[MAISY, RN-ER]

Not only is Express care (Fast track) needed, I wish we could double the size or ours! Sometimes I wonder how old the respondants are to these posts and whether they have children or sick family members. Maybe you are fortunate like I used to be to have a good dentist or doctor at any time. Those days seem to be long gone. I live in NJ, and you are lucky to get to the doctor in the same week you are extremely ill!! My sister lives in Massachusetts, it sometimes takes 3 weeks to see her doctor or pediatrician-most recently my 92 year old father in law was ill-his doctor doesn't even have an answering service any more! The doctor has plenty of patients and doesn't feel he needs to work after hours. (I did say doctor, not banker) Do I use the wild card that I am a nurse, YES..especially if someone is truly sick. At least I have that as a backup, what about the "REGULAR GUY".
Our ER is 55+beds, divided in medical, acute, pediatric and fast track. Everyone has someplace to go. Our beds are used for sick patients, when I work fast track and we are a little slow, I will accept patients to our FT area and work them up-at least their stuff is started.
Have you truly given any thought to having a toothache and no dentist or one who can't see you for a week. Or having abscesses that need to be drained because no surgeon will take medicaid and remove the sac that keeps filling, chronic pain, or how about the fact that physicians will not remove stitches, or even take care of their patients generalized needs anymore. (indigestion=MI, asthma=SOB and respiratory arrest, dizzy(hot)=TIA etc....) all afraid of malpractice. I am sorry if it bothers people to have simple complaints, but when you cant swallow or breathe, or sit, or walk you need medical attention just like everyone else! Maybe respondants hospitals should level the playing ground-any injury that comes in by ambulance is met by a doctor, there is no go ahead of the line unless it is active cp, stroke, or respiratory distress. Unfortunately, nausea and vomiting and pain is all lumped together in the waiting room. If I had my way, they would all be lined with iv fluids infusing-I feel the ER waits(at least my hospital) are directly caused by lack of beds on the floor, staffing, or discharges(all floor problems). Get rid of the backup and the ER will function properly. BUT, don't penalize the FT patients just because they don't require the million dollar workup! I sometimes wish we could do more for these people-THEY NEED IT!

[Jolie]

Originally Posted by teeituptom

why shouldnt they charge for after hours calls.

I don't have a problem with doctor's offices charging for after-hours calls. If they are providing a service, they deserve to be paid for it, and to have a reasonable expectation that patients won't take advantage of it.

And if you had Universal Health Care then this would be mute anyway

But I don't get how UHC would make this a mute point. UHC means that everyone would have access to coverage, not that everyone would have the right to free care at any time of the day or night.

[littleRNthatcould]

Originally Posted by JessicRN

our place is starting a new fee for service for PCP who send there pt for nonemergency reasons. IE dressing change,TB reads, lab checks for chemo persons, suture removal. The only thing is the PCP although they were told the pt would get this charge they do not tell their patients and send them any way

Too bad we cant charge the PCP instead of the patients. I can't begin to tell you how many patients show up to our ED DURING the PCP's regular office hours saying, "My doc sent me down here to get a cat scan/x-ray/check my potassium." etc... Of course when you ask if they just have a slip for an outpatient test, "oh no, doc said I could get something for my abd. pain/headache etc...down here!"

[CritterLover]

Originally Posted by MAISY, RN-ER

Not only is Express care (Fast track) needed, I wish we could double the size or ours! Sometimes I wonder how old the respondants are to these posts and whether they have children or sick family members. Maybe you are fortunate like I used to be to have a good dentist or doctor at any time. Those days seem to be long gone. I live in NJ, and you are lucky to get to the doctor in the same week you are extremely ill!! My sister lives in Massachusetts, it sometimes takes 3 weeks to see her doctor or pediatrician-most recently my 92 year old father in law was ill-his doctor doesn't even have an answering service any more! The doctor has plenty of patients and doesn't feel he needs to work after hours. (I did say doctor, not banker) Do I use the wild card that I am a nurse, YES..especially if someone is truly sick. At least I have that as a backup, what about the "REGULAR GUY".
Our ER is 55+beds, divided in medical, acute, pediatric and fast track. Everyone has someplace to go. Our beds are used for sick patients, when I work fast track and we are a little slow, I will accept patients to our FT area and work them up-at least their stuff is started.
Have you truly given any thought to having a toothache and no dentist or one who can't see you for a week. Or having abscesses that need to be drained because no surgeon will take medicaid and remove the sac that keeps filling, chronic pain, or how about the fact that physicians will not remove stitches, or even take care of their patients generalized needs anymore. (indigestion=MI, asthma=SOB and respiratory arrest, dizzy(hot)=TIA etc....) all afraid of malpractice. I am sorry if it bothers people to have simple complaints, but when you cant swallow or breathe, or sit, or walk you need medical attention just like everyone else! Maybe respondants hospitals should level the playing ground-any injury that comes in by ambulance is met by a doctor, there is no go ahead of the line unless it is active cp, stroke, or respiratory distress. Unfortunately, nausea and vomiting and pain is all lumped together in the waiting room. If I had my way, they would all be lined with iv fluids infusing-I feel the ER waits(at least my hospital) are directly caused by lack of beds on the floor, staffing, or discharges(all floor problems). Get rid of the backup and the ER will function properly. BUT, don't penalize the FT patients just because they don't require the million dollar workup! I sometimes wish we could do more for these people-THEY NEED IT!

