Misuse of the ER

Nurses General Nursing

Published

I work in a small rural hospital, where we deal with all areas, and the number of non-emergent ER visits I see is really making me hate my job! The other day, the Dr's clinic nurse informed me at 10:30 am that there would be a patient coming to the ER at 1:00 pm. This patient had fallen 3 days prior and had been suffering hip pain since. When I asked why the patient couldnt come now if it was an emergency, I was told that she did not have a ride until 1:00 and she did not want to call the ambulance. I then protested that if it were an emergency, she would come immediately rather than scheduling an ER appointment (i guess that's a thing?!?!?), and if it could wait then she could be seen in the clinic. The clinic nurse explained that it needed to be done in the ER because the Dr wanted the patient to be lying down for her assessment (LOLOLOL). I ended the call, then went and informed my DON of this, who found it as ridiculous as I did, and went to talk to the Dr. Upon returning, she stated that the patient was coming to the ER at 1:00 because she had told the Dr she did not want to be seen in the clinic due to her insurance coverage. Please share your thoughts on this, I see this sort of thing all the time and am just wondering if this happens anywhere else.

I wonder if this is an area type thing. Or perhaps is more dependent on the office/MD a person goes to. Where I live currently, if my kid were to get a fever and had to be taken out of school, and couldn't come back without a clearance note for a DR. There's no way I am getting a same or possibly even next day appointment with his PCP. Even when I break out with a cold sore and I want to see the PCP for some Valtrex, it's a 3 day wait... and that's their "soonest" appointment. I've had three different PCP's in this area and there was only one that would manage to sometimes get you a same day appointment but I couldn't tolerate being her patient.

I have to agree. Maybe 10 years ago you could get a same day appointment, nowadays it's unheard of. Husband had a respiratory issue. SOB, wheezing... Call his PCP, a pulmonologist, can't take him for x number of days. The local "Urgent Care" places seem to keep regular business hours, so where does one go? Not like there was much of a choice,

Specializes in Case Manager/Administrator.

Well as a nurse I see your rational for ED use I really do...as an Administrator I see a completely different side in which I will try to accommodate patients access to health care. Maybe it is just me getting older and more wise/understanding and perhaps a little (mind you "little" more liberal).

Keeping people out of the hospital, keeping people staying in their home as I discover throughout the years is important on so many levels. Keeping people in their home and out of hospital saves monies but it also gives the patient hope. Hope to continue living in their own home, to continue to interact hopefully with family/friends. It is about changing lives in the home/family, work, community and the world.

A lot of people live month to month and often rely on family/friends for assistance often daily or weekly. This not only taxes out those who offer but the patient themselves feel dependent when most their lives they have been independent. When a patient has a time frame due to transportation/appointment issues they are not being what can be perceived as needy but as I need to come in and see you and this is the only time I have a ride. It is humbling to have to depend on another for your life, I know I am a breast cancer survivor and my husband and children were there for me but I had to put aside my independence for awhile, it is humbling to have to have your spouse assist you out of the shower not once but over a period of time. People who are dependent and have a new norm of being dependent on others.

Now insurance is another issue. I currently work as a case manager with an employee owned insurance company-yes employee owned, and we approve way more than we deny.

If a patient has what is called a tiered network (aka narrow network) I can tell you the choices the patient has are slim and quiet possible the patient will have to travel greater than say 20 miles one way for access to care-this is all they can afford as far as healthcare choices. To present to the emergency department is more than likely less expensive for a patient where the copay/office visit/deductible is often around the $200.00 mark and an ED visit is $100.00 copay. Doing the math I would present to the ED. This is typical for commercial insurance.

I get on my soap box all the time for access to healthcare and how it is delivered. What we need is Prescribing providers and more nurses in schools, and areas where there is large population groups i.e. companies greater than 5000 employees. Working in a provider clinic your hours are basically 8-4, closed at lunch and on Fridays office will be closed at noon. If you are lucky you might find an office open once monthly on a Saturday (filled up for the next 4 months. Who can go to the doc at those times? I myself find it hard to coordinate appointments during those times and I work form home!

Lastly we do need to continue to educate patients and really start early in the schools about healthcare in general, about healthcare access, about healthy lifestyles and about growing older and the costs associated to all those. We teach young adults about economics, how to balance a check book, how to manage a household why not teach about healthcare costs this should certainly be included and not just at a global... this is how much the US spends on health care, but take a chronic disease like diabetes and teach/break it down about the monthly/annually cost of this. Same with say pregnancy- difference between prenatal cares verses non prenatal cares throughout the pregnancy and afterward to include child care, cost of diapers/formula, how much is the WIC worth each month and where this monies come from. Teaching this to high school students may make differences in the way these students think about lifestyles and how they access healthcare in the future.

