Go find your patient

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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

Specializes in LTC, Med-SURG,STICU.

Here is my question: Where are the parents!? Just because a parent takes the kid to the hospital does not relieve them of all responsiblity to keep the child in the proper areas so that the child can recieve the treatment they need.

Am I the only one wondering about the "responsible" adult that brought the child in to the hospital. I am a parent myself and I can tell you that if you child was suicidal enough that I felt they needed help their little butts would be sitting in the waiting room when their names were called. Why does suddenly become the healthcare provider's responsiblity to keep these people's children from misbehaving?

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
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.

are you an er nurse? i'm thinking that maybe you aren't (or have never done triage) or this post wouldn't be so unnecessarily harsh. the patient was 9. someone had to bring him to the er, and that's the person who should have been responsible for keeping him available for when he was called. or maybe you think the triage nurse can be wasting her time running around looking for this one kid with a roomful of other patients, some of whom may be actually dying?

i'm onboard with the notifying the charge nurse and security suggestion. and perhaps the police department and the administrator on duty. (because you know if the press got wind of it, it would be a pr nightmare!)

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Specializes in Float.
Here is my question: Where are the parents!? Just because a parent takes the kid to the hospital does not relieve them of all responsiblity to keep the child in the proper areas so that the child can recieve the treatment they need.

Am I the only one wondering about the "responsible" adult that brought the child in to the hospital. I am a parent myself and I can tell you that if you child was suicidal enough that I felt they needed help their little butts would be sitting in the waiting room when their names were called. Why does suddenly become the healthcare provider's responsiblity to keep these people's children from misbehaving?

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

I don't think that a suicidal gesture is as simple as misbehaving. IMO, it's the healthcare provider's responsibility because that's what they do, provide healthcare....and because it's a child.

How about this: a parent realizes momentarily through his/her own psychotic or drugged up haze that their child needs help. They get it together enough so that they bring the child to the ED but are unable to hold on enough to ensure treatment. For whatever reason they leave. Does the child then not get treatment because the 'responsible' adult left? And if the child being a child leaves...........:confused::confused:

What about the parent that drops off a newborn that they don't want? Isn't there some type of law that allows abandonment with no questions asked as long as the child/baby is taken to a safe place? Isn't a hospital considered a safe place? What if the child was abandoned? Isn't abandonment some sort of abuse, and don't you call in the authorities if a child is suspected of being abused?

I don't mean to say that you should chase after patients who don't answer or that you should have necessarily spent an inordinate amount of time looking for this child. What I am saying is that with a c/c such as he had, yes, it would have been appropiate to spend a little more time not only looking but also informing someone else, anyone else of the situation.

All I can see is "suicidal gesture". :(

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Specializes in OB, ER.

I am just wondering how the patient got out of sight in the first place. If we have anyone check in that claims suicidal they are immediately placed in a psych room with a security watch. They are not allowed to wander outside. If a patient states they are suicidal they are obviously not able to be responsible for themselves or their actions and the hospital could be held liable if something happened to that person.

Of course the parents should hold some responsibility but we all no that if a 9 year old is suicidal 9 times out of 10 it is the result of bad parenting, neglect, ect......

If the patient did happen to escape the watchful eye of staff they need to be found either by security or the police ect. How would you feel if that child was for real and went out to play in traffic!

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Specializes in ER, Trauma, ICU/CCU/NICU, EMS, Transport.
I'd think if they were able to be outside running around they wouldn't really need to be in the ED.

what if this pt was bipolar/manic?

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Specializes in ER, Trauma, ICU/CCU/NICU, EMS, Transport.
Some of these docs are nuts, aren't they?

Let him go find him.

Why??

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Specializes in ER, Trauma, ICU/CCU/NICU, EMS, Transport.
I don't think that a suicidal gesture is as simple as misbehaving. IMO, it's the healthcare provider's responsibility because that's what they do, provide healthcare....and because it's a child.

