ER's Turn Non-Emergencies Away?

[mwboswell]

The below article appeared on the website of a local news station in Rock Hill SC. Some people in the community have varied opinions about this. For those of us "in the business", what do you think about this kind of policy? Do you think it will actually make a difference or is it just bad public relations or giving people a mixed message about a hospital's concern for it's community? What if a patient has no insurance and can't afford a doctor's office visit, where do they go? What do you think?

Local Hospital's New Policy Of Turning Patients Away Upsets Some

Posted: 6:28 pm EDT May 12, 2009

ROCK HILL, S.C. --

Diana Burgess of Rock Hill went to the emergency room at Piedmont Medical Center last month with severe pain in her side."The doctors came in and just basically said they weren't going to do anything for me," she said. The ER doctors determined that the pain Burgess was suffering was not an emergency and didn't require immediate care. President and CEO of Piedmont Medical Center Charlie Miller explained the policy this way: "it is an emergency room, not a primary care clinic." "We think it's had a positive impact on wait times," Miller said. "Two-hundred to 250 people a month are leaving to see their primary care doctor instead." Hospital officials also said patient care is better when they can see a doctor outside of the hospital and form a relationship, rather than using the emergency room as their doctor. However, people like Burgess, who doesn't have any health insurance, said she can't afford to see a regular doctor. "I just left there crying," she said. "I was hurting too. I was really feeling bad. "Miller said the hospital does what is required by law, which means doing a medical screening for every person who comes into the ER. Then doctors determine if their condition requires immediate emergency care.

[ruralnurs]

As mentioned in a post above, people are TRAINED to use the ED for primary care. I used to do ED and loved it and saw the same thing. If EDs used EMTALA the way it was designed it would eventually work.

If a person come in for a non-emergency, like a sore throat or skin issue and they were triaged and seen by the doc and told, "You have XYZ and it is not an emergency and you need to follow up with your PCP" (and not give cough medicine or cream for the itch or whatever), eventually people in the community would slow down presenting for non-emergencies.

However, it is behavior modification at its finest. I show up to the ED for a lady partsl yeast infection, even if I have to wait a long time, I get evaluated (must happen per EMTALA) and treated (not required by EMTALA of it is non-emergent). If I showed up and waited for hours and then told by the doc to see my PCP and I still got billed (even if I don't plan to pay) then I may start rethinking wanting to spend my afternoon in an ED waiting room.

There are barriers to that however. I asked one doc I worked with why we didn't use EMTALA to our advantage. And this doc was one of the biggest complainers of when people would show up and wake him up for non-emergent stuff (and he was the CEO of the little hospital). He said it was PR, the hospital did not want the community to think badly of it. And he wanted to have good ER evaluations.

So we can't really blame all the people that are wasting our health care resources by presenting to the ED for non-emergencies, we need to blame the organizations that encourge them by treating non-emergent conditions.

[mollymutt]

I am not wanting advice, just want to share my own experience from both ends.

My daughter and I were recently having a discussion on pain management and she brought up the issue of her pain. She has Severe Crohns Disease and often feels like there is no help when she needs it. Her GI dr is useless (she is in the process of finding a new one) he never listens to her concerns and complaints, never does a physical exam, will not call back unless it's been 48 hours, and it makes her feel like all the issues she has is in her head and that no one believes that she is in real chronic pain. She will get extreme spasms that can last hours and even partial obstructions, she refuses to get seen by the ED or to call her dr unless they last over an hour. When she calls the dr on call, he says to wait it out but if it gets worse to go to the ED. Her worst attacks happen at night, after ALL the urgent care and PCP offices have closed for the day/week. When her dr doesn't help, and the only option is to go to the ED since there is nothing else open, what is she supposed to do? (rhetorical) She goes to the ED she is treated very poorly (most Crohn's patients are from what I hear) the last visit (her first ED visit in 2 years) she was never properly admitted (she was placed in a bed in the waiting room where everyone was watching her writhe in pain), was only given pain meds and labs, no other tests were run, the dr came to see her once and never gave a physical (including intestinal sounds to check for blockage) nothing. They just shot her up with pain meds and made her walk out of the hospital alone and un-escorted. She was still in a lot of pain and they would not do anything for her! How is this supposed to help people?

Now a few months later she went to a different hospital in hopes of better treatment, she has had a bad cold and a severe sore throat to the point where she was unable to swallow (her throat was so inflammed nothing would go down, not just because it hurt) and shortly after was having a difficult time breathing. In fear this could be an allergic reaction she was having to a decongestant she went to the ED. It was after midnight when these symptoms started so there was again no urgent care or PCP help. She waited for 45 minutes to be triaged because the triage nurse had disappeared and none of the other nurses could find her. She then was taken to a room within 20 minutes but waited 1 1/2 hours for the nurse to come in, who swabbed her mouth, then left. He checked on her in 30 minutes to let her know they were still awaiting the 7 minute test to come back (keep in mind the ED was not busy neither was the lab) 30 minutes later the test results still hadn't arrived. 15 minutes later the dr finally came in. He never examined her, just told her she had an URI and was going to send her home. He then left, the nurse came in 30 minutes later to start discharge paperwork, he went over the prescriptions the Dr had prescribed and they were the ones that were clearly written on her "allergy/intolerance" list. So the nurse left to get the dr again. Meantime she starts throwing up (with blood) and screaming because it hurts so bad, no one came to check on her and there was no call button. When the dr finally came in 45 min after the nurse left, she could barely tell him what happened. He just stared blankly at her, still said he was discharging her and to follow up with her useless GI (even though she didn't even go in for Crohn's symptoms) and sent her home. Just over 4 1/2 hours for an ED trip.

