turning non-emergent pts away

Specialties Emergency

Published

Do any of your ERs turn non-emergent pts away, like toothaches, lice, STDs, etc? Rumor has it that this week, we in triage are going to start handing out cards to the local free clinics to pts with minor complaints and telling them that this is an emergency room and their complaint is not emergent and they will not be seen here, to make an appt at the local health clinic. I can't see this working.

Specializes in Emergency Dept, ICU.

We are currently doing this.

After triage determines you are a routine complaint, the NP or PA comes to triage, does you're medical screening exam and if he/she agrees, the ER will only treat you if you pay a $200 up front fee.

It's EMTALA compliant

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Specializes in ER, ICU, L&D, OR.
We are currently doing this.

After triage determines you are a routine complaint, the NP or PA comes to triage, does you're medical screening exam and if he/she agrees, the ER will only treat you if you pay a $200 up front fee.

It's EMTALA compliant[/QUOT]

Im seeing more and more ERs do this. Then they leave those ERs and come to us because we dont do that. YET.

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If they really are going to do this where you work, I hope everyone has their malpractice/career insurance updated, because they are most certainly going to be sued.

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Specializes in Ante-Intra-Postpartum, Post Gyne.

In the state of california it is ILLEGAL to turn away any ER visitor. They may sit in the waiting room a long time because there are real sick people but they will be seen

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Specializes in Emergency Dept, ICU.
If they really are going to do this where you work, I hope everyone has their malpractice/career insurance updated, because they are most certainly going to be sued.

Some of you guys are freaking out a bit, the patients here are 1) Triaged

2)Seen by a health care practitioner 3) Vitaled and Assesed and only

after that it is determined they are ROUTINE and sent back out to the lobby.

Approached by finiacial cousler and required to pay 200 up front to be seen.

All bases are covered prior to being required to pay.

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Specializes in Emergency Dept, ICU.
In the state of california it is ILLEGAL to turn away any ER visitor. They may sit in the waiting room a long time because there are real sick people but they will be seen

Noone is turning anyone away, just requiring them to pay prior to being seen. If they don't think it's big enough emergency to pay up front then they can go to thier reg doctor or a health dept.

Bottom line: It's an emergency room. If you have an emergency you will be seen.

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Specializes in ER, ICU, L&D, OR.
Noone is turning anyone away, just requiring them to pay prior to being seen. If they don't think it's big enough emergency to pay up front then they can go to thier reg doctor or a health dept.

Bottom line: It's an emergency room. If you have an emergency you will be seen.

In Texas the Gov't is apparently looking at station an Immigration officer in the ER, for some reason, I dont understand.

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If they'd like to come to the ER and wait for 20-24 hours (our average wait time on some weekends), so be it! EMTALA says they can't be turned away.

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Specializes in Tele, ICU, ER.

Had to give an non-emergency kid some amoxicillin for an ear infection at like 0200 one night. Since we have to mix up the whole bottle, we give it to the parents (and a script) figuring it's already charged to the account, so maybe they'll save a little money. As I handed mom the bottle (with appropriate instructions) and explained the saving money part, she said "doesn't matter, not like I pay for it anyway". ARGHHHHHHHHHHHHHHHH. Kept my mouth shut, but only BARELY.

What possesses people to show up at 0200 for a rash they've had for a week??? And then to complain about the wait???? Our fast-track is only open from about 10am to about 9pm, so of course all these people show up after midnight.

Someone explain it to me please??? I just don't get it.

I love the intent of EMTALA, but HATE the way it's ended up being implemented. Just one more way for us all to get sued, eh?

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Specializes in ER, ICU, L&D, OR.

Welcome to the Wonderfull World of ER Nursing

hahahahahahahahahahaha

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Specializes in Peds, ER/Trauma.
emtala.com is the authoritative source. Anyone who works ER should know EMTALA, and recognize emtala.com.

The site you are referring to is NOT an official government site. It is run by a private individual. This individual does not list his/her credentials anywhere on the site, so the reliability of the site cannot be confirmed. THIS is the official EMTALA site: http://www.cms.hhs.gov/EMTALA/

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Specializes in ER.
The ER I work in has a policy where all patients meeting triage levels of 4 or 5 (we use the 5-tiered ESI) are sent to "Quick Care" where they receive a MSE (Medical Screening Exam) by a physician. If their chief complaint is then deemed to be non-emergent, the patient is instructed by the physician (by scripted dialogue) that their condition is not an emergency. The patient is then given the option of #1) staying at our facility to receive treatment after paying either $150 cash or their entire non-emergent co-pay or #2) leaving our facility to seek care at one of the many urgent care facilities across town or with their private MD.

The reasoning for this policy is that soooo many patients present to the ER with non-emergent complaints. These patients contribute to the overcrowding and sluggish throughput. Unfortunately, we nurses can't legally tell them that they are not having an emergency and need to leave. According to EMTALA, all patients must receive a Medical Screening Exam by a physician. By following our policy we cover all the bases. It seems to work WONDERS...and word has spread pretty quick around town, too! :D

Wow! Your system sounds great. Can you send me more details? We also use the ESI (5 tier), but I'm wondering how strict you are adhering to it. We have many nurses that are not trained in the ESI (we are supposed to be doing a class this fall) and so their judgments are very subjective.

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