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.

[traumaRUs, MSN, APRN]

I think we would all agree that working with psych patients in the ER is difficult at best. The ER is not set up to deal with this and the often chaotic environment can bring out the worst in people without psych problems let alone those that are truly mentally ill.

ERRNTraveler - why don't you propose a study about the relationship between a full moon and pych patients, traumas, and high volume. Here is a study done in Canada relating the tourist influx to ER visits:

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1878964

[ERRNTraveler, RN]

ERRNTraveler - why don't you propose a study about the relationship between a full moon and pych patients, traumas, and high volume.

Looks like mwboswell has already beat me to it.... :)

[loricatus]

....no, If you know what a meta-analysis is, then you know that (1) a substantial body of research (with adequate data) has already been done, and (2) it is looking at multiple different data collection methodologies.

So the final interpretations are a summary of what previous research has already been done - it is not one isolated research project.

My goal was to try to show that there was a relationship - but the data from the whole meta-analysis set did not support this.

My point exactly----I was referring to the all the research data collected that the meta-analysis was based upon. As another posted said, what you were trying to prove is difficult to quantify and would need to have a new design for data collection to be able to make the case for causal effects.

[canoehead, BSN, RN]

I know that when we order french fries everyone and their dog comes to be triaged. Most other foods you can zap in the microwave, but fries have to be eaten fresh for the full greasy delicious effect. French fries are my nemesis, it doesn't matter if the place is stone cold empty, the triage buzzer rings as soon as we settle in. Research be damned, I know what I see.

[edmia, BSN, RN]

I understand exactly how you feel. This week was actually the worst in terms of non-urgent cases coupled with the fact that it was also the worst in terms of real traumas coming in.

I try to educate and then I also laugh. I laugh with my colleagues and release the stress, I laugh when I get home and share the stories with my husband and I release the stress. You just have to help yourself by letting it go.

And, on the laughing theme, here's one from this week: 20 something female patient arrives via EMS. CC on triage "chest pain". EKG done right away - totally normal. Textbook Normal Sinus Rhythm. I get report and go see her.

RN: "Hi, I'm Ms. ABC, I'll be your nurse tonight. What brings you here tonight?"

PT: "I had a nose bleed"

RN: (Nose is not actively bleeding) Oh, how long ago did that happen? How long did it last?

PT: it happened about 3 hrs ago and it stopped in 15 mins.

RN: And you had chest pain as well.

PT: oh, not really. I was tired in the ambulance 'cause I had to walk down 3 flights to get in it. (pt. is overweight)

Moral of this story: $500 cab to get sent home 4 hrs late with a clinic appt. to follow up her nosebleed in 4 wks.

Abuse of our system, yes. Is it malicious, No. Educate, educate, educate is all we can do and hope that she'll realize that a nosebleed that stops on its own is not an emergency.

[KatERRN]

I don't know if anyone lives in california, but in california there is this insurance (state/fed money) called mediCAL and it lets people go the ER for free and get all meds for free (basically free medical care all together), I definetly feel your pain, my personal favorite is the subjective fever or pain x 5 years. but i constantly tell all of my patients to go to their primarys and i give them all a list of clinics in the local area.

on a better note, a coworker told me that apparently the gov is coming out with tv commercials about usage of Ers in orderr to educate the public and to hopefully decrease Er visits. but i consistently tell patients that if they come to the er with non acute problems they will wait in the waiting room for a long time..

i think it all leads back to lack of education

[ERRNTraveler, RN]

I don't know if anyone lives in california, but in california there is this insurance (state/fed money) called mediCAL and it lets people go the ER for free and get all meds for free (basically free medical care all together)

They have this in every state, it's just not called MediCAL in other states... but all states have some form of government sponsored medical assistance (Medicaid)...