Misuse of the ER

  1. 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.
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    About ShortFuse

    Joined: Aug '18; Posts: 3; Likes: 3

    56 Comments

  3. by   cenrn
    I know it's frustrating for sure to see people use the ER as a primary care clinic. Of course, for the hospital, it's all revenue, one way or another, so they want customers--and happy ones at that. And I hear it a lot, you know, "Why didn't you go to your primary care doctor?" But of course, these days, a primary care doctor is almost useless in what they can do in their office, a lot of people don't have insurance, so they don't have a doctor, and even me, I have great insurance (Tricare Prime for retired family), and I have a doctor, but he's never in, they always tell me to go to urgent care or the er, so I only use the guy for prescription refills. But it is true, when non-emergent patients come to the ED, the bog down the ED staff and that can make it worse for people who really need it. But then, I'm only getting paid because we have a busy ER., so I guess I can only complain so much, but I do feel your pain
  4. by   Sour Lemon
    Quote from ShortFuse
    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.
    That actually doesn't sound too bad to me. There are a lot worse abuses out there. I'm not even sure I would classify this case as "abuse".
    In any case, it's job security, right? You're there to work, so just do your job. Then, go home and count your money.
  5. by   not.done.yet
    There are a lot of reasons why this may be happening this way, many of which inspire pity more than wrath. You get paid either way and theoretically you triage patients, so your time isn't wasted. Extend people grace. Life is hard, often in ways we know nothing about.
  6. by   PolaBar
    My favorite so far was "Flu Like Symptoms".. Oh, and can I have a pregnancy test, too...
  7. by   KelRN215
    ER overuse is very common among people with Medicaid. Many Primary Care offices do not accept Medicaid which leads to these patients using the ER as primary care.

    Truthfully I don't see your example as horrible ER abuse though. The patient fell and still had hip pain several days later. She may have needed an X-Ray. Perhaps the Primary's office doesn't have one. I know the practice I went to as a child had a radiology department but no practice I've gone to as an adult has.

    Someone I went to high school with, on the other hand, regularly posts about being in the ER for things like a toothache or the sniffles.
  8. by   That Guy
    Lets be honest, the sick, non emergent people are what keep the doors open and give those every important numbers that keep us staffed every day. Yeah all sick people would be a lot more fun but its not the reality of what goes on.
  9. by   PeakRN
    Far from the worst I've had. I've had patients check in to ask for a bus ticket or to try to get a medicaid cab across town without any complaint.
  10. by   Gravery
    While I understand that this can be frustrating, please know that there are nurses like me, grateful for you and your ER. I work at a medical day program with adults with mental illness. I can't tell you how many times I've sent clients to the ER by ambulance for non-emergent ailments. I used to feel guilty but now I know it's in my clients best interest and am just grateful there's an option. Urgent care often isn't an option due to transportation issues, lack of family/friends. PCP's frequently don't have open appts.
  11. by   JKL33
    Quote from ShortFuse
    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!
    Right now, you have to make a choice. Save yourself or don't. With regard to this particular topic, you save your self (your sanity, etc.) by accepting that there is no misuse of the ED. Regardless why people come.

    You have much worse things coming your way eventually. Best to make up your mind now: Smile, help people the best you can, and don't worry about others' decisions.
  12. by   Miss.LeoRN
    Clearly the clinic could handle the case, which is why the patient was being sent to the ER. And there are plenty of people who wait for rides to go to the ER rather than take an ambulance simple because ambulance rides are expensive and a lot of insurances do not cover them.
  13. by   MHDNURSE
    I see it all the time and it really frustrates me. I work as a school nurse and I will call a family to come pick up their child who has a fever (can't be in school with a fever) and they will return to school a couple days later with a discharge note from the ER! Dx Strep, Otitis, etc. Very basic, primary care illnesses. I ask why the went to ER and they says "It's faster, or closer to my house, or I wanted antibiotics, etc.". I do as much education as I can about ER misuse/Abuse but it usually goes over their heads.
  14. by   Miss.LeoRN
    Quote from MHDNURSE
    I see it all the time and it really frustrates me. I work as a school nurse and I will call a family to come pick up their child who has a fever (can't be in school with a fever) and they will return to school a couple days later with a discharge note from the ER! Dx Strep, Otitis, etc. Very basic, primary care illnesses. I ask why the went to ER and they says "It's faster, or closer to my house, or I wanted antibiotics, etc.". I do as much education as I can about ER misuse/Abuse but it usually goes over their heads.

    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.

    However, where I lived previously, about 10 years ago, you could get a same day appointment no problem. I only have two different PCP's back then and they were at the same office.

    I also have to wonder about the number of urgent cares in the area and their hours. My current area has urgent cares popping up like starbucks. The local hospital here has seen a dramatic drop in ER visits for people with non-emergent concerns during the hours that it's open. In the area I work (same healthcare network system) there are fewer urgent cares and my hospital see's plenty of people where you just stare at them like "you came in for... this?!". Of course, we all also joke around that you can walk into my ER and sneeze and they would admit you right to stepdown with tele for a history and diagnosis of "we're not sure yet!" (Though, seriously, I've had patients where their admit diag stated "patient called 911 saying "they didn't feel well"", she ended up having trashy labs and a uti. we love to admit for UTIs).

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