[zamboni]

Originally Posted by CanERRN

"It was a good thing we all were able to get her to go to the hospital, otherwise we would have REALLY been between a rock and a hard place. "

This comment alone is enought to frustrate any ER Nurse, not to mention physician. My question would be what was the ER supposed to do?

Ever try to find a hospitalist or Family Care Practitioner to admit with a diagnosis of "No where else to go"? I'll bet Case Management had a field day with that - not to mention the CFO _ the hospital just provided ANOTHER free stay.

Unfortunately, the ER provides a temporary safe environment for the patient until something can be figured out. In the case of the OP, I suspect that they didn't feel like it was safe to leave the patient at the residence. If they had, and the patient fell 20 minutes later, it would have been not only their butts in a sling, but the patient would have been injured (which we all want to avoid, right?). Someone said that a social worker should have been called...I've worked in a lot of EMS systems, and not one of them had a social worker on staff. Adult Protection isn't interested at 3:00AM, and won't respond anyway just because the family doesn't want or can't deal anymore. EMS doesn't have the rescources to do what an ER can in this situation...all they can do is try to get the patient somewhere safe.

I know how frustrating it can be, I'm on the other side of the fence now in the ER. But a high at-risk patient is safer in the ER than being left with family that is done with them.

(Personally, I think it's a breakdown in our society...but that's a rant for another day...)

[ZippyGBR]

possibly admitted under emergency physician while sorting out place of safety placement in residential care

then competency assessment dfro ma psych poin t of view and bounce the whole shebang to social services as it's primarily a vulnerable adult issue if anything

[loricatus]

Originally Posted by zamboni

Someone said that a social worker should have been called...I've worked in a lot of EMS systems, and not one of them had a social worker on staff. Adult Protection isn't interested at 3:00AM, and won't respond anyway just because the family doesn't want or can't deal anymore. EMS doesn't have the rescources to do what an ER can in this situation...all they can do is try to get the patient somewhere safe.

I know how frustrating it can be, I'm on the other side of the fence now in the ER. But a high at-risk patient is safer in the ER than being left with family that is done with them.

(Personally, I think it's a breakdown in our society...but that's a rant for another day...)

In reality, there usually isn't a social worker available at 3AM in the majority of ERs and the only option would be to call adult protective service anyway ("who isn't interested at 3:00AM"). The ER doesn't have the resources you think; and, as I said earlier, once the patient (who had to be convinced to come and did not wish to stay) was medically cleared, they would most likely have incurred an expense to be transported right back where they came from. The social worker consult would be requested in the morning, as would adult protective services (usually having social workers as investigators) & that social worker would have to go to the home environment anyway. So to inform adult protective services while EMS was in the patient's home environment, in this case, would have most likely had the same effect (in the end) as sending the pt to the ER and then having to send them home because IT WAS NOT AN EMERGENCY.

I do agree with you that there is a breakdown in society; and, there should be some realistic solutions to situations like this-the solution just isn't in the average ER in today's society.

[Knoodsen]

I share your frustration regarding "dumps". Believe you me! But, let's get real. The ERs that we practice in are part of a goofy culture. There's a lot of learned helplessness out there. And, despite the huge amounts of tax dollars thrown at our various problems, it never seems to get to our problems. Does it? It isn't just police and EMS dumping on us, either. They'll come through triage as well. There wasn't any gas in any of the family vehicles so they had the neighbor lady bring them. Papa ain't right and no one can say for sure when he was last right. "He said a couple words on Tuesday." Next on the triage menu is the neighbor lady. She signs her five kids in for various minor complaints. (Here's the point of all this.) Where do you suppose I sent the neighbor lady, et al. Where would you have sent them? Right. Fast Track, or whatever you call it. Since when have ERs been about emergencies? You guys (excuse me, y'all) live or die by the survey they send to your patients. Oh, wait. They don't send them to all the patients. They only go to the ones that were discharged. You know, those patients that didn't have an emergency.

[Knoodsen]

Sorry. Gotta have a shot at the original question regarding "the disposition". My experience has been that, most of the time, it turns into a "social admit". Often, this is preceeded by one or more spats amongst the warm and friendly healthcare people. We want them out of the ER so a floor bed and a social work consult it is.

[loricatus]

Originally Posted by Knoodsen

Sorry. Gotta have a shot at the original question regarding "the disposition". My experience has been that, most of the time, it turns into a "social admit". Often, this is preceeded by one or more spats amongst the warm and friendly healthcare people. We want them out of the ER so a floor bed and a social work consult it is.

You have to remember that this patient had to be convinced to come to the ER & didn't want to be there. Without a medical problem being discovered, this type of patient would be sent home. In regards to it being a 'dump,' I was referring to the family and not about EMS. Their heart was in the right place wanting help for this person.