Yes, they need care, but not in an emergency department.

These are things that need to be taken care of by primary care physicians in offices.

Increasing the fast-track space isn't the solution. Even though the visit is considered "minor" in our eyes, it is still considered an ED visit for billing purposes.

Since ED visits are just about the most expensive way to receive care, this is an EXTREMELY inefficient use of limited resources (such as insurance company dollars). Any wonder why our insurance premiums keep going up?

This is a problem that needs to be approached from the primary-care side, increasing access/availability of primary care providers, office visits, and appointments.

Increasing fast track space only puts a band-aid on the problem. It makes people feel like something is being done to address the problem.

In reality, those people get seen, but there isn't any follow up. There isn't much by way of continuity of care. Things get missed that way. Little things that could be dealt with should proper follow up care be provided, can become big things.

ED visits just are a horrible substitute for primary care. (Actually, they really arn't even a very good supplement to it, either.)

[Altra]

Originally Posted by MAISY, RN-ER

Not only is Express care (Fast track) needed, I wish we could double the size or ours! Sometimes I wonder how old the respondants are to these posts and whether they have children or sick family members. Maybe you are fortunate like I used to be to have a good dentist or doctor at any time. Those days seem to be long gone. I live in NJ, and you are lucky to get to the doctor in the same week you are extremely ill!! My sister lives in Massachusetts, it sometimes takes 3 weeks to see her doctor or pediatrician-most recently my 92 year old father in law was ill-his doctor doesn't even have an answering service any more! The doctor has plenty of patients and doesn't feel he needs to work after hours. (I did say doctor, not banker) Do I use the wild card that I am a nurse, YES..especially if someone is truly sick. At least I have that as a backup, what about the "REGULAR GUY".
Our ER is 55+beds, divided in medical, acute, pediatric and fast track. Everyone has someplace to go. Our beds are used for sick patients, when I work fast track and we are a little slow, I will accept patients to our FT area and work them up-at least their stuff is started.
Have you truly given any thought to having a toothache and no dentist or one who can't see you for a week. Or having abscesses that need to be drained because no surgeon will take medicaid and remove the sac that keeps filling, chronic pain, or how about the fact that physicians will not remove stitches, or even take care of their patients generalized needs anymore. (indigestion=MI, asthma=SOB and respiratory arrest, dizzy(hot)=TIA etc....) all afraid of malpractice. I am sorry if it bothers people to have simple complaints, but when you cant swallow or breathe, or sit, or walk you need medical attention just like everyone else! Maybe respondants hospitals should level the playing ground-any injury that comes in by ambulance is met by a doctor, there is no go ahead of the line unless it is active cp, stroke, or respiratory distress. Unfortunately, nausea and vomiting and pain is all lumped together in the waiting room. If I had my way, they would all be lined with iv fluids infusing-I feel the ER waits(at least my hospital) are directly caused by lack of beds on the floor, staffing, or discharges(all floor problems). Get rid of the backup and the ER will function properly. BUT, don't penalize the FT patients just because they don't require the million dollar workup! I sometimes wish we could do more for these people-THEY NEED IT!

I respectfully disagree. Most of the things you list are bread & butter primary care stuff -- if your PCP won't handle it then it's time to find a new PCP. And if I went to my PCP and he/she suggested I go to the ER my next question would be "do you think I have a life threatening emergency?" If the answer was no, but he/she just wanted the results of umpteen tests I would reply "then either give me the scripts to get these as an outpatient, or directly admit me to the hospital."

And yes, I have both children and elderly grandparents who I care for.

