doctors using to ER to adment ?

psu_213, BSN, RN · Jul 15, 2011

I think (sorry I'm putting words in his/her mouth) the point of the OP is: why does a doctor sent a pt to the ED for a full workup rather that just doing a direct admit? Not really an EMTALA question. More a questions of why does the PCP "choose" to use ED resources to workup a patient when they intend all along to admit the pt? If I am wrong in that thinking, let me know.

In some cases, I agree, it is a waste. They will literally get in, basic lab work is sent of and they are admitted right away--without any results back--they are only there as a "easy" way for the PCP to admit them. In my mind, yes, this can/should be a direct admit and that basic testing (blood work, xray, etc) can be done on the floor.

In some cases, it is justified. Anytime a potentially unstable situation needs to have testing beyond what can be done in the PCP's office an ED eval is justified before admission. For example, abd pain or chest pain...testing can be done to rule of an unstable/emergent situation and then they can be admitted for followup testing and tx. for their condition.

ckh23, BSN, RN · Jul 16, 2011

Not all doctors have privileges at hospitals so when they see a patient in the office that needs to be hospitalized they cannot be directly admitted and need to go through the ER. For example if I have a bad cellulitis that requires treatment with antibiotics, my doctor cannot admit me to the local hospital because he doesn't have any contract/agreement to be allowed to treat me himself. So instead I would have to go through the ER, get worked up, and be treated by a house doctor for the infection and my family doctor would have no say in the course of treatment.

tokmom, BSN, RN · Jul 16, 2011

We do direct admits, sort of, but now they are filtered. Instead of it being the local doc sending anything over..ie..pt's that dont' qualify for a stay, the local dr has to call a placement center and request a bed. He then has to have orders written before the pt even hits the door if they are admitting, or have a hospitalist accept the pt.

I think sending them through the ED though filters what can go upstairs, thankfully.

mappers · Jul 16, 2011

Our doctors direct admit (oncology), but they have to be seen by us in the office first. We have patients call us with symptoms that really they should go to the ER for, but insist they come see us first. We are usually over booked and trying to work in a patient that is really emergent is .... Well dangerous. We had one guy drive himself to our office. When he got here, he was running a temp of 103 or more, with a HR in like the 160s, rigors, etc. He was so septic. We rushed him to the hospital and, I believe, died a few days later. He should have at the very least called us earlier, at the most called 911.

Ruby Vee, BSN · Jul 16, 2011

google is not helping me i am looking for the word that means "to be put in to the hospital" ?

admitted?

**canoehead, BSN, RN** · Jul 18, 2011

Our hospital doesn't have beds, so if the doc calls in a direct admit they get a roadblock. So they send their patients to the ER where we can't turn them away.

Roy Fokker, BSN, RN · Jul 18, 2011

Even better?

"Ok Mr. Smith. Have a seat in the waiting room and as soon as a spot opens up inside, we'll call you in".

"Waiting room?! But I'm going to be admitted! My doctor already called ahead!"

"Sorry Mr. Smith but we see patients according to the severity of illness and not by mode of arrival. Please have a seat in the waiting room and we'll call you in the second a spot opens up".

"This is outrageous! Mr. Big CEO will hear about this!"

Another patient. Another opportunity lost. And people wonder why I'm so cynical...

"Just go to the ER..."

This willful ignorance of the meaning of the word "EMERGENCY" in the term "EMERGENCY DEPARTMENT" is the real root of the problem.

"Just go to the ER". It's not an "Ambulance - an emergency vehicle equipped with speicalised equipment and staffed with trained medical personnel" ... it's just a 'big white taxi with shiny lights and a multi-tone siren'.

"Just go to the ER..." Who cares that you might not have an emergency? I'm too lazy to pick up the phone, call the hospital, talk to the house doc/hospitalist/nursing supervisor and arrange for an admission and bed. Almost every hospital today with inpatient beds has hospitalists/MHOs - it's not rocket science (and please don't quote the exceptions: exceptions aren't the rule and we aren't discussing exceptions here). Moreover, if you don't have privileges, why do you send your patients here [esceptions would be 'closest facility with no inpatient beds' etc.]? And if you've been consistently sending patients here, don't you think it prudent to gain privilege so as to better serve your patients?

