Reducing misuse of Emergency Departments! - page 7
After reading much of the posts about ED Nursing, my first suggestion would be for people to stop inserting objects where they do not belong!.On a more serious note, i just read an article in the... Read More
Dec 31, '08Occupation: Retired due to illness Specialty: Retired OR nurse/Tissue bank technician ; Joined: Dec '07; Posts: 165; Likes: 242Quote from Iam46yearsoldThat's no guarantee of proper ER use. We've got universal health coverage up here. I've been in the ER a few times and the things people have come in for are as bad as the ones you describe.Has nothing to do with the situation. It all boils down to strictly money. Just the war strictly boils down to nothing but oil. Get these people health coverage so the can be seen by MDs in private practice. Then they will not come as often th the ER
I was in one time for what we feared was a Steven-Johnson syndrome reaction to a drug. It was a busy day with several serious MVAs and codes/near codes, so I had to wait for a while to be seen. I was sitting near the triage desk and could hear some of what the people were saying as they checked in or as they swapped 'why are you here?' stories with other patients.
There were people there complaining of nausea and vomiting making purchases from the snack machine, people with a sore foot that were walking around and sometimes taking a few running steps without a limp or any sign of pain, 'horribly sick' babies that were walking around, laughing, pink and sucking on a bottle of juice.
Then there was the woman across from me in the waiting area who had already been to her family doctor that morning with a small lump in her neck. The doctor had told her it was less than 0.5cm across (it takes 2.5 centimetres to make an inch, so we're talking about 3/16") and was almost certainly a lymph node fighting a virus. She was to keep an eye on it and if it didn't go away in a few days, to come back into the office and he would reexamine her and if the node was still there or had gotten larger, would run blood work to ensure it wasn't anything more serious. Sounded to me like a perfectly treatment plan.
She was in the ER, in her own words 'to get a second opinion because it's better to be safe than sorry' . :trout:
A possible partial solution to inappropriate ER visits? More programs like the one I describe below.
My family doctor has tied in to an after-hours clinic through a local hospital. It's open four or five hours every weekday evening, plus four hours on Saturday mornings. Because it's in a hospital, they have access to X-ray, labs, etc that would not be immediatley accessible in most MD offices. A report of the visit, complete with all test results is usually in the GP's office the next morning. Some of the doctors who have tied into the clinic as well as some locum doctors who want to pick up a few extra shifts take turns seeing patients and most of the RNs working the clinic are part-timers from the nursing units who want to pick up a few extra 'easy' hours.
Last year I developed a nasty sore throat to the point that swallowing saliva had me in tears, followed days later by a sinus infection that had me up the better part of the night with the pain. My family doc wasn't able to get me in, so I went into the after hours clinic to be seen both times. I was taken in within minutes and saw a doctor right away. They did a full exam and wrote a prescription and/or else gave me ideas of how to treat the pain/pressure/breathing issues using OTC and home remedies if antibiotics were not the appropriate treatment. Everyone was professional, unhurried and empathetic.
Had I not been able to get into that clinic, I may well have wound up waiting for hours in ER for that sore throat, because the pain was making eating difficult if not nearly impossible, plus I was having some troubles with my vocal cord disorder. Instead I was in and out in less than 20 minutes, knew how to handle things at home and was reassured by the doctors that if I was still having trouble, I could come back the next night and be given more help. The cost to the healthcare system for my visit to the clinic? $40, compared to a couple of hundred if not more for an ER visit.
That won't help the people who call for an ambulance at 2am because they have a hangnail, but it might help divert some of the patients who would come in for things that are borderline as to whether they should be in ER or not, patients wanting a random pregnancy test, as well as parents with kids who come home from work and find a sick kid but can't (or don't want to) take time off of work to take the child to the doctor the next day. My doctor's office advertises the clinic and if someone needs to see a doc but can't get in, they'll be told to access the after hours clinic.
Now that it's been open a year or so it's probably busier than it was last winter when it was just a few months old, but even still, it beats a trip to the ER for less than emergent problems.
Dec 31, '08Occupation: College Student Specialty: Being the Patient ; Joined: Jan '05; Posts: 1,929; Likes: 686Quote from MrsWampthangI just wish I could educate the public on the proper use of EMS. I have had so many patients come in the front door that should have come by EMS that it boggles the mind! I always good naturedly admonish them. :chuckle
guilty....Vomited blood, went in by train to my hospital, when asked why i didnt call an ambulance, i was fine to get here my self...they told me what they thought of that plan
Jan 1, '09Joined: Nov '07; Posts: 487; Likes: 581I think educating the public of proper use of the ER needs done. Lots of times it's part of our discharge instructions. There will always be those who have nowhere to go and can't afford insurance though. It can be quite frustrating.....on both sides of the coin.
Jan 1, '09Occupation: Orthopedic staff nurse From: UK ; Joined: Apr '08; Posts: 233; Likes: 295Something on the news made me think of this thread and you guys
On my local news one of the hospitals up the road from me made an announcement on the local news saying 'if you have flu or a cold then DONT come to a+e/ER as there is nothing we can give you'
Wonder if it will work.....
Jan 1, '09From: CA ; Joined: Dec '08; Posts: 155; Likes: 185Don't let the thought that "free" healthcare will solve the abuse of the ER. We have a national health plan in Canada (although its not really free as many assume, I do pay for my premiums in BC) and we see the exact same things coming through the ER.
We have created a society in which people are afraid of things, if they vomit once they must have listeriosis, if they have a small cut they must surely be going to get flesh-eating disease, if they cough then they just know they have pneumonia .... patient education goes a long way, but I doubt we will ever see the abuse of the ER solved.
Jan 3, '09Occupation: Pediatric Nurse Practitioner Specialty: 2 year(s) of experience in Pediatric pulmonology and allergy ; From: US ; Joined: Feb '06; Posts: 1,947; Likes: 1,348Quote from Iam46yearsoldWhat makes you think this will solve the problem rather than making it 1000x worse?we all look forward to Universal Health Care to help this problem
Jan 6, '09Occupation: CEN RN STAFF NURSE Specialty: 25 year(s) of experience in ER,ICU,L+D,OR ; From: US ; Joined: Aug '08; Posts: 918; Likes: 539Because I like to think in a very positive manner about life in general I guess.