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ER. A Clinic?

Posted

Specializes in Emergency Room. Has 5 years experience.

I have been working in a 15 bed ER in a rural area for 5 months. To me, emergencies involve life or death. More pt's come with minor complaints such as pain meds, toothache, or sore throat. When we actually have a true EMERGENCY, we scramble for an available bed.

I have been told that the people are coming into the ER for minor complaints more often because of the new health insurance law.

Anybody have this issue?

Perhaps somebody can explain this healthcare law better.

IamVickiRN

Specializes in Developmentally Disabled, LTC, Clinic, Hospital. Has 10 years experience.

I have just the opposite problem! I work in a clinic that the patients think is an ER! They come in to us for chest pain, stroke symptoms, etc and get MAD when we tell them we are calling an ambulance to take them to the ER! Its unreal the things we have walk in on a daily basis! I feel your frustration!:banghead:

SummerGarden, ADN, BSN, MSN, RN

Specializes in ED, ICU, MS/MT, PCU, CM, House Sup, Frontline mgr. Has 12 years experience.

i have been working in a 15 bed er in a rural area for 5 months. to me, emergencies involve life or death. more pt's come with minor complaints such as pain meds, toothache, or sore throat. when we actually have a true emergency, we scramble for an available bed.

i have been told that the people are coming into the er for minor complaints more often because of the new health insurance law.

anybody have this issue?

perhaps somebody can explain this healthcare law better.

no, this is the norm. it always has been. no new health bill caused this to happen. some people think that their minor problems are actual emergencies. if they actually had to pay for their emergency room visit and treatment up front, then this would stop. however, many people who show up with minor problems have no insurance, do not qualify for insurance, and will lie about who they are just to be seen. they cannot go to doctor's offices because they would be required to present insurance or pay out of pocket at that time of service.

Is this your first experience working in the ED? It's certainly not a new thing. Many times I have seen patients come in for Rx refills. Some people don't have a GP and use the ED for everything. or they stop on their way home from work because it's more "convenient". One time I was triaging a lady and she told me she would have gone to her family doc but he was on vacation and one of his office partners was filling in while he was away, but she didn't want to see him because she didn't know him... apparently an ED physician (who she also didn't know) is okay though. I will never understand that logic:uhoh3:

We had a frequent flyer where I used to work. I truly believe the only reason she came in was because she had a crush on one of the Dr's. She would always present with a vague complaint, usually back pain, and would even ask in triage "is dr. xxx on tonight"

and don't forget the "I'm #1" mentality. What might seem minor to us could be a big deal to our patients.

I hate to say it, but get used to it. I don't see things changing anytime soon. I probably sound a bit jaded... It can be frustrating seeing patients who you don't think belong there.

LMAO, how do you tell someone a minor health problem is not an emergency? OK, i live in houston, TX and if you do not have insurance or money then the only place that you can be treated is the hospital usually in the ER whether it minor or major. Take for instance you wake up with a burning when urinating (not major), but if you have no insurance or money, then you are off to the ER. Please dont be judgemental about some of this folks, i used to be one before i became a nurse and got insurance

merlee

Has 36 years experience.

The new health care regs have not really come into practice yet.

Many uninsured have no other place to go. A bad toothache is an emergency to the person who is suffering. I wish there were more walk-in clinics for 'minor' emergencies.

I agree that this has nothing to do with the new health care law. This has been happening for a long time.

It's because many people are uninsured and this is the only place they can go and receive treatment without having to pay up front.

Many of our clinics, both county and private, have closed due to budget issues. Some of the health care providers including RNs who worked in those clinics would now more than likely be using the ED for their health care due to lack of insurance. People who have had insurance most of their lives are now finding themselves in this situation. In the U.S. if you have no insurance, you are not entitled to a family doctor like those of us who might have insurance and take it for granted. There have been people who have grown up in poor conditions where insurance has never been the norm. The clinics or ED depending on availability of the clinics have always been the source of their health care. Many of us growing up in middle class working families would never understand being in this situation or may have been too young to remember when your father was laid off from his job for awhile. Many, many people working in low income jobs do not have insurance and their employers are not mandated to supply it. Even if they did the employees probably could not afford especially when they make $10/hour. Yes there are many who do abuse the system but there are several who do not have a choice. Count your blessings if you have a job and insurance because many formerly employed professional people are swallowing their pride and going to the ED for their medical care. Now there are not even enough clinics available to refer the patients for a followup and they must come back to the ED. Social workers and case managers try to help some but it is a difficult situation when there are not enough resources available and it falls back to the ED and the hospital. Preventative medicine or routine checkups are not even considered. Welcome to healthcare in the U.S.

WonderRN

Specializes in ED. Has 5 years experience.

Yep, not a new thing.

Many reasons people use the ED for non-emergent symptoms:

no insurance (and in the ED, no payment required upfront.... or, EVER)

sick and no established PCP- and can't establish one when sick

can't get into their doc for 2 weeks

in pain and its the middle of the night

couldn't get a ride to their doc, but the cab-ulance could take them to the ED

loved one finally convinced them to come, but it was after their doctor closed

"free" boxed lunches

they are a drug-seeker and their doctor fired them

etc etc etc

We move stable folks to the hallway when a really sick one comes in. They might get mad, but when they someone hooked up to the bipap rolling past them into their old room, the decent folks just might understand. And the ones that don't....too bad, so sad

Emergency RN

Specializes in ED, CTSurg, IVTeam, Oncology. Has 30 years experience.

