Yelling, screaming and ducking the cranky triaged patients

Specialties Emergency

Published

In our tiny hospital in the sticks I triaged a woman for dental pain who had just come from another ER three towns away. They didn't give her the meds she wanted so she hitchhiked to us. she was loud and demanding, and got more so over the next 30 minutes. Security was called, and when she took a swing at him she was told to leave the facility.

So...my question is since everyone is required to have a medical screening exam if they present to triage, under what circumstances do other ERs consider a patient's behavior unacceptable and tell them to get out. If you don't kick them out how do you handle them without having everyone else waiting realize that the way to be taken back immediately is to be loud and demanding?

Specializes in ER, Outpatient PACU and School Nursing.

document and get my OT police officer to handle the issue. its not worth getting myself hurt or worse. If they decide to calm down then we can proceed.. I love having a cop but it took a nurse being held hostage for 11 hours with a razor to her throat to finally get one in our ER..

what do you do when the very annoying patient is someone you know well, even have taken them to the er. and then they start to get really annoying and complaining and then.... above complaing about the food and the service start calling the nurses "nursie" i wanted to die and the ground swallow me up. i was so ashammed to be with them. they were demanding and so rude i would have hit them if i could. but the worst thing is that i said nothing afterwards. when i use to work in a coffee house we would give customers sneeze (cheese) scones....they hadn the speacial treatment and we all did it. pity you cant hock a loogie into an iv huh?

Specializes in ER.

How many of the respondents out there would have had to see her no matter what she did, and how many would have kicked her out or called the police?

i believe that at all times we will have to prioritize the patients based on the triage system. if a patient gets unruly because of feelings of being ignored and starts causing a commotion that it disrupts the er staff, then that patient must be shown the way.

Specializes in Emergency & Trauma/Adult ICU.
How many of the respondents out there would have had to see her no matter what she did, and how many would have kicked her out or called the police?

In my 2 years in the ER ... I have seen three occasions where we have had pts. escorted out by security (once) or arrested (twice) without the MSE.

Specializes in ER, Outpatient PACU and School Nursing.

we wouldnt deny her care but they have to calm down. If the cop feels like they are being a disruption then they take over and arrest the patient. we have alot more patients that act up after being discharged for one reason or another- then the cop will escort them off the property or if they keep up- arrest them. our security really doesnt take part in anything besides watching baker acts or driving the van around the property.. :rolleyes: I have lost track over the years on how many patients that have acted out..

Specializes in pure and simple psych.
How many of the respondents out there would have had to see her no matter what she did, and how many would have kicked her out or called the police?

It probably depends on the state. Or maybe OBRA funding, which states that all patients must recieve care for life-threatening issues... Threatening ours dosen't count.:rotfl:

Specializes in pure and simple psych.
what do you do when the very annoying patient is someone you know well, even have taken them to the er. and then they start to get really annoying and complaining and then.... above complaing about the food and the service start calling the nurses "nursie" i wanted to die and the ground swallow me up. i was so ashammed to be with them. they were demanding and so rude i would have hit them if i could. but the worst thing is that i said nothing afterwards. when i use to work in a coffee house we would give customers sneeze (cheese) scones....they hadn the speacial treatment and we all did it. pity you cant hock a loogie into an iv huh?

I Beg Your Pardon?:eek:

Specializes in ER, telemetry.

We have a security officer at the greet desk during the day, and a deputy at the greet desk at night. If a pt gets rowdy or threatening staff, they are spoken to by security, if they escalate, they are asked to leave the premises, escorted by security, if they escalate further, refusing to leave, the police are called. Very rarely do we have to escort pts out of the building or have them arrested. We have done this more with irate or obnoxious family members. If a pt is threatening and showing signs of mental illness, we will take them to our psych rooms. I have had security talk to many pts waiting for loud rude behavior or cursing though, and that usually nips it in the bud.

Specializes in Emergency / Trauma RN.

Situations like this is what really gets my goat (grinds my gears even). Usually it is the poor "depressed" person with chronic neck and back pain who are unhappy with not getting their oxy's. They threaten the Doc, the RN or lab tech with violence then get sat on by me until either they are restrained (if they are really sick) or until the police arrive to take them away.

The problem is (and I reinforce this with new staff) is that once a person is in four points they generally get drugged and admitted just for being an ass, but if you sit on them for a while the police can haul them off for being annoying and causing a disturbance (once the doc looks them over of course)

We are fortuante, 24 hour "Intervention Officers": big guys who can touch patients, silent panic button at triage to the security post in the hopsital and the city police who work very closely with us only a quick 911 call away. You should see them tear into the parking lot when we call for real.

It's pretty amazing what a simple "Code White at ER triage" paged overhead can accomplish. Our staff (the guys at least in my department have realtively little patience for behaviour of this sort.

Ian

Specializes in Emergency / Trauma RN.

And then of course after kicking them out you get a call from their mother the next day angry that we mean ER nurses threw their baby out into the snowbank when they were sick.... long story, not getting into it.

Specializes in ER.

I called a code white at my facility and got one short fat lab guy who zoomed in like he was on speed. Notably the administration group, who are closer than the lab, didn't even send us a phoned congratulations for keeping everyone alive.

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