And to you kind folks who say that the patient when told to "go to the hospital tends to dilly-dally and finally get to the hospital way later than expected" - you just proved my point - "just go to the ER... No you don't have an actual emergency but who cares anyway?"

It bears repeating: A lack of planning on your part does not constitute an emergency on my part.

ER over-crowding and abuse is not a joke. How many people are quick to jump up and skewer the ED staff when people die in waiting rooms? How many people complain about wait times?

cheers,

Roy (an "'E' stands for 'EMERGENCY'" Nurse)

Altra, BSN, RN · Jul 20, 2011

10,000 Kudos for Roy's post!

~Mi Vida Loca~RN, ASN, RN · Jul 21, 2011

I wonder if sometimes it has to do with the hassle the Hospitals will give the docs sometimes.

I knew someone we will call "Si Vida Loca" They were pregnant and a high risk pregnancy. The Doctor who was seeing her had plans to induce at 38 weeks because of the complications of the pregnancy. Vida was dilated to a 3 already and effaced 50% and at a +1 station at 38 weeks. The hospital had just recently had a huge problem with docs inducing around vacations and patient preference. This lead to increased rate of emergency c-sections. Because of this the hospital decided it would not allow inductions unless the patient was referred out to one of their docs and they said it was needed. This would have taken 2 weeks which would have been pointless. The Doctor was being frustrated with the new policy and the patient was already in a lot of pain and baby was at risk from other complications going on.

So finally at 38 and 2 days check up the doc broke the patients water in her office and sent her to the hospital (5 mins away) where the patient would then HAVE to be admitted and baby delivered. The original plan was to have the patient be a direct admit.

Anyway, from what I have seen sometimes it seems like it's less hassle to have the patient go to the ED and be admitted and then treat them. It's less resistance than dealing with a direct admit at times. I have no idea if this is the norm though.

Roy Fokker, BSN, RN · Sep 3, 2011

Anyway, from what I have seen sometimes it seems like it's less hassle to have the patient go to the ED and be admitted and then treat them. It's less resistance than dealing with a direct admit at times. I have no idea if this is the norm though.

Less resistance and less hassle for whom?

Is it ok to clog the ER with non-emergent patients making it more difficult for emergent patients to get the care they need and deserve?

"I'm sorry you've been waiting 3 hours to see the doctor, M'am. Unfortunately he's busy working up pts. who should've been direct admits but their doctor thought it was less of a hassle to send 'em to the ER to be admitted. I'm sure the doctor will be by shortly. And no M'am, I can't give you anything more for pain till a doctor sees you".

Naturally, that's NOT a conversation I would have with my patients.

Instead, I put up with their anger, frustration and tongue lashing about 'sitting around for hours and I haven't seen a damned doctor yet!" with a smile and ask "can I do anything else for you, I have the time...?"

By the way: Si Vida Loca - is an exception (high-risk pregnancy with complications), not the rule.

I'm also wondering: Was the pregnancy known to be high risk early on or was it new onset risk? Because if it was known fairly ahead of time...

psu_213, BSN, RN · Sep 5, 2011

There is actually a nurse in our ER who is currently conducting a study of the number a pts. we get who are supposed to be a could have been a direct admit. (Not sure what the results of the study are showing) This is an attempt to alleviate a bit of congestion so that we can provide better care for the pts. who are there for actual emergencies (what a strange idea!).

Trekfan · Nov 9, 2011

Why do some doctors have to send people to the ER to be admitted to the hospital? this makes NO sence to me at all if the doctor thinks you need to go into the hospital WHY can they not just put you in ? What am I missing this seems like the dumbest thing ever .

Well I just got out of the hospital after spending a week there ,I had gone to my doctors office that by the way was connected to the hospital , and told I needed to be put in she left to make a call for a bed and I had gotten worse when she came so they ( Wait for it ) called 911 to move me from the office to the er ( how dum was that and the 911 people where not happy this was there 5 call in two days to move people)

So I get to er and the hole place is full so I had to spend my first 24 hours :eek: in the er with no sleep . There has to be a better way .