turning non-emergent pts away - page 3

Do any of your ERs turn non-emergent pts away, like toothaches, lice, STDs, etc? Rumor has it that this week, we in triage are going to start handing out cards to the local free clinics to pts with... Read More

  1. by   arual56
    If they really are going to do this where you work, I hope everyone has their malpractice/career insurance updated, because they are most certainly going to be sued.
  2. by   HeartsOpenWide
    In the state of california it is ILLEGAL to turn away any ER visitor. They may sit in the waiting room a long time because there are real sick people but they will be seen
  3. by   mmutk
    Quote from arual56
    If they really are going to do this where you work, I hope everyone has their malpractice/career insurance updated, because they are most certainly going to be sued.
    Some of you guys are freaking out a bit, the patients here are 1) Triaged
    2)Seen by a health care practitioner 3) Vitaled and Assesed and only
    after that it is determined they are ROUTINE and sent back out to the lobby.
    Approached by finiacial cousler and required to pay 200 up front to be seen.
    All bases are covered prior to being required to pay.
  4. by   mmutk
    Quote from HeartsOpenWide
    In the state of california it is ILLEGAL to turn away any ER visitor. They may sit in the waiting room a long time because there are real sick people but they will be seen
    Noone is turning anyone away, just requiring them to pay prior to being seen. If they don't think it's big enough emergency to pay up front then they can go to thier reg doctor or a health dept.

    Bottom line: It's an emergency room. If you have an emergency you will be seen.
  5. by   teeituptom
    Quote from mmutk
    Noone is turning anyone away, just requiring them to pay prior to being seen. If they don't think it's big enough emergency to pay up front then they can go to thier reg doctor or a health dept.

    Bottom line: It's an emergency room. If you have an emergency you will be seen.
    In Texas the Gov't is apparently looking at station an Immigration officer in the ER, for some reason, I dont understand.
  6. by   meandragonbrett
    If they'd like to come to the ER and wait for 20-24 hours (our average wait time on some weekends), so be it! EMTALA says they can't be turned away.
  7. by   EmerNurse
    Had to give an non-emergency kid some amoxicillin for an ear infection at like 0200 one night. Since we have to mix up the whole bottle, we give it to the parents (and a script) figuring it's already charged to the account, so maybe they'll save a little money. As I handed mom the bottle (with appropriate instructions) and explained the saving money part, she said "doesn't matter, not like I pay for it anyway". ARGHHHHHHHHHHHHHHHH. Kept my mouth shut, but only BARELY.

    What possesses people to show up at 0200 for a rash they've had for a week??? And then to complain about the wait???? Our fast-track is only open from about 10am to about 9pm, so of course all these people show up after midnight.

    Someone explain it to me please??? I just don't get it.

    I love the intent of EMTALA, but HATE the way it's ended up being implemented. Just one more way for us all to get sued, eh?
  8. by   teeituptom
    Welcome to the Wonderfull World of ER Nursing


    hahahahahahahahahahaha
  9. by   ERRNTraveler
    Quote from TazziRN
    emtala.com is the authoritative source. Anyone who works ER should know EMTALA, and recognize emtala.com.

    The site you are referring to is NOT an official government site. It is run by a private individual. This individual does not list his/her credentials anywhere on the site, so the reliability of the site cannot be confirmed. THIS is the official EMTALA site: http://www.cms.hhs.gov/EMTALA/
  10. by   lexiesnana
    Quote from RedERRN
    The ER I work in has a policy where all patients meeting triage levels of 4 or 5 (we use the 5-tiered ESI) are sent to "Quick Care" where they receive a MSE (Medical Screening Exam) by a physician. If their chief complaint is then deemed to be non-emergent, the patient is instructed by the physician (by scripted dialogue) that their condition is not an emergency. The patient is then given the option of #1) staying at our facility to receive treatment after paying either $150 cash or their entire non-emergent co-pay or #2) leaving our facility to seek care at one of the many urgent care facilities across town or with their private MD.

    The reasoning for this policy is that soooo many patients present to the ER with non-emergent complaints. These patients contribute to the overcrowding and sluggish throughput. Unfortunately, we nurses can't legally tell them that they are not having an emergency and need to leave. According to EMTALA, all patients must receive a Medical Screening Exam by a physician. By following our policy we cover all the bases. It seems to work WONDERS...and word has spread pretty quick around town, too!
    Wow! Your system sounds great. Can you send me more details? We also use the ESI (5 tier), but I'm wondering how strict you are adhering to it. We have many nurses that are not trained in the ESI (we are supposed to be doing a class this fall) and so their judgments are very subjective.
  11. by   mamalle
    we just started doing something with our Tenet run ER.

    MSE exams

    triage nurse evaluates pt- determines it is not a medically necessity.
    pt goes into a different room and waits for either the ER doc or PA to come in and evaluate him/her. If they decide it is not something that needs to be seen now- they will give them the option of staying and paying or refer out to the clinic. After the pa/ er doc goes in- then the financial person goes in and asks about insurance/ payment. etc. Its been in force for about 1.5 weeks so far. So far we have had return customers with worsening symptoms because they did not f/u with the clinic and more admissions. Today my PA was all pissed because a pt did not pay his copay since the registration people said its in their policy to not deny them since their insurance will pay the contracted amount. He felt like it could turn into a lawsuit since the ones that didnt have the money ie. insurance were being turned away and the ones that did have the insurance were given care. Its a big debate right now..
    Last edit by mamalle on Jun 9, '07
  12. by   rph3664
    Quote from ruby vee
    this sounds like a good first step toward fixing what is wrong with our health care system. if there are free clinics and urgent care facilities that the poor can use for their primary care providers, then let's ease them into doing so and away from clogging the er. telling them they must either pay up front or see a primary care provider still gives them choices -- and if they have the money for multiple piercings, tattoos and acrylic nails perhaps they do have the money for an er visit.
    or, for that matter, a visit to a regular physician and the time to make the appointment.
  13. by   TraumaNurseRN
    Quote from Melina
    I know you couldn't possibly have meant to this to sound the way it does
    I'm not certain why you feel this way
    Last edit by TraumaNurseRN on Jun 30, '08

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