How do you deal with Non-Urgent Patients

[mom2michael]

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.

[ERRNTraveler, RN]

:fnypst: Yes, the "Therapeutic Wait" really isn't used often enough!

[scattycarrot, BSN, RN]

I always find it amazing how the ER waiting room is emptier when something is going on, eg...a big ball game or on one particular and memorable occasion, the ER I worked in had a lovely quiet shift as the area was hit by a freak snow storm. The area was not used to snow and basically shut down for a few hours over about 1-2 inches of snow (which is hilarious as I look out of the window right now at a white Wisconsin!). So, those with real need came into hospital and those non-emergant cases must have looked out the window and figured it wasn't worth it. So, it does show you how many people come in on a regular shift who don't reallhy need to.

[morte, LPN, LVN]

I always find it amazing how the ER waiting room is emptier when something is going on, eg...a big ball game or on one particular and memorable occasion, the ER I worked in had a lovely quiet shift as the area was hit by a freak snow storm. The area was not used to snow and basically shut down for a few hours over about 1-2 inches of snow (which is hilarious as I look out of the window right now at a white Wisconsin!). So, those with real need came into hospital and those non-emergant cases must have looked out the window and figured it wasn't worth it. So, it does show you how many people come in on a regular shift who don't reallhy need to.

yup, we used to call 'em, "bad TV nocs"......

[mom2michael, MSN, RN, NP]

I work with a doctor that calls rain Troll spray. It keeps the Trolls inside while all those that really need the ER come out. He cracks me up but he's right. Whenever it is raining hard, we don't see that many non urgent patients.

[Altra, BSN, RN]

I once had a patient who came to the ER "for the pill to make my period come immediately because I'm going on vacation next week."

I did the same as Loricactus ... just walked out of her room without a word and told the doc to either discharge her immediately or let her sit there for a long time.

[rph3664]

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.

Hey, watch it! I went to the ER with a stubbed toe a while back because it was EXTREMELY painful (especially after I put a shoe on and felt something bend that wasn't supposed to) and it was broken. Took a long time to heal, too.

Here's another perspective on unnecessary ER visits. I have a relative whose ex-husband had to pay the kids' medical bills after they divorced, and she would take the kids to the ER instead of a regular doctor, just to soak him. :trout:

[LilgirlRN, ADN, RN]

What we've started doing at our ER is.... we screen them out. If they do not meet emergent requirements, they are asked to pay their copay if they have insurance, 110 bucks if they don't. Word has gotten out and we don't see nearly as many non-emergent patients as we used to.

[bigsyis]

I always find it amazing how the ER waiting room is emptier when something is going on, eg...a big ball game or on one particular and memorable occasion, the ER I worked in had a lovely quiet shift as the area was hit by a freak snow storm. The area was not used to snow and basically shut down for a few hours over about 1-2 inches of snow (which is hilarious as I look out of the window right now at a white Wisconsin!). So, those with real need came into hospital and those non-emergant cases must have looked out the window and figured it wasn't worth it. So, it does show you how many people come in on a regular shift who don't reallhy need to.

We had a blizzard in our area of GA in '93 (very unusual for our state). I had been called in to work the night before (Fri) for my 11a-11p weekend shift and threatened w/firing if I didn't show up. Our ER was pretty empty until about 10 a.m. Then we got a pt who'd driven across seriously icy and snowy roads to get to us because she wanted something done with her ingrown toenail! I kid you not. The Doc let her wait for a while. None of us could believe it.

[kaycee]

Two reasons in my opinion that we get so many nonurgent pt's in our ED. First MD offices are so booked that the instant response of many office personnel is, we can't see you, GO TO THE ER. The other big reason is money. People with no insurance or public assistance don't have to pay up front. People with insurance have co-pays but we don't force them to pay that day. Most MD offices and Urgent Cares want money the day of service or no servive is rendered.

Many of our uninsured pt's give false names, address's and SS #'s. They never have ID, and they know we can't turn them away. It's free care to them and they take full advantage of it.

[LeahJet, ASN, RN]

We are starting something in our ED next week that everyone is really excited about.

If the patient is triaged a 4 or 5, they go to a small exam room with a nurse practitioner for their medical screening. If the NP agrees this pt. is non-urgent, they will be promptly sent to the Financial Person.

We will be glad to see non-urgent patients but they have to PAY first!!

This is supposed to decrease our volumes by 20-30%. I don't really think it will be that much..... more like 10-15%.... but it really does help knowing that they can't just waltz in and out without a care in the world!

I hope word of mouth gets out that the free ride is OVER!

[Altra, BSN, RN]

LeahJet, I applaud this idea and I hope it works for you all.

But it will depend, at least partly, on your patient population.

In my state, Medicaid guarantees payment for an ER visit and pays for prescriptions for Tylenol, Ibuprofen, etc. So ... a policy like what you describe would not have much impact in an ER that sees a large number of Medicaid patients.

And what about those with insurance? Those who are willing, at least in theory, to pay their $50 or $100 co-pay to get what they want when they want it? For example, I must have triaged 50 people yesterday with the chief complaint of n/v and sometimes d ... x no more than 2 days. Otherwise healthy adults - I'm not including young children, the elderly, or those with significant co-morbidities. They do not need to be in the ER, but are willing to cough up $50 - $100 to feel temporarily, slightly, better NOW with some IVF, Zofran & Toradol instead of the common-sense solution of staying home with rest, fluids and a bland diet for a few days.

[LeahJet, ASN, RN]

Oh yes, we are a Medicaid heavy area.

But you see, they have only so many "punches" on their card.

And to be honest, just making them pay 3 dollars is good for our morale!