ER. A Clinic?

[JSlice.]

I have been working in a 15 bed ER in a rural area for 5 months. To me, emergencies involve life or death. More pt's come with minor complaints such as pain meds, toothache, or sore throat. When we actually have a true EMERGENCY, we scramble for an available bed.

I have been told that the people are coming into the ER for minor complaints more often because of the new health insurance law.

Anybody have this issue?

Perhaps somebody can explain this healthcare law better.

[Fribblet]

LMAO, how do you tell someone a minor health problem is not an emergency? OK, i live in houston, TX and if you do not have insurance or money then the only place that you can be treated is the hospital usually in the ER whether it minor or major. Take for instance you wake up with a burning when urinating (not major), but if you have no insurance or money, then you are off to the ER. Please dont be judgemental about some of this folks, i used to be one before i became a nurse and got insurance

There is no reason an otherwise healthy individual should be seen at an ER for a UTI. Most UTIs in healthy people can be treated without a visit to the MD. I've never once seen an MD for a UTI, and I've never taking antibiotics for one either. (This was before I was a nurse.)

Even if you don't have any money, ER visits are not free. You get a bill, and a pretty hefty one at that.

What I particularly hate is a parent who wakes up their kid at 0200 to come to the ER to get some minor complaint checked out, but doesn't bother to take them to the children's ER another two miles down the street because she's got some STD she needs a shot for. >.

[shannons1]

I currently work as a NP in the "county hospital" where we live. The city is one of the poorest in the USA. I have worked a long time in this facility(I love it, my own family gets all their care there)and I agree that this has been the situation for EDs for decades. However, I also have to agree that we are seeing more and more non-emergencies. My hospital has a pretty good, longstanding rating system for those that can't afford insurance but so many pts either can't be bothered or are overwhelmed by it. It is a very difficult situation and I find myself doing more and more education on trying to get my patients rated!

[Tonjia]

welcome to the wonderful world of ER nursing in 2010. For years people have used ER's as walk in clinics, but now with the

economy like it is you are going to be hard pressed to find an emergency room that isnt full of clinic patients. And they all know the laws of EMTALA. If you dont believe them, they will tell you.

Just one more reason why I have given up a 16 yr career in emergency nursing.

[Lunah, MSN, RN]

ENA newsline had a blurb yesterday about EDs taking reservations ... arrghh. Call-ahead seating. I just shook my head. :)

[Guest219794]

To you the emergency room is for emergencies. The public just didn't read the same textbooks you did. To them, the ER is a place where they can get all their health care without an appointment 24/7. The ER is great, you don't have to shop around, get directions, find out their hours, schedule an appointment, or spend a lot of time filling out forms. They might even give you a snack. And by law we can't say no.

A common misconception.

This site is worth perusing:

http://www.emtala.com/faq.htm

Any patient who "comes to the emergency department" requesting "examination or treatment for a medical condition" must be provided with "an appropriate medical screening examination" to determine if he is suffering from an "emergency medical condition".

If the patient does not have an "emergency medical condition", the statute imposes no further obligation on the hospital.

[Guest219794]

There is no reason an otherwise healthy individual should be seen at an ER for a UTI. Most UTIs in healthy people can be treated without a visit to the MD. I've never once seen an MD for a UTI, and I've never taking antibiotics for one either. (This was before I was a nurse.)

Even if you don't have any money, ER visits are not free. You get a bill, and a pretty hefty one at that.

What I particularly hate is a parent who wakes up their kid at 0200 to come to the ER to get some minor complaint checked out, but doesn't bother to take them to the children's ER another two miles down the street because she's got some STD she needs a shot for. >.

I think the determining factor is not whether somebody is insured, but whether or not their visit is free. To them.

In my state most people are covered one way or another. The people who use ERs as a walk in clinic generally don't pay anything. I have no idea if there is a co-pay, but I know they don't pay it.

The ER is free and convenient. The care is based on a customer service model rather than a best practice model.

If your doctor will only give you nsaids for your chronic condition, c'mon in. Good chance we'll give you some narcs.

Having the same abdominal pain that you have been scanned for 4 times already? Been ignoring your doc's orders on diet and excercise? Chances are your doc won't order a ct, and if he does, you will have to wait, then come into the hospital. C'mon in- we don't want to be sued, so we will scan you. It won't do you any good, and in fact the risk/benefit ration clearly indicates we shouldn't. But, apparently having CT's makes you feel better.

Smoke two packs a day, and having trouble breathing? Spending $300 a month on cigarettes and can't afford a $30 copay for your inhaler, c'mon in. We'll give you one.

Mildly dehydrated, tolerating po, but feeling lousy? Think your doc will give you a couple of liters of IVF? Unlikely- we will. C'mon in.

Sick of hearing from your pcp that narcotics are not indicated for headaches? Don't believe the research aout rebound pain? Cmon in. apparently we don't believe it either.

I understand the benfits of primary care. But look at it from a patient's perspective. Patients value convenience. Patients also equate quantity and quality of care. ER's do far more testing and procedures for the same problem than a PCP would. The PCP is far more likely to combine a long term understanding of the individual with sound clinical judgement.

