How do you deal with Non-Urgent Patients

[mom2michael, MSN, RN, NP]

I'm really getting burned out very quickly with the life sucking force of non-urgent patients in the ER. I've been in ER for 3 years now (2 nursing NS as a tech, 1 as an RN). I'm not new to the obvious abuse of the system but lately I would rather hear nails down a chalkboard that listen to these people in triage with their c/o they've had for 6-7 months.

It seemed to plauge us Wed night something awful. Our entire ER filled up in 15 mins. with things that obviously could've been addressed at a PCP or Urgent Care. Which, BTW, those are abudent in our area. And, you don't have to wait to get into a PCP, most have same day appts. We even have a great Urgent Care that sees patients until midnight down the road from the ER.

How do others deal with this?

Let me give you examples of Wed night. URI s/s for 30+ days. It hurts when I insert a tampon. Back pain for 6 months. I hit a wall 3 weeks ago and I just now think it needs to be checked depite the fact I have full ROM and no swelling and/or pain right now. My child has a "fever" of 98.6. My child was exposed to chicken pox 3 days ago. A man with totally vague s/s during triage and later we find out, he just wants a physical and a work note. A woman with chronic dental pain, on ATB already, the tooth has been pulled AND she already had pain meds at home.

Our Urgent Care and PCP can all order labs/X-rays from their office and people can come to hospital for OUTPATIENT stuff. Our Urgent Care is open until midnight 7 days a week. Our lab and/or X-ray will see patients until midnight as well. We even have 2 PCP's that see patients until 7p.m. at night. Obviously they have bent over backwards to address the needs of working people here.

Usually I don't even mind people who come in with minor c/o and not really emergencies,. But for the last couple of months I find myself having this urge to just scream whenever I hear WEEKS or MONTHS in their sentences during triage. I can't even begin to describe the feeling I get when I hear "nothing" when I ask what they've done for the said complaint that has plauged them for WEEKS or MONTHS.

Then we have a staff meeting about the stupid PG and how we are slacking and how we need to improve customer satisfaction. I could come up with the ways, but I don't think the hospital would find my ways very funny.

I'm at my wits end I really am.

I need some great words of wisdom or some humor or something to continue this madness.

[getoverit, BSN, RN, EMT-P]

hey there. I know what you mean, it's a universal problem. I"ve always wondered if it's a lack of education to the general public, a symptom of what seems to be wrong with our culture (demanding to have their needs be met NOW, over everyone else's) or something totally different.

I'm sure all of us involved in emergency medicine have taken care of so many people with the exact same complaints (not to trivialize yours in any way!). When I would triage people, one of my standard questions would be "When was or is your most recent doctor's appt?" at least 50% of the time it was within 24 hrs. They want a second opinion on the sapphenous grafting scars that are 18 months old and have healed without any problems, want some Demerol even though they have 4-5 months worth of Percocets piled up in their bag, show us their herpes, want a shave because they have lice, etc....the list is endless.

There are people out there who really need our help and those are the times we live for. Think about all the different people who you've truly made a difference in their lives, whether is was something clinical or spiritual (or both or neither). Sometimes I"ve thought, "the only reason that I was at work today was to listen to Mr. or Mrs. _____ tell me this." It may have been some small, inconsequential but of information; but they needed to know that someone heard them. You may have been the only one who listened for a long time.

I don't know if these are the words of wisdom or encouragement you were hoping for, but I sure feel your frustration and have been in the exact same frame of mind. Where I"ve thought "I just don't want to hear anyone tell me what's wrong with them anymore" and usually not too long after I feel that way, something happens which returns me to the thoughts I usually have of feeling privileged to be here and serve as their nurse.

If you're at work today, I hope you have a better shift! I'll send out some positive thoughts for you.

[oncnursemsn]

Boy this is frustrating, wish I had some words of wisdom or even something inspirational. Sigh. I don't. I used to do phone advice, and got calls from parents that their kids needed to be seen NOW. For a runny nose. A rash. A sprained ankle. A cough. Their insurance plans required them to get pre-authorization- so hence the call to me. It's supposed to help the appropriate patients go to the hospital and the remainder to their PCP. Sounds great. Didn't work. I could be sued if I refused authorization and something happened. So I advised the moms to bring their kid, a blanket, bottle or other beverage and a book. They're going to have to wait. A long time, especially in winter flu season. We have a fairly decent healthcare system in this country, compared to developing nations. Hang in there, be patient with yourself when you're feeling taxed.

[bigsyis]

Tuesday night, 1/22, was Full Moon. Wednesday was probably just overlap from that.

[locolorenzo22, BSN, RN]

true....however, it may be likely that due to the lack of knowledge about the urgent care/PCP availability....people have medical issues...and they think "hey, let's go to the ER cause I know exactly where that is...." Most people don't really know what urgent care is....

If the hospital is that concerned with pg scores....maybe a suggestion for improved marketing for urgent care is needed...something about, "do you have an emergency that is non-life threatening....etc..then come to our urgent care clinic....faster and easier than the ER...etc." I dunno, i don't do marketing....

[scattycarrot, BSN, RN]

At triage, when someone is complaining of their 6 month history of back pain (which..."no, it isn't any worse tonight, no I haven't had any history of trauma, no I haven't taken any analgesia, no I don't have any other sypmtons, no I haven't seen my PCP and yes, I am just here to annoy you and make your shift living hell and also, yes I will be the loudest complainer in the waiting room"), I usually ask them as nicely as I can if they are aware that this is an EMERGENCY room and does this constitute an emergency. I will tell them that of course we will see them but in the future perhaps, they should think about whether their problem is in fact a genuine emergency and that the best place for them is their PCP or UC. Now, granted, it doesn't make any difference

but it makes me feel a whole lot better! Inside my head, I am not being so polite about it!

