Does the ED stand for Emergency Department or the Everything Dumpster?

Specialties Emergency

Published

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 care of patients, so they dump patients in the ED. It's just very frustrating. It's even going to the extreme where nursing homes are sending dying patients by the transport van, instead of by ambulance. Just a couple of days ago, I had a patient that was sent over to the ED from a local nursing home by a local transport service, for altered mental status. Now why was the patient having altered mental status? Because the patient was in third degree heart block. When this patient was hooked up to the cardiac monitor, it showed that the patient's heart rate was nearly asystole. Now why this nursing home chose to send this patient by a transport van instead of by ambulance is beyond me. What if this patient died while in the transport van? The drivers are not even trained in CPR. And apparently this nursing home has sent very sick patients by transport van many times before. This is just a rant, with no particular focus at all. Just frustration with how the medical establishment sees the emergency department as a dumping ground.

Specializes in PICU, NICU, L&D, Public Health, Hospice.

The ED as a dumping ground is the way our capitalist system has evolved.

It is not likely going to change in the near future.

LTCs/SNFs/ALFs will continue to send their elderly and ill patients to you for all sort of crazy reasons and a few good ones. Those patients will be transported to a large degree the way their families want them transported...even perhaps in the back seat of their car.

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.

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?

You 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.

... Some staff at NH will send problematic patients to the ED to give themselves a rest.

What? We can do that??? Dang! I'm chartering a bus!:cheeky:

Specializes in NICU.

Is 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.

Specializes in LTC,Hospice/palliative care,acute care.
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.

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. What was the status on your patient? DNR? What was the outcome?

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

Specializes in kids.
Because 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.

Sorry :yawn: Disagree with the idea completely..... that we send them out for a break

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?

Yay! Thank you!!! I HATE that word and can't stand hearing it!

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.

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.

Specializes in LTC,Hospice/palliative care,acute care.

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.

Yup, people have sent patients to ER without calling patients doctor

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