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Ghosts of the ER (Clerks)

Professionalism   (1,487 Views | 36 Replies)
by Cody1991 Cody1991 (New) New Pre-Student

Cody1991 has 7 years experience and specializes in Registration / Insurance.

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You are reading page 3 of Ghosts of the ER (Clerks). If you want to start from the beginning Go to First Page.

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8 minutes ago, egg122 NP said:

And unless it is an true emergency (which will happen more often than in other settings given it is the ER), the medical and nursing staff can wait for you to finish your transaction with the patient before busting in like that.

You are not correct. If the basic EMTALA obligations have not been satisfied, then payment operations may not delay the provision of screening or the care required to complete the screening or stabilization.

Secondly, beyond EMTALA, all clinical staff are being timed on everything and being judged by such speed without regard to patient acuity, and not just by our employers' policies or harebrained initiatives as in the OP situation: ED throughput is a CMS quality measure. That does mean that the actual care and treatment of the patient is being used to officially judge quality of care. There's nothing about making sure to collect $50 in those quality measures. Granted, those procedures are  important, but for different reasons. Therefore, different approaches for satisfactory performance of those duties are needed.

Lastly, if you were the patient which would you prefer:

1. Nurse or provider is extremely rude to clerical personnel who are interacting with you and tells them to leave.

2. Nurse or provider stands in corner while you are uncomfortable and/or anxious, delaying the resumption of care provision until you are done providing your payment information and fumbling around for your various cards.

3. Nurse or provider (the people you came to the ED to see) pop their head in and see that you are engaged with billing procedures and say they will come back later, which is likely going to be 10-20 minutes from now.

4. Your actual care is prioritized and the business end of things is taken care of efficiently without interrupting or delaying any other aspect of your hands-on care.

You would not appreciate #1, 2 or 3 as a patient. You would appreciate #4.

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54 minutes ago, egg122 NP said:

JKL33, 

I don't see how those are the only 4 scenarios available. I will provide a 5th. The provider or RN addresses the clerk as a human being and advises that we need to do something urgently and that they need to come back later. That would take 10 seconds or less. As a patient, I would want to be ensured that my care team can communicate with each other clearly and with basic courtesy. Patients also become uncomfortable when they see negative interactions between health professionals. Teams that cannot communicate effectively or treat each other with respect have poorer outcomes. The clerk is a part of your team. Would you not agree that direct communication is best?

 

Edited by egg122 NP

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Yes, your #5 is part and parcel of #4; it's exactly how #4 happens.

I've already described my practice in a previous post so I won't repeat myself.

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16 minutes ago, JKL33 said:

JKL33

This is your scenario 4: "4. Your actual care is prioritized and the business end of things is taken care of efficiently without interrupting or delaying any other aspect of your hands-on care.

 

Then it should be addressed issue with their manager or your manager and treating front line co-workers with respect.  Or communicating with the registration staff about how to handle scenarios for the shift directly. There are ways of doing this without degrading or being passive aggressive to coworkers.

 

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Yes. That's what the whole discussion has been about.

It seems we agree on all of that. I only disagree with your assertion along the lines that we're all equal and so clinical staff should wait their just as much as anybody in this scenario. I don't think they should and the law agrees with me, but that doesn't condone rudeness on the parts of these RNs. My comments to you are only to point out that there are some pretty official reasons why decent places try very hard to incorporate reg/billing in a way that doesn't approach interference with medical/nursing care.

I make no excuses for these RNs. As I said, they are official mean girl.

I also believe that there is no excuse for these RNs' behavior, but at the same time this toxic process (and many others like it in EDs around the country) is ultimately to blame. It's much easier for me to try to see my coworkers' POVs and try to work together with them,  than it is to try to defend anything as asinine as telling registration personnel to run into the room the instant it's time for nursing interventions to get underway. That is not fair to anyone involved, not the OP, the nurses, or the patient.

Edited by JKL33

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Just now, JKL33 said:

 I only disagree with your assertion along the lines that we're all equal and so clinical staff should wait their just as much as anybody in this scenario. I don't think they should and the law agrees with me, but that doesn't condone rudeness on the parts of these RNs. 

