I have been a nurse for a long time. I have worked in the Emergency Room a long time. The last few years......I have become curious as to why the definition of what an emergency department does or does not do has been re-defined. ED's have always been the safety net...the one's open when all else is closed.
I worked in the days before EMTALA and COBRA. I remember hospitals sending patients to other facilities based on the ability to pay. I remember patients coding in the back of ambulances because they were turned away based on ability to lay to pay until a hospital that would take them answered the radio. It wasn't pretty.
Why not treat a dental abscess with antibiotics? I get no narcs.... but antibiotics?
If there were more dentists that kept better hours sure send them there...but they don't AND they won't see you if you don't have cash up front or insurance...so the solution is let them suffer until they need IV antibiotics and can be charged more for revisits. You don't write prescription for HTN so it's best to let them go without because it's not emergent enough until they stroke? Many don't have the up front cash to make the appointment with their PCP. Where do we tell these people to go? So only those who have insurance deserve treatment....I disagree.
While I agree there is a misuse of emergency Departments......like teen girl wanting a "pee test" to see if they are pregnant.....an ambulance ride a hang nail.....cure the abuse of the system. Many who do call their PCP's get the go to the ED line...so when they show up in the ED and the expectation that they were sent there....who's fault is that the trusting patient? or the lazy PCP? To VICEDRN.......I am curious.....Who is doing the MSE at your facility?
I'm all about efficiency but.....Do not punish the vulnerable.
If we are deciding that they don't need the emergency room with an abscessed tooth...where do we send them? Where do these people go when you decide they aren't sick enough to be seen? That they stroke in the parking lot. This all sounds good as well.....until something is missed and you (the collective you) is sued. Someone needs to care for those who slip through the cracks.
Many times the cluster of LTC patients coming at once is because these patients have been sick and the MD just now has made their weekly/monthly rounds...these old people (amongst the most vulnerable of our society) who deserve respect and care are just an annoyance to the ED staff. They actually needed to come days ago.....but the MD just came in now....so they are sent out.....the ED staff is NOT happy...and it shows. That bothers me....A LOT.
I'm all for cutting waste....but not at the cost of good care. I signed up to be a nurse first...the ED just happens to be my area of expertise. I do believe the system is broken and I'm not so sure how to fix it. But I do believe the most vulnerable need our protection and care. It's a complex problem.