Your ER policy on giving rides home

Specialties Emergency

Published

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?

Specializes in ED.

When I first started at my current facility I would try and get taxi vouchers and soon discovered we had a 5 page list of pts that have abused the system so much they were not allowed to be given taxi vouchers. I don't have time to spend 10 mins scanning to see if your name is on the list. So now I just give some lame excuse about getting management authorization (which we technically need) and a bag of food to tide then over. If that does not work, we have security "motivationally" discharge the patient. Some times they just come right back into triage claiming suicidal ideation and we get to start all over again.

Specializes in Medical Surgical Orthopedic.
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.

Unfortunately, I have hit rock bottom (at least my rock bottom) and been dependent on the city bus for transportation. I wish I wasn't speaking from experience, but....

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.

I hear what you're saying. The ED can't become the major transportation hub for the looney, annoying, or mildly decrepit....but what about those who are too embarrassed to say they don't have cab fare, and the bus takes an hour to get to within 2 blocks of their home- and they have ambulation issues (and live alone, with an elderly parent across town from the hospital as the only potential resource, after daybreak- maybe- when he's home)? I do all I can to keep 15-20 bucks in my wallet for cab fare in an emergency (disability sometimes requires that money be used for rx's so not available- or be "convicted" of non-compliance if I don't get the meds, and end up in the ED for sure ).....

I''m sincerely asking what to do.... I know you don't know the EDs here (especially since I won't name them-lol)- one is great (the one I primarily go to - but haven't needed in over a year- yeah:)- but further away from home), and one is definitely run by the Marquis de Saad's direct descendants.... I have NO one. Suggestions are welcome- and to avoid highjacking the thread (not my intention - PM is fine). Thanks :) It's embarrassing to be an RN , on disability, but needing ED services-- fortunately less now than years ago...but it's still something I have to be prepared for. I've been PUT in cabs without being able to stand up- literally crawled on the ground from the w/c to the cab... (later found out it was a drug interaction that was causing TIAs from severe hypotension)... etc- the stories go on. During the worst time period, I'd be treated enough to regain consciousness, and turfed home alone. I had NO problem paying for the cab- when i had the money.

But I also learned to sink my own NG for gatorade boluses (with stuff I got from eBay) because of how I was treated by the nurses.....

I've been a nurse for a long time- longer than MANY of those who took "care" of me had been alive- I never asked for anything, didn't use the call-light (mostly from learning it most likely wasn't going to be around), never c/o pain- no mater what, etc. I never knew why I got the attitude. So, it was safer to risk dealing with the hypotensive episodes at home. My PCP knew- and had an MD from that ED who was decent tell her that if I said anything about how they treated me, he'd seen it.

When I figured out what meds were interacting, and got them changed, things changed a lot...I had other issues, but at least I wasn't getting B.P.s of 56/38 at home, with a heart rate of 48....I have dysautonomia to begin with- the meds really messed things up- but I was treated like a total psych case (no psych diagnoses in the mix at all).

Anyway, I'm sorry.... sometimes it's not that easy to tell who can or can't get home. And with a BP that low, I couldn't drive myself.

Hopefully, it won't be an issue since meds were changed years ago, and it's been better- but it was demoralizing and frightening to feel so hated, for some reason I didn't understand. But what do you do in that situation??? :)

I don't need medical advice- just how to plan on getting home IF the cab situation isn't an option .... that money is a LAST resort- and I'm not 'out' that often- but it does happen, and makes me nervous..... I was seen as "fine" when I crawled into the cab. It scared the snot out of me when I couldn't pick out my apartment and had to walk around in the dark looking for it.... but I was "stable" to discharge?????

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
: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".

aren't you lucky . . . we get nada! except, of course, the migraine.

Specializes in Emergency Dept, ICU.

Funny story....

One time we got a patient flown in via helicopter for an ACUTE MI, when we discovered it was not an acute MI but likely just a muscle strain. Air-Evac just had their 12 lead EKG leads mixed up. So we discharged him home from the ER.

Needless to say I felt sorry for him since he was flown in over 60 miles away and then discharged, so I did give him an (expensive) cab ride home.

xtxrn,

Your question is how you should get home from the ED if you cannot drive, don't have a support system, don't have money for a taxi and are unable to walk the two blocks from the bus stop from your home, is that right?

