A hospital in my state is the topic of this article about using the ER and when it might not be the best option. There are family members points of view in the article and many comments as well that make me realize some people just don't get it (true reasons for an ER visit).
How can we do a better job at educating patients and families on emergency vs non emergency?
Does your doctor have a paging system for after hours? Do many know about it?
Just wondering what some of you more experienced people have to say. I'm not meaning to start any arguments but ideas on how I can help my patients understand.
There are no urgent care clinics in my area (high retirement population) and many of the local clinics and private practices keep limited hours (many docs up here work 4 days/week) and/or have no on call services so what's someone to do when they have intolerable symptoms or a semi serious problem but their dr doesn't work on Thursdays, it's only 3:00 but the office is already closed with no one taking calls, or the clinic is booked and THEY refer you to their own ER?
One that always stands out in my memory is a patient with non symptomatic hyperglycemia, I call her clinic doc who gets on the phone with me and directs me to send patient to his hospital based clinic's own ER. "But I'm here and can do whatever monitoring you want, just call something in, no reason to send patient to the ER (who just prescribed some first line meds and released patient home) when this could be managed at home." Not like this wasn't his own known patient (who should've/could've been already managed as an out patient anyway).
I can't count the number of times I've called to report significant symptoms on a patient and was referred to the ER because they just can't fit them in and neither of us is willing to put our licenses on the line. It's not just ignorant abusive individuals, it's a system wide problem as well.
But that poster said they had NO insurance, "uninsured". How can that be free to go to ER?
There is Thought Process A: If I go to the ER, the bill will probably be expensive. What might the total be? If I can't pay it over a couple of months, they'll refer me to collections. My credit will be affected. This could really affect my life -- do I really need to go to the ER today?
Then there is Thought Process B: an individual whose financial realities do not include consideration of maintenance of credit score, or future financial consequences, but simply the here and now: I have Symptom X, so off to the ER I go, whether I consider the symptom to be minor or potentially life-threatening.
I have a $200 ER copay, unless I'm admitted, regardless of the nature of the visit. I was doing a motorcycle training course to get my license and wrecked, flew across the handlebars, landed on my right knee then side, and rolled. I was able to make it home for my husband to drive me to the ER. I'd sprained my right knee and had two sections of road rash (one on the right knee that was covered with a 4x4, one on my right side that took two 3x8 to cover). The next day I was back because my ankle was swollen, another $200 copay for a sprained ankle/foot. I went to the ER in case something was wrong and I needed surgery, which fortunately wasn't the case. Working in an office setting, we do recommend the ER or urgent care if it can't wait until the next day if we're slam packed. Asthma pts calling with wheezing and using their neb q 4 hours x 3 days (yes, calling right at the end of the day) are directed to the ER. Sore throat--urgent care or wait until tomorrow. Our office does have an after-hours line with direct paging to a physician but pts tend to panic and forget that. ER doesn't replace PCPs anymore, they do the bare minimum. My son's friend broke his arm after hours, mom took him to the ER, they x-rayed and gave pain meds then wrapped it and told her to call ortho in 2 days. Ortho set and casted his arm then. ER will alleviate the pain and tell you who to follow up with.
Specializes in Care Coordination, Care Management.
And Medicaid recipients don't seem too alarmed...I mean, what's going to happen? An ER won't turn them away for treatment, so they'll continue to use the ED whether it is covered or not.
I send out ER visit letters and flyers all of the time to our "repeat offenders", and 95% of the patients whose ER visits I follow up on have Medicaid.
Some states have been cutting Medicaid to the bone and will alert recipients that they are only billing for "true emergencies"; unfortunately, that's running the risk of what would constitutes as an "emergency" since some of the simplest, vaguest complaints can be potential illness that are "emergencies".
Specializes in Care Coordination, Care Management.
I don't understand this...one of our local hospitals used to have an UC or "fast track" on site. They then built the UC at a different location, d/t space issues and eventually building a new hospital. They also have another UC location in a nearby town. It is hospital affiliated.
Urgent care wants the $50 upfront before being seen. They have the option to turn you away for non-payment. The ED will take $5 payments until the bill is paid. When you have no money but need to be seen, it is an easy choice if you cant be seen by your PCP.
My director has told me an urgent care section of the ED would be a liability for the hospital and that many insurances wouldn't cover it. Not sure the specifics but I know they looked into it and ended up opening their own urgent care 1 mile from the hospital. People still come to the ED instead of urgent care and we are not allowed to suggest they go there instead.
And Medicaid recipients don't seem too alarmed...I mean, what's going to happen? An ER won't turn them away for treatment, so they'll continue to use the ED whether it is covered or not.
I send out ER visit letters and flyers all of the time to our "repeat offenders", and 95% of the patients whose ER visits I follow up on have Medicaid.
