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 LTC, Family Practice, Meg/Surg.

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 :)

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Specializes in LTC, Family Practice, Meg/Surg.
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![/quote']

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!

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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?

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Specializes in Education, FP, LNC, Forensics, ED, OB.

One last warning. (note, posts have been removed since last staff redirect)

Stop the one-on-one attacks and divisive replies.

Future replies will result in points against member account.

Final warning.

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

Obviously if you are in the middle of a code you'll activate EMS first and then call the doc. after the dust settles,that's a no -brainer.IMHO I have just never seen a nurse decide on her own to just send someone out

Things to know about LTC-most don't have lab or radiology services on site so a stat eval calls for transfer to the ED.

A resident with late stages of Alzheimer's disease CAN have AMS-we know these people and we KNOW when something is going on and DNR does NOT mean do not treat.We have to deal with family members pushing for what we may consider to be futile care,often you see the results.It's what we do-the plan of care is NOT driven by us.

Why so much anger at LTC? What about all of the other groups that have gotten stereotyped together and bashed on here over the years? Is the prevailing attitude that these elders don't deserve our resources? How many frequent flying drug seekers were in your ED ruining the day when this LTC resident was dumped ?

If this crap really is occurring frequently in your local nursing homes it needs to be reported it-it's neglectful and maybe abusive.

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Specializes in Emergency.

It "feels" like we're being dumped on when the multiple pts from the same nh show up on friday afternoon for ams. And we can't figure out what's different because we don't know them. And there's a list of meds from the doctors orders but no mar.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Sorry :yawn: Disagree with the idea completely..... that we send them out for a break
I was not referring to anyone in particular. My response is based on YEARS of experience with many different facilities in multiple states....unfortunately the behavior occurs...but is by no means a reflection on NH and nurses who work in nursing homes.

It is my personal observation...nothing more.

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The unfortunate thing about er personnel is that they feel they should be able to pick and choose their clients. People go there because they have no where else to go and feel their health is in immediate danger. The er is suppose to have personnel and equipment to figure out what is wrong. Insurance companies put other providers responsible for the cost of ambulances if a client is moblle. They of course cannot afford to pay these fees. if you cannot deal with these things perhaps it is time for you to move out of emergency services and find another specialty. As far as drug seekers, it is unfortunate their physicians did not properly address the problem and that is why they are in emergency. Addicts can get there medicine much easier from a dealer. It is unfortunate that er personnel cannot deal with each patient in as well as possible and move on to the next one. If you are understaffed it is managements fault not the patient.

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I'm sorry, but that's just too funny to not say something! :roflmao:

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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.[/quote']

The people that you state are "dumped" are people who who deserve to be cared for. If a nursing home cannot safely care for a patient, they do not have a lot of options. They can "let the person die in place" or "send them to hospital for diagnosis and/ or treatment." Most (thankfully) will opt for sending them. They need your assistance in managing the illness. The nursing home may not have the skills or resources to properly assess and manage the current situation.

The problem, as I see it, is in the system that does not facilitate appropriate options for diagnostic services for the elderly. When a "new" problem arises (particularly a sudden change), there is no back up plan to manage the person. If they do not send them to the ER, they would be negligent if the person died of something minor and treatable.

As I see it, the current system expects that the ER's will manage these situations. It is disappointing to read that nurses view certain patients as unworthy of their knowledge and skills. These patients deserve to be treated with dignity.

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

Nh patients transported to the ED likely do not provide the same level of excitement, activity, and challenge as say; a big trauma. My friends in ED prefer trauma, drama, and intensity.

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Specializes in Emergency.
Nh patients transported to the ED likely do not provide the same level of excitement, activity, and challenge as say; a big trauma. My friends in ED prefer trauma, drama, and intensity.

Disagree. I have no issue working up any pt from anywhere who needs help. I think my real issue with nh pts who seem to come in for no real reason is lazy docs who respond to calls from the ltc rn by saying "send them to the er".

I understand the ltc staff has no choice when the doc says ship 'em out.

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