ER's Turn Non-Emergencies Away?

Specialties Emergency

Published

The below article appeared on the website of a local news station in Rock Hill SC. Some people in the community have varied opinions about this. For those of us "in the business", what do you think about this kind of policy? Do you think it will actually make a difference or is it just bad public relations or giving people a mixed message about a hospital's concern for it's community? What if a patient has no insurance and can't afford a doctor's office visit, where do they go? What do you think?

Local Hospital's New Policy Of Turning Patients Away Upsets Some

Posted: 6:28 pm EDT May 12, 2009

ROCK HILL, S.C. --
Diana Burgess of Rock Hill went to the emergency room at Piedmont Medical Center last month with severe pain in her side."The doctors came in and just basically said they weren't going to do anything for me," she said. The ER doctors determined that the pain Burgess was suffering was not an emergency and didn't require immediate care. President and CEO of Piedmont Medical Center Charlie Miller explained the policy this way: "it is an emergency room, not a primary care clinic." "We think it's had a positive impact on wait times," Miller said. "Two-hundred to 250 people a month are leaving to see their primary care doctor instead." Hospital officials also said patient care is better when they can see a doctor outside of the hospital and form a relationship, rather than using the emergency room as their doctor. However, people like Burgess, who doesn't have any health insurance, said she can't afford to see a regular doctor. "I just left there crying," she said. "I was hurting too. I was really feeling bad. "Miller said the hospital does what is required by law, which means doing a medical screening for every person who comes into the ER. Then doctors determine if their condition requires immediate emergency care.

Specializes in Emergency Dept, M/S.
Part of the problem is people don't want to bother making an appointment for follow-up because it takes too much time out of their day, or they don't want to think about it once the immediate pain/situation is taken care of-until the next time they get symptomatic and then it's off to the ED again for insta-relief.

Exactly. And the ED is available when it's convenient for them. They can go after work or on weekends when the Dr office is closed.

It ticks me off that a good portion of these same people can think far enough ahead to make sure they don't run out of beer or cigarettes, but not when they see they have one b/p pill left. Or that gee whiz, I've had this abd pain on and off for 6 months, but in those 6 months, can't remember to call to set up with a PMD, or even CALL their PMD if they have one, because we all know it will take a couple days to get an appt. And I do like asking pt's that - "So you've had this pain for 6 months and have been here 5 times for it, but haven't called your PMD about it? Why?" Pt: "Because they couldn't get me in." :banghead:

Specializes in ED/trauma.

The E stands for emergency. Anything else-make an appointment with the doctor. Where I work we would still have an abundance of work if only real emergencies were to come in. And it bothers me when people say that they don't have insurance and can't afford to pay as some of the others have said. Even McDonalds offers insurance, if you think there is even a remote chance that you or your family may get sick then you should have the either the means to pay and a pcp or free clinic in mind if you don't have the means to pay.

I have always made sure myself and my children were covered in case we got sick, even when I was a very poor college student- I just got a second job if need be.

A fellow student in my MSN program and I had a friendly debate about this not long ago. She was talking about being on welfare and getting finacial aid because how else was she supposed to get through school, and she also stated that it is a good thing that she was on welfare because her son was born premature and needed a lot of care and diapers and formula are expensive, and was she just supposed to let him die because he was sick and hungery...she wanted to know what brilliant ideas I had as a remedy... get a job with insurance, get a second job to pay your own tuition, and don't have kids if you can't pay for them (especially when you just told me that you can't pay for yourself).

We have to remember that America is a society of needy, greedy, want- something-for nothings. I volunteer in a free clinic. The people that we see there that really are down and out or disabled come there like they are supposed to, are very grateful for the help we give, and are usually trying to get to a better place. Then we also have an overflow of people who are there bleeding the free ride to death, who are on disability, or welfare who EXPECT and feel they deserve free care, most of this population lives much better than I do. The poverty stricken/disabled are NOT overcrowding the EDs and taking advantage of government services, it is the pre-madonna, "It is an emergency because it is affecting ME"-types.

I don't know what the answer is, but I am an Emergency Room nurse, when I go there I should be seeing life-or-limb threatening injuries only, I volunteer at the free clinic so that I can help those in need of chronic illness or acute, non-lethal ailments. I don't think we should have to educate the public about this-everyone knows this, they just don't care.

I for one would love to work at an agency that had a policy like this! It would surely cut down on the "No, I didn't buy Tylenol for my kid because I am too poor" (but somehow I managed to get drunk/high today) and the "No I don't need a work note because I am on disablility for a severe back injury" (but somehow I managed to hurt my knee water skiing) types.

Specializes in ER, Trauma, ICU/CCU/NICU, EMS, Transport.
The E stands for emergency. Anything else-make an appointment with the doctor. Where I work we would still have an abundance of work if only real emergencies were to come in. And it bothers me when people say that they don't have insurance and can't afford to pay as some of the others have said. Even McDonalds offers insurance, if you think there is even a remote chance that you or your family may get sick then you should have the either the means to pay and a pcp or free clinic in mind if you don't have the means to pay.

So did you vote for Obama and universal health care?

and don't have kids if you can't pay for them

Do you think she "chose" to have kids?

I volunteer in a free clinic. The people that we see there that really are down and out or disabled come there like they are supposed to, are very grateful for the help we give, and are usually trying to get to a better place.

I'm going to pause and give you a big kudos here. MANY people who ***** and moan about "the system" won't get off their asses to do anything to help fix the problem or to contribute otherwise. So I sincerely applaud you for volunteering your time.