For a large segment of our population, the price is the same. Free. The ER is faster, and from their perspectives, a better value.

I challenge anybody reading this post to tell me why I should go to a PCP instead of my local ER.

[mcknis]

I don't know what everyone's issue is, but the Emergency Department is there to serve everyone's emergency! When I have a really bad hang nail that is only treated with a shot of the medicine that starts with a "D" and the other one "...F something...", I have to go to to the Emergency Department! And, at 3am is the only time the ER is open, right? Oh, before I forget...I am allergic to acetaminophen, ibuprofen, aspirin, all NSAIDs, and anything that isn't Dilaudid or Phenergan.

[Freedom42]

Frivolous ER visits -- and yes, any nurse who's witnessed the 911 caller hop out of the ambulance knows what I'm talking about -- are hardly new. But I can't resist offering this quote from "President" George W. Bush:

"I mean, people have access to health care in America. After all, you just go to an emergency room." (July 10, 2007)

An earlier poster asked for one good reason why he/she should go to a PCP instead of the ER. Here's why: Because it's the responsible thing to do when your condition is not emergent. And of course the poster knows that; his/her point was that ER is more convenient than the doctor's office. But until we start penalizing people for abusing the ER system (and yes, patient who came in for your 47th visit of 2010 this year, I'm talking about you), there's no reason for them to stop.

One more observation, and then I'll quit my kvetching: Isn't it funny how many people tell you they have no insurance and can't afford the drugs the doctor has prescribed after telling you only a short time earlier that they smoke two packs a day? Ah, financial priorities. But I guess when someone else is constantly picking up your tab, it's tough to keep them straight. (I'm reminded of the patient who wanted to take home a thermal blanket: "Can't you just charge it (to Medicaid)?" Sweetie, I am Medicaid!) And to think I was a bleeding heart liberal when I started this job.

Darn it, now I've got a headache. Anybody got some Vicodin? Because that's the only drug that works for me.

[GreyGull]

What do you suggest we do to those who use the ED as their PCP? Put them in prison which then costs another $20k - $45k per year plus several more thousand for medical expenses? What referral services do you have in your ED and to what resources in your community? Is there a viable option for these patients that haven't closed or also been severely overburdened by cuts in budget and staff?

The ones who abuse the system are not going to care one way or another because of mental illness or an established pattern that probably goes back a few decades.

Those who are most likely to hear your message are the people who do not want to be labeled as deadbeat, drug seekers and have some pride to not want to be a burden to you or ask for charity. These are the ones who will delay getting medical care because they really do want to pay their bills but have been put in a financial position where they feel useless and a failure to their families. These are the people you will never see because they will be an ME case. They will ignor the chest pain and severe headache because they don't want to be thought of as a drug seeker or will be in denial of their condition. This will also include the elderly who don't want to be a burdern. These are the people EMS can easily get a refusal signed so there will be no transport. There will also be no detecting diseases like cancer or COPD early because they are no longer insured. Yes the educated public read the newspapers and are aware of the health care situation. You only see a small amount of the population although it seems like millions of patients each shift in your ED.

The attitude that everyone is a deadbeat drug seeking screw the world type of patient just wanting drugs skews your assessment for those who truly need your help including those with drug and alcohol problems. You may also not be looking past the obvious to see the bigger picture for medical issues. Not many ICU RNs want someone on a ventilator for 2 weeks due to an acute problem that was not taken into consideration until it became critical and later complicated by detoxing. The same goes for the patient who could have sought early help for chest pain and headache. I am really saddened by some of the stories I hear in the ICU and wonder how much better the prognosis might have been if the patient had only gone to the ED before they became a field emergency and usually a "code".

I am also disgusted by health care workers who judge every patient they encounter and feel they must label some as a useless waste of time rather than understanding that humans are flawed and not everyone is perfect. Accept this, do your job and you'll be less stressed or find a way to become part of a plan to solve the problems.

Unless your hospital and community have a better plan with alternative treatment resources, the ED will continue to pick up where health care and government have failed in the U.S.

I am curious to know who here does not have insurance and what their alternative medical plan of action is. Sometimes when we have insurance and/or have been raised in a nice middle class or above situation, we take a lot for granted and don't understand the lifestyle which has patients using the ED instead of a nice PCP in the burbs. Also, how many have asked some doctor at work for a script rather than going to their own PCP for some minor illnesses? I know I have because I couldn't get in to see my PCP at a convenient time for me. I've also utilized the "backdoor" of the ED for treatment. I'm not about to criticize someone else because I have easier access to health care then others. I've also known health care professionals who have abused their relationships with several physicians to establish a nice pharmacy of their own.

I also remember the days before EMTALA and in no way would I want to see the EDs go backwards to that time. EMTALA serves a purpose.

[Freedom42]

I have no issue with people who use ERs because they don't have insurance. I have no issue with the mentally ill. But I have a big issue with people who use ERs for convenience. That's what clinics are for, and there are many of them in our community. Every patient who leaves our ER is given information on them, and they are open well into the night.