I have no answers, no words of wisdom but you are not alone in your feelings of frustration. Just don't let them bring you down!

[BSN74]

One reason people may come when it is not an emergency is because it can take so many weeks to get an appointment with your doctor. I have had ulcerative colitis of the whole colon for 30 years. Right now I am bleeding and in pain. My GI is booked until March and even though I told them about my symptoms they will not see me. They said to go to the ER. I hate to do that because it is not really an emergency, but what will happen to me if I bleed like this until March?

[grammyr]

One reason people may come when it is not an emergency is because it can take so many weeks to get an appointment with your doctor. I have had ulcerative colitis of the whole colon for 30 years. Right now I am bleeding and in pain. My GI is booked until March and even though I told them about my symptoms they will not see me. They said to go to the ER. I hate to do that because it is not really an emergency, but what will happen to me if I bleed like this until March?

I would have you in a bed ASAP if you come to my place. I think what the OP is talking about are like the ones I triage and in my ever so kind motherly voice say : "Please have a seat in the waiting room and someone will be with you as soon as possible" and their chart goes to the back of the stack.

[scattycarrot, BSN, RN]

One reason people may come when it is not an emergency is because it can take so many weeks to get an appointment with your doctor. I have had ulcerative colitis of the whole colon for 30 years. Right now I am bleeding and in pain. My GI is booked until March and even though I told them about my symptoms they will not see me. They said to go to the ER. I hate to do that because it is not really an emergency, but what will happen to me if I bleed like this until March?

This is a genuine complaint and deserves our sympathy and concern. I think most of us here are talking about patients who do not have problems that need to be seen in a hospital and are minor, such as that pesky in-growing toe-nail, menstrual cramping, rhinitus for a few days, etc... the list goes on. I doubt any of us are suggesting that people with known medical conditions or severe, recurring or worrying symptons should not attend the ER. In fact, your situation is exactly why its so frustarting that the ER is blocked with non-emergant cases. If people thought twice about coming to the ER with their stubbed toes then there would be more room for people with need. Like yourself.

[Dental Hygienist]

Just to play devil's advocate and give a patient's perspective: sometimes the patients really don't know what to do or where to go...they may have a feeling that the ER is not the most appropriate place, but figure "I'm not a nurse, I don't know".

I'll give my example: I had a snowboarding accident, no broken bones, no major complications, they kept me in the hospital for 2 days to monitor a slight pneumothorax (no chest tube required) and because I had complained of numbness in my right hand for approximately 15 mins after the accident. When I was released I was given written and verbal instructions to call a certain number if I had any difficulty breathing, chest pain or sudden change in symptoms; I even stated "Well I have generalized pain right now, including chest pain" and the discharge nurse/person told me "well, just call if the chest pain gets worse"...OK so fast forward to about midnight that day and I'm in a lot of pain, especially my neck/chest area and my pain meds aren't cutting it...I know that it's probably just inadequate pain control and I'm fine, but I can't sleep and I'm a bit worried, so I call the number...they act like I'm some kind of moron and say: "well, we can't diagnose you over the phone, you need to just come into the ER" Well, I knew that I didn't have an EMERGENCY and the ER would be overkill...so I call the RNadvice line provided by my ins. company and she said "you need to go to the ER" well...again I KNEW that was overkill, I'm not having a heart attack, I'm not having difficulty breathing...I'm just in SEVERE muskuloskeletal pain and they told me to call....

SO....I don't go to the ER and I call my PCP in the morning....they actually have available appointments, but refuse to see me because according to the receptionist I need to go to the ER. So, I go to the urgent care and tell the doctor my story....he seems to think I'm some kind of idiot for not taking the advice of 3 different providers and just going to the ER like I was told....but they do a chest X-ray and exam and I am fine...they just changed my pain meds...

So...I guess moral of the story is I REALLY REALLY didn't want to go to the ER, but everyone else seemed to want me to...and I almost did...I seriously considered it 3 times because everyone was telling me to. Had I shown up in the ER I'm sure my signs and symptoms would have seemed ridiculous to any triage nurse and I would have been moved to "the back of the pile"...which is why I ultimately did not go.

[ERRNTraveler, RN]

It's gotten so bad in San Diego, where I'm currently on assignment, that they were actually telling people on the news: "The emergency rooms are over capacity. Don't go to the emergency room unless you actually have a life or limb threatening EMERGENCY!" I wanted to drive down to the news station and kiss the news anchor for saying that!

[loricatus]

I feel the most taxing thing is that the non-urgent patient has absolutely no patience and usually wants you to be their personal servant at the expense of your other patients who may be critical.

Just the other night (the full moon night) I had the lady with the back pimple (it wasn't an abcess or a cyst) that she wanted popped so she could wear a certain outfit the next day and not have the pimple exposed. I put a warm compress on her back, after my typical question of WHAT EXACTLY made you decide to come to the ER at this hour that made you think this is an emergency situation? I just told her that on the scale of acuity, she ranks at the 'please go home level' and will have to wait for the pimple to pop on it's own with the warm compress. I then went to the doc and threatened him not to go near her for at least 2 hours. Of course, she came out when the compress got cold and wanted a meal (3AM) with my personal service to replace the compress and make her comfy. I directed her on how she could take care of herself while she waited for the pimple to pop. When I finally gave her discharge instructions, I reminded her that we are having a rash of the flu and strep and that she shouldn't be surprised when she comes down with something real. Told her "What do expect when you sit in a waiting room with sick people and walk around the ER past all the rooms where the contagious people are?":flmngmd: "And, by the way, if you use the ER when you come down with the flu, cold, whatever, you are going to set yourself up to catch something much worse because your immunity will be even lower than it is now.

This is how I get my frustration out.

And no, the little whitehead never popped.