Brain surgery last week, then coming to ED for pain. Wait 4 hours to be seen.

Nurses General Nursing

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Nurses, I want to know your take on this situation.

I'm not a nurse, just a student. I volunteer at the ED. Families talk to me about what's going on and I listen.

This family came in and you could just see something wasn't right. They started talking to me and their son had been in the ED since last night. He had brain surgery last week. He came in because he said he felt pressure and pain in his head. They had him wait 4 hours.

Now, I know I don't know very much, but it just seemed like to me that if a person comes in with that kind of pain and they knew he had surgery, wouldn't it be more of a priority to get him seen? This guy clearly felt horrible. My immediate was reaction was well what if there was bleeding in the brain, which is exactly what the family was concerned about.

They were so polite, just the nicest people, despite what they were going through. I know the doctor and nurse didn't answer all of their questions and they did leave today, but you could tell they were not satisfied at all. I gave them the patient relations number and advised them to speak with them about the matter.

As a nurse, would you think that he should have been a higher priority, at least to make sure there wasn't any bleeding? I know I don't have any more details really to give, but based on just all of that info, what do you think?

I'm going to assume the nurses and docs did the right thing, but people do make mistakes. I'm just curious what your experience would tell you.

Thanks!

I worked one shift as an agency RN in a large, busy ED/ER, and hadn't worked in an ED before. When the other nurse went on her break I was supposed to do all the observations. Well, I had about 12 patients (could have been more) on my side in the section where patients had already been triaged. I was finishing off a blood transfusion, watching for adverse reactions; then someone else wanted a commode then wouldn't move as she'd come in for back pain; someone else had come in with a cut head - their daughter was freaking out cos her Mum's head was still bleeding everywhere; another patient was going psychotic & they had to get a guard for her, then the director of emergency came along to give me instructions for one of the patients - it was absolute mayhem. I didn't get any ob's done & the time just flew away. It gets very busy and I had to keep changing my priorities as to who needed what. I was told that night that if a patient is not deemed critical, they are resting in bed, ob's OK, breathing etc, basically they are not urgent and see to the urgent patients first who have been triaged. If this person had been triaged, had extremely bad head pain, was vomiting, etc as a RN, I would alert the Dr/director (who was helping us the night I was on) and get another opinion just for legal reasons and of course, to ensure the patient is taken care of. I remember I am always legally responsible as a RN as well. As long as you report any changes to your senior nurse/Dr and document it, you are covering yourself and the hospital in a legal sense.

It does get very busy in these huge EDs though, so extremely ill patients always take priority, not that I have any experience mind you, but have known a few people who have worked in EDs.

It's great that you are on here asking questions and wanting more info. As a potential nurse, you should ALWAYS query something you are unsure of, because your license is on the line and there are always legal obligations to consider, and of course you want to do the best for your patients.

Keep it up.

I can't believe they left you with that many patients! That is crazy!

I'm sure they did report and document. Thanks for mentioning that.

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Specializes in Acute Care, CM, School Nursing.

OMGoodness, I do believe that I will *never* work as an ER nurse! Med-surg is stressful enough. LOL

Kudos to all of you ER and ICU nurses out there! :)

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Specializes in Trauma ICU, Peds ICU.
I'm not looking to "get in the middle" of anything. I'm just curious. That's all.

The waiting 4 hours isn't biased. I can look that up.

Sorry, my response is a bit late. I'd like to explain where I was coming from with my post.

Everything you wrote makes it sound to me like this family came to the emergency room with fears that turned out to be unfounded (although understandable), that they reacted to that assessment with unease/dissatisfaction, and then found a sympathetic ear for their concerns (you).

It's an understandable and not uncommon reaction on the part of the family. The situation is foreign to them, and as a consequence, more frightening than is actually justified. They want to hear that they were right, that this was an emergency, and to see us pull out all the stops to "make sure" everything is ok. When that doesn't happen, because it's not indicated, they react with varying levels of confusion, concern, and/or anger.

It sounds like you got a little sucked in by their story. If the family has issues with the care he received, they need to address that with the health care team. It's great that you're willing to listen to them vent, but better to redirect them to a nurse or physician who can do something about it. Maybe they did express their concerns to the staff, perhaps even at your urging, but you made it sound more like you decided they were getting a raw deal and referred them directly to the grievance process. At worst that's overstepping, at best it's premature. I'm not trying to minimize your role, at all, just suggesting that 1) you should have more faith in your triage nurse, and 2) try to promote open direct discussion of their concerns with the team before you send them in a completely different direction.

As for my comment about bias, I was referring to the family's bias which surely shaped their account of events to you.

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Never come in or go to anyones ED, call 911 for the ride in. Otherwise, you are just another cow in the herd.

If you don't need 911, then you don't need ED you need primary care.

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Just like to add this:

From my experience, at least 80%, maybe more, of people who've recently had ANY kind of surgery, will, a few days later feel that something is TERRIBLY wrong.

My theory is that all the initial anesthesia has worn off, now getting PO pain meds, as opposed to IV, and maybe most importantly, they are no longer the center of everyone's attention. I truly don't mean this in a bad way. It's just that immediately post op, there is a ton of monitoring and close contact with the health care team. When this eases off, the patient/family starts to take over the worry. Then, I think the anxiety actually increases pain, and here they are. It happens in peds ALL the time. I mean so frequently, that it's almost comical.