This is just one example of meeting people where they are.

I've been in the waiting room with a family member who legitimately needed to be there. A family was also there and seemed pretty relaxed and laughing and hanging out. After a while, they had a pizza delivery come in for them! I'm not sure why they were there but they probably could've just gone to the walk-in and avoided missing dinner.

Specializes in Med-Tele; ED; ICU.

It also frustrates me sometimes.

The flip side is that when one of my beds is taken by a walkie-talkie, calm and cooperative patient with a non-emergent complaint, it means that the ambulance rolling in with screaming dude in restraints and covered in feces isn't dropping into that bed...

I worked on an ambulance prior to working as a RN. One of my top ten ridiculous calls was a 0130 911 call for tooth pain. When we arrived to assess the pt., it turned out that the last tooth in her mouth hurt. She had try to alleviate the pain by digging a safety pin in the gum, to no avail. Yup, she insisted on a ride to the ER.

Not you - the typical patient. You're a nurse and have extensive knowledge. However, your example is nearly perfect. Severe abdominal pain can be indicative of plenty of both non-emergent and emergent conditions. Do you really want someone with no medical knowledge to self-diagnose their RLQ abdominal pain? Ectopic pregnancy? Appendicitis? Gastroenteritis? A tummy ache?

I totally get that people both abuse the ER and use the ER when it's not appropriate for their conditions. However, it's still best for the patient if we are the ones who decide whether or not their ER "trip" was appropriate. YOU understand what epiglottitis is. I understand what epiglottitis is. But a patient may not necessarily understand the difference between that and a severe strep throat (which generally is not something that needs to be treated in the ER).

I'm just saying that it gave me a new perspective when thinking about why and how patients present to the ER.

Specializes in Trauma, Teaching.

Lots of abuse. But, they are the bread and butter of it all, and we catch a few that seemed like "why are you here" who end up with something really serious.

I once asked a mom why she was there at 0200 for a baby's earache of a couple of days, and she replied that was when she could use the family car, as her husband needed it to support them until late at night.

My son called an ambulance for his sister, rightly so, but insurance wouldn't pay. $700 out of pocket, plus ER copay plus deductable. I now understand a lot more about the folks bringing some serious stuff in POV to my front door. Your taxes make amublances available, just not the use of them (said sarcastically).

But for venting, over in the Specilaties area, Emergency Nursing, there is a very long thread with some hilarious reasons for coming to the ER, titled:

"What was the MOST ridiculous thing a patient came to the ER for?"

no

You are an RN and can be trusted more to make the determination. Although God knows we do sometimes miss it.

1. Im an RN student

2. Even before I was an RN student I could tell if I had a normal sore throat or I was in danger of suffocating.

:roflmao:

Not you - the typical patient. You're a nurse and have extensive knowledge. However, your example is nearly perfect. Severe abdominal pain can be indicative of plenty of both non-emergent and emergent conditions. Do you really want someone with no medical knowledge to self-diagnose their RLQ abdominal pain? Ectopic pregnancy? Appendicitis? Gastroenteritis? A tummy ache?

I totally get that people both abuse the ER and use the ER when it's not appropriate for their conditions. However, it's still best for the patient if we are the ones who decide whether or not their ER "trip" was appropriate. YOU understand what epiglottitis is. I understand what epiglottitis is. But a patient may not necessarily understand the difference between that and a severe strep throat (which generally is not something that needs to be treated in the ER).

I'm just saying that it gave me a new perspective when thinking about why and how patients present to the ER.

No Im a nursing student.

Im also not an idiot.

Sorry but I frankly dont think the ER needs every tom, dick and harry with a sore throat and tummy ache jamming it up.

I mean, on one hand you're right, there are people who are so dumb as to be unable to not tell the difference between bad gas from the tacos they ate tonight and appendicitis....thankfully that doesnt apply to the majority of people and we dont need to be scaring them into coming into the ER for non-sense reasons.

Specializes in Cardiac Stepdown, PCU.
No Im a nursing student

Well.. That explains a lot.

Well, I am an idiot because I've panicked and taken my kid to the ER two times for "nothing". I paid dearly for it.

One thing I was on the fence about due to my assessment. But I'm not a pediatric nurse or a pediatrician, and I couldn't cope with the possibility that I might be wrong.

The patient probably needed to be referred to a SNF for short term rehab, which requires a 3 day hospital stay in most cases. The doc was probably hoping they'd be admitted or that social services could get them in another way.

As I said, ins fraud

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