Not all places have urgent care centers, never mind 24-hour urgent care. My area has 1 hospital and 3 urgent care centers, which are open 7 am to 7 pm. The hospital-affiliated urgent care clinic is open 8 am to 8 pm, and is the only one that takes Medicare and Medicaid. When the choice is 3 weeks to see a PCP or 6 hours in the 24-hour ER, many people will choose the ER.
A study released about a year ago concluded that less than 10% of Medicaid ER visits were frivolous. Medicaid recipients can, and do, have emergencies.
Not all places have urgent care centers, never mind 24-hour urgent care. My area has 1 hospital and 3 urgent care centers, which are open 7 am to 7 pm. The hospital-affiliated urgent care clinic is open 8 am to 8 pm, and is the only one that takes Medicare and Medicaid. When the choice is 3 weeks to see a PCP or 6 hours in the 24-hour ER, many people will choose the ER.
A study released about a year ago concluded that less than 10% of Medicaid ER visits were frivolous. Medicaid recipients can, and do, have emergencies.
If your area has even a single urgent care center, count yourself lucky compared to where I work. There isn't a single UC anywhere. If you're in need of care, you are lucky if you can get an appointment to be seen within 3 weeks at any of the clinics in the area, but more commonly it's much longer than that... so the ED there has to see it all. In places like that, yes, the ED is abused, but it's what happens when there are just no other options around.
I live in a very populated area that has many options for care, including some 24 hour urgent care centers. Even with those options, people still often opt for the ED. The times I have had to use an ED near home, I've been very lucky that I was seen extremely quickly as the ED was at a low census that day. I've been places where the ED has been packed to the gills with wait times >6 hours.
Specializes in Care Coordination, Care Management.
Of course Medicaid recipients have emergencies. But, the data I am seeing personally (collecting and tracking as part of my job) shows that a large portion of ER visits by our Medicaid patients are for non-emergent medical issues. And I am in an area with several urgent care and after hours clinics, including one 24 hour urgent care center, so there are options available.
Do you have a link to the study by any chance?
Not all places have urgent care centers, never mind 24-hour urgent care. My area has 1 hospital and 3 urgent care centers, which are open 7 am to 7 pm. The hospital-affiliated urgent care clinic is open 8 am to 8 pm, and is the only one that takes Medicare and Medicaid. When the choice is 3 weeks to see a PCP or 6 hours in the 24-hour ER, many people will choose the ER.
A study released about a year ago concluded that less than 10% of Medicaid ER visits were frivolous. Medicaid recipients can, and do, have emergencies.
I am all in with the ED having a separate treatment area for all incoming patients. With that in mind, the theory of service oriented care must relax. We are not McDonalds or American Eagle. If we are neglectful, disrespectful or texting at the nurses station, then they can bring up the issue of service. Nurses are VERY busy with everything being important. If doctor offices do not want to have a triage nurse on call, they can hold classes or hire an educator. The other thing they can do is set up online teaching that all parents can access. The best option is a triage nurse on call that can work from home. This benefits the nurse and the patient. A two way access would be optimal so the nurse can get their eyes on the patient. In regards to a secondary treatment area, anyone over there would not be deemed an emergency so they can come on a first come, first serve basis. Behavioral therapy may stop them from sitting for hours over a runny nose or hang nail.
Sadly, the proportion of the general population that is uneducated is only going to increase. The average person lacks the knowledge to determine what constitutes a medical emergency.
The best solution would be to monopolize ER's. This way, there is no competition for the ER's and the management of ER's can freely encourage their staff to be more assertive with the way they educate anyone visiting the ER for something that isn't urgent.
The urgent care facilities in my area won't bill you and payment is due in full before you are seen. When my insurance starts in January, I have to pay 100% until I reach my deductible. An office visit can run me anywhere from 50-200, depending on what its for. (Once I hit the 900 dollar deductible they pay 80-100% of everything)
I wouldn't have a choice if I really needed to be seen and I didn't have the money, since the ED will bill me and urgent care won't. It's just that simple. Not everyone has credit cards or savings accounts. It's a matter of pay later and get the treatment you need or suffer.
Libby1987
3,726 Posts
There are no urgent care clinics in my area (high retirement population) and many of the local clinics and private practices keep limited hours (many docs up here work 4 days/week) and/or have no on call services so what's someone to do when they have intolerable symptoms or a semi serious problem but their dr doesn't work on Thursdays, it's only 3:00 but the office is already closed with no one taking calls, or the clinic is booked and THEY refer you to their own ER?
One that always stands out in my memory is a patient with non symptomatic hyperglycemia, I call her clinic doc who gets on the phone with me and directs me to send patient to his hospital based clinic's own ER. "But I'm here and can do whatever monitoring you want, just call something in, no reason to send patient to the ER (who just prescribed some first line meds and released patient home) when this could be managed at home." Not like this wasn't his own known patient (who should've/could've been already managed as an out patient anyway).
I can't count the number of times I've called to report significant symptoms on a patient and was referred to the ER because they just can't fit them in and neither of us is willing to put our licenses on the line. It's not just ignorant abusive individuals, it's a system wide problem as well.