As a side note, my own contribution to allaying this visit is to go over discharge instructions VERY carefully with post op patients/families, so that they are very clear about what to expect and what to watch for.

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Specializes in Med/Surg.

Just playing devil's advocate here. Sometimes things do get lost in translation "nausea/dizziness" is not an ominous presenting complaint. As a matter of fact we once had a patient admitted with the same. He did not complain overly much and was described as a relatively "easy pt" however as you mentioned pt/family did feel that there was something definitely wrong. Pt came at shift change and so we did not receive much information from the ED. Pt waited awhile to be seen as he was not being considered a high acuity. However it turned out your worst fear confirmed, he did have a bleed. I still wonder if his admitting reason was different if he would have gotten more attention sooner, but you never know.

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Never come in or go to anyones ED, call 911 for the ride in. Otherwise, you are just another cow in the herd.

If you don't need 911, then you don't need ED you need primary care.

Hell, half the EMS patients get their ass taken straight to the waiting room where they can sit and think about their non-emergencies.

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Hell, half the EMS patients get their ass taken straight to the waiting room where they can sit and think about their non-emergencies.

Once had someone call an ambulance for a paper cut. They brought her in because she was freaking out over the blood(!) and started complaining of breathing trouble. So because she was registered as a respiratory distress, she was taken right on back by the paramedics. For a paper cut. The NP gave her a band aid and sent her home in 5 minutes, I believe :)

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If you don't need 911, then you don't need ED you need primary care.

So you're saying the gall bladder pain I had in the wee hours of the morning, when my PCM's office & UC clinic were closed, wasn't cause for me to go to the ED/ER just because I didn't need 911's assistance or ride? I get that some patients believe coming in on a rig equals immediate care, but just because someone doesn't come in on a rig doesn't mean they don't need ED/ER care.

I'm a bit perplexed by your statement, did I miss the punch line or something? Sorry if I did.

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Specializes in LTC, Hospice, Case Management.
So you're saying the gall bladder pain I had in the wee hours of the morning, when my PCM's office & UC clinic were closed, wasn't cause for me to go to the ED/ER just because I didn't need 911's assistance or ride? I get that some patients believe coming in on a rig equals immediate care, but just because someone doesn't come in on a rig doesn't mean they don't need ED/ER care.

I'm a bit perplexed by your statement, did I miss the punch line or something? Sorry if I did.

I wondered the same thing. I drove myself to the ER with what I was hoping was just a pulled leg muscle (although I suspected there was probably more to it). Within an hour I was on my way up to my room with a DVT & PE.

I decided to let it go because I could come up with many many situations where someone may not need 911 but would be appropriate to go to ER.

PS: I called my MD, but my appointment was 3 days away & our local urgent clinic is staffed by "quacks". Glad I decided to just go check it out.

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Specializes in Rehab, Med Surg, Home Care.

Going thru the ED was fundamentally the wrong approach unless he called the surgeon or on-call coverage and was specifically told to report to the ED- in which case the family should make it known on check-in that they had been told to come in by a specific MD. It wasn't clear to me if he has had the surgery at this hospital or was just going there b/c it was the closest one. Hopefully when he was discharged after surgery he was given a number to call in case there were any issues. Has to do this with my husband who developed an after-hours fever following a procedure. As instructed, we called the hospital where he had been seen and had the operator page the resident covering that service. The MD called us back us at home and decided with my husband that he shoud be admitted. He then made the arrangements for my husband to be admitted. We had to come thru the ED and tell them my husband was a direct admit to Dr X and the service he was being admitted to. They took some preliminary info, put a wristband on my husband and called the transporter. I don't even remember if they got vital signs before he got up to the floor.

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So you're saying the gall bladder pain I had in the wee hours of the morning, when my PCM's office & UC clinic were closed, wasn't cause for me to go to the ED/ER just because I didn't need 911's assistance or ride? I get that some patients believe coming in on a rig equals immediate care, but just because someone doesn't come in on a rig doesn't mean they don't need ED/ER care.

I'm a bit perplexed by your statement, did I miss the punch line or something? Sorry if I did.

Yea, I'm going to have to second that one CGMedic. Last year my appendix acted up and the pain got worse within a couple of hours. Family members didn't call an ambulance they drove me to the hospital a few minutes away. I was tested, admitted and had surgery immediately. I think stating that:

Originally Posted by Flying ICU RN viewpost.gif

If you don't need 911, then you don't need ED you need primary care.

is kinda extreme.

On another note, I also went into the ED several days after a major surgery because I had severe pain. The nurse took my temperature as I sat in a wheelchair with flannel pjs on, a wool hat, and a wool blanket, shivering and complaining of being cold, and she said, that I didn't have a temperature. My Dr. happened to be there, came out and saw me, and took back immediately, took my temp (rectal) and it was 102 degrees. I had a kidney infection and she took the catheter (sp?) that I had in out immediately.

I say this to say...that sometimes we all make mistakes. We're human...nurses and hospital staff included.

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