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 Emergency/ Critical Care.

Perhaps thinkertdm and PhoenixTech can sit in ER waiting rooms across the country and force pts to stay until they are seen...

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Specializes in ER.

I would notify security and the charge nurse, we would all be on the lookout for patient/parents, and if they were found security would stay with them to make sure the patient stayed and got treated.

If they were not found, or found and not willing to stay, I would make a call to child protection and notify them that the child living at xxx address was brought in with c/o suicidal behavior and the parents did not see fit to stay and get the needed medical treatment.

Also an option is to send the police out for a welfare check, and urge them to come back. Police can take the child in for medical treatment without parental consent if they feel there is imminent danger. I'd run that one by a suoervisor first though.

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Specializes in ER, education, mgmt.

Ok, even though thinkertdm may have been "harsh" in his wording, unfortunately for the OP he is correct. MB brings up the wonderful point of safe and prudent as well. Had there been a poor outcome, the OP would not have a leg to stand on. Neither would the facility.

Now, for some complaints there is no way I am hunting down that patient (we see over 75,000 pts a year). However, for a 9 year old with a "suicidal gesture" you can bet your sweet EMTALA that I (or another person) is hunting him down until his security can be verified. And speaking of the Almighty EMTALA there most certainly would have been a fine levied for this. And as far as the ER responsibility- the jursidiction is 250 yards- not feet. Believe me, I have trudged alot farther than 250 feet to respond to emergency calls. just my 2 cents.

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I'm not sure how our peds dept does it, as we have separate triage areas, but if an adult presents with SI they stay in sub-triage which only exits with a badge. Also, personal belongings are removed, and they are placed in a hospital gown. It's not 100% (we've had a few bolt through the door when it opens, then we call security), but it's pretty effective. ~ Diane

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Specializes in acute rehab, med surg, LTC, peds, home c.
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?

Chances are if their is a 9 year old in the ER for suicidal ideation there is some sort of dysfunctional family dynamics going on.

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Specializes in Float.
Perhaps thinkertdm and PhoenixTech can sit in ER waiting rooms across the country and force pts to stay until they are seen...

Ok, I don't know if you read my first post or if you're responding to the EMTALA post but since my point seems to be the concensus across this thread, I'm not getting your sarcasm. :confused:

However, if I ever float to my ED again and run across a 9 yo pt. w/ suicidal gestures not responding to my call, you can bet your satirical a** that I'd do more than stand behind my triage desk scanning the entrance to catch a glimpse of him/her. :trout:

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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

1. That seems ridiculous!! Keeping track of potentially suidal patients is not ridiculous!!. Or ridiculous! Or even ridiculous. It's actually a pretty good idea.

2. you have to go round up your patients if they are not in your waiting room when they are called? No. Not if they are there for, let's say, dental pain. On the other hand, if losing track of somebody might mean the death of a 9 year old, you might want to put a little more effort into it. Part of being a triage nurse involves distinguishing levels of priority.

3. From where I was standing I saw no one outside, so I called the next patient. Wow. Let's say there had been an adverse outcome. Would you feel comfortable defening this action in front of your BON, or a jury?

I am curious- after giving this some thought, and getting some feedback, what are your thoughts?

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Specializes in Emergency Dept, ICU.

It might be security's job to find the patient, but most obviously not yours.

The EDs are busy enough as it is, we don't need to go finding more patients in addition to the ones already there

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Specializes in ER, education, mgmt.
It might be security's job to find the patient, but most obviously not yours.

The EDs are busy enough as it is, we don't need to go finding more patients in addition to the ones already there

OK, it most certainly is the nurses's job to locate the patient. While he/she may not physically be the one to look, we are the ones responsible for their safety. And if I remember the original post correctly, this is not "finding more patients". this is treating the one that is already there. This is not a gray area, folks. I, too am interested in the perspective of the OP after the feedback.

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Specializes in Float.
It might be security's job to find the patient, but most obviously not yours.

The EDs are busy enough as it is, we don't need to go finding more patients in addition to the ones already there

Just one more point. The OP said a 'few pts presented' to triage that day and from the tone of the post, I'm not determining an influx of pts. While I understand the assiduousness of the ED, that doesn't appear to be the case in this scenerio.

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Specializes in Emergency Dept, ICU.

cookienay phoenixtech,

you are both missing a very important situation here, the 9y/o patient had not only not recieved a mse (medical screening exam) but also had not even seen the triage nurse yet.

this is a "left without being seen" patient. the nurses responsibility here should be to call for the patient in the waiting room 3 times 5 minutes apart. if no answer *maybe* notifiy security to check the campus. otherwise move on to the next patient on the list waiting to be triaged.

i have always working in large busy ers and there are frequently patients who sign in and change their mind about wanting to be seen or opt to go to another hospital prior to receiving a triage, these are lwbs patients and if i searched the entire campus everytime this happened i would never get to see another patient.

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cookienay phoenixtech,

you are both missing a very important situation here, the 9y/o patient had not only not recieved a mse (medical screening exam) but also had not even seen the triage nurse yet.

nope. i got that. as mboswell pointed out, the question here revolves around whether the nurse had a "duty to act".

a- the patient was on the hospital grounds, seeking help.

b- the nurse was aware that the patient was suicidal.

you sound as though you would be comfortable in front of a jury, or the bon, explaining why you had no duty to act. i wouldn't.

regardless of how that information got to the nurse, whether through the registration process, or an actual triage, i believe that the nurse had an obligation. i'm no expert, but i have done a bunch of reading about negligence. liablility has been proven with a lot less than this.

this is a "left without being seen" patient. the nurses responsibility here should be to call for the patient in the waiting room 3 times 5 minutes apart. if no answer *maybe* notifiy security to check the campus. otherwise move on to the next patient on the list waiting to be triaged.

alternately, you could notify security immediately, call the police and notify them, let the charge nurse know what's going on, and make a quick note documenting the above. while this might take a couple of minutes more than the course of action you recomend, it is probably worth the time. remember- years down the road, you may have to defend your actions.

i have always working in large busy ers and there are frequently patients who sign in and change their mind about wanting to be seen or opt to go to another hospital prior to receiving a triage, these are lwbs patients and if i searched the entire campus everytime this happened i would never get to see another patient.

i have been following this thread, and must have missed the part where somebody suggested that any time a patient leaves without being seen, the triage nurse should drop everything and search the entire campus. you are right that this would be a bad idea.

i personally think many people should leave without being seen. or even better, either stay home, or go to their doctors office, or a walk in clinic. most people who leave without being seen don't need emergency care. many of them don't need medical care at all, and would benefit more from lifestyle changes and better choices. it rarely bothers me when somebody leaves without being seen. in fact, it generally amuses me when somebody threatens to leave to go to another hospital.

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as i wrote earlier, i don't think all patients should be treated the same. while the registration process only gives limited information, it does give you something to work with. let's say you have 5 patients waiting to be triaged: 3 dental pains, a chronic back pain, and a girl wanting a pregnancy test. a 6 year old with sudden onset acute abdominal pains is carried in. would you treat all these patients the same? would you triage these patients in order of arrival?

i suggest that the fact that thurse was aware that the patient was suicidal (and yes, i do realize it is unlikely that the patient was actually suicidal, and in immediate danger), created an obligation which the nurse failed to fulfill.

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