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| No. 30 | 
Sep 23, 2009, 11:21 PM
 Re: If an ER patient is Not Sick, are we still supposed to treat? Originally Posted by MikeyBSN  Her questions is whether we have to treat someone who she feels is not sick. The answer to that questions is: yes. EMTALA, which she initially discussed, only requires that you stabilize a person. However, you still have to treat someone once you see them, because this is the standard of care. It doesn't matter whether you are in an ER or a doctor's office. Although sending a patient like the one in the example home would probably not be below the standard of care, you always take some risk with minimal treatment.
Please give me a authoritative citation/reference where you are getting that this "standard of care" to treat everyone exists? I'm very interested in whatever reference you can cite.
Just because "everyone does it" does not make it "standard of care"....
If everyone is doing it "wrong" then you establish the wrong standard of care....
Please explain.
 | | Advertisement Sponsored Links | | | | No. 31 |
Sep 24, 2009, 12:21 AM
Re: If an ER patient is Not Sick, are we still supposed to treat?
I LOVE the ER's I have worked where they have established a "medical screening exam". That's all you are truly entitled to under EMTALA.
There are SOME complaints identified as exclusions but the system works AND has been held up in court.
Patient comes in with whatever minor complaint you want to insert here. A Dr, PA or NP sees the patient, determines if there is a medical emergency.
Yes- right this way please.
No- Sorry you need to see your Doctor. Bu-Bye!
| | No. 32 |
Sep 24, 2009, 11:46 AM
Re: If an ER patient is Not Sick, are we still supposed to treat? Originally Posted by EmergencyNrse I LOVE the ER's I have worked where they have established a "medical screening exam". That's all you are truly entitled to under EMTALA.
There are SOME complaints identified as exclusions but the system works AND has been held up in court.
Patient comes in with whatever minor complaint you want to insert here. A Dr, PA or NP sees the patient, determines if there is a medical emergency.
Yes- right this way please.
No- Sorry you need to see your Doctor. Bu-Bye!
You're right! That's what our ER does, and we haven't had much of a problem with it. Some of the _____ people come to the ER with, and when a trauma comes in and you are having to move patients to get the critical pt in to be treated.
Some of our patients have the most ignorant of reasons. Some say "Well, my MD is busy and I didn't want to bother him with this. I figured you guys could handle this."
We've had patients come in in the middle of the day with a toothache - not abcessed, no fever, ect. and they haven't even tried to call and see their dentist. And I feel their pain on this one, I HATE toothaches and even going to the dentist, but I wouldn't tie up an ER with it unless I just had to. We have had some come to the ER wanting an MD excuse after they skipped a day of work or school and claimed to be sick. They weren't seen or even come to the ER with it, but want an excuse anyway. The ER docs I work with LOVE that one.
It is great using the MSE and sending them on their way to the MD or dentist, ect if appropriate.
Anne, RNC
| | No. 33 |
Sep 28, 2009, 12:36 PM
Re: If an ER patient is Not Sick, are we still supposed to treat? Originally Posted by mwboswell Please give me a authoritative citation/reference where you are getting that this "standard of care" to treat everyone exists? I'm very interested in whatever reference you can cite.
Just because "everyone does it" does not make it "standard of care"....
If everyone is doing it "wrong" then you establish the wrong standard of care....
Please explain.
The standard of care can come from anywhere. When she asked whether or not we have to treat someone who is not sick, that depends on what she means by "have to treat." The statutory law only says we have to screen and stabilize. However, in terms of medical malpractice and negligence, we do have to treat. The "standard of care" is whatever a jury says it is. If the patient in her example sued then the defense is going to put on 50 doctor #1's who are going to argue that it is the standard of care. In her example, I doubt that there would be any type of liability. But in closer cases you have to be careful when you have the cowboy attending who just sends everyone home. In med mal cases you have to remember that any jury will be one of regular people who don't see BS every day of their lives and don't really understand why you don't get antibiotics when you have a viral infection. The patient/plaintiff is just going to tell them something that they can all relate to: I went to the hospital, and they didn't do anything for me. Not saying I agree with it or that it will work in all cases, just saying that we have to be careful about simply discharging all of those nonsense complaints. The good thing for us is that this is more of a medical decision.
| | No. 34 |
Oct 01, 2009, 02:33 AM
Re: If an ER patient is Not Sick, are we still supposed to treat?
