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Does the ED stand for Emergency Department or the Everything Dumpster?

Posted

Has 3 years experience.

Why, why, why does it seem like we are the dumping ground for the whole medical community? From primary care providers offices, to nursing homes, to the urgent care it just seems like no one wants to be accountable for taking care of patients, so they dump patients in the ED. It's just very frustrating. It's even going to the extreme where nursing homes are sending dying patients by the transport van, instead of by ambulance. Just a couple of days ago, I had a patient that was sent over to the ED from a local nursing home by a local transport service, for altered mental status. Now why was the patient having altered mental status? Because the patient was in third degree heart block. When this patient was hooked up to the cardiac monitor, it showed that the patient's heart rate was nearly asystole. Now why this nursing home chose to send this patient by a transport van instead of by ambulance is beyond me. What if this patient died while in the transport van? The drivers are not even trained in CPR. And apparently this nursing home has sent very sick patients by transport van many times before. This is just a rant, with no particular focus at all. Just frustration with how the medical establishment sees the emergency department as a dumping ground.

canoehead, BSN, RN

Specializes in ER. Has 30 years experience.

It's the Exasperated Room, or Everyone's Retarded.

And by retarded I mean Snookie, or Tom Cruise jumping on Oprah's couch. Nobody have a cow.

I just wanted to mention, as a LTC Nurse, that I seriously have family members who insist on us sending their loved one out. An uncomplicated fall, maybe a resident rolled out of the bed placed to the floor and onto the mat, etc.. Some family members seriously insist that we send them out.

End stage COPD resident has SOB, we are 'told' to send them to the ER because we want a blood gas, or because we want to see if 'anything else' can be done. Really?!

Pudnluv, ASN, RN

Specializes in ED. Has 20 years experience.

I had a nursing home send a patient by ambulance for insomnia. It was 8 o'clock in the evening, the patient came in fully dressed and was sound asleep on the ambulance stretcher. I had to wake her up to triage her. Turns out the patient had dementia and would get up in the middle of the night and wander the halls. They hadn't even tried to put her in bed yet. They could have at least waited until a little later at night and had her in her pajamas. That may have been a little more convincing about their complaints of "insomnia".

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

Because the ED/ER always has been the dumping grounds. It always will be. This nursing home sending patients out by transport needs to be talked to....you can't necessarily blame the staff as you have NO idea what they have been told to do. If they have been told by admin that his is what must be done of be fired....in this job market...you do what you are told. Sending out "half dead" patients....if they have had too many deaths recently....and they want their numbers down....guess where they are going to be sent. Some staff at NH will send problematic patients to the ED to give themselves a rest.

I just wanted to mention, as a LTC Nurse, that I seriously have family members who insist on us sending their loved one out. An uncomplicated fall, maybe a resident rolled out of the bed placed to the floor and onto the mat, etc.. Some family members seriously insist that we send them out.

End stage COPD resident has SOB, we are 'told' to send them to the ER because we want a blood gas, or because we want to see if 'anything else' can be done. Really?!

The problem in the OP is that a LTC facility chose to send a sick resident via van instead of an ambulance. If it is a life threatnening emergency than the resident should have been sent via ambulance. I'm sure it is cheaper to use the van however it is not the most prudent.

whichone'spink, BSN, RN

Has 3 years experience.

I just wanted to mention, as a LTC Nurse, that I seriously have family members who insist on us sending their loved one out. An uncomplicated fall, maybe a resident rolled out of the bed placed to the floor and onto the mat, etc.. Some family members seriously insist that we send them out.End stage COPD resident has SOB, we are 'told' to send them to the ER because we want a blood gas, or because we want to see if 'anything else' can be done. Really?!
I realize that some LTC patients are sent out unnecessarily by ambulance. I'd rather kvetch about that than rant about how a legitimately sick resident was sent in a transport van. At least the ambulance has equipment needed to monitor patients.

martymoose, BSN, RN

Specializes in PCCN. Has 18 years experience.

I thought it stood for emergency drugseeking?

I too work in LTC and have many of the same issues. Hospice pt, No Code and family still insist that their family member be sent to the hospital or the DON wants them sent out for obvious reasons.

