Anyone have to call back patients who have left without being seen.

zena231 · May 4, 2007

I've not seen it done, but as a patient I would think it's a bad idea. If you've waited so long that you're sick of waiting, why would you want to drive back there? And , what if by the time you came back, there were more important cases in front of you again? That just seems like it will set you all up for more customer service related type issues.

On the other hand,I will say though that maybe a follow up call to check on them could be a good thing. Here's the example I have. My friend was involved in a bad auto accident where she was stopped at a light and a large truck slammed into her at about 40mph. She was taken by ambulance to one of our level 1 trauma centers which was nearby and she had waited 8 hours to be seen, finally her husband took her to another nearby hospital and they got her in within an hour. Now, as much as I like the 1st hospital, it seems extreme that they were that busy and couldn't get to her. And because of that , she and everyone else who knows about it (including myself) will repeat the story of how she had to wait so long there until she had to leave. So as far as PR goes, it looks bad. Maybe if they had called her to check on her it might have looked like they cared at least a little....

TazziRN, RN · May 4, 2007

Nope. We are encouraged to call LWBS pts the next day to make sure they're okay and that they know they can either come back or go see their own doc, but even that's only if we have time the next day.

Encouraging them to come back only creates more of a backlog because the ones who are really sick rarely LWBS.

pkapple · May 4, 2007

SAme as Taz--our mgmt really wants to know why they left as much as if they are ok. We have a refusal form for those who leave after triage or who leave before completing care-we try to get it signed. Our AMA's are those who have actually been told they need to stay or choose to seek a different treatment than that advised by the doc. Usually they get a discharge and an AMA much like those on the floor who want to go home before they are cleared by the doc kinda cya type of thing.

walk6miles · May 4, 2007

I spent 3 years in the ER at the trauma center - I left for ICU and Cardiac Recovery. People left in droves (AMA and LWBS) and I hope to

God we never had to call. The ER had everything covered well: trauma, med obs, med, gyny, fast track, chest pain and additionally, step down fast track.

Was the wait long? Sure, especially during events like races, bike week, etc. but no one was deliberately left to sit and wait.

stayseerrn · May 4, 2007

Yep, our hospital had to start calling pts who LWBS and left AMA. We were told that it was some JCAHO thing because of the enforcement of EMTALA now being so strict.

They also created an entire form that we have to fill out if someone comes up to tells us that they are LWBS (and they get a copy of the form), and if we call them multiple times and they don't answer. We have to document three times calling the pt, at least ten minutes apart, before we can declare a pt LWBS. Originally we had the charge nurses doing it, but like you said, it really made it impossible for the charge nurses to do their regular duties.

Then management actually HIRED (whole 'nother talk show that SO does not need to be started here) someone to do it. She quit shortly after for two different reasons. First was that she was tired of getting yelled at by the people she called. Our ER sees 80,000 pts a year (and this is a pedi ER), therefore we do have long waits. Most of the pts who are LWBS are typically in the ER for hangnail type complaints, and they are the ones who complain the most about long wait times (because they have to wait until all those of a higher acuity level are seen first). So, the person who was hired got tired of spending 10 minutes on the phone being yelled at by some person who was totally *^#&)+ off for having to wait for a stupid complaint, and the caller had to sit there and politely eat crow the whole time. The second reason the person quit was because she got tired of having to sift through the paperwork that we had to create, then turn around and create a report for the manager showing all kinds of different reasons why the people are LWBS.

Oh yeah, she also had to do it within a specific time frame. Which was quite difficult due to the volume we see. If I am not mistaken, she had to have it all done in 48 hours for each day's LWBS / AMA. The manager said that JCAHO was requiring a call to every LWBS or AMA withing 24 hours after the incident, which gave the caller another 24 hours to prepare her report. Needless to say the person hired did not stay around long to endure that type of harrassment (both from pts and management).

Management then tried to put it back on the charge nurses, and we all eventually unintentionally revolted because we couldn't spend our time performing our regular duties and track down all those who decided to leave the ER. So they hired ANOTHER person to do the same thing the first person was hired to do. I have since left the hospital to start traveling, and last I heard they were on their FOURTH person hired specifically for that job.

I am not sure if this is a true JCAHO or EMTALA requirement, you may have to do some research on that. But evidently it has become a national trend. I feel that this is truly assinine and a waste of a perfectly good FTE that could be used to hire another nurse to help move pts through the ER.

bill4745, RN · May 4, 2007

If their problem was so minor that they left, it is a waste of time to call them back. Why encourage needless visits?

neneRN, BSN, RN · May 5, 2007

We have two full-time ER follow up nurses (work strictly in an office-no physical pt contact) who do have to call every LWBS and AMA. I don't know if they have a specific time frame or not, but if they cannot reach the pt by phone they then have to send a letter to the pt instructing them to call the ER. Its basically a call to see if they are still having the presenting c/o, if they had rec'd care since the ER visit, encourage to return for any concerns.

grammyr · May 5, 2007

There is an EMTALA reg about being responsible for thses patients for up to 48 hours after they leave. I can't quote it but I have read it. Add that to the pt safety issues with JC and that may be the reason for the calls. I just hope my facility doesn't start it. Most of the ones who leave show back up anyway so we don't have too much to worry about.

CHATSDALE · May 5, 2007

my son went to er d/t chest pain and sob, they did some lab work, ekg and sent him home

by the time he got home he had a message asking him to return but directing him not to drive himself, apparently neither the er md nor the nurses could read an ekg

nurse had the nerve to tell his girlfriend that they figure that people coming in with c/o cp are trying to get on fast track

if he had had a mi on the way home would hospital be responsible??

i bet they would have covered but in a hurry

justme1972 · May 5, 2007

my son went to er d/t chest pain and sob, they did some lab work, ekg and sent him home
by the time he got home he had a message asking him to return but directing him not to drive himself, apparently neither the er md nor the nurses could read an ekg
nurse had the nerve to tell his girlfriend that they figure that people coming in with c/o cp are trying to get on fast track
if he had had a mi on the way home would hospital be responsible??
i bet they would have covered but in a hurry

That's HORRIBLE!

I had to go into the ER once with chest pains...and I told them when I got there that I didn't have a cardiac history, but it was really bothering me, what scare me even more is when I sat down to wait for the EKG, my nose starting pouring in blood. I don't have nose bleeds!

I was convinced that something horrible was wrong, my blood pressure was elevated, mainly b/c I was so freaked out. I also had a massive migraine that started right before the chest pains did.

Then when the doctor came in...he looked in my ears and said, "Have your ears been bothering you lately?" I told them they had, and that both my kids had ear infections.

Here was the diagnosis:

My ears triggered a tension headache, and pulled on the muscles on the side of my neck, down to my chest, therefore mimicing a "smothering" sensation. My EKG was normal. My ears were full of infection.

He sure enough was right....however, someone else could have gone into the ER right behind me, same symptoms, different outcome.

I just think when someone gets that complacent about their job...time to move to another department.

jojotoo, RN · May 6, 2007

Who was complacent about your visit?