Your ER policy on giving rides home

[psu_213]

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?

[psu_213, BSN, RN]

I understand not wanting the ED to enable addicts- yet having even one patient with legit pain not treated is more reprehensible in my book. Junkies will get meds- period.

In theory I agree with you. However, this becomes a practical issue as much as a moral one. If an ED took every pain rating at face value, every drug seeker within a 20+ mile radius of that ED would be there with 10/10 pain. That ED would be so backed up and most of the time would be taken up with that 1%.

[oeue2007]

Haha - I signed on to rant about the opposite problem ("I need help getting someone out of the car!") and started reading. I can never decide if it makes me feel better or worse that all ER's have the same ridiculous issues!

Anyway, let me get it out and lower my BP :). "How the frick did you get them IN the car?" "Why didn't you call the fricking ambulance? They just brought in a 20-year-old with a cold. I think they would have accomodated you." and finally "Conan, you look alot stronger than me or the other middle aged female working tonight so here's your wheelchair." Ahhhhhh, better already.

[LilgirlRN, ADN, RN]

How in the world did this go from do you provide a way home for your patient to us (ER) mistreating people? No, we do not give rides home. Never. It's a liability issue.

[ReggaeRN]

Does your hosptial have any written policy on arranging transportation home?

Short answer: no. No policy regarding this.

I work at a rural hospital, covers multiple towns, and several counties. Taxis and buses? Hah! The taxi drivers here work bankers hours - roughly 9a-5p, Monday-Friday, no holidays or weekends.

They are very kind and older folks love them because they'll stop at the pharmacy on the way home, or the grocery store, or help them carry in their milk or bags. But, they are only available during the day.

What we do? Generally speaking, we don't give rides home. Once in a great GREAT while, one of the ER staff will actually give patients rides home. This is a rare occasion, though there's a doc that lives in a town 20 minutes away that I've seen give at least a couple people a ride just because it's 8am on a Sunday and he knows them, knows they won't get home any other way.

I have called the administrator on call and had them come in and give patients rides home. I have also called the county and city police (depending on the destination), and they've given patients rides as well. I personally wouldn't let someone in my car unless they were a relative or personal friend. Actually, there's some relatives that, well, I'd probably run and hide or call the county before I offered them a ride...

That's how we work - I wish we had a policy too. Then there's the once in a blue moon case where we had a patient that had been hitch-hiking for 3 states, ended up in our ER, and we involved social services and got him a bus ticket to where he needed to be (another 3 states away)... because it was the right thing to do. Most of the "responsibility" we assume for making sure patients get home is on a case by case basis. (Like... if you walked or rode your bike TO the ER, you will most likely be capable of walking home FROM the ER. LOL.)

[nivigeorge]

Quick question everyone who works at the ER. How do you help patients when the bus or taxi is not in service when the patient is discharged? Any other things you guys do other than giving a ride for the patient? What would you do if there was no waiting area for the ER?

[JKL33]

Quick question everyone who works at the ER. How do you help patients when the bus or taxi is not in service when the patient is discharged? Any other things you guys do other than giving a ride for the patient? What would you do if there was no waiting area for the ER?

Curious how the waiting area fits into this - discharged patients can't loiter in the waiting area anyway.

[nivigeorge]

Is that rule that they aren't allowed to wait in that area until they have a ride? I'm not sure about that exactly. So what would you do with patients who say they don't have a ride at 2 in the morning when there is no service available to take them home? A local hospital near me is having this problem. They are just discharging the patient and letting them stay there until they can find a ride for them in the morning. But since they are still at the hospital wouldn't it be the staff's responsibility to look after the discharged patient? Very interested on this topic.

[JKL33]

Is that rule that they aren't allowed to wait in that area until they have a ride? I'm not sure about that exactly. So what would you do with patients who say they don't have a ride at 2 in the morning when there is no service available to take them home? A local hospital near me is having this problem. They are just discharging the patient and letting them stay there until they can find a ride for them in the morning. But since they are still at the hospital wouldn't it be the staff's responsibility to look after the discharged patient? Very interested on this topic.

Every hospital I've known any details about has a method of using reason/being reasonable about this on an case-by-case basis. Generally speaking, one may not loiter on the premises; this is not a federal law, it is a policy of many, many businesses, not just hospitals. But the general answer to your question, is no, absolutely not - we are not responsible for "looking after" individuals who are not patients, aside from our EMTALA obligations. There are times that hospitals try to help beyond that, despite not having the obligation or the budget to do so on a large scale.

It sounds like you have a particular situation in mind which will have to be addressed with the ED in question.

[Kuriin, BSN, RN]

Our hospital does not provide transportation (taxi vouchers) unless they legitimately need them. A frequent flyer coming in every day for the same reason will NEVER get a taxi voucher...neither will a homeless person unless they have a long distance to go.

We also do not provide opioids to patients unless we know for a fact that the patient has a means to get back to where they belong.

[nivigeorge]

Thanks for responding to my questions! :) How do the social workers at your hospital help you with an issue like this? Do they help patients find transportation or do the nurses usually take care of the issue? The hospital in my town use an early out fund to help patients pay for a taxi, or even a medicar and then they keep track of patients who have already use the early out fund and lets the patient know this is a one time help. Does anyone else have a similar process at their hospitals?

[Guest374845]

Our state medicaid plans have a transportation benefit, so it's sometimes pretty easy to actually get them a ride. BUT, they'll only transport to the current mailing address listed in their plan and won't dispatch unless a medical professional is the one actually calling. So it's still on us to an extent.

[rhkenji]

I hate this!

2 nights ago, I had a patient come in via EMS. She demanded that they be discharged as soon as she got into an ER gurney. The doctor discharged the patient right away and she requested for a ride home. "I came via ambulance, WE need a ride home (she came with her sister)". I did my best to find her a ride as she was 50+ year old. Normally, I just say NO, which is 99% what the house supervisor would say. But, trying to do the extra mile, I called, I got yelled at but was able to get her some bus tokens.

I offered what was available at the time. They just looked at me angry, "This is unacceptable!". They then was able to pop a phone out and was able to get somebody to pick them up.

I will just say no next time.