I got a direct admit with active chest pain from the doctor's office.
Patient was told to come directly to the hospital and a bed assignment was given. Patient then went home, packed, had lunch, and then finally came to the hospital -- getting "lost" on the way -- and eventually got to the hospital some FIVE hours after seeing the doc.
Of course the patient had stat orders that we nurses had to implement as fast as humanly possible.
I have to wonder: rather than put the patient at risk or put the receiving staff between a rock and a hard place trying to get hours-old "stat" orders completed, why in heaven's name did the doc not simply call 911????
EMS could've given O2, started an IV, given NTG, put the patient on an EKG monitor, and the patient would have gotten treated stat.
By the way, the patient was a full code and turned out to be having an MI. I worked as fast as possible and the ASA was given, O2 was on, the EKG was done, NTG was given and the IV started and labs drawn within an hour of the patient's arrival.
The patient was shipped over to ICU when the first set of enzymes came back.
However, I feel that this puts the nurses in a precarious position. Are we floor nurses not held to the same standards that the ER nurses would be held to in a case like that?
I don't think the floor nurses could be found negligent re: when the STAT orders were finally carried out. If the physician faxed orders there should be a time stamp somewhere on the orders. If he phoned in orders, the nurse who took the orders should have timed and dated when the telephone orders were taken. The time the patient actually arrived on the floor is documented by the admitting nurse. Also the time the patient was registered into the hospital (I'm assuming if they felt well enough to pack and eat lunch they probably stopped by registration on their way to the floor) would be documented.
Assuming the patient didn't wait for an hour on the floor before they were seen by the nurse, I don't see how the floor staff is responsible for the delay in treatment and they are not responsible for any further cardiac damage that occurred because the patient didn't report directly to the hospital.
I think it was very risky behavior on the physician's part to allow a patient with active chest pain to go to the hospital via private transport. If the patient refused an ambulance, I hope the physician documented this in the chart and also documented that the risks of refusing ambulance transport were explained to the patient.
The patient also carries some responsibility for his/her own health.
IMHO, if anything had happened during those 5 hours, that would surely be the patient's fault.
Altho it might have been better for 911 to be called, the patient DID bring himself into the doctor's office for chest pain and obviously refused to do as the doctor recommended which was go to the hospital immediately.
ekg in md office may have been showing minimal irregularities enough to concern the md but if the patient insisted on going per private car it many have been acceptable at that time
patient in full denial goes home and packs suitcase eats a bite all the while the chest pains continue to get more intense intil maybe his wife insisted that he go in [i use that gender because denial is a male term]
My initial response was going to be that the doc certainly did use poor judgment. However, I remember when I worked in employee health, we would occasionally get someone in who needed to go to the hospital by ambulance and oh my God you would not believe the reactions. 90% of the time they would absolutely refuse to go, stated that if they had to go by ambulance then they would leave and go back to work, go home, etc. So often the only compromise was to explain to them the urgency of their symptoms and the need for immediate treatment and make them promise to get someone else to drive them to the ER right away all of which we would document, document, document. You can't force them to go by emergency transport if they are capable of refusing.
That leads me to my next set of thoughts. What responsibility does the patient bear for their own health? If they were told that they needed to go to the hospital right away and the reasoning was explained to them and they still chose to go home and have lunch then I don't fault the doc for that.
Also when I worked telephone advice, I swear to you we would get people who would call in at 30mins to close with symptoms that they had had since the night before but they got up and went to work and worked an entire day and then wanted to be seen at the office before close. They didn't want to call in, upset their normal routine or be inconvenienced in any way by their own physical needs and at the last minute they wanted everyone to stop and see them their way on their own terms. Talk about frustrating!
They didn't want to call in, upset their normal routine or be inconvenienced in any way by their own physical needs and at the last minute they wanted everyone to stop and see them their way on their own terms. Talk about frustrating!
My initial response was going to be that the doc certainly did use poor judgment. However, I remember when I worked in employee health, we would occasionally get someone in who needed to go to the hospital by ambulance and oh my God you would not believe the reactions. 90% of the time they would absolutely refuse to go, stated that if they had to go by ambulance then they would leave and go back to work, go home, etc. So often the only compromise was to explain to them the urgency of their symptoms and the need for immediate treatment and make them promise to get someone else to drive them to the ER right away all of which we would document, document, document. You can't force them to go by emergency transport if they are capable of refusing.
That leads me to my next set of thoughts. What responsibility does the patient bear for their own health? If they were told that they needed to go to the hospital right away and the reasoning was explained to them and they still chose to go home and have lunch then I don't fault the doc for that.
Also when I worked telephone advice, I swear to you we would get people who would call in at 30mins to close with symptoms that they had had since the night before but they got up and went to work and worked an entire day and then wanted to be seen at the office before close. They didn't want to call in, upset their normal routine or be inconvenienced in any way by their own physical needs and at the last minute they wanted everyone to stop and see them their way on their own terms. Talk about frustrating!
I agree Sharon. Let me add that with a bad outcome, a family that sues, a good lawyer for the other side would pick up on the length of time between being advised to go to the hospital and the actual arrival.
Well, I know, in my Dad's case, the doctor wanted him to be admitted to the ER from his office (not with chest pain) via ambulance--my Mother, however, wanted to "take him home first and call paramedics, or an ambulance".....the reason???
(drum roll and everybody sit down, please)
Seems as though their insurance won't pay for either the ambulance OR the ER, if they go from the doctors office..... they have to go from elsewhere!!!
Can I tell you how I flipped when I heard THAT ONE!!!!
Problem is that I'm 3,000 miles away from them.....thank God I have a good relationship with the office nurses......
PS I insisted that he go in the ambulance to the ER and then I spent SEVERAL HOURS and 10 letters to the insurance company getting this paid for.
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everthesame, LPN, LVN
188 Posts
I don't think the floor nurses could be found negligent re: when the STAT orders were finally carried out. If the physician faxed orders there should be a time stamp somewhere on the orders. If he phoned in orders, the nurse who took the orders should have timed and dated when the telephone orders were taken. The time the patient actually arrived on the floor is documented by the admitting nurse. Also the time the patient was registered into the hospital (I'm assuming if they felt well enough to pack and eat lunch they probably stopped by registration on their way to the floor) would be documented.
Assuming the patient didn't wait for an hour on the floor before they were seen by the nurse, I don't see how the floor staff is responsible for the delay in treatment and they are not responsible for any further cardiac damage that occurred because the patient didn't report directly to the hospital.
I think it was very risky behavior on the physician's part to allow a patient with active chest pain to go to the hospital via private transport. If the patient refused an ambulance, I hope the physician documented this in the chart and also documented that the risks of refusing ambulance transport were explained to the patient.