Wasteful use of Emerg - page 2

How do you all react when friends or family members tell you about trips to the emergency room when they could've stayed home and gone to the doctor's office in the morning? This is a HUGE pet peeve... Read More

  1. by   hogan4736
    kids-r-fun...

    having worked in many ERs, I would have to disagree that the docs "saw a cash cow" in your mom. Most ER docs are so worried about liability, they cover their butts, and most ALWAYS overorder. They treat an algorithm, not a patient.

    i.e. your mom's doc gives most headache patients dilaudid and phenergan (dilaudid may, for example, have caused a vomiting episode in one of his past patients)

    anyway, I have yet to meet a doc that's overordering for extra $$$... It's a combination of how he was educated, and his experiences up to that day.

    I do agree that that the poor attitudes suck, as well as the wait.


    "If you walk into a restaurant, and every table is full, you'll expect to wait. But if you walk into a jammed ER, you'll want to see a doctor now. Don't blame the ER. Do you think that we're having a party back there????"

    Me
    Last edit by hogan4736 on Mar 11, '02
  2. by   kids
    Originally posted by hogan4736
    kids-r-fun...
    having worked in many ERs, I would have to disagree that the docs "saw a cash cow" in your mom. Most ER docs are so worried about liability, they cover their butts, and most ALWAYS overorder. They treat an algorithm, not a patient.

    I still disagree...her ONLY "admit slip" was a lab requsition with a notation for IV therepy to draw from the PICC. There was NO liability, at NO point was she a patient of the ED, the bracelt they finally put on her identified her as a cancer center lab patient. The whole thing just got away from us. Like I said, it WILL get pulled for UR, and I am sure it will come up that she was NEVER seen by admitting and NOTHING was ever signed. And I really hope everyone involved gets a big reality check when the hospital has to eat the cost of the whole mess because of it, because I really don't 'think' the insurance company will just let the claim slip through.
    Last edit by kids on Mar 11, '02
  3. by   kids
    Originally posted by hogan4736
    kids-r-fun...

    i.e. your mom's doc gives most headache patients dilaudid and phenergan (dilaudid may, for example, have caused a vomiting episode in one of his past patients)[/B]
    DILAUDID FOR A HEADACHE WHEN THE PATIENT IS ASKING (repeatedly) FOR TYLENOL...yeah right...I can see that happening all of the time.




    Originally posted by hogan4736

    "If you walk into a restaurant, and every table is full, you'll expect to wait. But if you walk into a jammed ER, you'll want to see a doctor now. Don't blame the ER. Do you think that we're having a party back there????" [/B]
    No, but given the number of staff playing solitaire and the triage Nurse reading a book when we left I do think would have been really nice if someone could have gotten a wheel chair for my Mom instead of telling me where to find one. I'm not being nasty, I am really glad for them that they were having a quiet period.
  4. by   hogan4736
    kids-r-fun,

    I worked in an ER in a retirement community, and after 1900, we got a lot of pts who would go to the outpatient center during business hours to get their IV antibiotics, but now the business is closed, so they come to the ER. Anyway, they had an order for Vancomycin, let's say, and that was it. No need to see the ER doc. Well, some of the docs felt that if something happened to that patient while in the ER, then it could be his hyde. So we were required to sigb the patient in, and have the pt see the ER doc. Many docs then worked the pt up. Some are friends of mine. They said they're just covering their butts. That was their normal style of practice.

    And as for the Dilaudid, I had a patient Friday night that was asking for Toradol I.M., and the doc insisted on ordering Demerol. Some docs just do what they want to do. YES THAT'S RIGHT!!!!!!!

    And did you follow the RN around to make sure that she had only washed her hands once. I usually was mine out of sight from the patients, in the nurses' station.

    And why didn't she refuse the Dilaudid and Phenergan, ask for the charge nurse, and DEMAND Tylenol (all her rights to do)
    Last edit by hogan4736 on Mar 11, '02
  5. by   hogan4736
    When a patient walks throgh your ER door, the liability falls on the ER, and the staff within!

    Irrespective of the order from his primary that he is carrying.

    Look, no hard feelings here. I got FRIED from working ER for only 5 years. I've been out of ER for the last 2 years.

    Outpatient blood draws don't belong in the ER. This isn't your mother's fault, rather a fault of the "system."
    Hopefully nobody blamed you or your mom for her being there, though I'm sure it felt differently.

    Is there not an urgent care/walk-in clinic that could do these labs??

    sean
    Last edit by hogan4736 on Mar 11, '02
  6. by   canoehead
    I agree, once the patient comes to the ER then the ER staff have a responsibility to do an independent assessment and treatment plan. If they just drew the blood and a patient was septic, hypotensive, or had the beginnings of a meningitis and they didn't bother to do a full screening, well it would be their butt.

    And given that, if you go to an ER (especially a teaching hospital) the full wrath of every specialty gets called in "just to make sure". They are trained and ready to deal with critical, life threatening illness, and if you go to Midas you get a muffler. And apparently at this ER you get the most aggressive care possible. Possibly it would be easier and safer to wait til morning next time.
  7. by   RoaminHankRN
    Here's my gripe when I worked the ER.

    My taxes were paying for the very people I took care of that had no insurance and complain because of this or that. Especially those frequent flyers.

    How dare you come at me with an attitude and part of my paycheck is paying for your visit!!!
  8. by   JillR
    When a PCP or any other physician sends one of their patients to the ER, it is really not thier call as to what is and isn't ordered there. The ER docs will usually consult with that doc, but the ultimate decision and responsibility lies with the ER docs. I agree that the decisions that the ER doc made was probably more of a liability issue than a money issue.
  9. by   fiestynurse
    We have patients showing up in the Urgent cares, who should have gone to the ER. We have patients showing up in the ER who should have gone to their Primary care doctor. We have Urgent care patients showing up without an appointment at the Primary clinics expecting to be seen right away. It's a screwed-up system!!
  10. by   4XNURSE
    I've read all the posts in this thread, and I haven't seen anyone address the root cause.

    Without lawyers taking thousands of frivolous suits to court, winning millions of $$$ in unrealistic settlements, we could start treating the sick people and sending the whiners home. Healthcare insurance would be affordable, and abuse would surely decrease.

    Since most of the system abusers can find a lawyer to file a suit, for huge damages, regardless of the right or wrong of the care delivered, everyone in the delivery system (us, and the docs) has to pretty much do what the abuser wants, just to keep their license and home. Malpractice goes up with each law suit. And the strain on the system increases.

    problem is not the doctors, nurses, techs. It's the lawyers who file all the suits.

    just my $ .02

    ken

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Wasteful use of Emerg