Go find your patient

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

It might be security's job to find the patient, but most obviously not yours.

The EDs are busy enough as it is, we don't need to go finding more patients in addition to the ones already there

It might be security's job to find the patient, but most obviously not yours.

The EDs are busy enough as it is, we don't need to go finding more patients in addition to the ones already there

cookienay PhoenixTech,

You are both missing a very important situation here, the 9y/o patient had not only not recieved a MSE (medical screening exam) but also had not even seen the triage nurse yet.
Nope. I got that. As mboswell pointed out, the question here revolves around whether the nurse had a "duty to act".
A- The patient was on the hospital grounds, seeking help.
B- The nurse was aware that the patient was suicidal.
You sound as though you would be comfortable in front of a jury, or the BON, explaining why you had no duty to act. I wouldn't.
Regardless of how that information got to the nurse, whether through the registration process, or an actual triage, I believe that the nurse had an obligation. I'm no expert, but I have done a bunch of reading about negligence. Liablility has been proven with a lot less than this.



This is a "Left Without Being Seen" patient. The nurses responsibility here should be to call for the patient in the waiting room 3 times 5 minutes apart. If no answer *MAYBE* notifiy security to check the campus. Otherwise move on to the next patient on the list waiting to be triaged.
Alternately, you could notify security immediately, call the police and notify them, let the charge nurse know what's going on, and make a quick note documenting the above. While this might take a couple of minutes more than the course of action you recomend, it is probably worth the time. Remember- years down the road, you may have to defend your actions.


I have always working in large busy ERs and there are frequently patients who sign in and change their mind about wanting to be seen or opt to go to another hospital prior to receiving a triage, these are LWBS patients and if I searched the entire campus everytime this happened I would never get to see another patient.
I have been following this thread, and must have missed the part where somebody suggested that any time a patient leaves without being seen, the triage nurse should drop everything and search the entire campus. You are right that this would be a bad idea.

I personally think many people should leave without being seen. Or even better, either stay home, or go to their doctors office, or a walk in clinic. Most people who leave without being seen don't need emergency care. Many of them don't need medical care at all, and would benefit more from lifestyle changes and better choices. It rarely bothers me when somebody leaves without being seen. In fact, it generally amuses me when somebody threatens to leave to go to another hospital.

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As I wrote earlier, I don't think all patients should be treated the same. While the registration process only gives limited information, it does give you something to work with. Let's say you have 5 patients waiting to be triaged: 3 dental pains, a chronic back pain, and a girl wanting a pregnancy test. A 6 year old with sudden onset acute abdominal pains is carried in. Would you treat all these patients the same? Would you triage these patients in order of arrival?

I suggest that the fact that thurse was aware that the patient was suicidal (and yes, I do realize it is unlikely that the patient was actually suicidal, and in immediate danger), created an obligation which the nurse failed to fulfill.