Doctors office

Call 911. If they want to refuse EMS services they can. 

What type of specialist is it? What is the patient complaining of?

"very sick" needs to be seen in the ED. Call 911 and let them refuse.

If there is no one to see this patient, then I would agree the appropriate thing would be to refer the "very sick" patient to the emergency room, not necessarily 911 because if they were well enough to show up for an outpatient appointment then they might be well enough to be taken to the ER by the person who brought them an hour late to the appointment.  I don't think the staff needs to assess since they can't treat what they find.

Tweety said:

not necessarily 911 because if they were well enough to show up for an outpatient appointment then they might be well enough to be taken to the ER by the person who brought them an hour late to the appointment.

Fair enough; my rationale is to avoid staff doing ANY triage of this situation. Definitely want to avoid getting involved in whether or not the ED is necessary and by what means s/he should be transported there.

Maybe just state clearly that the patient cannot be seen today and would pt/family like 911 to be called.

By the way, too bad OP doesn't provide more information. After I posted I thought it's probably a homework question...?

JKL33 said:

By the way, too bad OP doesn't provide more information. After I posted I thought it's probably a homework question...?

ugh......

JKL33 said:

By the way, too bad OP doesn't provide more information. After I posted I thought it's probably a homework question...?

No this is not a homework question. 

Heather Dill said:

No this is not a homework question. 

Well there just isn't a lot to be done in this scenario. There are only a couple of right answers and they have already been mentioned.

The specialist they came to see is not there, and there are no protocols.

The staff present should not get involved in assessment. This is not an emergency department and anything related to EMTALA does not apply. This is not much different than a grocery store parking lot scenario. If the patient is in the building already (or has otherwise been observed by staff) and is in obvious extremis, call 911. Anything other than that, state that the patient cannot be seen and ask if the family would like 911 to be called.

Heather Dill said:

No this is not a homework question. 

Then would you mind answering my questions?

In my specialty office, if a patient is late and have to reschedule, we do not do an assessment (even if the patient claims to be very sick), we refer to PCP or urgent care). If they were able to wait for a visit.. it's not as urgent as they are making it out to be .. and if it is truly is that urgent, they need to see urgent care.

At the primary care clinic I used to manage, the nurses had an independent standing order to assess any emergent triage patients, and then could independently determine what was needed (ED - call 911; same day - direct them to nearest UC; next day - reschedule them with a provider the following day). That's why I wanted to know what the specialty was and what the patient's complaint was.