Misuse of the ER

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.

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.

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.

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."

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.

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.

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.

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.

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.

I have to agree. Maybe 10 years ago you could get a same day appointment, nowadays it's unheard of. Husband had a respiratory issue. SOB, wheezing... Call his PCP, a pulmonologist, can't take him for x number of days. The local "Urgent Care" places seem to keep regular business hours, so where does one go? Not like there was much of a choice,