How is any of this ethical treatment? If some one comes in with a legitimate concern they should be treated, end of story, regardless if we as nurses and doctors feel it isn't an emergency. I worked for 18 years in an ED, the treatment for patients has increasingly become worse and even more so since I moved on to another department. None of this is ethical, I feel it violates our oath we took to help patients no matter what. My daughter has now sworn to never visit an ED unless she is already dead because she has gone in more than twice with no support or help and is turned away or not given proper treatment. By even turning legitimate patients away that have no other means of treatment because there are no UC or PCPs open is morally and ethically wrong. These are only the 2 recent stories I have, but I certainly have more. If hospitals actually took care of their patients and went through the time and effort to help them, not only medically but by providing even more payment options, then they could increase their bottom line significantly, which in the end is all they care about.

[emtb2rn, BSN, RN, EMT-B]

methinks billygoat gruff in the house.....

[Fribblet]

I am not wanting advice, just want to share my own experience from both ends.

My daughter and I were recently having a discussion on pain management and she brought up the issue of her pain. She has Severe Crohns Disease and often feels like there is no help when she needs it. Her GI dr is useless (she is in the process of finding a new one) he never listens to her concerns and complaints, never does a physical exam, will not call back unless it's been 48 hours, and it makes her feel like all the issues she has is in her head and that no one believes that she is in real chronic pain. She will get extreme spasms that can last hours and even partial obstructions, she refuses to get seen by the ED or to call her dr unless they last over an hour. When she calls the dr on call, he says to wait it out but if it gets worse to go to the ED. Her worst attacks happen at night, after ALL the urgent care and PCP offices have closed for the day/week. When her dr doesn't help, and the only option is to go to the ED since there is nothing else open, what is she supposed to do? (rhetorical) She goes to the ED she is treated very poorly (most Crohn's patients are from what I hear) the last visit (her first ED visit in 2 years) she was never properly admitted (she was placed in a bed in the waiting room where everyone was watching her writhe in pain), was only given pain meds and labs, no other tests were run, the dr came to see her once and never gave a physical (including intestinal sounds to check for blockage) nothing. They just shot her up with pain meds and made her walk out of the hospital alone and un-escorted. She was still in a lot of pain and they would not do anything for her! How is this supposed to help people?

Now a few months later she went to a different hospital in hopes of better treatment, she has had a bad cold and a severe sore throat to the point where she was unable to swallow (her throat was so inflammed nothing would go down, not just because it hurt) and shortly after was having a difficult time breathing. In fear this could be an allergic reaction she was having to a decongestant she went to the ED. It was after midnight when these symptoms started so there was again no urgent care or PCP help. She waited for 45 minutes to be triaged because the triage nurse had disappeared and none of the other nurses could find her. She then was taken to a room within 20 minutes but waited 1 1/2 hours for the nurse to come in, who swabbed her mouth, then left. He checked on her in 30 minutes to let her know they were still awaiting the 7 minute test to come back (keep in mind the ED was not busy neither was the lab) 30 minutes later the test results still hadn't arrived. 15 minutes later the dr finally came in. He never examined her, just told her she had an URI and was going to send her home. He then left, the nurse came in 30 minutes later to start discharge paperwork, he went over the prescriptions the Dr had prescribed and they were the ones that were clearly written on her "allergy/intolerance" list. So the nurse left to get the dr again. Meantime she starts throwing up (with blood) and screaming because it hurts so bad, no one came to check on her and there was no call button. When the dr finally came in 45 min after the nurse left, she could barely tell him what happened. He just stared blankly at her, still said he was discharging her and to follow up with her useless GI (even though she didn't even go in for Crohn's symptoms) and sent her home. Just over 4 1/2 hours for an ED trip.

How is any of this ethical treatment? If some one comes in with a legitimate concern they should be treated, end of story, regardless if we as nurses and doctors feel it isn't an emergency. I worked for 18 years in an ED, the treatment for patients has increasingly become worse and even more so since I moved on to another department. None of this is ethical, I feel it violates our oath we took to help patients no matter what. My daughter has now sworn to never visit an ED unless she is already dead because she has gone in more than twice with no support or help and is turned away or not given proper treatment. By even turning legitimate patients away that have no other means of treatment because there are no UC or PCPs open is morally and ethically wrong. These are only the 2 recent stories I have, but I certainly have more. If hospitals actually took care of their patients and went through the time and effort to help them, not only medically but by providing even more payment options, then they could increase their bottom line significantly, which in the end is all they care about.

Cool story, Bro.

[Chixie]

We have a system in our a+e where the triage nurse sees you,does her assessments and if she believes the presenting complaint is not an emergency/accident you are referred to BEDDOC which is an out of hours GP service (its just down the corridor from the a+e department)where your complaint will be dealt with and it doesn't take up valuable resources and time from the a+e staff.

[360jRN]

Everybody knows the system is abused over and over and over again every single day. Had a lady bring her baby in two nights ago for...Well frankly bull. So doc sees the bambino and writes a script. Next day mom brings the baby back in because "She didnt have time to go and get her prescription filled so just needs another dose of her medicine."

My motto after joining the nursing profession: People are dumb. (Please dont feel the need to bombard me with any self-righteous comments... Because I guarantee you've thought it before too! Lol! )