Misuse of the ER

Published

I work in a small rural hospital, where we deal with all areas, and the number of non-emergent ER visits I see is really making me hate my job! The other day, the Dr's clinic nurse informed me at 10:30 am that there would be a patient coming to the ER at 1:00 pm. This patient had fallen 3 days prior and had been suffering hip pain since. When I asked why the patient couldnt come now if it was an emergency, I was told that she did not have a ride until 1:00 and she did not want to call the ambulance. I then protested that if it were an emergency, she would come immediately rather than scheduling an ER appointment (i guess that's a thing?!?!?), and if it could wait then she could be seen in the clinic. The clinic nurse explained that it needed to be done in the ER because the Dr wanted the patient to be lying down for her assessment (LOLOLOL). I ended the call, then went and informed my DON of this, who found it as ridiculous as I did, and went to talk to the Dr. Upon returning, she stated that the patient was coming to the ER at 1:00 because she had told the Dr she did not want to be seen in the clinic due to her insurance coverage. Please share your thoughts on this, I see this sort of thing all the time and am just wondering if this happens anywhere else.

Specializes in Cardiac Stepdown, PCU.
I see it all the time and it really frustrates me. I work as a school nurse and I will call a family to come pick up their child who has a fever (can't be in school with a fever) and they will return to school a couple days later with a discharge note from the ER! Dx Strep, Otitis, etc. Very basic, primary care illnesses. I ask why the went to ER and they says "It's faster, or closer to my house, or I wanted antibiotics, etc.". I do as much education as I can about ER misuse/Abuse but it usually goes over their heads.

I wonder if this is an area type thing. Or perhaps is more dependent on the office/MD a person goes to. Where I live currently, if my kid were to get a fever and had to be taken out of school, and couldn't come back without a clearance note for a DR. There's no way I am getting a same or possibly even next day appointment with his PCP. Even when I break out with a cold sore and I want to see the PCP for some Valtrex, it's a 3 day wait... and that's their "soonest" appointment. I've had three different PCP's in this area and there was only one that would manage to sometimes get you a same day appointment but I couldn't tolerate being her patient.

However, where I lived previously, about 10 years ago, you could get a same day appointment no problem. I only have two different PCP's back then and they were at the same office.

I also have to wonder about the number of urgent cares in the area and their hours. My current area has urgent cares popping up like starbucks. The local hospital here has seen a dramatic drop in ER visits for people with non-emergent concerns during the hours that it's open. In the area I work (same healthcare network system) there are fewer urgent cares and my hospital see's plenty of people where you just stare at them like "you came in for... this?!". Of course, we all also joke around that you can walk into my ER and sneeze and they would admit you right to stepdown with tele for a history and diagnosis of "we're not sure yet!" (Though, seriously, I've had patients where their admit diag stated "patient called 911 saying "they didn't feel well"", she ended up having trashy labs and a uti. we love to admit for UTIs).

Up Vote Up Vote ×
I work in a small rural hospital, where we deal with all areas, and the number of non-emergent ER visits I see is really making me hate my job! The other day, the Dr's clinic nurse informed me at 10:30 am that there would be a patient coming to the ER at 1:00 pm. This patient had fallen 3 days prior and had been suffering hip pain since. When I asked why the patient couldnt come now if it was an emergency, I was told that she did not have a ride until 1:00 and she did not want to call the ambulance. I then protested that if it were an emergency, she would come immediately rather than scheduling an ER appointment (i guess that's a thing?!?!?), and if it could wait then she could be seen in the clinic. The clinic nurse explained that it needed to be done in the ER because the Dr wanted the patient to be lying down for her assessment (LOLOLOL). I ended the call, then went and informed my DON of this, who found it as ridiculous as I did, and went to talk to the Dr. Upon returning, she stated that the patient was coming to the ER at 1:00 because she had told the Dr she did not want to be seen in the clinic due to her insurance coverage. Please share your thoughts on this, I see this sort of thing all the time and am just wondering if this happens anywhere else.

sounds like insurance fraud.

Up Vote Up Vote ×
I work in a small rural hospital, where we deal with all areas, and the number of non-emergent ER visits I see is really making me hate my job! The other day, the Dr's clinic nurse informed me at 10:30 am that there would be a patient coming to the ER at 1:00 pm. This patient had fallen 3 days prior and had been suffering hip pain since. When I asked why the patient couldnt come now if it was an emergency, I was told that she did not have a ride until 1:00 and she did not want to call the ambulance. I then protested that if it were an emergency, she would come immediately rather than scheduling an ER appointment (i guess that's a thing?!?!?), and if it could wait then she could be seen in the clinic. The clinic nurse explained that it needed to be done in the ER because the Dr wanted the patient to be lying down for her assessment (LOLOLOL). I ended the call, then went and informed my DON of this, who found it as ridiculous as I did, and went to talk to the Dr. Upon returning, she stated that the patient was coming to the ER at 1:00 because she had told the Dr she did not want to be seen in the clinic due to her insurance coverage. Please share your thoughts on this, I see this sort of thing all the time and am just wondering if this happens anywhere else.