 

My original post also clearly stated that if it is a true emergency that the registrar needs to wait. You can be EMTALA compliant and have the clerk collect information in the room once the case has been screened and deemed not emergent.

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16 minutes ago, egg122 NP said:

You can be EMTALA compliant and have the clerk collect information in the room once the case has been screened and deemed not emergent.

Yes, but now you're getting into weeds that are simply not going to be parsed out each time registration visits a patient room.

Is registration making an attempt to know whether the patient 1) has been screened and cleared 2) whether an EMC has been found to exist or 3) whether the testing has been ordered to rule out an EMC or 4) the treatment has been ordered to treat an EMC? No. They do not know these things and #2, 3, and 4 are all situations where EMTALA obligations are not yet satisfied.

They operate from one basic process and therefore it needs to cover all scenarios. Patients to whom the hospital technically no longer has an EMTALA obligation could be asked for payment/co-payment  before any further care is rendered and they can even altogether be referred elsewhere. But all of that gets into very dicey territory and so it is just not the way things are.

 

Edited by JKL33

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1 hour ago, JKL33 said:

Yes, but now you're getting into weeds that are simply not going to be parsed out each time registration visits a patient room.

Is registration making an attempt to know whether the patient 1) has been screened and cleared 2) whether an EMC has been found to exist or 3) whether the testing has been ordered to rule out an EMC or 4) the treatment has been ordered to treat an EMC? No. They do not know these things and #2, 3, and 4 are all situations where EMTALA obligations are not yet satisfied.

They operate from one basic process and therefore it needs to cover all scenarios. Patients to whom the hospital technically no longer has an EMTALA obligation could be asked for payment/co-payment  before any further care is rendered and they can even altogether be referred elsewhere. But all of that gets into very dicey territory and so it is just not the way things are.

 

We will have to agree to disagree. I think this post is going into the weeds. Thanks. 

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Okay...?

We do not disagree about basic kindness and consideration of one another. I'm not sure why you would disagree about the rest of it; it's pretty straightforward.

But--as you wish.

Edited by JKL33

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PollywogNP has 41 years experience as a ADN, BSN, MSN, LPN, NP and specializes in Med-Surg/Tele/ER/Urgent Care.

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Why do you have to wait until the doctor has  seen them ? (“Moves from waiting to be seen to treatment in progress”) before you can see them to complete the registration???

What is to be gained ?  In a busy ER patients could wait quite a while before the doc/pa/np sees a patient and writes treatment orders.

The Lobby wait time can be hours long ( recently waited 2 hours), another  opportunity to finish the registration? 

 

 

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6 hours ago, PollywogNP said:

Why do you have to wait until the doctor has  seen them ? (“Moves from waiting to be seen to treatment in progress”) before you can see them to complete the registration???

What is to be gained ?  In a busy ER patients could wait quite a while before the doc/pa/np sees a patient and writes treatment orders.

The Lobby wait time can be hours long ( recently waited 2 hours), another  opportunity to finish the registration?

Technically you don't have to. The law only says that the screening for an emergency medical condition or the care required to stabilize an emergency condition may not be delayed in order to inquire about the patient's finances/insurance, and we all know that if there is a delay in screening it is likely due to patient volume vs. resources, and more efficient or less efficient processes.

The problem is having to prove the why beyond a shadow of a doubt after an allegation has been made. No one wants to be investigated for an EMTALA violation or, as I said earlier, give even the appearance that someone's screening or care was delayed in order to inquire about their payment method.

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I think the EMTALA thing is a distraction to this thread and frankly derailed it in an attempt to show who is top dog in all things nursing. I'm not clear why we had to go there, particularly when there is nothing about the OPs post that indicate there is anything non-compliant going on and implying that collecting money in a room was some how a violation was factually incorrect.

 

Getting back to the original purpose of the post... The fact is, no one has the right to treat the OP in the ways described in this post.  OP- I am sorry you are experiencing this. 

Edited by egg122 NP

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