Educating patients on ER use

[anh06005]

Parents might need to think twice before bringing their child to the E.R.

A hospital in my state is the topic of this article about using the ER and when it might not be the best option. There are family members points of view in the article and many comments as well that make me realize some people just don't get it (true reasons for an ER visit).

How can we do a better job at educating patients and families on emergency vs non emergency?

Does your doctor have a paging system for after hours? Do many know about it?

Just wondering what some of you more experienced people have to say. I'm not meaning to start any arguments but ideas on how I can help my patients understand.

[xoemmylouox, ASN, RN]

This doesn't make sense to me. The ER bill will be much higher than the urgent care bill. I guess that means there is no intention on the part of the patient who can't afford a 50 copay to pay the ER bill?

When my kid needed a school physical, I went to a Walgreens clinic because the total cost was cheaper than my insurance copay at his peds office. I figured I would save the entire "system" a few bucks.

I don't believe that insurances can charge you a copay for wellness/preventative care. It is worth looking into because you might have paid for something that should have been "free" as long as you pay your insurance premiums.

[studentnursemon86]

In my ER it seems that parents bring their sick children in around 3am. Usually for fevers, coughs, and vomiting.

I always ask when a fever is over 102 if they have given Tylenol or Motrin. The answer is usually, "no." That is a little frightening, but we give it in the ER then.

Something about 3am. I guess that's when the kids wake the parents up because they feel sick.

[scaredsilly, BSN, RN]

EDs are by mandate not allowed to turn patients away for inability to pay. Clinics and urgent cares don't do that, so people show up in EDs with no intention of paying because that is the only place they can be seen for "free". It is a ridiculous waste of resources. Why isn't this a part of healthcare reform? It would make sense for ACA to provide more free clinics in areas where they are needed. It would be considerably cheaper than wasteful ED visits.

And yes! PCPs need to be more diligent with their recommendations. If they honestly feel that it could be an emergency, that's one thing but to send a patient to an ED just because they don't have the time to see them is outrageous!

[BuckyBadgerRN, ASN, RN]

But that poster said they had NO insurance, "uninsured". How can that be free to go to ER?

A number of people who abuse the ED, have 0 copay. They have so many outstanding bills that another one for an ED visit? No biggie, who cares. Because the rules are different for urgent cares, the urgent care can demand up front payment. The ED can't do that. If someone presents to the ED, they must have a medical screening exam by a doctor, even if the person has no means to pay for the visit.

[Lev, MSN, RN, NP]

I was floated to the tele unit at my PRN job this week. I was talking to one of the unit clerks and told her that I was switching to an ER job at x hospital. She said that she goes there all the time. I said "So you're not much of a clinic user?" She said "Well, sometimes they're not open, so I have to go to the ER." The unit clerk said she'll take her daughter there, like if she needs stitches. She said that the ER is more organized and you have your own room, instead of being in a small room with everyone coughing on you. She said she also prefers the ER because you get test results right away and don't have to wait. One of the techs who was in attendance agreed. I didn't lecture her on how much the ER costs and she should go to the clinic even if she has to wait. Plus her reasons sounded pretty reasonable if you don't care about keeping healthcare costs down.

[Loo17]

This doesn't make sense to me. The ER bill will be much higher than the urgent care bill. I guess that means there is no intention on the part of the patient who can't afford a 50 copay to pay the ER bill?

When my kid needed a school physical, I went to a Walgreens clinic because the total cost was cheaper than my insurance copay at his peds office. I figured I would save the entire "system" a few bucks.

Urgent care wants the $50 upfront before being seen. They have the option to turn you away for non-payment. The ED will take $5 payments until the bill is paid. When you have no money but need to be seen, it is an easy choice if you cant be seen by your PCP.

My director has told me an urgent care section of the ED would be a liability for the hospital and that many insurances wouldn't cover it. Not sure the specifics but I know they looked into it and ended up opening their own urgent care 1 mile from the hospital. People still come to the ED instead of urgent care and we are not allowed to suggest they go there instead.

[studentnursemon86]

Our ER has an express care area where they handle things like sutures, asthma attacks, and cold symptoms. All of our walk ins go through there. If it is something more serious, we just wheel them over to the acute care area. It has been going on for a little over 2 years now and for the most part it has been a positive. It has cut back the waiting room times as well as speeding up the length of stay for many who don't have money for urgent care or when they're closed.

[klone, MSN, RN]

Our hospital also has an urgent care clinic attached to the ED. Each person gets triaged and are sent to either the urgent care clinic or the ED. After 9 or 10 pm, the urgent care clinic closes and the ED remains open overnight. It seems to work well.

[nrsang97, BSN, RN]

My clinic has an office open M-F 8-8 and Sat and Sun from 12-2 for urgent needs when you can't get into your PCP or peds doc. I have used it a few times and it is great if you have a need when it is open. Last year my son got a part of a crayon stuck up his nose and my dad and I were not able to get it out. In the clinic they were and saved me a bunch of money, the cost of an office visit co pay instead of an ER copay.

Last New Year's the clinic was not open and my son had an awful cough and 104 fever. I had to take him to ER. I had no choice. I also got a letter from my insurance company telling me I should have used urgent care. I had to call them and say if the office or urgent care was open I would have went there.

[AJJKRN]

Consider donating your extra time when you're an NP to a free clinic in your surrounding area. This is what one of my NP friends has been doing for decades now. Having insurance and or getting Medicaid in no way ensures that you or your family members may not wait upwards of a year or more trying to get a PCP in the congested system of healthcare we currently have in most areas of America.

[studentnursemon86]

I had to use the ER in October. All night I was having a fever that wouldn't come down and my blood pressure and heart rate were out of control despite beta blockers. The walk in clinic was closed.

My insurance called as well. They informed me that next year a non emergent ER visit will have a $200 copay.

I asked who determines what is emergent.

I never did get an answer.

I have had SVT in the past and my heart rate was 140. Should I have waited 3 hours until the wall in clinic opened at 8am? Pfft!

[imintrouble, BSN, RN]

My daughter has insurance now, but there was a time she didn't. When she didn't, she couldn't afford an office visit so went to the ER.

Now that she has insurance, there are times she can't afford the co-pay at the office.

She then goes to the ER. She doesn't abuse the ER with several visits a week or month. More like 3-4 a year.

When you've witnessed a family members hard choices, it's easier to be a little more compassionate.