Can I challenge you a step further to be involved with your local, state and national ENA (http://www.ena.org) to help work on some of these same problems? (Oh, and if you already are in the ENA and active then DOUBLE Kudos to you!!!! - you can rant on as much as you like!)

I don't think we should have to educate the public about this-everyone knows this, they just don't care.

I wouldn't assume everyone knows this. I ask a LOT of my patients why they came to the ED for their problem, and a LOT of them say, becuase I need to get (insert name of problem/condition) "checked"..... I ask this quite a lot, and I hear this answer over and over and over.

Besides, even G Bush doesn't know this, after all he said that we (Americans) had access to health care, jus to go the E.R.! So I think your statement is an over-generalization that people "don't know".

I for one would love to work at an agency that had a policy like this!

Well see what you can do to get involved and suggest/promote this type of system at your workplace. Don't tell me it won't work at your place - the places that are doing it now used to say that and guess what! They're doing it; more and more places are. Just needs someone to start to champion change.

Hey, I just wanted to say, don't feel like I'm tearing into your post. It's very obvious you have some emotional involvement in this topic and you are fired up about issues in your practice and workplace.

Again, I strongly commend you for your community involvement - I sure wish more nurses would get involved at that level - OUTSTANDING!

And I'm totally serious about the ENA thing - take your supercharged energy and influence and take it to the next level!

Keep up the good work - thanks for the post.

-Mark B.

Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
Besides, even G Bush doesn't know this, after all he said that we (Americans) had access to health care, jus to go the E.R.! So I think your statement is an over-generalization that people "don't know".

G Bush is in no way an average American ... he never had to worry about keeping a roof over his head or food on the table, much less about access to healthcare. I'm not surprised he didn't know.

I've found it's not that people don't know; they do know. But they also know that a doctor's office or urgent care wants money up front, and the ER doesn't. (Sure, our registration folks ask for it, but the patients know they don't have to pay it before being seen.) We're easy/convenient. We live in a fast-food society, and many people think their healthcare should be available on a drive-through basis.

Specializes in ER, Trauma, ICU/CCU/NICU, EMS, Transport.
We're easy/convenient. We live in a fast-food society, and many people think their healthcare should be available on a drive-through basis.

Right, as well, it's also a learned behavior thing too.

Alot of our 20-somethings that come in now, were babies during the 80's when THEIR parents started taking them to the ED for inappropriate stuff, and NOW they've learned this as the thing to do and that it's socially acceptable.

Kind of like that lady recently who made the news when she called 911 to report her being mis-treated at McDonald's. Some of today's society has learned (as much as we've become tolerant as well) that certain things (911, ED's, Ambulances etc, etc) are "allowed" to be used for other-than-what-they were meant for purposes - and they're not ASHAMED of it at all!

I can just see them turning away the wrong patient who really might need care and a law suit will follow!

Specializes in ED/trauma.

To respond to you post, I am an active member of the ENA and attend all of the state as well as national meetings. I am also very involved in stregthening and empowering the role of the RN in policy change at my hospital. I am a charge nurse at a HUGE 100 bed level 1 trauma center, and I serve on many commitees there. I am also very involved in my role as a public health nurse. I have learned a lot in my many years doing this, and research and problem solve whenever I feel very strongly about something. The unfortunate thing is that I don't think anyone has any idea how to remedy this-I wish we did, very sad.

And I don't feel that turning someone away who has a real emergency would be much of a problem. As it stands right now everyone is entitled to a SCREENING, not treatment. And I have found that we can usually tell pretty quickly if the person is sick or not.

Specializes in ER and Home Health.
If it's not an emergency, you shouldn't be at the ED, regardless of insurance.

Theres a few times Ive needed to be seen for illness or injury, I have not gone to the ER yet. My copay in ER is 75 dollars, I go to either the doctors office or urgent care clinic and it is 20 to 30 dollars. Plus I can triage in on line and they call me when the doctor can see me. Sweet deal.

Specializes in ER and Home Health.
So did you vote for Obama and universal health care? Of course I did.
Specializes in ER, Trauma, ICU/CCU/NICU, EMS, Transport.
To respond to you post, I am an active member of the ENA and attend all of the state as well as national meetings. I am also very involved in stregthening and empowering the role of the RN in policy change at my hospital. I am a charge nurse at a HUGE 100 bed level 1 trauma center, and I serve on many commitees there. I am also very involved in my role as a public health nurse. I have learned a lot in my many years doing this, and research and problem solve whenever I feel very strongly about something. The unfortunate thing is that I don't think anyone has any idea how to remedy this-I wish we did, very sad.

You are awesome in my book! Keep up the good work! Get your colleagues to follow suit!

Specializes in ED staff.

We do this in our ER too. We have quite a number of patients that come in at LEAST once a week. Most of them are either drug seekers or attention seekers. If you come to the ER and tell the triage nurse that you've had abdominal pain for three years every time you have your period, we're likely to consider you nonemergent. In the end it's up to the MD though. And yes, coming to the ER all the time is a learned behavior. We have a mom and a grown daughter that show up every few weeks like clockwork.

Your first point is taken.

But your second point - I don't share.

I don't mind people coming to the ER for non-emergencies...so long as they can pay for my service and time. I'm just guessing here, but I'm thinking "non-emegencies" pay our labor/operating costs a lot more than "emergencies" do....

A LOT OF US would be out of jobs if only "emergencies" came in.....

Go figure.

Extremely good point.

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