Does the ED stand for Emergency Department or the Everything Dumpster? - page 3

by whichone'spink

12,613 Views | 70 Comments

Why, why, why does it seem like we are the dumping ground for the whole medical community? From primary care providers offices, to nursing homes, to the urgent care it just seems like no one wants to be accountable for taking... Read More


  1. 0
    I seriously doubt LTCs are sending pts over just to get a break from them. Remember, NH and LTC have limited capabilities and sometimes need the ED to help their pts. Are there some sent unnecessarily? Probably, but if your parent or grandparent was in LTC and had an issue that wasn't fully addressed wouldn't you be upset? NH--nursing HOME--is where these pts live, and just like at YOUR home, they need more help than what's available. It's no fun for the LTC facility when they have to send someone out because they have to disassemble the chart and discharge the pt, only to turn around and reassemble the chart and readmit the pt upon return, even if it was a same-day visit. As for non-LTC/NH pts, people go to the ED because they can't be refused treatment due to inability to pay. I'd rather go to the ED, get the help I need and deal with the bill later, than be denied at the urgent care or doctor's office because I don't have the $100 up front for the visit.
  2. 5
    Many NH don't have anything more than aerosol treatments, bp cuffs and spo2 monitoring.
    I don't think it's far fetched for them not to know the problem is 3rd degree heart block. How would they know without cardiac monitoring?

    As for transport, the NH have to eat the costs of transport, especially if 911 is utilized. I was told many years ago 911 is only to be used in the event of cardiac/resp arrest.

    I cut nh a lot of slack when they call and give me report up until they give me some indication that they are sending their pt for a ridiculous reason. I always ask was their doc notified, family notified. If the doc didnt say send em or the family and they tell me 'Oh they wouldn't take their pills' and they come a-ox's 4. Then I'm annoyed.
    workingharder, Nascar nurse, ktwlpn, and 2 others like this.
  3. 0
    How can anyone send a resident from a NH to the ED for eval without a physician's order? Am I misunderstanding your post? You have received residents who were transferred from LTC without a doctor's order? It would hit the fan where I work if that happened.
    I have given report to the ED and given the nurse a head's up regarding a difficult situation such as an unrealistic family-that's just courtesy. Then again you could say that I have then prejudiced that ED staff against the family sight unseen-I'm very careful with what I say.
  4. 0
    Yup, people have sent patients to ER without calling patients doctor
  5. 1
    Quote from ktwlpn
    In my LTC if the resident has DNR they almost always go in a transport van.In PA. if we sent them in an ambulance and they tried to die they would be coded despite their DNR status.
    Texas has Out of Hospital DNRs (OOHDNR)... if PA doesn't have 'em, sounds like something they need badly. As a Texas paramedic, if a photocopy of that completed OOHDNR is handed to me with, I will must adhere to its intentions except in the cases of something very easily resolved (such as choking), and will otherwise not "work" the patient if he or she goes into cardiac arrest.

    Most other care and medical treatment is given to the DNR patient like any other patient if not at the point of death. In other words, I can treat SVT, v-tach with a pulse, bradyarrhythmias, traumatic injuries, respiratory distress, comfort measures, etc. like any other patient, as long as I don't pace the heart, defibrillate, or intubate the OOHDNR patient.

    The OOHDNR can be revoked at any time by the patient (verbally), or even by family with medical control consent over the med radio.

    However, in our state, we cannot honor a physician's order for a DNR. The DNR has to be on the Texas OOHDNR paper with the two physician signatures on it, or an official OOHDNR from another state (my service is kinda close to the border of another state). That physician's order DNR becomes a misunderstanding and sometimes a point of conflict with nurses at care facilities in our area. If that's all they have, we have to work the patient as a "full code".

