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Go find your patient



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No. 20
from JKL33
Old Aug 21, 2009, 01:32 AM
Updated Aug 21, 2009 at 01:45 AM by JKL33

Default Re: Go find your patient
Personally I think you should talk to your manager about what you are to do next time this occurs. In this situation you have an obligation to try to locate the patient, especially given the complaint and the 'what ifs' mention already mentioned - your obligation is simply that you need to inform the appropriate person right away so an effort can be made to find this patient, without you having to abandon your triage duties. It doesn't matter if he's goofing off in the parking lot - you don't know anything about the actual seriousness of the complaint (or lack thereof, I should say) until you lay eyes on him. And really, it doesn't matter if his parents are complete morons or not when it comes to your license and you acting in a professionally prudent manner.

I do understand your frustration and frankly no I do not personally check out the bathrooms and the vending machines and the parking lot and the smoking area across the street in attempt to locate people with less-than-urgent complaints. I inform the charge nurse, leave the patient's name up on my screen and call them several times (triage another patient, then call the missing person's name again, etc). The specific scenario you mentioned is another thing entirely, though. If anyone does elope at any time after being registered, I believe our policy is that we are supposed to fill out an incident report - I say that only to say that you should know your facility's related policies.
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No. 21
from erdiane
Old Aug 21, 2009, 07:29 PM

Default Re: Go find your patient
EEEKS! no one addressed EMTALA that I can see. Your ER is responsible for everyone in the ER and for everyone WITHIN 250 FEET OF THE ER. Call security.
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No. 22
Old Aug 21, 2009, 09:08 PM

Thumbs up Re: Go find your patient
Originally Posted by erdiane View Post
EEEKS! no one addressed EMTALA that I can see. Your ER is responsible for everyone in the ER and for everyone WITHIN 250 FEET OF THE ER. Call security.
EMTALA!
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No. 23
Old Aug 26, 2009, 11:42 AM
Updated Aug 26, 2009 at 11:49 AM by SecondGenRN

Default Re: Go find your patient
Originally Posted by irmaRN View Post
Greetings.... tell me what you think of this....the other day we had a few patients presenting to triage. I went to call the patient (who was 9), and no answer. the registration clerks said "He's outside running around". (the complaint was suicidal gesture). From where I was standing I saw no one outside, so I called the next patient. The ER doc working that day asked me "Where is this kid?" I told him that the clerks said he was outside but I saw no one. Well this ER doc tells me that it is our responsiblity to go find this kid. He says, "Once they're on our property, they are our responsibility". So, to all you seasoned ED nurses, who know that some days in triage can be a nightmare, you have to go round up your patients if they are not in your waiting room when they are called? That seems ridiculous!! what if they are on the other side of the hospital grounds which can be pretty far away? Thanks

Where were the guardian's/ people who brought the child in?? They would be the one's responsible for the child IMO. It the pt is an adult and is not in the WR when we call, we simply move on to the next pt. We call the pt 2 more times, if no response they are discharged as LWBS... you can't chain people to their chairs

as a side note, when a person is triaged and the c/o is self harm/suicidal or similar c/o we get them into a room or crisis room immediately
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No. 24
Old Aug 26, 2009, 11:47 AM

Default Re: Go find your patient
Perhaps thinkertdm and PhoenixTech can sit in ER waiting rooms across the country and force pts to stay until they are seen...
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No. 25
from canoehead
Old Aug 26, 2009, 12:04 PM

Default Re: Go find your patient
I would notify security and the charge nurse, we would all be on the lookout for patient/parents, and if they were found security would stay with them to make sure the patient stayed and got treated.

If they were not found, or found and not willing to stay, I would make a call to child protection and notify them that the child living at xxx address was brought in with c/o suicidal behavior and the parents did not see fit to stay and get the needed medical treatment.

Also an option is to send the police out for a welfare check, and urge them to come back. Police can take the child in for medical treatment without parental consent if they feel there is imminent danger. I'd run that one by a suoervisor first though.
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No. 26
from cookienay
Old Aug 26, 2009, 01:22 PM

Default Re: Go find your patient
Ok, even though thinkertdm may have been "harsh" in his wording, unfortunately for the OP he is correct. MB brings up the wonderful point of safe and prudent as well. Had there been a poor outcome, the OP would not have a leg to stand on. Neither would the facility.
Now, for some complaints there is no way I am hunting down that patient (we see over 75,000 pts a year). However, for a 9 year old with a "suicidal gesture" you can bet your sweet EMTALA that I (or another person) is hunting him down until his security can be verified. And speaking of the Almighty EMTALA there most certainly would have been a fine levied for this. And as far as the ER responsibility- the jursidiction is 250 yards- not feet. Believe me, I have trudged alot farther than 250 feet to respond to emergency calls. just my 2 cents.
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No. 27
from DianeMyra
Old Aug 26, 2009, 07:44 PM

Default Re: Go find your patient
I'm not sure how our peds dept does it, as we have separate triage areas, but if an adult presents with SI they stay in sub-triage which only exits with a badge. Also, personal belongings are removed, and they are placed in a hospital gown. It's not 100% (we've had a few bolt through the door when it opens, then we call security), but it's pretty effective. ~ Diane
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No. 28
from meluhn
Old Aug 27, 2009, 07:07 AM

Default Re: Go find your patient
Originally Posted by JB2007 View Post
Here is my question: Where are the parents!? Just because a parent takes the kid to the hospital does not relieve them of all responsiblity to keep the child in the proper areas so that the child can recieve the treatment they need.

Am I the only one wondering about the "responsible" adult that brought the child in to the hospital. I am a parent myself and I can tell you that if you child was suicidal enough that I felt they needed help their little butts would be sitting in the waiting room when their names were called. Why does suddenly become the healthcare provider's responsiblity to keep these people's children from misbehaving?

Chances are if their is a 9 year old in the ER for suicidal ideation there is some sort of dysfunctional family dynamics going on.
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No. 29
Old Aug 28, 2009, 07:09 PM

Thumbs down Re: Go find your patient
Originally Posted by SecondGenRN View Post
Perhaps thinkertdm and PhoenixTech can sit in ER waiting rooms across the country and force pts to stay until they are seen...

Ok, I don't know if you read my first post or if you're responding to the EMTALA post but since my point seems to be the concensus across this thread, I'm not getting your sarcasm.

However, if I ever float to my ED again and run across a 9 yo pt. w/ suicidal gestures not responding to my call, you can bet your satirical a** that I'd do more than stand behind my triage desk scanning the entrance to catch a glimpse of him/her.
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