that case have the PA start writing some orders and do RPM to get the door to provider time down for those patients.  If it is a predominance of FT patients in the waiting room, then just have the PA stay in FT because that's a better way to keep things flowing.
11. Don't Panic.  Keep the nurses happy and they will run along with you even if they're exhausted like you at the end of the day.  It is extremely fast paced but very rewarding when you can keep things moving.