A Headache is not an emergency

LadyFree28, BSN, LPN, RN · Jun 21, 2016

I already replied to the same question, which is a good one. But my doctor doesn't have an after hours service.

Exactly...or they tell someone to go to the ED because they are impacted with appointments already.

I can pick up my phone and each of my doctors has at least an answering service, coordinator, or resident on call or something like that; I am acutely aware that not all providers can afford after hours service or to pay people; I'm sure there are still some "sole proprietor" providers out there where the ONLY backup and solution (at least to the provider) is the ED.

ixchel · Jun 21, 2016

Exactly...or they tell someone to go to the ED because they are impacted with appointments already.

The worst offender of this that I have ever heard of is tricare. Some areas, getting an urgent appointment with a PCP (especially overly-impacted specialists, like pediatricians) literally takes 1-3 WEEKS. (Admittedly, I heard this anecdotally from a military mom/spouse.) They freely state the best option is the ED.

If we back away from focus on abuse of EDs by patients, and look instead at other problems:

1. Overly-impacted providers

2. Public/government insurance rules and reimbursement rates discouraging providers from participation

3. Lack of providers, especially specialists, and in rural areas

4. Overbooking practices of outpatient offices, not allowing urgent visits. I wonder if these providers do this intentionally knowing the ED can pick up their patients, or if they are required to take on a certain number of public/government insurance patients.

I'm sure there is wayyy more.

Nursing, as a unified body, could perhaps stand together on issues outside patient control that lead them non-emergently to EDs. As an inpatient nurse, I hate the consequences of ED overcrowding and SOMETHING needs to be changed to prevent lives from being lost as a result.

Imagine nursing unifying with physician organizations to lobby for measures to create more access to education programs for physicians, NPs and PAs. For instance... The town I work in stopped being classified as rural this year. Rural meant the state gave physicians school loan reimbursement. It sucks breaking in an MD fresh off residency, but at least we had enough MDs before this. We had ten internal/family med hospitalists. Now we have eight, and good look recruiting. The name of this town does not at all inspire confidence to relocate here. If we really are no longer rural, we only lost that title by a few people in population growth.

There was no transition for this change, and there is no assistance offered for recruitment. The physicians have since joined a larger network, a change that they are not happy with as they feel their autonomy being squeezed even more by policies and protocols. And they are stretched much thinner, and they really don't have hope that this is going to get better anytime soon. I'm wondering how long we will be able to keep the physicians we have left.

I hate to say that the government should largely bare this burden, but what happens to our medical system as a whole as the rug gets pulled out from under our hospitals and outpatient providers? Less providers and more patients is scary to me. We are very much seeing this here in rural areas.

Editorial Team / Moderator · Jun 21, 2016

Coming from a military ER, yes â€” it is abused because there is no copay and primary care is very happy to tell patients that they are welcome to visit the ER for "immediate evaluation."

ixchel · Jun 21, 2016

Coming from a military ER, yes â€” it is abused because there is no copay and primary care is very happy to tell patients that they are welcome to visit the ER for "immediate evaluation."

(I liked this not because I like what's happening. I'm liking that you are sharing your experience.)

Editorial Team / Admin · Jun 21, 2016

I remember how when I was 12, I sliced my finger open. My pediatrician met us in the office at midnight to put in 4 sutures. No office does that anymore. Combine that with the no longer saving appointments for urgent visits, it's no wonder the ER is left holding the bag. The whole medical practice needs an overhaul.

aeris99 · Jun 21, 2016

Just recently visited my local ER with my son. He'd had a viral URI for a week. Suddenly turned a fearsome shade of red with raised welt looking hives and smaller purple bumps. I literally watched it go from light pink to lobster red in under 5 minutes.

I called the pedi office and was told to give him benadryl (already had) grab the inhaler and head to the ER right now.

It being Motorcycle week and a Friday I knew it would be at least 3 hours wait time but took him anyway because honestly, I panicked. All it would have taken was 5 minutes for someone to listen to his lungs, eyeball him and tell me he was ok.

Instead we waited for 4.5 hours and no one even assessed him.

By the time he was finally looked at (and I really DO mean looked at. That's all that happened.) his skin color and temp had returned to normal.

I think the problem is a combination of patients not knowing when to use the ER, PCP's sending patients to the ER because it's too close to closing time to see anyone, services not being available elsewhere and no way to fix the problem.

It's frustrating. I don't like taking up space. I also don't like being shifted off to the side and not taken seriously. That's my kid! Take a minute and check him.

allnurses Guide · Jun 22, 2016

PCP's sending patients to the ER because it's too close to closing time to see anyone

I work in primary care (adults only) and often I am the only provider in the clinic. I often have to make the decision when patients call with chest pain, shortness of breath, stroke symptoms, system allergic rxns, etc of having them come into the clinic or go right to the ED. It's not easy and I don't turn people away because it is closing time but I do if I think that it is dangerous for them to be in the car or in my office. Often times people aren't happy that I tell them to go to the ED and I worry they feel like I am blowing them off but the truth is I do it for their safety.

Editorial Team / Moderator · Jun 22, 2016

All it would have taken was 5 minutes for someone to listen to his lungs, eyeball him and tell me he was ok.

It's frustrating when your waiting room is packed with people who just need five minutes. That's what so many patients say â€” I just need this one thing, can't I just get it and go? Which translates to can't I just jump ahead of everyone else who just needs five minutes? It's frustrating for patients, and frustrating for staff.

Instead we waited for 4.5 hours and no one even assessed him.
By the time he was finally looked at (and I really DO mean looked at. That's all that happened.) his skin color and temp had returned to normal.