Welcome to healthcare in America?

This is every ER in the US right now, basically.

Id suggest watching "Code Black" the 2013 documentary.

Up Vote Up Vote ×

I appreciate this perspective I was given a few years ago:

A patient with a sore throat from a cold / similar virus. Should they go to the ER, from a medical perspective? (No, of course not).

A patient with a sore throat, due to strep? (No, probably not - urgent care or their primary care physician would be better).

A patient with a sore throat, due to epiglottitis? (Yes, a medical emergency threatening the airway).

The issue? All of the patients could have similar symptoms ... and, most importantly, do you really want the patients self-diagnosing and making that decision?

The point was ... there will be patients in the ER that don't belong there, but it's better that a medical professional decides they don't belong as opposed to a patient self-diagnosing. It made me think at least a little bit differently about it.

Just food for thought.

Up Vote Up Vote ×

Based on that line of thinking every time I have abdominal pain I should call the ambulance because it could actually be appendicitis.

And epiglottitis is characterized by a restricted airway far and above a typical "sore throat."

Up Vote Up Vote ×
I work in a small rural hospital, where we deal with all areas, and the number of non-emergent ER visits I see is really making me hate my job! The other day, the Dr's clinic nurse informed me at 10:30 am that there would be a patient coming to the ER at 1:00 pm. This patient had fallen 3 days prior and had been suffering hip pain since. When I asked why the patient couldnt come now if it was an emergency, I was told that she did not have a ride until 1:00 and she did not want to call the ambulance. I then protested that if it were an emergency, she would come immediately rather than scheduling an ER appointment (i guess that's a thing?!?!?), and if it could wait then she could be seen in the clinic. The clinic nurse explained that it needed to be done in the ER because the Dr wanted the patient to be lying down for her assessment (LOLOLOL). I ended the call, then went and informed my DON of this, who found it as ridiculous as I did, and went to talk to the Dr. Upon returning, she stated that the patient was coming to the ER at 1:00 because she had told the Dr she did not want to be seen in the clinic due to her insurance coverage. Please share your thoughts on this, I see this sort of thing all the time and am just wondering if this happens anywhere else.

This is not new and it likely happens in many ER's.

Why LOLOLOL about her lying down?

Insurance and expenses are very real concerns for millions of people.

I do understand your frustration, but this is reality. Most doctors do not have weekend, night, or holiday hours, so guess where their patients are told to go if something comes up during these times - even if they're not hemorrhaging or having respiratory troubles.

When I worked ER, we had people come in after they got off work - for colds or other minor, not really emergent issues.

Some people don't know folk remedies or how to use OTC treatments, so they come to the ER.

Up Vote Up Vote ×
I see it all the time and it really frustrates me. I work as a school nurse and I will call a family to come pick up their child who has a fever (can't be in school with a fever) and they will return to school a couple days later with a discharge note from the ER! Dx Strep, Otitis, etc. Very basic, primary care illnesses. I ask why the went to ER and they says "It's faster, or closer to my house, or I wanted antibiotics, etc.". I do as much education as I can about ER misuse/Abuse but it usually goes over their heads.

At least their kids are getting taken care of. With parents working, parents must sometimes choose an option that doesn't force them to call off from their jobs.

As someone said above, life can be very hard. Too bad you, as an NP, can't (apparently) diagnose and prescribe in your role at the school.

Up Vote Up Vote ×
Based on that line of thinking every time I have abdominal pain I should call the ambulance because it could actually be appendicitis.

And epiglottitis is characterized by a restricted airway far and above a typical "sore throat."

no

You are an RN and can be trusted more to make the determination. Although God knows we do sometimes miss it.

Up Vote Up Vote ×
Specializes in Short Term/Skilled.

The patient probably needed to be referred to a SNF for short term rehab, which requires a 3 day hospital stay in most cases. The doc was probably hoping they'd be admitted or that social services could get them in another way.

Up Vote Up Vote ×
Specializes in Surgical, quality,management.

Ahh socialised healthcare

Many GPs bulk bill (Medicare) so no out op pocket expenses for the patients, superclinics open until 11PM and weekends, the children's hospital has a GP 24/7 so those that are not really ill and likely 5hr wait time.

Up Vote Up Vote ×
Specializes in kids.
Lets be honest, the sick, non emergent people are what keep the doors open and give those every important numbers that keep us staffed every day. Yeah all sick people would be a lot more fun but its not the reality of what goes on.

But DO they contribute to the bottom line? In light of those who have Medicaid, the reimbursement is pitifully low (hence the reasons that insurance is not accepted at many private offices) and those who just don't pay. Our local hospital has closed several areas claiming that they are over burdedned with Medicaid patients whose reimbursemnt is low.

Up Vote Up Vote ×

When I read these types of posts I'm assuming the OP is using one of the better examples to support their point. So in using a possible fracture that didn't come in by ambulance as abuse, my immediate reaction.. that's the best you got?

I come from rural community based healthcare where I'm as aware as OP should be that urgent care and clinics with comprehensive diagnostics are uncommon.

Up Vote Up Vote ×
+ Join the Discussion