turning non-emergent pts away

  1. 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.
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    About Jennifer, RN

    Joined: Oct '05; Posts: 230; Likes: 43
    registered nurse
    Specialty: 11 year(s) of experience in ER, telemetry

    50 Comments

  3. by   Ariesbsn
    Me either. It will suck to be the triage person.
  4. by   AnnieOaklyRN
    Umm If I am not mistaken it is illegal to turn down patients and I beleive it is an EMTALA violation especially without an assessment from a physician, as all patients have the right to that assessment before being refered to another facility or clinic.

    Sweetooth
  5. by   psalm
    Hope triage nurses don't have to have their surname on their nametags!!
  6. by   neneRN
    Can you really do this? I thought every patient presenting had to have a medical screening....there are plans in my area to open several free clinics, but we were told we would only refer them there when discharging, i.e., "next time you have a problem like this, there is such and such free clinic that offers these services..."
  7. by   kstec
    Whether it be illegal or unethical, it's a great idea. Alot of people have the idea that an ER is a clinic and need to be educated what it is for. It especially seems that the ones who don't have to pay for their healthcare abuse it. Just think how nice it would be if these people had to make an appointment with their primary doctor like the rest of us do and pay a co-pay like most of us have to.
  8. by   Jolie
    As I understand, it is a violation of EMTALA to turn a patient away without a minimum of a medical assessment, if the patient insists. But I don't believe that there is anything wrong with informing the patient, based on his/her complaint, that the ER is not an appropriate place for treatment, and offering the option of other sources of care. Then it becomes the patient's decision to stay (and wait, and face a substantial bill) or go.

    Regardless of the legalities, I believe that administration should staff your ER 24/7 for the first few weeks of this policy in order to address the concerns, complaints, and behaviors of patients who may be uncooperative. It should NOT fall on the nurses, docs, or techs to have to address unsatisfied patients and explain the financial ramifications of their choices in seeking care. That said, I'm sure administration will be nowhere near the ER!
  9. by   Melina
    Whether it be illegal or unethical, it's a great idea.
    I know you couldn't possibly have meant to this to sound the way it does
  10. by   CritterLover
    Quote from melina
    i know you couldn't possibly have meant to this to sound the way it does

    oh, i understand exactly what she is saying.

    i agree -- it is a good idea to come up with some way to get the non-emergent stuff out of the er

    however, like other posters have said, it is an emtala violation to turn a patient that presents to the er for treatment away without a medical screening exam. emtala seems to be very clear that triage is not a medical screening exam.

    (though, with my understanding, some of that is facility-dependent on which personnel the facility desginates as qualified to do the screeing exam. for example, some facilities designate rns -- mostly l/d, as qualfied to r/o labor on a presenting patient.)

    there is a facility in florida that is doing the mse, and if the exam doesn't meet "emergency" criteria, they are telling them they can stay and be treated for an up-front fee, or they get a list of local clinics to go to.

    so i guess i'm wondering if your facility is putting mid-levels in triagel. that is the only way i can think of that they will be able to get away with it.
  11. by   TazziRN
    Quote from Melina
    I know you couldn't possibly have meant to this to sound the way it does
    I agree with Critter. I love the idea but it will never happen because of EMTALA. More and more ERs are being used as clinics because they think they will be seen faster in the ER.

    Mind you, it would have to follow strict guidelines: toothaches, colds, abrasions, no small children, etc.
  12. by   kstec
    My comment was not meant to cold hearted, but I know to many patients that will leave the doctors office from just being seen and next thing I know I'm getting a report that they went to ER that same day for the same complaint. I don't understand why they can't take UTI, cold, bronchitis, need a dentist or there's just nothing wrong with you. People wonder why healthcare is so expensive. I of course have my own opinion as everyone else does. I'll respect yours if you respect mine. Just think our tax money is paying for alot of drug seeking and bored people. I don't believe a child should ever be turned away but as far as mature adults who abuse the system, I say go to a clinic. I guess I am kind of cold hearted to a point because I hate it when I have a someone who comes to my clinic and pays cash for their appointment and gets a prescription and can't afford to pay for it and then joe schmo comes in and gets seen and goes right to the pharmacy and gets his norco and abx filled with no problem. I know life is not fair but this irritates me to no end. I'm a nurse who is for the underdog, who works hard or has worked hard in their life and are old and have no assistance or free ride.
  13. by   Chaya
    Anyone work in an ER facility with ajoining walk-in clinic for the sore throats/ boo-boos, etc?
  14. by   RedERRN
    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!

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