Harbor:YAFT (Young Adult Fast Track)

YAFT (Young Adult Fast Track)

  • 21-25 y/o ESI 4 & 5
    • Patients 21-25 years of age and ESI 4/5 are to be added to PED track and sent to the PED WR after triage/MSE
    • YAFT will be open at all times
      • Aggressive, psychotic, or intoxicated adult patients should never be sent to PED
      • Triage providers should write “no PED” in RN comments column if not appropriate for PED
    • These patients will be registered after triage, go to tasking, and stay in the AWR after tasking.
    • ESI will be assigned in triage, orders should be placed, and pain medications can be given.
    • If beds are open in the PED and the patient will be roomed quickly, labs/imaging will be performed in the PED.
      • If the PED is busy and the patient will be waiting in the PWR, the orders placed during the MSE will be done by tasking and then the patient will be sent to the PWR.
    • Reassessment after pain medication will be done in the PED
    • If the PED WR is full, these patients should still be moved to PWR on the track but can wait in the AED; this should be indicated on the tracking board under nursing notes (“in AWR”).
    • The 21–25-year-old patients will then be pulled from the PED WR track and can be placed in any room in the PED. The PED Charge RN will decide the most appropriate room for the patient.
    • The young adults sent to the PED WR will be registered in the PED by the registration staff near the PED.
  • 21-25 y/o ESI 3
    • ESI 3 21-25-year-olds can be seen in the PED under the following process:
      • The PED Charge RN should bring these patients to open rooms in the PED once workups are completed (reserving P1-4, 15 & 16 for pediatric patients).
      • For most efficient throughput, these patients ideally have a completed workup and are marked as Teal (stable, easy dispo)
      • If the PED attending is pediatric-trained (Drs. Padlipsky, Saidinejad, or Escalona) and is uncomfortable caring for the acuity/presenting complaint or is a pediatric trained fellow (Dr. So – can only see up to age 21), the EM resident should present the patient to a purple, green, or surge attending.
    • All pts over age 20 requiring admission go to adult inpatient services

BRIDGE (Bridging Resources for Integrated Delivery of General Emergency patients)

  • Patients > 25 y/o in PED
    • When the PED census is low, all available rooms should be utilized for care of adult patients, generally selected by longest wait with completed workup
      • All of these patients should have an MSE initiated, MSE note completed, and orders placed.
      • These patients will not be sent to the PWR to wait to be seen but pulled directly from triage or AWR to a PED room.
      • If there is a patient who needs to be seen immediately, before workup completed and a room is available in the PED, the patient should be discussed with the PED CN and the PED attending.
      • The PED Charge Nurse should pull patients from AWR into the PED rooms until full (reserving P1-4, 15 & 16 for pediatric patients), utilizing their judgement to:
        • Avoid aggressive, psychotic, or intoxicated adult patients
          • MSE provider should write "No PED" if noted to be inappropriate for PED
        • Reduce the number of adult patients brought to PED as pediatric volumes increase with a general trigger of
          • 5 or more pediatric patient in the PWR, or
          • The wait to be seen for patients in the PWR is >2 hours
    • These patients will primarily be managed by the PED team unless:
      • On conference Thursdays, until 1 pm, the >21-year-olds will be assigned to the Purple or Green teams unless the PED attending has capacity (and residents) to see the patients.
      • If the PED attending is pediatric-trained (Drs. Padlipsky, Saidinejad, or Escalona, So).
      • If the AED is boarded and the teams have capacity, the patients should be balanced amongst the PED, purple, green, and surge teams
      • If the PED attending is encumbered with a critically ill patient, they can discuss with the purple, green, and surge attendings offloading some of the adult patients to these teams
    • Residents:
      • Pediatric-trained PEM fellows working shifts as a "resi-fellow" can only see patients up to 25 years of age.
      • An EM R4 can independently disposition ESI 4/5 adult patients with the approval of their on-shift PED attending.
      • Although pediatric residents should prioritize seeing <21 y/o patients, they can see <25 y/o ESI 4/5’s patients who are within their scope of practice. These should all be seen by the attending to ensure appropriate management.
      • Family medicine residents can see all ages, but they have a requirement of seeing 50 pediatric patients during their month in the PED.
    • APP’s:
      • NP’s in the PED (Jazmin, Kelly, & Long) can only see patients under 21 years of age.

Updated by Dr. Padlipsky and Dr. Chappell 7/1/2026

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