Who am I talking about? The woman who came in at 0200 on Monday because she found her cosmetic contact lenses uncomfortable. The women who come in at every hour of every day for pregnancy tests rather than go to any number of clinics that offer free tests; it's not unusual for these patients to call an ambulance for a free ride. The woman who came in at 0300 on a Saturday because it hurt to get off the floor by pushing off with the dorsal surface of her foot. The man who came in at 0400 on a Saturday for a cholesterol test. Oh, and the latest trend: the truck drivers who bring in urine samples for testing at their employers' request. These people aren't mentally ill. They just don't get it.

Do I judge these people? You bet. Because when we have to attend to them, we are not caring for other patients who have genuine needs, and we are wasting precious resources and dollars. Do I blame these people? No. We have created an attitude in this country, as evidenced by George W. Bush's statement, that says the ER is for any need, any time. Health care costs have skyrocketed. We need to change people's attitudes. We need to share responsibility.

What's the answer? A small rural hospital in my state has, for years now, offered a "work for care" program for those patients unable to pay but who believe in sharing responsibility. They make a valuable contribution. That's a starting point.

You may be sick of health care workers who judge patients, but until we start exercising some judgments and working for cultural change, this problem is only going to get worse.

[Guest219794]

What do you suggest we do to those who use the ED as their PCP? Put them in prison which then costs another $20k - $45k per year plus several more thousand for medical expenses? What referral services do you have in your ED and to what resources in your community? Is there a viable option for these patients that haven't closed or also been severely overburdened by cuts in budget and staff?

The ones who abuse the system are not going to care one way or another because of mental illness or an established pattern that probably goes back a few decades.

Those who are most likely to hear your message are the people who do not want to be labeled as deadbeat, drug seekers and have some pride to not want to be a burden to you or ask for charity. These are the ones who will delay getting medical care because they really do want to pay their bills but have been put in a financial position where they feel useless and a failure to their families. These are the people you will never see because they will be an ME case. They will ignor the chest pain and severe headache because they don't want to be thought of as a drug seeker or will be in denial of their condition. This will also include the elderly who don't want to be a burdern. These are the people EMS can easily get a refusal signed so there will be no transport. There will also be no detecting diseases like cancer or COPD early because they are no longer insured. Yes the educated public read the newspapers and are aware of the health care situation. You only see a small amount of the population although it seems like millions of patients each shift in your ED.

The attitude that everyone is a deadbeat drug seeking screw the world type of patient just wanting drugs skews your assessment for those who truly need your help including those with drug and alcohol problems. You may also not be looking past the obvious to see the bigger picture for medical issues. Not many ICU RNs want someone on a ventilator for 2 weeks due to an acute problem that was not taken into consideration until it became critical and later complicated by detoxing. The same goes for the patient who could have sought early help for chest pain and headache. I am really saddened by some of the stories I hear in the ICU and wonder how much better the prognosis might have been if the patient had only gone to the ED before they became a field emergency and usually a "code".

I am also disgusted by health care workers who judge every patient they encounter and feel they must label some as a useless waste of time rather than understanding that humans are flawed and not everyone is perfect. Accept this, do your job and you'll be less stressed or find a way to become part of a plan to solve the problems.

Unless your hospital and community have a better plan with alternative treatment resources, the ED will continue to pick up where health care and government have failed in the U.S.

I am curious to know who here does not have insurance and what their alternative medical plan of action is. Sometimes when we have insurance and/or have been raised in a nice middle class or above situation, we take a lot for granted and don't understand the lifestyle which has patients using the ED instead of a nice PCP in the burbs. Also, how many have asked some doctor at work for a script rather than going to their own PCP for some minor illnesses? I know I have because I couldn't get in to see my PCP at a convenient time for me. I've also utilized the "backdoor" of the ED for treatment. I'm not about to criticize someone else because I have easier access to health care then others. I've also known health care professionals who have abused their relationships with several physicians to establish a nice pharmacy of their own.

I also remember the days before EMTALA and in no way would I want to see the EDs go backwards to that time. EMTALA serves a purpose.

The majority of non-urgent patients I see have a PCP and insurance. We have excellent referral services. I don't blame these people for using the ER. The price is the same (free) and they get more of what they perceive to be valuable (drugs, tests, and procedures). It is silly to blame them for using the system as it is set up. There are billboards advertising low waiting times and efficient service. The hospital wants these people to come and rewards them.

I have never heard a co-worker express resentment over a pt who can only access the ER despite other attempts. I have never heard a co-worker express resentment over a parent who truly showed concern for a child.

As far as no insurance: I spent years living on very low wages. Just aove what it would take to get free health care. I carried catastrophic insurance, and had to pay for health care. In order to afford this, I had very little in the way of luxuries. FWIW, I consider TVs, cable, internet, cell phones, fast food, cigarettes and alcohol luxuries.

I do not look to see whether somebody is insured or not. It has no bearing on how I treat them. The subject comes up when i ascertain their access to medications and medical services.

I share your concern for thos who truly have no access to medical care. I am proud to be able to help provide them with some of the best health care the world has to offer.

[anneles]

Anybody works in Kaiser Permanente as an Emergency RN-Clinic?

I saw a job posting regarding this. Please let me know why is it called clinic?