How true this is

Meriwhen, ASN, BSN, MSN, RN · May 31, 2016

I spend a lot of time in the ED doing psych consults, and I find that the ED's definition of "medically stable" varies depending on how badly they want a patient out of their hair.

elkpark · May 31, 2016

I spend a lot of time in the ED doing psych consults, and I find that the ED's definition of "medically stable" varies depending on how badly they want a patient out of their hair.

Exactly -- you can be bleeding from every orifice, but, if you're a psych patient, you're "medically stable" for transfer. I've seen that in EDs and inpatient (med-surg) units over many years.

A&Ox6, MSN, RN · May 31, 2016

I spend a lot of time in the ED doing psych consults, and I find that the ED's definition of "medically stable" varies depending on how badly they want a patient out of their hair.

I would totally agree. I recently had a patient admitted for anxiety and depression. EKG showed an acute MI.

Mandychelle79, ASN, RN · Jun 1, 2016

I spend a lot of time in the ED doing psych consults, and I find that the ED's definition of "medically stable" varies depending on how badly they want a patient out of their hair.

my favorite quote from a hospitalist (who I have a great relationship with).... Well technically he is medically stable just more medically complex than you normally deal with..... Consistent Bps in the 190/120 range with huge cardiac/ cva hx.

Mandychelle79, ASN, RN · Jun 1, 2016

Exactly -- you can be bleeding from every orifice, but, if you're a psych patient, you're "medically stable" for transfer. I've seen that in EDs and inpatient (med-surg) units over many years.

i honestly didn't realize this happened in other facilities. Umm no we are not picking up the patient we transferred medically for this issue when you haven't completed the testing to r/o reasons why we sent in first place. Then you have when you are sure a patient is 99.9 percent faking whatever to get out of unit but the Dr. Admits them medically. It's like really we have trouble transferring a patient in resp. Failure but this one who just helped flip themself over even though they were "unresponsive" get transferred immediately.

elkpark · Jun 2, 2016

i honestly didn't realize this happened in other facilities. Umm no we are not picking up the patient we transferred medically for this issue when you haven't completed the testing to r/o reasons why we sent in first place.

Yeahhhhh, I think that happens everywhere with psych. I've even seen EDs outright lie about the individual's medical condition in order to get us (psychiatric facility) to agree to take them. The other really scary thing is that, in lots of EDs, once an individual has been identified as a psych client, they apparently stop paying attention to any medical issues and pursuing any kind of adequate medical work-up. I particularly recall one night we got an individual from an area ED whom we had been told had some "scratches" on her/his forehead; when the individual arrived s/he had a hematoma on her/his forehead the size of half a grapefruit (when stopped by the police for driving erratically, s/he had expressed her/his displeasure by beating her/his head repeatedly against the metal barrier on the side of the highway), and the records sent from the other facility indicated they hadn't done any kind of neuro work-up, just focused their efforts on getting her/him to us (and out of their ED) as quickly as possible. Shortly after arriving at our facility, the individual became obtunded, and we ended up quickly shipping her/him over to our general medical hospital for the full neuro work-up that should have been done in the first place at the original facility. The house officer on duty that night called the ED doc at the other facility and tore him a new one; actually threatened to report him to the state medical board.

TCASII, ADN · Jun 3, 2016

This is pretty typical. They lie a lot. The way of dealing with this....send them back. Do not admit at all, just turn them around and teach the hospital a lesson.

elkpark · Jun 3, 2016

This is pretty typical. They lie a lot. The way of dealing with this....send them back. Do not admit at all, just turn them around and teach the hospital a lesson.

But that's really punishing the client, not the facility. None of the facilities for which I've worked over the years have been willing to mistreat clients in order to "teach a hospital a lesson."

Mandychelle79, ASN, RN · Jun 6, 2016

I don't have that luxury. My unit is inside a general hospital. Though I do call a condition and have had people transferred immediately upon arrival.

B52, ADN, BSN, MSN, RN · Jun 10, 2016

A patient who was medically cleared died on our unit. Another patient the ED sent over had a chin laceration so deep that liquids spilled out when she drank water, juice etc.

Penelope_Pitstop, BSN, RN · Jun 11, 2016

When I worked acute care this didn't happen in my facility - probably because we didn't have an inpatient psych department.

However, my friend works inpatient psych at the facility's smaller hospital and assures me it happens all of the time to her. However, when I worked at that facility on MedSurg I found the opposite to be true - the very SECOND an inpatient psych patient coughed, he or she was transferred. I found that unfair to everyone because the patient really needed the help from the psych team more than anything.

I lost it at "I snowshoed across Nepal."