Educating patients on ER use

Esme12, ASN, BSN, RN · Dec 17, 2014

It is an effort in futility. Until parents have someone to talk to or a pediatrician that will triage on the phone and stop using the...go to the ED...as their release of responsibility. It isn't going to happen.

The emergency room has always been the safety net for the uninsured and under insured as well and those who are illegal to seek care. I think that all emergency departments need to have an urgent care where the less critical can be seen. With the litigious society in the US everyone is afraid to say...the baby is fine...no they don't need stitches...I'm sure thier arm ins fine see me in the morning...and be responsibile for any issues until the child reaches 7 years past the age of majority.

dudette10, MSN, RN · Dec 17, 2014

I think every hospital with an emergency department should have an urgent care area and an emergency area, and patients triaged into one or the other. I don't know why more don't do that. Urgent care need not be a separate facility, I think.

RNsRWe, ASN, RN · Dec 17, 2014

As long as what defines "Emergency" is up to the individual to determine, the ED will see everything and anything that is so very clearly NOT an emergency. But just try explaining THAT to the person who has no Tylenol at home and has a headache NOW. But it's a REALLY REALLY BAD headache. Like maybe a brain tumor. That's an emergency, isn't it? A possible brain tumor?? OF COURSE he has to go to the ED, are you MAD, ignoring a potentially life-threatening illness?!

Sigh.

SHGR, MSN, RN, CNS · Dec 18, 2014

I do follow up on transitions of care (hospital discharges), making calls from the PCP's office during the day after discharge. I also do as many ED follow up calls as I can but we don't have a good system in place for this. I've made it a habit to explain that after hours our office number transfers over to the after-hours nurses, 24/7, just call our number and it will transfer over...people tell me they had no idea.

I think we should have the providers reiterate this at every visit, too.

Or, have not just the UC in the ED but a primary care office as well.

CopperEmerald · Dec 18, 2014

I think every hospital with an emergency department should have an urgent care area and an emergency area, and patients triaged into one or the other. I don't know why more don't do that. Urgent care need not be a separate facility, I think.

I agree with you. However, many people go to the ER because they don't have insurance, or they simply don't have money for a doctor visit. Here, a visit to an urgent care clinic will cost you $50 or more. I'll be honest, I've been in the position before of needing to be seen urgently (whether it was an 'emergeny' or not is a matter of opinion) and being uninsured, I went to the ER simply because I didn't have the $50 to spare to pay them. (Otherwise I would have). It's an embarrassing situation for many, I would imagine.

dudette10, MSN, RN · Dec 18, 2014

I agree with you. However, many people go to the ER because they don't have insurance, or they simply don't have money for a doctor visit. Here, a visit to an urgent care clinic will cost you $50 or more. I'll be honest, I've been in the position before of needing to be seen urgently (whether it was an 'emergeny' or not is a matter of opinion) and being uninsured, I went to the ER simply because I didn't have the $50 to spare to pay them. (Otherwise I would have). It's an embarrassing situation for many, I would imagine.

This doesn't make sense to me. The ER bill will be much higher than the urgent care bill. I guess that means there is no intention on the part of the patient who can't afford a 50 copay to pay the ER bill?

When my kid needed a school physical, I went to a Walgreens clinic because the total cost was cheaper than my insurance copay at his peds office. I figured I would save the entire "system" a few bucks.

psu_213, BSN, RN · Dec 18, 2014

This doesn't make sense to me. The ER bill will be much higher than the urgent care bill. I guess that means there is no intention on the part of the patient who can't afford a 50 copay to pay the ER bill?

A number of people who abuse the ED, have 0 copay. They have so many outstanding bills that another one for an ED visit? No biggie, who cares. Because the rules are different for urgent cares, the urgent care can demand up front payment. The ED can't do that. If someone presents to the ED, they must have a medical screening exam by a doctor, even if the person has no means to pay for the visit.

Not_A_Hat_Person, RN · Dec 18, 2014

In my area, most Urgent Care clinics don't accept Medicare or Medicaid.

Esme12, ASN, BSN, RN · Dec 18, 2014

In my area, most Urgent Care clinics don't accept Medicare or Medicaid.

That is correct...if they are free standing. If they are apart of the ED acute facility they can be billed.

Gooselady, BSN, RN · Dec 19, 2014

Some people you teach appropriate use of ER to will take it to heart. The rest won't for about ten thousand reasons all stated above.

I read an article written by a former hospital CEO about problems with patient expectations in the ER. Her hospital used Press-Ganey scores from the ER to create a new list of things to change, like hours of wait after checking in, being frequently checked on and informed, etc. She says in her article she saw her ER go straight to hell in a handbasket after public education promised no more than a two hour wait and frequent staff attention once admitted. People were enraged when their frontloaded expectations weren't met (ie, had to wait 2.5 hours, were denied narcotics). Makes you question the implementation of Press Ganey results in such a place.

The ER is always going to be a catch-all as long as people are human. Doesn't mean we shouldn't bother trying. Realistically, unless they want to double the ER staff on duty, 'damage control' is all that can be done.

CopperEmerald · Dec 19, 2014

This doesn't make sense to me. The ER bill will be much higher than the urgent care bill. I guess that means there is no intention on the part of the patient who can't afford a 50 copay to pay the ER bill?

Unfortunately some see it that way. And there are others that may not have that $50 right then, or would pay what they can on the ER bill.