Does the ED stand for Emergency Department or the Everything Dumpster? - page 2
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... Read More
Jan 21, '13Quote from canoeheadOr you could just not use the word. You obviously know that some would birth a bovine by its use, yet your comment was really sooooo important to be offensive anyway?It's the Exasperated Room, or Everyone's Retarded.
And by retarded I mean Snookie, or Tom Cruise jumping on Oprah's couch. Nobody have a cow.
Jan 21, '13You know what is weird though, sometimes family members ask that an ambulance NOT be used. I swear, I love my job, but the whackadoo family members really grate on my nerves!
Then we had one family member attempt to demand we send a patient with an ingrown toenail via 911 to the ER. Podiatrist visit was the very next day, but his foot hurt. Yanno, I could have given him his percocet... Family ended up calling 911 because *I* did not under orders from doc and DON.
I have all sorts of fun stories.
Jan 21, '13Quote from Esme12What? We can do that??? Dang! I'm chartering a bus!... Some staff at NH will send problematic patients to the ED to give themselves a rest.
Jan 21, '13Is it because people with no insurance HAVE to be seen if they show up at the ER? I know so many patients who use the ER as their PCP. Which really sucks. It makes waiting time longer for everyone and takes staff away from patients who are truly sick. If ER is overrun with patients, some may be either incorrectly triaged, or triaged; sent to wait their turn, then can't speak up when their condition worsens.
Jan 22, '13Quote from crazy&cuteRNIn 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. What was the status on your patient? DNR? What was the outcome?The problem in the OP is that a LTC facility chose to send a sick resident via van instead of an ambulance. If it is a life threatnening emergency than the resident should have been sent via ambulance. I'm sure it is cheaper to use the van however it is not the most prudent.
Often the family insists the resident be transferred,it's not up to us.
I have transferred dying patients to acute care and I have received new admissions and hospital returns from acute care who were obviously in that transition and died within the hour.It happens and it's not something we can control. I try not to take it personally and let it ruin my day
Jan 22, '13Quote from Esme12Sorry Disagree with the idea completely..... that we send them out for a breakBecause the ED/ER always has been the dumping grounds. It always will be. This nursing home sending patients out by transport needs to be talked to....you can't necessarily blame the staff as you have NO idea what they have been told to do. If they have been told by admin that his is what must be done of be fired....in this job market...you do what you are told. Sending out "half dead" patients....if they have had too many deaths recently....and they want their numbers down....guess where they are going to be sent.
Some staff at NH will send problematic patients to the ED to give themselves a rest.Last edit by NutmeggeRN on Jan 22, '13 : Reason: clarification
Jan 22, '13Quote from woohYay! Thank you!!! I HATE that word and can't stand hearing it!Or you could just not use the word. You obviously know that some would birth a bovine by its use, yet your comment was really sooooo important to be offensive anyway?
Jan 22, '13I 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.
Jan 22, '13Many 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.
Jan 22, '13How 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.
Jan 22, '13Quote from ktwlpnTexas 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.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.
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!
Jan 22, '13I'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?