ER "One Stop"

gonzo1, ASN, RN · Sep 17, 2008

We are getting a lot of people who say they called their doctor and he told them to go to the ER. For simple stuff. We are also getting a lot of people from the urgent care centers who say they wouldn't stitch them up, etc.

How can we stay afloat when all the other health care providers are sending their patients to us in droves?

Lurksalot, BSN, RN · Sep 17, 2008

That was a good article, but I'm not suprised at the facts. I really don't blame people for using the ED the way they do when they've tried to do everything the right way, schedule their specialist appointments for months away, wait weeks to get simple xrays done, and then have huge bills and insurance aggravation on top of it. It is impossible to get appointments with many specialists, or get MRIs or CT scans. I can't imagine knowing something is wrong with you that your PCP couldn't make better, so you have to get all these tests done and see specialists, but hey--none of that can get done for weeks or months. Going to the ED, getting it all done in one shot, and getting some kind of resolution is very,very tempting.

Does that keep me from continuing to educate on inappropriate ED use? No, I still do. In fact I think I got reported today because I dared to question why a 20 year old with a runny nose didn't try any OTC meds before she came to the ER, and the mother of the 20year old didn't like that I asked. She said she was bringing her baby to the ER because she needed the charity care. :banghead: So there will always be those that will go to the ER rather than buy tylenol, and I hate to say it but it IS cheaper. The ER is free for those who can't pay, and that $5 spent on tylenol maybe was gas money or burger king. (Who knows)

TraumaNurseRN · Sep 17, 2008

That was a good article, but I'm not suprised at the facts. I really don't blame people for using the ED the way they do when they've tried to do everything the right way, schedule their specialist appointments for months away, wait weeks to get simple xrays done, and then have huge bills and insurance aggravation on top of it. It is impossible to get appointments with many specialists, or get MRIs or CT scans. I can't imagine knowing something is wrong with you that your PCP couldn't make better, so you have to get all these tests done and see specialists, but hey--none of that can get done for weeks or months. Going to the ED, getting it all done in one shot, and getting some kind of resolution is very,very tempting.
Does that keep me from continuing to educate on inappropriate ED use? No, I still do. In fact I think I got reported today because I dared to question why a 20 year old with a runny nose didn't try any OTC meds before she came to the ER, and the mother of the 20year old didn't like that I asked. She said she was bringing her baby to the ER because she needed the charity care. So there will always be those that will go to the ER rather than buy tylenol, and I hate to say it but it IS cheaper. The ER is free for those who can't pay, and that $5 spent on tylenol maybe was gas money or burger king. (Who knows)

I guess my take on the article would be this. I still think it's abuse of he "Emergency" system. I don't have a problem with patient's who are "ill" or "injured" coming into the ER but many many people come in to the ER for chronic non-emergent ailments that could be taken care of with over-the-counter modalities which could be paid for if not for their cell phone bill, cable, cigrettes, beeper, gucci purses, etc. So instead of going to the Dollar Store for Children's Tylenol /motrin for their feverish child who hasn't had a bath in a week they come to the ER and get angry that they have to wait. Some take their anger out on the over-worked doctor or nurse which is another abuse. The "I have insurance" abusers of the system take the same attitude many times. Or the patient who comes in after months of the same ailment thinking the ER is going to cure them. Or the drug-seekers, "I think I have something going on down there"/STD checks.

I had a 19 year old come in with abdominal pain, no period for 2 months who got ticked when I asked her could she be pregnant. "Uhhhh, I don't know" So I ask, "Well, do you have unprotected sex?" " Ummm, yeah" she says... with a look of disbelief I had the gull to ask her that. Her mother's sitting there too. "I asked (knowing the answer), have you been to your OB/GYN, taken a pegnancy test?" "Ummmmm no" I ask why not...she says she can't afford it. This young adult already had one baby at home....grrrrrrr.....So I ask her if she would give me a urine sample and she asked why......grrrrrr again....To check to see if you're pregnant duh girl I wanted to say.

Ignorance is no excuse to visit the ER, demand "Drive-thru Care" and get crappy with the staff. This is the kind of stuff that frustrates me. What would happen if there was a small co-pay to come to the ER.....it would stop most of the abusers....It would also stop the mentality to call a squad for a runny nose. EMS should beable to refuse transport when it's non-emergent. (The EMS system is competent enough to clear c-spine (with certain exclusionary circumstances) in the field. They should certainly beable to refuse transport for lice, runny noses and other minor ailments....That kind of abuse ticks me off too!

ruralnurs · Sep 17, 2008

As someone that works in the ER quite a bit, often we are our own worse enemies. If you feed a stray cat he will always be on your doorstep. EMTALA requires that a person receive a medical screening exam and if it appears emergent, then the person is treated if not they are sent away.

I see many people come in for the non-emergent things and the docs treat them anyway and give them meds instead of a prescription.

If the person that comes in with a runny nose were medically screened and told, "You do not have an emergent condition." and sent away it may eventually slow down. I know in my small community we have "trained" the people that live here to use the ER.

Yes part of it is poverty and people that have been "fired' from the clinic for non-pay will use the ER. But our clinic (that is attached to and affiliated with the hospital) will bend over backwards to help people with no money.

Some just don't care. They don't have the $5.00 for a co-pay for the medicaid-paid-for antibiotics prescription but they sure can buy smokes and cell phone and have several tattoos and body piercings.

