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.

[NurseOnAMotorcycle, ASN, RN]

In the last few months:

Guy came in by ambulance for a 2 inch by 3 inch rash.

Girl came by ambulance because she poked her thumb with a needle while hand sewing.

Old lady came from home by ambulance because "My family won't pay attention to me." (This one kind of sad but still...)

Leg cramp, resolved.

A cough after drinking "down the wrong way", resolved. (male, 30s)

Sigh.

I think this is going to turn into the "Triage complaints-good, bad, ugly" thread.

[Mulan]

Is insomnia an emergency?

[VICEDRN, BSN, RN]

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.

Just as a point of education, I do not believe that the role of the emergency room is to identify the cause of any patients complaint and treat it. Rather, it is our job to identify, stabilize emergent conditions and move patients to the appropriate level of care. We would end a lot of frustration if folks would realize that we have no intentions of identifying the condition once we have identified that no emergency tExists and no plan to cure it either. Some examples: we no longer treat dental abscesses with antibiotics unless you need iv antibiotics as this encourages revisits. We do not write scripts for hypertension in our er.We would love to help identify a stroke in you ltc/nursing home patient but if they were acting like this last time and act like it again today, we have nothing to go on.We do in fact pick and choose. It's called medical screening and hospitals are becoming more anymore aggressive about it.

[VICEDRN, BSN, RN]

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.

There were and are very few seekers in our er because we refuse to give them what they want so they go other places that cater to them. I don't think there is a thought that the ltc patients don't deserve emergent care but rather that they don't deserve to be in the er. It is disruptive to them, exposes them to infection and frankly,rarelyq results in an improved outcome for these patients. I agree that we should be reporting some facilities but there isn't much to report when someone dumps five pts on you at once from one place. As for why that causes resentment, well, I signed up to work in the er today, not the ltc. I am sorry you are short staffed ( the ltc that does the dumping of five at once) but we are not volunteering a nurse to you.

Have a good story: have a friend that works in an er eight blocks up from mine. One day, I got a few ltc patients from this one place and when I was complaining to her about my day in triage, she said she had a similar problem. Same place sent her er a few too! Now don't tell me that's not about abusing the er!

Believe it or not, we prefer to help the emergent patients!

[ktwlpn, LPN]

Have a good story: have a friend that works in an er eight blocks up from mine. One day, I got a few ltc patients from this one place and when I was complaining to her about my day in triage, she said she had a similar problem. Same place sent her er a few too! Now don't tell me that's not about abusing the er!

Believe it or not, we prefer to help the emergent patients!

Could it simply be due to the fact that the doctor made his rounds on that day? We have been full of URI's over the past three weeks-one unit had 4 transfers in one day.All LOL's admitted with pneumonia.Doc made rounds on Wednesday-he goes to 3 local LTC's.I'm sure there were other admits -Is that abusing the ER? Most of my co-workers hate to see our folks go to acute care because we know the staffing is just not sufficient to meet their needs.

I imagine when you walk into the er you know you are going to be taking care of anyone that comes in-I guess those little old folks just don't give the adrenalin boost that some nurses seem to require.

[VICEDRN, BSN, RN]

Could it simply be due to the fact that the doctor made his rounds on that day? We have been full of URI's over the past three weeks-one unit had 4 transfers in one day.All LOL's admitted with pneumonia.Doc made rounds on Wednesday-he goes to 3 local LTC's.I'm sure there were other admits -Is that abusing the ER? Most of my co-workers hate to see our folks go to acute care because we know the staffing is just not sufficient to meet their needs.

I imagine when you walk into the er you know you are going to be taking care of anyone that comes in-I guess those little old folks just don't give the adrenalin boost that some nurses seem to require.

Unfortunately, I think you might be stereotyping. I have been an adrenalin junkie. I actually kind of prefer the easy uncomplicated d/c. For example, fractures, sutures, needs a neb, insulin pump broken, etc. don't really like tons of drama as it is a lot of paper and a lot of scrutiny and patient family face time.

It isn't from the doctor visiting because the nurse will tell you in report that the doctor didn't evaluate patient in person and amazingly, the patients transferred are always the "problem children".

Again, I think folks need to move away from the idea that we take care of anyone who walks in. We screen for emergencies. It isn't our job to treat people who don't have emergent conditions and we actively turn them away.

[ktwlpn, LPN]

Unfortunately, I think you might be stereotyping. .

YES-seems to be ALOT of that going on,doesn't there?

[VICEDRN, BSN, RN]

YES-seems to be ALOT of that going on,doesn't there?

I tired to explain it to you in a civil manner and you decided to respond like this. I reported your post to the moderators.

[libran1984, ASN, RN]

I'm an ER nurse (weekend option) and accepted my very first LTC assignment for PRN agency work just to try it.

I miffed and muffed the DoN when i was required to send a client to the nearest ED for a follow up cxr post abx therapy for PNA. She straight up said to me that it was what the doctor ordered and Medicaid (the patient was a young guy) was the only payer and any other method would require the facility to pick up the tab.

I was so upset and felt horrible for doing that to my ED peers

[tewdles, RN]

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.

Disagree with what?

LOL with UTI is as exciting and challenging as MVA/gunshot/etc?

My friends don't enjoy trauma, drama, and intensity?

[ktwlpn, LPN]

We in LTC have tried to explain our policies,procedures and the constraints we face and it seems to have fallen on deaf ears.

Ironically enough I transferred a LOL to the ER this afternoon.We gave her the best supportive care we could for several days,the doc made rounds this afternoon and out she went.I wonder of someone is saying " O here we go again! It's Friday afternoon-someone in the home just wants a break from this one" I hope she is treated with kindness and a little compassion despite the fact that she has dementia and can sometimes be difficult.

[Sassy5d]

People are venting here. Just because they vent their frustrations, does not mean they treat people any less or give them horrible care.

I do find it odd that this is an emergency nursing forum, yet so many people come here not in emergency nursing.

Every aspect of nursing has it's own frustrations and stress. I'm sure if I visited a LTC forum, there would be frustrations vented on there. I guess it's safe to think other nursing peeps visit their and complain about how our elders are being vented about.

I was in LTC for years as an LPN, even did years as agency/prn. I'm well aware of the frustrations and stress. That being said, I don't recall ever being able to just call transport to come pick up a difficult patient. Even when we were trying to get a pt into geropsych, we still had to rule out uti, acute illness ect which I'm well aware gets repeated at the hospital.

That being said, I do get frustrated, with my previous experience, when I take a nh report and I can't quite make sense of why they are sending them. In the same breathe, I worked with docs who always said go to ER regardless.. The other doc would order tests and interventions.