If that is your question, then you would be someone that I would ask my charge nurse for a taxi voucher for. But if you don't communicate any of that because you are too embarrassed, or for any reason really, then I have no way of knowing. I am not a mind reader and my crystal ball is still in the shop. ;-p

Specializes in Emergency, Telemetry, Transplant.
Funny story....

One time we got a patient flown in via helicopter for an ACUTE MI, when we discovered it was not an acute MI but likely just a muscle strain. Air-Evac just had their 12 lead EKG leads mixed up. So we discharged him home from the ER.

Needless to say I felt sorry for him since he was flown in over 60 miles away and then discharged, so I did give him an (expensive) cab ride home.

Now that would be an example of someone who does deserve a ride home...

xtxrn,

Your question is how you should get home from the ED if you cannot drive, don't have a support system, don't have money for a taxi and are unable to walk the two blocks from the bus stop from your home, is that right?

If that is your question, then you would be someone that I would ask my charge nurse for a taxi voucher for. But if you don't communicate any of that because you are too embarrassed, or for any reason really, then I have no way of knowing. I am not a mind reader and my crystal ball is still in the shop. ;-p

Yeah- agreed. :) It just gets really frustrating (at one ED in particular, that I avoid like the plague, but EMS won't take me to the 'good' one because my HR is 37). Having been on both sides of the nurse-patient more than I ever dreamed I would be (like who anticipates it- lol :uhoh3:), there have been many times when I just suck it up, and have had to say something- one time in particular...they ended up calling a wheelchair van service (10 times the price of a cab- but billed to me, not the hospital- which seemed to delight the nurses to no end- downright chipper that night when I left, still somewhat hypotensive) - sent me home not ambulating- when that isn't my norm- Very odd. I can't walk 2 blocks, but I can navigate in my apartment, and shorter distances; at the store, I need the cart for anything very long. I have waited for hours in the waiting room (vs ask about cab vouchers) until daylight when my dad (79y/o) might be awake, to come and get me...but I won't wake him up in the middle of the night to come 'fetch' me.....:yawn:

One place is very nice. The other acts like I'm bringing back the plague. But, as I said, I haven't had to go in nearly as much since the med interactions were solved , and keep $ just for cab fare whenever I can :) Using a voucher is embarrassing enough without being looked at like I'm there because the mall closed early and I had nothing else to do (LOL- I can't get around in the mall anymore !).

I can definitely see the frustration of ED nurses who have the seriously entitled patients think that the ED is a concierge service.

Maybe a news story on the local evening news would be helpful ? Seriously- you guys really shouldn't have to deal with a lot of the needless, non-medical stuff you do. Or the social workers. Get the PR folks to be interviewed by the news station on what to expect at the ED for the boneheads who think you're there for other than medical issues. :) It couldn't hurt (might not actually sink in with the targeted audience- but their friends/family MIGHT be more sympathetic to you guys- if the family tree forks enough :D).... ?

Specializes in ER.

nope, no taxis anymore. The state no long reimburses the hospital because my state's insurance has made this state broke, so no more taxi passes. Period. It's nice, too, because it shuts off a patient immediately. Nope, not gonna happen. You can take this lovely pillow and blanket and lay on some chairs in the lobby until there's a more appropriate time to call your neighbor to come pick you up, but you're discharged.

Specializes in ER.
Buses are inconvenient and bus passes are not much of a reward. I would be highly annoyed if I had to waste my time "arguing" with people over whether or not they're entitled to bus fare. Giving it to them makes things easier on everyone- even if they're undeserving.

you obviously don't work in an ER.

They tell their friends, and they tell their friend and so on and so on. It is not much easier. All of their drug addicted friends all end up coming in at 0200 on a Saturday night creating more havoc than we already have, so no, it is not "just easier" to give in. It's encouraging the bad behavior.

Just like docs give in and prescribe Oxycodone like there's no tomorrow, just to "treat their pain" and get them out the door. Um, doc, how about Ibuprofen and Tylenol? What's so wrong with that?

Specializes in ER.
: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".

wow, big bucks.

Our charges get $1/hr. How's that for super charging?

Specializes in ER.
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 ....

it's called state run health insurance. They DON'T pay for it. We do.

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