The doctor has to make the determination if the patient is emergent or not. Since opinion differs with each doctor, they are both right (although I'm with you, the patient didn't need an iv etc). The media has done the public another huge disservice with all the hubub about swine flu.
| | No. 35 |
Oct 01, 2009, 02:43 AM
Re: If an ER patient is Not Sick, are we still supposed to treat? Originally Posted by MikeyBSN The standard of care can come from anywhere. When she asked whether or not we have to treat someone who is not sick, that depends on what she means by "have to treat." The statutory law only says we have to screen and stabilize. However, in terms of medical malpractice and negligence, we do have to treat. The "standard of care" is whatever a jury says it is. If the patient in her example sued then the defense is going to put on 50 doctor #1's who are going to argue that it is the standard of care. .
"Standard of care" is defined by experts, professionals, professional organizations, educational entities and peer leaders.
"Expectation of care" is defined by the public at large and what they perceive as what should be done - the public (nor the jury) sets the standard. The jury may subcumb to it at the hands of a skillful prosecution or defence, but precedence is NOT set in the courtroom which establishes "standard of care"...some lawyers may tell you that it does, but it does't.... the experts (et al) set and re-establish the standard during each testimony.
PS: you still haven't given me any citations or references for your statements...
| | No. 36 |
Oct 01, 2009, 02:45 AM
Re: If an ER patient is Not Sick, are we still supposed to treat? Originally Posted by LilgirlRN The doctor has to make the determination if the patient is emergent or not. Since opinion differs with each doctor, they are both right (although I'm with you, the patient didn't need an iv etc). The media has done the public another huge disservice with all the hubub about swine flu.
I know this may be off topic, but, LilgirlRN - what do you mean by: "The media has done the public another huge disservice with all the hubub about swine flu." ???
| | No. 38 |
Oct 04, 2009, 11:42 PM
Re: If an ER patient is Not Sick, are we still supposed to treat? Originally Posted by whatdayoftheweekisit Sounds like you need the QMP or ESP process....using the ESI five-level acuity system, all 4s and 5s in our ED are QMP eligible. The ED phsyican provides the MSE - if no EMC (emergency medical condition) exists, then the patient is visited by registration. They are given the choice to pay their co-pay if they want to stay and see the physician for tx anyways - or a lump sum if they have no insurance. If they can't/won't pay then they are let go with a not that states that the patient chose not to be treated by the phsyician. Perfectly legal and cost-effective. We have a list of QMP exclusions - basically old people, babies...and a list of medical complaints that are no brainer emergencies anyways.
I know of a local facility doing something similiar...
1) Triage pt
2) MD notes pt meets criteria for "frequent flyer" or repeat customer; uses a stringently defined criteria set by administrative policy (IE number of visits, nature of visits etc)
3) Pt in room, MD performs medical screening exam, documents "no emergency condition present"
3) Before any further treatment is rendered, billing/registration sees pt in room and discusses that since this is not an "emergent" visit, payment arrangements must be made before further treatment. Pt's copayment is determined or if uninsured a $100 deposit.
4) If pt pays or makes arrangements, treatment continues at the discretion of the MD.
Works okay so far but we find the inclusion/exclusion criteria (over 65, medicare, children, etc) allows many that we think would qualify to not qualify - so it actually rarely gets used.
BUT it has been VERY NICE to see the administration support this move and make it policy.
| | No. 39 |
Oct 05, 2009, 10:55 AM
Re: If an ER patient is Not Sick, are we still supposed to treat? Originally Posted by mwboswell pt meets criteria for "frequent flyer" or repeat customer; uses a stringently defined criteria set by administrative policy (IE number of visits, nature of visits etc)
It doesn't need to be just the "frequent fliers".
Patients of all kinds without "emergent" conditions begin the "QMP" process- medication refills, pregnancy tests, chronic pain issues: (neck, back, orthopedic problems), routine labs, dermatology issues and so on.
You receive a "medical screening exam" and that's it. You can elect to stay and you're treated like an outpatient clinic would proceed. Payment, copay, deposit or out the door you go to follow up with your PMD.
Used correctly it really cuts back on ER backlog.
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