Our ED is also a homeless shelter for those that have found out that two magic words (Chest Pain) gets you a few hours on a warm cot. In a very large city with mulitple ED's, we have a few that actually make the area's ED's their rotating home; one night with us, the next with the one up the block, and following night across the street, then two nights downtown, another cross town, etc. We had one called Tommy Tuesday, because he seemed to always come in on Tuesdays. We finally figured out he was homeless and using the ED's on a schedule, LOL...

And no, this was long before the recent changes in health care.

As for scrambling to get a bed for a true emergency? We always try to keep at least one or two empties with a monitor available at all times for the sudden catastrophe that inevitably seems to show up whenever you're busy. Also, there is nothing in health care that dictates stretcher occupancy as de rigueur for any pt. You can be seated in a chair in the hall, or if need be, stand up in the waiting room until your labs come back or you're called to XR. The point is, we're a working Emergency Department and not a hotel. While this may not sit well with some customers, we have to care for the health and well being of all of them. Thus, bed space and occupancy of gurneys are subject to a constant triage process too. If one does not "need" the gurney at that moment, then they have to get off.

Edited by Emergency RN

ZippyGBR, BSN, RN

Specializes in Spinal Cord injuries, Emergency+EMS.

Many uninsured have no other place to go.

this is a significant issue for the USA , it doesn't however mean that ED misuse is eliminated in a 'free at the point of delivery' system. but at least in the UK we have the option to triage into cat 5 and offer a timed OOH gp slot ( you can await 3 and half hours and be told what i've just told you {you should have gone to your GP) or you can have a timed appointment at the OOH centre and will be seen on time ....

A bad toothache is an emergency to the person who is suffering. I wish there were more walk-in clinics for 'minor' emergencies.

that and proper Out of Hours services from Family Docs /GPs - while the previous UK government messed up the sums in making it not costly enough for GP practices to opt out at least there is 24/7/365 access to primary care ...

it's also about people having some personal responsibility and keeping basic meds and First aid equipment in

nurse2033, MSN, RN

Specializes in ER, ICU.

To you the emergency room is for emergencies. The public just didn't read the same textbooks you did. To them, the ER is a place where they can get all their health care without an appointment 24/7. The ER is great, you don't have to shop around, get directions, find out their hours, schedule an appointment, or spend a lot of time filling out forms. They might even give you a snack. And by law we can't say no.

I live in a small rural town and after 7pm pretty much your only option is the ED. I have kids and they tend to get hurt after the urgent care clinic closes. Thankfully our hospital just opened an urgent care clinic. You go to the ED and if you aren't an Emergency they send you there.

Many who are uninsured would probably love to have a book of doctors to choose from like most of us instead of getting the luck of the draw at the ED. They might also enjoy having a scheduled appointment and complaining if the the doctor keeps them waiting 15 minutes past that instead of the 8 - 24 hour wait in the ED. For some, their families may never have been in the financial position with insurance to have a primary care doctor and the ED is all they have known to use for the past few generations. Breaking the cycle can be hard and it is not isolated to the inner city areas.

The homeless is another issue that has grown since many of our shelters, mental health facilities and clinics including those roaming the neighborhoods in mobile vans have disappeared. Can we really blame those that could legally be declared incompetent to make a legal decision for themselves? Yet, we've closed most of the facilities that helped with their decisions for shelter and medical care.

Sometimes those who are in the group of the "have", including most of us, may not know the side of the "have not" and hopefully will never have to be in that position. I do know many health care professionals that got their homes foreclosed and felt like they were heading deep into the "have not" category.

Pixie.RN, MSN, RN, EMT-P

Specializes in EMS, ED, Trauma, CNE, CEN, CPEN, TCRN. Has 12 years experience.

I've definitely seen an increase in visits from people who have lost their insurance and literally have nowhere else to go -- even the urgent care/clinics want some payment up front, and some of these folks literally have two nickels to rub together, and that's it. We do have a high number of paying, insured patients in our county (it's a fairly affluent place), but we also have a lot of patients for whom we are the last resort.

There are no easy answers. I just try to be compassionate as best I can.

AprilRNurse

Specializes in Med/surg, rural CCU. Has 3 years experience.

I had a friend recently vent to me that she had to wait 10 hours in the ER when she was there for heavy menstrual bleeding. It's very hard to tell your friend that if the nurse didn't feel her life was in danger...than it wasn't an emergency. She kept saying they didn't know- didn't run tests etc for so many hours... again I expained that lack of dizziness (asked during triage) and her skin color told the nurse a LOT. She was still upset, even with her nurse friend trying to explain. The random patient's definately don't get it.

I had a favorite ER dr at my last job. He'd look the patient straight in the eye (the obvious "clinic" type visits) and say " Hello, my name is Dr. XXX, what exactly is your EMERGENCY at three AM today" and would emphasize EMERGENCY and the time lol.

Honestly- even then they never got it...but it always gave us nurses a chuckle when the young mom started rambling about her 3 year old who wouldn't sleep because of the bilat ear infection she saw the dr for yesterday and started antibiotics but no..she hasn't given anything for the discomfort....

seems to be the normal; I know an ER doc that has mentioned several times how people come in the ER with a cold....etc....minor things that are NOT emergencies.

Altra, BSN, RN

Specializes in Emergency & Trauma/Adult ICU.

This has definitely been the norm for the 6 years that I have been an ER nurse. If there was a specific point in time when it became the norm, it was probably after the implementation of EMTALA in the 1980s.

And I'd like to point out ... it has been the norm at both the inner city ERs I've worked in, with large populations of uninsured/indigent/homeless ... and at the "nice" suburban ER with a more affluent population as well.

Same stuff, different day.