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

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

  1. Visit  N1colina profile page
    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.
  2. Visit  tewdles profile page
    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...
  3. Visit  VICEDRN profile page
    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.
  4. Visit  VICEDRN profile page
    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.
  5. Visit  Nascar nurse profile page
    3
    Quote from Sassy5d
    Yup, people have sent patients to ER without calling patients doctor

    In 25+ years, I have sent more than one resident (full code of course) out to ER due to coding, choking, extreme hemorrhage, etc out without a doctor order. I'm not playing phone tag waiting on a doctor - I'll deal with that later as soon as they are transported out. Priorities matter.
    tewdles, Esme12, and workingharder like this.
  6. Visit  VICEDRN profile page
    0
    Quote from Nascar nurse
    In 25+ years, I have sent more than one resident (full code of course) out to ER due to coding, choking, extreme hemorrhage, etc out without a doctor order. I'm not playing phone tag waiting on a doctor - I'll deal with that later as soon as they are transported out. Priorities matter.
    You're right. Nursing homes priorities are geared towards abusing the er for just about anything. More than once, I have accepted a "hemorrhaging" patient that really had diarrhea and, a "choking" patient who really needed a speech consult. You guys know bls right. I'll assume your choking patient needed a tracheotomy to clear airway. And that your code cart told you patient was coding since I have learned on this thread that nursing homes apparently only have PO meds and aerosolized breathing treatments.
  7. Visit  Orca profile page
    1
    In the last hospital I worked in (geropsych unit), a representative of a local nursing home brought a patient to ER for mental health admission (our admissions team had not been called) and abandoned him in the emergency department. Multiple times nursing homes brought people to ER that they were simply tired of dealing with.
    VICEDRN likes this.
  8. Visit  workingharder profile page
    7
    Quote from VICEDRN
    You're right. Nursing homes priorities are geared towards abusing the er for just about anything. More than once, I have accepted a "hemorrhaging" patient that really had diarrhea and, a "choking" patient who really needed a speech consult. You guys know bls right. I'll assume your choking patient needed a tracheotomy to clear airway. And that your code cart told you patient was coding since I have learned on this thread that nursing homes apparently only have PO meds and aerosolized breathing treatments.
    Oh no, we also have voodoo dolls and a defibrillator made from an extension cord with the end cut off.
  9. Visit  Nascar nurse profile page
    7
    Quote from VICEDRN
    You're right. Nursing homes priorities are geared towards abusing the er for just about anything. More than once, I have accepted a "hemorrhaging" patient that really had diarrhea and, a "choking" patient who really needed a speech consult. You guys know bls right. I'll assume your choking patient needed a tracheotomy to clear airway. And that your code cart told you patient was coding since I have learned on this thread that nursing homes apparently only have PO meds and aerosolized breathing treatments.
    I see your bait....I will not bite. It is this exact kind of statements that continue to pit one specialty against another. Very sad indeed.
    flyingchange, canoehead, Rose_Queen, and 4 others like this.
  10. Visit  tnbutterfly profile page
    9
    ADMIN REQUEST

    Let's please remember that nurses who work in LTC's or any other nursing settings have obtained their licenses in the same manner as those nurses who work in the ED. Each area of nursing, whether it be Peds, ED, Assisted Living, etc. has their priorities.......hopefully the patient's safety and well-being are at the top of the list.

    As nurses, we should strive to work together.....not try to see who is the king of the hill.

    Please refrain from posting divisive remarks.
    JBudd, Susie2310, Rose_Queen, and 6 others like this.
  11. Visit  N1colina profile page
    4
    Quote from Nascar nurse

    I see your bait....I will not bite. It is this exact kind of statements that continue to pit one specialty against another. Very sad indeed.
    Good for you! Obviously this person has never worked in LTC... And we'll just leave it at that
    JBudd, workingharder, Nascar nurse, and 1 other like this.
  12. Visit  N1colina profile page
    1
    Quote from VICEDRN
    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!
    Well considering this is the kind of report you get in the nursing home: "he's fine, she's fine, he passed away last night, and he's fine" sometimes it's a little difficult to figure out what the "normal" is for a patient, especially patients that have had a major stroke where their mental status changes from shift to shift sometimes... Better safe than sorry. These nurses are in charge of 30+ residents some nights and may not know jack **** about any of them... They look funny, they're getting evaluated by an MD. Sucks, but that's the way it is, and it will never change. Unless of course, they start staffing MD's/NPs/PAs overnight in the nursing home. Now that would be an idea... Or maybe more equipment in the nursing homes to treat these patients. Heck, even a respiratory therapist would be nice!
    Last edit by Esme12 on Jan 23, '13
    workingharder likes this.
  13. Visit  wooh profile page
    6
    Quote from N1colina
    Well considering this is the kind of report you get in the nursing home: "he's fine, she's fine, he passed away last night, and he's fine" sometimes it's a little difficult to figure out what the "normal" is for a patient, especially patients that have had a major stroke where their mental status changes from shift to shift sometimes...
    Or the other extreme. Back when I was a CNA, I caught a change in a patient that the nurse didn't recognize because she was a new PRN nurse that didn't know the patient, but I knew the patient well and knew the subtle difference between her "usual" altered mental status and the altered mental status that she had that day. Nurse trusted me and sent patient to the ED. Turned out that she'd had a stroke. Good thing she didn't go to the ED and get a resident MD who just sees "altered mental status" and thinks that's normal because the patient is always altered. Perhaps it's not the LTC staff that needs to rethink their assessment skills?
    Last edit by wooh on Jan 23, '13
    Susie2310, morte, DeirdreG, and 3 others like this.


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