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

[whichone'spink]

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.

[Aliakey]

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!

[VICEDRN, BSN, RN]

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?

[N1colina]

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?[/quote']

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, RN]

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...

[VICEDRN, BSN, RN]

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.

[VICEDRN, BSN, RN]

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!

[Nascar nurse, ASN, RN]

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.

[VICEDRN, BSN, RN]

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.

[Orca, ADN, ASN, RN]

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.

[workingharder]

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.

[Nascar nurse, ASN, RN]

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.

[tnbutterfly - Mary, BSN]

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.