Your ER policy on giving rides home

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Orange Tree

728 Posts

Specializes in Medical Surgical Orthopedic.
While it is easier not to "argue" at the time, does it not set up for more problems later...i.e. more ambulace trips to the hospital for very minor issues (or things that aren't issues at all), with most expecting a ride home?

Nah, those people are always going to be around. They'll just start finding alternate ways to get what they want or need. Taxi and ambulance rides home are a bit more expensive, so I can understand that being more of an issue. Bus passes provide minimum assistance and get the patient out. Traveling by bus means waiting in the elements, taking hours to get to where you're going, stopping every two blocks, and traveling in close proximity (strangers' arms/legs touching your own) with people who can be "different" to say the least. I just can't see it as something rewarding enough that it would make people want to go to the ER more often.

WonderRN

91 Posts

Specializes in ED.

They can call a ride and wait in the waiting room.

Or we will call a cab for them and the cab can take them by an ATM on the way home.

If they are really belligerent I will call the charge nurse and let them deal with it. Thats why they get paid the big bucks. Then they MIGHT get a bus pass.

TrafalgarRN

45 Posts

Specializes in Oncology, Emergency.
They can call a ride and wait in the waiting room.

Or we will call a cab for them and the cab can take them by an ATM on the way home.

If they are really belligerent I will call the charge nurse and let them deal with it. Thats why they get paid the big bucks. Then they MIGHT get a bus pass.

:yeah::yeah::yeah: Big bucks for the Charge nurse? Its 5 % premium on your hourly rate where i work which ends up being like $ 40 extra for the night and sometimes you go home with a massive headache or mental "tiredness".

Footballnut

161 Posts

Specializes in CAPA RN, ED RN.

We can give a bus pass whenever we want. A taxi ride involves the charge nurse authorizing it. I give out only 1-5 bus passes a week and I am happy to do it after I am sure it will be hard for a pt to get a ride. It ends up being very rare that a patient gets a taxi ride home from me, maybe once a year or so. Our patients seem to have resources available and they use them. Medical transport ends up being well used. I don't often have time to call medical transport and pts seem to know the number so I have them do it.

And, it's that old adage that discharge planning begins with the initial assessment :). I recently helped resuscitate an almost completely dead pt with a heroin OD at the far end of our parking lot. The "crew" of buddies had called ahead on their cellphones to let us know they were coming. While the rest of the ED team took the pt in for further interventions I stayed behind to get info from his buddies (you know how they always split). Sure enough, they were able to produce his cellphone. When he was ready to go we had his numbers and his family had already agreed amongst themselves about how to get him home.

We get a few people that can't really stay even if they want to. They get charged with trespass and escorted off by the police but I don't think they get a ride home. So, everybody gets to leave somehow, sooner or later.

Altra, BSN, RN

6,255 Posts

Specializes in Emergency & Trauma/Adult ICU.
Traveling by bus means waiting in the elements, taking hours to get to where you're going, stopping every two blocks, and traveling in close proximity (strangers' arms/legs touching your own) with people who can be "different" to say the least. I just can't see it as something rewarding enough that it would make people want to go to the ER more often.

Spoken like someone who does not ride the bus ... and that's fine.

But for those who utilize public transportation daily, it is not an issue.

There is, however, a core group of frequent flyers who do make the most of their ER visit. In one stop shopping they get treatment for a minor symptom, a meal, slipper socks, umpteen ginger ales, use of a TV & phone while they're there (or outlet for charging their own cell phone), a work/school excuse for their mother/brother/friend/aunt/cousin who accompanies them AND transporation to their next destination.

psu_213, BSN, RN

3,878 Posts

Specializes in Emergency, Telemetry, Transplant.
And, it's that old adage that discharge planning begins with the initial assessment :). I recently helped resuscitate an almost completely dead pt with a heroin OD at the far end of our parking lot. The "crew" of buddies had called ahead on their cellphones to let us know they were coming. While the rest of the ED team took the pt in for further interventions I stayed behind to get info from his buddies (you know how they always split). Sure enough, they were able to produce his cellphone. When he was ready to go we had his numbers and his family had already agreed amongst themselves about how to get him home.

This is definitely quite a bit different that some one who comes in by ambulance for a sore throat for over a week. If they find this an emergency then I feel they need to participate in their discharge planning by finding a ride home. There are phones in the room...they can use it. (Not to mention the fact, they have a 'free' cellphone courtesy of the government and our tax dollars). I already helped to pay for their ambulance...I don't need the financing for their ride home to come from my paycheck.

Sorry to sound so cold about it, but these are my thoughts on the issue.

RNJB784

6 Posts

I'll start off with a story that is mostly rant, but does have a question at the end of it. Recently our ER treated a 30-something pt who fell at home around 8am (per her account). Arrived at the ER via ambulance with a friend, who also took the ambulace, at 11am. CC of twisted ankle. Before anything else, she asks for a sandwich and ginger ale for herself and for her friend, saying "well, we didn't have a chance to eat breakfast before we came it." (my guess is somewhere in those 3 hrs they could have had a bowl of cereal) Anyway, the nurse (not me) tells the pt "no" (in a polite way). After xrays, pt dx with sprained ankle and given airsplint/crutches. On discharge, pt tells the nurse "well, I came by ambulace and you have to find me a way home." When told about taking the bus if no one could pick them up, the friend said "we don't have no money for the bus." (Meanwhile, when they were told they would no be given food, the friend went to the cafeteria and bought a large amount of food for the two of them). The nurse got the case manager involved. Pt tells the CM "the nurses here really have to work on their bedside manner." Not sure what was arranged for this pt, but this was my rant on the situation (thanks for reading!).

