Originally posted by Charles S. Smith, RN, MS
There are all kinds of reasons why people hit the ED doors with what, we as healthcare providers, know are not emergencies. But, we are healthcare providers, and the general public think we are there as a walk in clinic for any and all ails. What we define is an emergency is certainly different than what they think an emergency is. By law, our doors are open and we must treat regardless of the symptoms. Sometimes people just need to be reassured that they OK, sometimes they just need someone to listen, sometimes what seems minor turns out not to be. And yes, some use it as the gateway to the healthcare system because they have no insurance and have no where else to turn. We can not judge their motives, only educate them as we go, hoping to help them understand that coming to the ED requires some thought. Once they come through the doors we are duty bound as patient advocate and that means helping them find different avenues for care as we can. The MDs have a role in this too and I am more concerned with inappropriate and extensive medical care that reinforces their belief that the ED is the best place to come. Educate your docs too.
I recently had a conversation with one of our new ED docs who, in addition to writing lots of prescriptions, wanted to send pain meds (narcotics) home with the patient so the patient would not have to go to the pharmacy at nite. My position was, we are not a pharmacy dispensing service and in fact our liability is increased if we give meds to go, they take them on the way home and get in an accident rather than waiting to take the meds at home. If they can get here for minor problems, they can get to a pharmacy.
So educate everyone you can within the scope of your hospital policy and treat them and street them....with dignity intact.
With all due respect Charles, there is a massive shortage of space in our ERs this winter... I work in Phoenix, AZ and I am absolutely frightened of the state of affairs our ERs are in right now.
That being said, we NEED to judge their motives for coming to the ED.
I work in an all-night walk-in urgent care. At 0230 on Thursday morning, we sent a patient to the ER (by private auto), as he required bloodwork, which we don't provide after 0200. He arrived at the ER, and was told there was a 7 hour wait (I had called a phone patch to the charge nurse prior to his departure)
He then drove back to the urgent care and said "I just want medicine for pain. The wait is 7 hours and I have an appointment at 10 AM" I politely roomed him, and let our doctor know.
10 minutes later I see a fire truck and an ambulance pull up. He scurries out to meet them. I followed, and asked his wife what happened. She said "he wants to see someone NOW!" I remarked (to her) that his action was inappropriate, and let the medics know what had just happened. They glared at him, he confirmed, and they loaded him up for a ride to the ER (2 blocks away, mind you). I call the charge nurse at the ER again, and she tells me that she will boot him to the lobby to wait his turn (for his chronic ailment).
Well, he DRIVES back SEVEN minutes later, wanting to now bee seen for a headache, and asks for my name. I room him and inquire as to his issue w/ me. He implies that I am responsible for his being sent to the waiting room at the ER, and says "you're not the judge and jury. it's none of your business anyway"
I inform him that since I am the only nurse here, an ambulance coming to this clinic IS MY BUSINESS, and I walk away.
Charles, this idiot doesn't need reassurance, he needs to be arrested. As I informed him, he could have been delaying care for an actual sick patient, and HOW DARE HE BAHAVE THIS WAY.
We have an obligation to inform and educate, customer service be damned!!!
Any thoughts anyone?