Unless you truly need the pain meds then you are given less than adequate. Just speaking from personal experience. I broke both legs when thrown from my horse a couple years ago. I stayed in the ED for four hours in agony. When I asked for something for the pain you would have thought I asked for oxycotin. I was given Hydro 5/325mg one and sent home with discharge instructions to see ortho surgeon on Monday. I left the ED Saturday morning at 0200 in a wheel chair praying I could make it till Monday without killing my kidneys on extra strenght apap.

N1colina

Specializes in LTC, Family Practice, Meg/Surg. Has 6 years experience.

Unless you truly need the pain meds then you are given less than adequate. Just speaking from personal experience. I broke both legs when thrown from my horse a couple years ago. I stayed in the ED for four hours in agony. When I asked for something for the pain you would have thought I asked for oxycotin. I was given Hydro 5/325mg one and sent home with discharge instructions to see ortho surgeon on Monday. I left the ED Saturday morning at 0200 in a wheel chair praying I could make it till Monday without killing my kidneys on extra strenght apap.

Just want to point out that all that APAP would be tough on your liver but either way, it sounds like BS that they didn't send you home with any pain meds after breaking your legs... 1 Lortab while you were there?? I'm sorry that you encountered that kind of experience.

N1colina

Specializes in LTC, Family Practice, Meg/Surg. Has 6 years experience.

Just want to point out that all that APAP would be tough on your liver but either way, it sounds like BS that they didn't send you home with any pain meds after breaking your legs... 1 Lortab while you were there?? I'm sorry that you encountered that kind of experience.

I stand corrected. I guess new research (new to me) shows that Tylenol can be nephrotoxic as well :/

tewdles, RN

Specializes in PICU, NICU, L&D, Public Health, Hospice. Has 31 years experience.

The ED as a dumping ground is the way our capitalist system has evolved.

It is not likely going to change in the near future.

LTCs/SNFs/ALFs will continue to send their elderly and ill patients to you for all sort of crazy reasons and a few good ones. Those patients will be transported to a large degree the way their families want them transported...even perhaps in the back seat of their car.

It's the Exasperated Room, or Everyone's Retarded.

And by retarded I mean Snookie, or Tom Cruise jumping on Oprah's couch. Nobody have a cow.

Or you could just not use the word. You obviously know that some would birth a bovine by its use, yet your comment was really sooooo important to be offensive anyway?

You know what is weird though, sometimes family members ask that an ambulance NOT be used. I swear, I love my job, but the whackadoo family members really grate on my nerves!

Then we had one family member attempt to demand we send a patient with an ingrown toenail via 911 to the ER. Podiatrist visit was the very next day, but his foot hurt. Yanno, I could have given him his percocet... Family ended up calling 911 because *I* did not under orders from doc and DON.

I have all sorts of fun stories.

workingharder

Has 2 years experience.

... Some staff at NH will send problematic patients to the ED to give themselves a rest.

What? We can do that??? Dang! I'm chartering a bus!:cheeky:

twinkletoes53

Specializes in NICU.

Is it because people with no insurance HAVE to be seen if they show up at the ER? I know so many patients who use the ER as their PCP. Which really sucks. It makes waiting time longer for everyone and takes staff away from patients who are truly sick. If ER is overrun with patients, some may be either incorrectly triaged, or triaged; sent to wait their turn, then can't speak up when their condition worsens.

ktwlpn, LPN, RN

Specializes in Med Surg, Homecare, Hospice.

The problem in the OP is that a LTC facility chose to send a sick resident via van instead of an ambulance. If it is a life threatnening emergency than the resident should have been sent via ambulance. I'm sure it is cheaper to use the van however it is not the most prudent.

In my LTC if the resident has DNR they almost always go in a transport van.In PA. if we sent them in an ambulance and they tried to die they would be coded despite their DNR status. What was the status on your patient? DNR? What was the outcome?

Often the family insists the resident be transferred,it's not up to us.

I have transferred dying patients to acute care and I have received new admissions and hospital returns from acute care who were obviously in that transition and died within the hour.It happens and it's not something we can control. I try not to take it personally and let it ruin my day