But again, if we really used EMTALA they way it was designed we would help ourselves. If they are not emergent then send them away, and I would have a very low tolerance for the "maybe real sick" and treat them, but some people are obviously not sick. And if they are sick give them a script not the meds (unless there is no available pharmacy then you can give the amount of meds needed until the pharmacy opens).

If they are not really sick, screen and street I say.

Lurksalot, BSN, RN · Sep 17, 2008

I guess my take on the article would be this. I still think it's abuse of he "Emergency" system. I don't have a problem with patient's who are "ill" or "injured" coming into the ER but many many people come in to the ER for chronic non-emergent ailments that could be taken care of with over-the-counter modalities which could be paid for if not for their cell phone bill, cable, cigrettes, beeper, gucci purses, etc. So instead of going to the Dollar Store for Children's Tylenol /motrin for their feverish child who hasn't had a bath in a week they come to the ER and get angry that they have to wait. Some take their anger out on the over-worked doctor or nurse which is another abuse. The "I have insurance" abusers of the system take the same attitude many times. Or the patient who comes in after months of the same ailment thinking the ER is going to cure them. Or the drug-seekers, "I think I have something going on down there"/STD checks.
I had a 19 year old come in with abdominal pain, no period for 2 months who got ticked when I asked her could she be pregnant. "Uhhhh, I don't know" So I ask, "Well, do you have unprotected sex?" " Ummm, yeah" she says... with a look of disbelief I had the gull to ask her that. Her mother's sitting there too. "I asked (knowing the answer), have you been to your OB/GYN, taken a pegnancy test?" "Ummmmm no" I ask why not...she says she can't afford it. This young adult already had one baby at home....grrrrrrr.....So I ask her if she would give me a urine sample and she asked why......grrrrrr again....To check to see if you're pregnant duh girl I wanted to say.
Ignorance is no excuse to visit the ER, demand "Drive-thru Care" and get crappy with the staff. This is the kind of stuff that frustrates me. What would happen if there was a small co-pay to come to the ER.....it would stop most of the abusers....It would also stop the mentality to call a squad for a runny nose. EMS should beable to refuse transport when it's non-emergent. (The EMS system is competent enough to clear c-spine (with certain exclusionary circumstances) in the field. They should certainly beable to refuse transport for lice, runny noses and other minor ailments....That kind of abuse ticks me off too!

I totally agree, it's abuse of the system. I was trying to explain that I understand why it happens, on many different levels. I still educate my patients on inappropriate use of the ER, and I try to give them resources to get the primary care help they need instead of using the ER as a one-stop shop.

It is a system wide failure in healthcare that people feel compelled to abuse the ER the way they do. And probably a societal failure, too, because people are used to going to the ER for "free". :twocents:

Pat_Pat RN · Sep 29, 2008

As someone that works in the ER quite a bit, often we are our own worse enemies. If you feed a stray cat he will always be on your doorstep. EMTALA requires that a person receive a medical screening exam and if it appears emergent, then the person is treated if not they are sent away.
I see many people come in for the non-emergent things and the docs treat them anyway and give them meds instead of a prescription.
If the person that comes in with a runny nose were medically screened and told, "You do not have an emergent condition." and sent away it may eventually slow down. I know in my small community we have "trained" the people that live here to use the ER.
Yes part of it is poverty and people that have been "fired' from the clinic for non-pay will use the ER. But our clinic (that is attached to and affiliated with the hospital) will bend over backwards to help people with no money.
Some just don't care. They don't have the $5.00 for a co-pay for the medicaid-paid-for antibiotics prescription but they sure can buy smokes and cell phone and have several tattoos and body piercings.
But again, if we really used EMTALA they way it was designed we would help ourselves. If they are not emergent then send them away, and I would have a very low tolerance for the "maybe real sick" and treat them, but some people are obviously not sick. And if they are sick give them a script not the meds (unless there is no available pharmacy then you can give the amount of meds needed until the pharmacy opens).
If they are not really sick, screen and street I say.

:yeahthat:

Toquay · Sep 29, 2008

I agree with many of the above posters, but the sad thing is most ERs will continue to encourage non emergent visits. Patients with even simple complaints will get narcotics and scripts (morphine in house and percocet script for a sunburn). Years ago the nurses were able to be more vocal to patients about using the appropriate community resources but today if a patient takes offense (so many do) and complains the nurse that tried to educate gets put on notice or fired. I heard an economist on a talk show say, "The US used to be a land of opportunity but now is the land of entitlement". The monies recieved from the state for indigent care and the write offs all help the bottom line of the hospital and not until hospitals really takes losses on non emergent care will they change their policies. Who knows maybe the government will start reviewing (like the insurance companies) what cases are true emergencies. Scary!!

Toq

ecat81 · Oct 3, 2008

I work in a non-profit community hospital seeing 58,000 ED patients a year. This year the hospital has been hit hard by the "charitable care" given to the community. The hospital has for years let the community get away with coming in and not paying their bills and now it is hurting the hospital. Don't get me wrong the hospital is still making money, but only half what they wanted to make and the hiring freeze :devil: has only hurt the employees. The ED is in the early stages of hiring NP/PA to see our wound rechecks/re-evaluations in a clinic and eventually to start seeing medically screened patients by appointment. This is to curtail the abuse of our ED and the loss of capital. There is no quick solution. You're right if we try to educate the public then they cry to adminstration and then they talk with us. And I wonder why there is so much burnout and turnover in the ED:banghead:?