    Hope it helps!
    wooh likes this.
  6. 1
    I'm sorry but nursing homes/ltcs occasionally do dump their patients on us. There are many many times I can recall getting five or six patients from the same facility inside of a few hours. A couple of things happened: a new inexperienced nurse should up or they are short staffed and dumped a few on us to even out the load.My personal favorite complaint ever from nursing home: pic line. I couldn't understand the complaint. Then I started reading the chart: pt had three chest X-rays all done out patient in the past three months. In the third, the report says pic line seen in svc. So the np decides to transfer patient to er. For what, I don't know. Apparently there is an outpatient radiology site and the patient has gone nowhere but the nursing home so it's obviously a freaking typo!!!!!!!!!!!!!!! Ugh!My favorite is when we play what I call the "express admissions game." A transfer that you know is admitted but goes to er first. Like when trauma accepts a patient but sends them to er because "the ct machine is down here. Are you kidding me? Or new onset a fib diagnosed in cards clinic. Seriously?
    redhead_NURSE98! likes this.
  7. 2
    Quote from VICEDRN
    I'm sorry but nursing homes/ltcs occasionally do dump their patients on us. There are many many times I can recall getting five or six patients from the same facility inside of a few hours. A couple of things happened: a new inexperienced nurse should up or they are short staffed and dumped a few on us to even out the load.My personal favorite complaint ever from nursing home: pic line. I couldn't understand the complaint. Then I started reading the chart: pt had three chest X-rays all done out patient in the past three months. In the third, the report says pic line seen in svc. So the np decides to transfer patient to er. For what, I don't know. Apparently there is an outpatient radiology site and the patient has gone nowhere but the nursing home so it's obviously a freaking typo!!!!!!!!!!!!!!! Ugh!My favorite is when we play what I call the "express admissions game." A transfer that you know is admitted but goes to er first. Like when trauma accepts a patient but sends them to er because "the ct machine is down here. Are you kidding me? Or new onset a fib diagnosed in cards clinic. And the Logic is: i know patient will get line and lab in er. Seriously?
    Just curious, what kind of patients are they sending you that are "just evening out their load"? I know it must be frustrating receiving patients that don't need emergency treatment, but you have to remember that a lot of times these are LPNs or inexperienced/unqualified RNs that are sending these patients out because they don't feel comfortable taking care of them in the nursing home, or just sending them home from the doctor's office, in the condition they are in. I've worked in both LTC & family practice, so I've been there. You have to remember these people are not as experienced or qualified as you, and something that appears obvious/easy to diagnose to you, could be foreign to them. They are just protecting the patient (and sometimes their own a**es to protect their license, & or consequences from family members).
    tewdles and workingharder like this.
  8. 0
    Also, remember that if the family wants the patient transported to the ED the facility will transport without an MD order, the family may call for transport themselves...
  9. 0
    Quote from N1colina
    Just curious, what kind of patients are they sending you that are "just evening out their load"? I know it must be frustrating receiving patients that don't need emergency treatment, but you have to remember that a lot of times these are LPNs or inexperienced/unqualified RNs that are sending these patients out because they don't feel comfortable taking care of them in the nursing home, or just sending them home from the doctor's office, in the condition they are in. I've worked in both LTC & family practice, so I've been there. You have to remember these people are not as experienced or qualified as you, and something that appears obvious/easy to diagnose to you, could be foreign to them. They are just protecting the patient (and sometimes their own a**es to protect their license, & or consequences from family members).
    Again, five in a row? That says something. I have come to understand that sometimes this involves less qualified or educated personnel and sometimes not enough staff but my point is that we need to revise emtala. It was not intended to give people already being cared for by licensed personnel a place to be dumped.The dead giveaway is when the complaint is altered mental status but a review of the chart notes from neuro reveals the patient is at baseline. For example, pt is ams and violent and that's the norm for patient according to his chart.
  10. 1
    Better yet and now that I think about it, I have had a resident say to me: I recognize this patient and he was exactly like this the last time I saw him!
    Tina, RN likes this.


Top