As CritterLover stated in the post above, the patient is not well served by treatment in the ED with no follow up.

[MAISY, RN-ER]

Ok guys this is my last attempt at posting -previous 3 went bye bye. I guess you are kind of lucky-were long and ugly.

Costs are going up and will continue to do so as medicine advances. You can thank the Nixon administration for HMO-less care for more money with clerks and nonmedical personnel making decisions about our care.

If people could choose their physicians for their specific problem without BS gatekeepers insurance would be less. Isn't it a shame you have to go to the hopsital for a guarenteed referral-a doctor that must take any insurance you have-that is guarenteed followup.

PCP's do what they feel like doing-treat what they feel like treating-prescribe what they feel like prescribing-and the patient be damned. Many come to FT with an ailment that was originally simple but turned into something major-why pcp cannot/will not see for at least another week. I hope to see many more medicare centers like cvs taking care of those streps, ear infections etc quickly and cheaply. If they can do it so can we! I have had many patients simple and ez complaints turn into many dvts, OR admits, pneumonia, resp distress, tunnelled abscess, iv antibiotics (cellulitis and skin infections) etc....They needed to be in hospital and if their "simple problem-bump, rash, sore throat, etc waited-maybe they would return up to the standards set by some of the ER nurses-in ambulance and much worse for the wear!

Oh and by the way, what annoys me? Nausea and vomiting-obvious-virus-stay home and don't take up my beds!!

Maisy

I have sent many patients

[CritterLover]

Many come to FT with an ailment that was originally simple but turned into something major-why pcp cannot/will not see for at least another week. I hope to see many more medicare centers like cvs taking care of those streps, ear infections etc quickly and cheaply. If they can do it so can we! I have had many patients simple and ez complaints turn into many dvts, OR admits, pneumonia, resp distress, tunnelled abscess, iv antibiotics (cellulitis and skin infections) etc....They needed to be in hospital and if their "simple problem-bump, rash, sore throat, etc waited-maybe they would return up to the standards set by some of the ER nurses-in ambulance and much worse for the wear!

I agree that many things that look simple can turn out to be something serious.

That is why we advocate for people to see their PCPs rather than ignore problems.

If it turns out to be more than it originally looks, then the PCP can either do a direct admit to the hospital, or send to the ER.

I understand that it can be very difficult to get in to see a prmiary care provider for non-routine visits.That is not acceptable.

I understand that doctors don't want to take call. I understand that they want to maximize their profits by squeezing in as many patients per day as they can, leaving little form for walk-ins or last minute appointments. However, taking call and being availbe for urgent visits are part of doing primary care

It seems as though we agree as to what the problem is (ineffective primary care), but disagree on what to do about it. I think that it needs to be fixed on the prmiary care end, and you would like to fix in on the ER end.

I do see the allure of increasing ER fast track beds -- it would be easier, since that is basically an adminitrative fix. But I still maintain that it is the wrong way to fix it, for many of the reasons I stated in my earlier post.

[MAISY, RN-ER]

Many of us agree PCP's and basic medical care should be available to sick people. In a perfect world that would be the case.

I have medical through my husband which is a PPO, the medical coverage offered to myself and fellow nurses is an very basic HMO. The nurses complain bitterly that they have limited access to PCP's whose numbers are dwindling daily-why?-non payment of benefits.

I have a problem with ear infections that within 24 hours become a living hell-in the past-with the HMO I saw the PCP who insisted on treating, suffered for days, ended up on several different antibiotics and finally at the hospital.(SEVERAL TIMES PER YEAR) During one of these visits I went to a refferal ENT-that same night who relieved my pain, and took care of my needs. Needless to say, I now go directly to the specialist who staves off the infection and sees me immediately. I have had only one bad infection in the past 3 years. Formerly, it was multiple visits and cost to the insurance company in dollars, my employer in missed time, and me in PAIN! The ER was my saviour! This was prior to me becoming a nurse. Now imagine, having no insurance-should that patient have their eardrum blown, or like me face a brain infection due to the extreme invasiveness of these infections? I think not.


Express care provides access to everything at one time-its a shame it is required due the nature of PCP's limitations, schedules or lack of caring, but it is necessary. We can't fix the doctors, but we can help the patients. They are sick, need help, and I don't pick and choose who should receive that help and care. I don't judge when someone tells me their pain is 10/10-whether it is their big toe, ear, throat, or back-judging is not my job-CARING IS-SO BACK TO THE ISSUE-WE NEED EXPRESS CARE as long as the system performs the way it does!
Maisy