Anyway, now to the question: within the last year, our ER has posted signs that basically say that we are not responsible for providing you with transportation home. We had a supply of bus tickets, now that they are gone, they are no more. Obviously we would arrange transportation in extreme situation or if a pt is incapable of getting back home/to LTC/etc. The problem is, if people come by ambulance (even for a sore throat) they think that it is our obligation to find them a ride home. When I started in the ER we gave out bus passes like crazy, so many people think we still do this. Plus, I'm sure 'word on the street' is that we give rides home ("my aunt was here last year and she got a bus pass...I came by ambulace, I should get one too"). Does your hosptial have any written policy on arranging transportation home?

Don't you just love those patients that come in and the first thing they ask for is something to eat and drink even before they get of the gurney. I do, especially when they start trying to complain that I'm not feeding them right away I refer them to the department they can file a complaint with. If a patient has been in the ED > 6 hours then I would try and find them something to snack on since its been awhile, but if you've been having ankle pain X 1 week and you decided to come in without eating via ambulance....well, lets just leave it at that. We have the same problem happening in my hospital regarding transportation. From 0830-2030, there is a social worker that is around to pass out bus tokens or help arrange pt transfer. Working the night shift, we have pt's that come via ambulance (sore throat, sprained ankle, knee pain X 10 yrs, "i want to stop drinking" at 2 am in the morning...etc.) in expecting there to be a social worker to arrange for their ride home. We tried using taxi vouchers for awhile for pts that don't live to far away, but they got abused and were being given to patients where the fair totaled > $160. Patients that were aware of the taxi vouchers, when they were still available, would use our ED as a mid-stop to their final destination. They would call an ambulance for our hospital (for chronic complaints such as knee pain @ "10/10" X yrs), arrive and ask to be fed, and then ask for a voucher to their house (when nothing life threatening is found as expected) in the completely opposite direction of where they were picked up. Personally, I never gave out a taxi voucher unless the patient lived within the same city as the hospital and it was necessary to have him out the ED. As for policy, we do not have a policy for transporting patients home. One of the my co-workers working in another hospital says that the other hospital he works for doesn't do it either. According to him, he has never worked in an ED where the hospital has policies to take patients home. In our hospital, if we have a patient that is medically cleared and refuses to leave we simply contact the police to escort them out since they are considered trespassing. I'm not sure if this applies during the days, but it works at night. Sorry I ended up ranting as well but you brought up a topic that's pretty near and dear to my heart...hope I was able to answer your questions.

Trekfan

466 Posts

How are these people not getting billed for ambulance???? its not free at least around here I have a $500 bill hear on my table from when I had to call one months ago after my insurance I still have to pay $287 ....

Anna Flaxis, BSN, RN

1 Article; 2,816 Posts

I don't know that we have an actual "policy", but we do provide taxi vouchers and bus tokens at times. I just use my discretion. Most walkie-talkies can ride the bus if they absolutely can't find anyone to come pick them up (and I do work to make sure they have exhausted all their options), but the frail elderly person who lives alone on Social Security, or the homeless alcoholic going to the sobering station, or the person with mental illness who lives in a group home gets a taxi voucher, because these people are vulnerable and I want to make sure they get from point A to point B safely.

I don't have any problem helping get people home, except for the ones who aren't sick, are perfectly able bodied and of sound mind, and have access to resources. They get reminded that they are in an EMERGENCY department, and that what we do is rule out threats to life and limb. The rest is up to them. I tell them there are phones and phone books in the lobby.

psu_213, BSN, RN

3,878 Posts

Specializes in Emergency, Telemetry, Transplant.

Another real life example...a patient was being discharged. Came out of her room and asked for her nurse. That nurse was't there, so I asked if I could help her with something. "Yeah, I need to talk to a social worker." (this was around 2 pm). I asked her what she needed to talk to the SW about..."I need her to find me a ride home." When she went back in the room, I hear her say to her friend "Yeah, you just have to learn how to work the system...."

Specializes in Critical Care, Emergency Medicine, Flight.
Another real life example...a patient was being discharged. Came out of her room and asked for her nurse. That nurse was't there, so I asked if I could help her with something. "Yeah, I need to talk to a social worker." (this was around 2 pm). I asked her what she needed to talk to the SW about..."I need her to find me a ride home." When she went back in the room, I hear her say to her friend "Yeah, you just have to learn how to work the system...."

bunch of jerks.....:rolleyes:

must be nice to milk the system and abuse it , and take up space for people who really need the resources...

TrafalgarRN

45 Posts

Specializes in Oncology, Emergency.
Another real life example...a patient was being discharged. Came out of her room and asked for her nurse. That nurse was't there, so I asked if I could help her with something. "Yeah, I need to talk to a social worker." (this was around 2 pm). I asked her what she needed to talk to the SW about..."I need her to find me a ride home." When she went back in the room, I hear her say to her friend "Yeah, you just have to learn how to work the system...."

Practically you can kick her out and tell her she is discharged and the Social Workers job is no to get her a ride. Social Workers are there for more important things. I would have talked to the S/W and ensured that she didn't waste their time.

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