Was he not seen by an RN in triage? Vitals stable?

So glad he's okay, I am sure that was scary for you. Unfortunately that happens all too often â€” kids looks great by the time physicians see them! Good for the kids, but the parents then think we think they're crazy! But we believe you, parents. :)

mindofmidwifery, ADN · Jun 22, 2016

Instead we waited for 4.5 hours and no one even assessed him.
By the time he was finally looked at (and I really DO mean looked at. That's all that happened.) his skin color and temp had returned to normal.

Was this at a children's ER or general? In the general ER that I work at (granted, it's smaller, being on the outskirt of the city), we try our hardest to bring children back ASAP, especially for something like what you're explaining. At the Children's hospital I worked at, you couldn't really do that because every patient is a child but of course higher acuity patients were seen sooner, but we also had a fast track for kids with things like URIs... But at any ER there is a triage where the nurse sees the patient and determines where to place them, I understand that it's frustrating to have to wait for care but believe me, the staff does everything they can do for the most part to bring people back as soon as they can. No one likes having to see a full ER lobby and to get the brunt of everyone's frustration.

vintagemother, BSN, CNA, LVN, RN · Jun 22, 2016

A headache is not an emergency, except for when it is :)

And that is indeed the rub.

My story: had migraines and my managed care insurance medical providers told me there's nothing they can do for me to prevent them. They actually told me there's no migraine meds. (I was about 19, and not a nurse so accepted the fact that I had to go to the ED q6 mos for a shot)

About a decade later, my sibling wanted me to take her to the ED for a headache. I told her I don't have time, they won't do anything for you anyway.

Turns out, the ED found that my 30 yr old baby sibling had a GBM. (Worst days of my life, thinking that she'd die in

Headaches are complicated....

After I entered the healthcare field, I learned there are migraine meds, such as sumatriptan. I asked for a script for it, and recvd it from my PCP.

Roy Fokker, BSN, RN · Jun 22, 2016

Just think if all of the "non-emergent" cases were to stop, staffing would decrease, people could and probably would be laid off or just lose their job all together...hmmm...job stability would be one good reason for me to take a Pt with a headache and smile about it

Yeah, no. It is actually lose-lose.

I didn't become a nurse - especially an ED nurse - for "job stability." In as much as I didn't become a nurse to treat "customers" instead of "patients."

This is exactly the kind of hokum peddled by un-supportive management to ensure a continuation of ED abuse and over-crowding. A few years ago at my old ED job, management tried to convince ED nursing staff that an establishment of an "Observation Unit" (monitoring admitted, stable Observation patients - usually for chest pain/ r/o ACS) was in our best interests. More "hours posted" for nurses/techs to pick up, hence bigger paycheck etc.

NONE of the nurses/techs 'assigned' the Obs Unit liked working it - for obvious reasons (not all that different from taking care of holds/boarders!)

And let me remind everyone - ED overcrowding is as serious as a heart attack, and can be just as deadly! How many of you would like to bring your Father or Grandmother to the ED with complaint of chest pain and be told to wait in the waiting room? Or let us assume the initial EKG shows an acute MI but the ED is so full (with emergent and 'non-emergent' complaints), the staff has to "create a bed" to accommodate an obvious emergency - would you like the nurse taking care of your Father or Grandmother, to also be responsible for 5 other patients? Or would you prefer that the nurse be able to hand off her patient load momentarily so that s/he can pay undivided attention to your loved one in their hour of crisis?

Or let us even assume that the initial EKG at triage was normal or borderline - how many of you would want the triage nurse to send you back to the waiting room instead of a monitored bed? Be truthful!

I saw a woman who had called the ambulance and went to the ED for "lady partsl itching/yeast infection".

I had one a few months ago.

Very young, adult female. Came in by EMS. I triaged her out to the waiting room because I had no open beds. At 0830 in the am. She huffed and certainly appeared offended that she was going to the 'waiting room' even though "I came by ambulance."

As the EMTs were wiping down their stretcher and getting ready to head out, I noticed that their radios were going off constantly. The EMTs looked upset. I leaned over and asked "Y'all ok?"

"No. Not ok. That's the third call out requesting an ambulance to transport a critical patient but nobody in the township or county can respond because we're tied up with BS calls!"

The very young, adult female that came by EMS? Her chief complaint?

'lady partsl discharge'...

Nope, not kidding.

Just think if all of the "non-emergent" cases were to stop, staffing would decrease, people could and probably would be laid off or just lose their job all together...hmmm...job stability would be one good reason for me to take a Pt with a headache and smile about it

* Have you EVER had to take a "chronic headache patient" and smile about it, when it is the patient's 240th visit in the ED in 2016? For the same "chief complaint"?

The ones who are allergic to everything except Dilaudid and Benadryl/Phenergan? None of which are drugs recommended to treat chronic migraines or headaches?

* The ones who refuse Imitrex (for example) because "it doesn't work. That drug what starts with the D... Dilauntin.... usually helps."

* The ones who occupy a stretcher in the ED with their chronic, non-emergent complaint - while 80 year old gramma lies in withering pain in the waiting room!

Not burned out - but I am certainly very frustrated!

cheers,

kiki-rn · Jun 25, 2016

As an ed nurse I have been to the ed twice with a headache. Meningitis. Sometimes a headache is more than a headache. I have seen tumors, meningitis and stroke all diagnosed off of headache complains. Although the histrionic screaming headache can be annoying, it can also be an emergency... and sometimes not.