How about this: a parent realizes momentarily through his/her own psychotic or drugged up haze that their child needs help. They get it together enough so that they bring the child to the ED but are unable to hold on enough to ensure treatment. For whatever reason they leave. Does the child then not get treatment because the 'responsible' adult left? And if the child being a child leaves...........:confused::confused:

What about the parent that drops off a newborn that they don't want? Isn't there some type of law that allows abandonment with no questions asked as long as the child/baby is taken to a safe place? Isn't a hospital considered a safe place? What if the child was abandoned? Isn't abandonment some sort of abuse, and don't you call in the authorities if a child is suspected of being abused?

I don't mean to say that you should chase after patients who don't answer or that you should have necessarily spent an inordinate amount of time looking for this child. What I am saying is that with a c/c such as he had, yes, it would have been appropiate to spend a little more time not only looking but also informing someone else, anyone else of the situation.

All I can see is "suicidal gesture". :(

A registered nurse would be hard pressed to defend themselves if:

1) a patient (or child) presented to the ED asking for "help"

2) the registered nurse failed to assess or monitor the patient/situation

3) the registered nurse failed to take "prudent" action to place this patient in a "safe" environment

As a result of the above 3 conditions, you would have clear cut NEGLIGENCE.

****The words "prudent" and "safe" can be interpreted/implemented many ways. One example maybe to notify security or the charge nurse, another example may be to quickly stick your head outside and peek. The "safe" environment could be any controlled setting [triage room, treatment room etc]****

There's many different ways to look at this, however, I guarantee you, a failure to at least attempt to do something, especially for a minor/pediatric patient (REGARDLESS of where/what the parent's are/are not doing) is a HUGE professional, personal and institutional liability. If anything happened to that kid, I'd love to be the lawyer bringing the lawsuit....'cha ching!

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Specializes in Peds/outpatient FP,derm,allergy/private duty.
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.

While this post is probably isn't a violation of TOS for personal attack, it's implication comes very close to it. You don't know what you're talking about. I'm sorry if you've had negative experiences in your life that cause you to project motives and emotions onto someone you kinow nothing about, complete with violent scenarios and cynical assumptions about her character.

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Personally I think you should talk to your manager about what you are to do next time this occurs. In this situation you have an obligation to try to locate the patient, especially given the complaint and the 'what ifs' mention already mentioned - your obligation is simply that you need to inform the appropriate person right away so an effort can be made to find this patient, without you having to abandon your triage duties. It doesn't matter if he's goofing off in the parking lot - you don't know anything about the actual seriousness of the complaint (or lack thereof, I should say) until you lay eyes on him. And really, it doesn't matter if his parents are complete morons or not when it comes to your license and you acting in a professionally prudent manner.

I do understand your frustration and frankly no I do not personally check out the bathrooms and the vending machines and the parking lot and the smoking area across the street in attempt to locate people with less-than-urgent complaints. I inform the charge nurse, leave the patient's name up on my screen and call them several times (triage another patient, then call the missing person's name again, etc). The specific scenario you mentioned is another thing entirely, though. If anyone does elope at any time after being registered, I believe our policy is that we are supposed to fill out an incident report - I say that only to say that you should know your facility's related policies.

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Specializes in Emergency Room.

EEEKS! no one addressed EMTALA that I can see. Your ER is responsible for everyone in the ER and for everyone WITHIN 250 FEET OF THE ER. Call security.

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Specializes in Float.
EEEKS! no one addressed EMTALA that I can see. Your ER is responsible for everyone in the ER and for everyone WITHIN 250 FEET OF THE ER. Call security.

:yeahthat: EMTALA!

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Specializes in Emergency/ Critical Care.
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

Where were the guardian's/ people who brought the child in?? They would be the one's responsible for the child IMO. It the pt is an adult and is not in the WR when we call, we simply move on to the next pt. We call the pt 2 more times, if no response they are discharged as LWBS... you can't chain people to their chairs

as a side note, when a person is triaged and the c/o is self harm/suicidal or similar c/o we get them into a room or crisis room immediately

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