Go find your patient

[irmaRN]

Greetings.... tell me what you think of this....the other day we had a few patients presenting to triage. I went to call the patient (who was 9), and no answer. the registration clerks said "He's outside running around". (the complaint was suicidal gesture). From where I was standing I saw no one outside, so I called the next patient. The ER doc working that day asked me "Where is this kid?" I told him that the clerks said he was outside but I saw no one. Well this ER doc tells me that it is our responsiblity to go find this kid. He says, "Once they're on our property, they are our responsibility". So, to all you seasoned ED nurses, who know that some days in triage can be a nightmare, you have to go round up your patients if they are not in your waiting room when they are called? That seems ridiculous!! what if they are on the other side of the hospital grounds which can be pretty far away? Thanks

[Boog'sCRRN246, RN]

I'd think if they were able to be outside running around they wouldn't really need to be in the ED.

[arelle68]

I'd think if they were able to be outside running around they wouldn't really need to be in the ED.

I think the complaint was that the child was suspected of being suicidal.

[ImMrBill3, RN]

My suggestion is call security and notify your supervisor. I don't think a triage nurse can walk away from a room full of patients to find one who has left.

[Boog'sCRRN246, RN]

"you have to go round up your patients if they are not in your waiting room when they are called? That seems ridiculous!! what if they are on the other side of the hospital grounds which can be pretty far away?"

I was referring to this part of the post. IMO if you've got a legitimate reason to be visiting the ED, you're gonna wait in the waiting room to be called, not go outside and smoke, walk around, run around, look for food or any of that nonsense.

[tvccrn, ASN, RN]

If the patient was suicidal, who brought them in? Shouldn't that person or persons be the ones responsible for making sure the patient is there when called for treatment?

[Mulan]

Some of these docs are nuts, aren't they?

Let him go find him.

[F.E.R.N., BSN, RN]

Not sure how your triage system works, or at what point in the process they went missing (did you just know there was a patient with suicidal ideation being checked in, or had they actually been triaged already and were awaiting a room?). I believe that at our ER, we would have called x2 over the loudspeaker, then sent staff to look in the 2 waiting areas and just outside the doors (patients frequently wander between these areas, especially emotional ones). If patient wasn't found, the charge nurse and possibly security would have been notified to handle it from there, all of this allowing the triage nurse to continue with other patients/manning the desk while the search was going on.

If all we had was that a patient was suididal, but they hadn't completed registration or triage, we wouldn't go further than security, in case they remained on the hospital grounds. If they had actually registered or completed triage, or in some other way we had enough information, I think we would notifiy the local PD for a welfare check--Joe Smith is a child of Jill Smith living at ....phone numer...threatened to kill self...anything else pertinent to their wellbeing, like, if we have reason to believe they may have ingested something.

This is basically what we do for any suicidal/homicidal patients that manage to escape the ER once admitted to a room. While we try to keep a close eye on them, it does happen. We have also been known to follow AMA's into the parking lot if we believe they have a good chance of dropping dead if they don't stay...some of them turn around.

I don't know what the legal limit of responsibility is for the ER/staff, and it probably varies by location. I know that if this happened to me, and there was a parent involved, I would be obligated to call APD and possibly child protective, because it would be possible that the parent either removed the child from medical help or did not/cold not make sufficient effort to keep the child at the ER, and that could be considered endangerment or neglect in this state. Besides, does anybody want to have the death/injury of a child on their conscience because we didn't do all we could? I'm not suggesting the triage desk be abandoned for a 3 hour search for the kid, but I would definitely involve additional resources.

[Mulan]

I would call security or the cops to go look for him.

[thinkertdm]

So...you saw "suicidal gesture" on the chart, couldn't see the patient from where you were standing, shrugged your shoulders and went on to the next patient? Nice.

Well, maybe the nice part is where you think it's ridiculous that you should look for him.

You also say "what if they are on the other side of the hospital grounds which can be pretty far away?".

How about this: what if they were in an empty room cutting their wrists? What if they were in the bathroom tying their belt around their neck?

At least tell someone, for crying out loud! I know it's a lot of trouble for you to go through.

[Whispera, MSN, RN]

irmaRN, all the above suggestions fit the situation. I wish you had done something other than just go on to the next patient. A suicidal gesture in a 9 year old is a huge thing. Who brought the child in? Did they just drop him off and leave?

Chances are if the parents brought the child in, they just decided to take him home, but really, someone at the hospital should have followed up on it. Finding a dead person in the ER bathroom is not fun for staff, and a suicidal gesture is a scream for help. It should be attended to. I think the hospital could have some liability if the child had completed another attempt while on-grounds.

I don't think the doc meant for you personally to go find the child. I think he meant something should be done to find him, by someone...

[wifey08]

If the patient was suicidal, who brought them in? Shouldn't that person or persons be the ones responsible for making sure the patient is there when called for treatment?

Exactly! It's not where's the patient - it's where's the flipping parent!