Cooler weather and homeless "patients"

[NurseOnAMotorcycle, ASN, RN]

We're seeing a larger influx of homeless coming in who aren't accepted at the shelters saying that they "have ankle pain", etc. While they aren't completely overwhelming our emergency room, the worry is that one of these times someone will be in need of care but no one will see it because "you know, it's just Steve back again."

So we do the million-dollar-workup each and every time they come in. It's draining and time consuming.

[rjflyn, ASN, RN]

I dont know how much work up "ankle pain" requires. At my facility thats a complaint that typically if its during the hours its open goes through our express care area, if not its treated as such and they are in and out as fast as they can be seen and x-rayed if required. I we have one an its needed they get a bus pass and sent on their way, we provide them with the hotline number for shelter placement if they request it.

[VICEDRN, BSN, RN]

Yes, this is typical in my facility. They complain that the shelters are not safe and that they would rather sleep outside but tonight is too cold or too rainy, etc. usually, they know the right complaint, know they can refuse to go to fast track and drag their feet with regards to their care. They will refuse to speak with md when he or she arrives (prompting some residents to "wait a minute") buying the patient hours on end sleeping in stretcher. They will refuse labs until they see md to delay process. They will refuse to speak to nurse so process is slower than usual. What is your question?

[NurseOnAMotorcycle, ASN, RN]

Wish we had something we could do about finding them someplace safe to go. Shelters won't take them, they're full.

[EmergencyNrse]

Treat 'em and street 'em...

Nothing you can do to change their arrival. Doesn't change your

paycheck either. Try not to be too concerned about the things

you cannot control. It will burn you out.

[NickiLaughs, ADN, BSN, RN]

Its a social issue not a medical issue. If you can remember and take that to heart your golden

[whichone'spink, BSN, RN]

How the hell do you acknowledge their legitimate need for shelter, but keep throughput going smoothly? It's impossible to kick them out without being accused of violating EMTALA.

[Guest219794]

How the hell do you acknowledge their legitimate need for shelter but keep throughput going smoothly? It's impossible to kick them out without being accused of violating EMTALA.[/quote']

So what if somebody wrongly accuses you of violating EMTALA?

Pt's who have recieved appropriate care are discharged, not kicked out.

Otherwise, it would be called "kicked out paperwork".

[VICEDRN, BSN, RN]

Everyone keeps forgetting that they patients are entitled to an assessment, not treatment. All that is required is that a nurse practitioner or md depending on your state greet them in triage the minute they register and evaluate them. When no emergency medical condition is detected, they can be screened out. In Washington, the state threatened to not pay for more than 3 er visits a year so ERs started getting creative with the frequent fliers and it worked.

[NickiLaughs, ADN, BSN, RN]

Everyone keeps forgetting that they patients are entitled to an assessment, not treatment. All that is required is that a nurse practitioner or md depending on your state greet them in triage the minute they register and evaluate them. When no emergency medical condition is detected, they can be screened out. In Washington, the state threatened to not pay for more than 3 er visits a year so ERs started getting creative with the frequent fliers and it worked.

I'm kinda curious to know what they did with the frequent flyers. For example, what do you do with the drug addicts, they are going to keep coming to the ER?

[Altra, BSN, RN]

I'm kinda curious to know what they did with the frequent flyers. For example, what do you do with the drug addicts, they are going to keep coming to the ER?

Your providers can more selectively prescribe opioids. Trust me, it works.

[Esme12, ASN, BSN, RN]

How the hell do you acknowledge their legitimate need for shelter but keep throughput going smoothly? It's impossible to kick them out without being accused of violating EMTALA.[/quote']

Not true....EMTALA doesn't guarantee them a place to stay. It gives them the right to be seen and receive a medical screening exam without insurance verification. EMTALA.COM - Resources and information

EMTALA requires most hospitals to provide an examination and needed stabilizing treatment, without consideration of insurance coverage or ability to pay, when a patient presents to an emergency room for attention to an emergency medical condition.