Mobile IV infusions... for hangovers

[Dogen]

Have you ever heard about in-home IV infusion to get rid of hangovers? This is an idea I started thinking about when I read about it being offered in New York, and because in personal experience it works well, but someone has beat me to it locally.

The basic idea is extremely simple. You call, talk to a prescriber (currently an MD, but they're looking for NPs) who asks you about your health history and symptoms, then a nurse shows up and starts an IV. They don't take insurance obviously; no one will cover this. It seems a little sketchy, like back alley medicine... but it's also pretty low risk if your screening is thorough.

Now, the NYC operation I first heard about is pretty slick but seems more questionable. For instance they have different packages you get to pick from, the highest of which apparently includes IV magnesium (it says "liquid magnesium"). Not sure how I feel about that.

Anyway, what do you think? If you were going to do this, how would you do it so that it was ethical? I have no intention of starting a competing business... but it seems like a brilliant way to make money.

[Been there,done that, ASN, RN]

ED Nurse, BSN RN said:

I think this is a genius idea- not for just hangovers but at marathons for runners. If I found a doctor willing to do this with me I would certainly do it!

A doctor's order does not cover nursing malpractice.

[That Guy, BSN, RN, EMT-B]

My friend works for something like this. Their company works with on an call basis so anyone can access it but they also landed a deal working with a local pro sports team.

[Dogen]

Been there,done that said:

Malpractice insurance perhaps, to cover the company. How would that cover the nurse? Is that not why hospital nurses have their own coverage?

Do home health nurses have trouble getting insurance? I'm not aware of this being a problem.

Quote

You could also be "just" be administering IV fluids. Does the client have a history of CHF, ESRD, or cardiomyopathy? Flash pulmonary edema would not be able to be handled in this setting.

Yeah, that's why you screen people. Just like you would in a home health setting. Flash pulmonary edema would be a problem in any outpatient setting, that's not unique to this. Do you have the same reservations about a home health nurse administering IVF? I'm unclear, perhaps because to me this seems very much like HH (just for probably young, entitled, wealthy people), but you seem to think it has a lot more risk involved.

[Julius Seizure]

Hmmm wonder if theres one in Dallas...

[ED Nurse, RN]

emmy27 said:

I wouldn't want to work at one of these places because a. I imagine there might be a tendency towards a certain attitude/age/entitlement level among the clientele and b. I would really worry about that one time in a hundred or a thousand that the "hangover" turns out to have been something serious and we're stuck in, basically, a very minimally-equipped lounge with a crashing patient who presented with all kinds of warning signs but was seen for their "hangover" anyway because referring people to the ED is the quickest route to angry Yelp reviews for your luxury medical business.

But if somebody else wants to run that risk and it keeps the merely-hungover out of the ED, awesome.

The sense of entitlement is rampant in healthcare- I doubt, if this is a pay upfront for services rendered, that the people who have the largest sense of entitlement will not be frequenting a place like this- based in cost.

People crash anywhere, anytime- you do your BLS or ACLS if you have the means, until EMS arrives. Those pts would stand a better chance as proven by successful outcomes based on immediate CPR administration in the field.

I'm also all for keeping non-emergency issues from the ED so we can focus on actual emergencies.

[ED Nurse, RN]

Dogen said:

Do home health nurses have trouble getting insurance? I'm not aware of this being a problem.

Yeah, that's why you screen people. Just like you would in a home health setting. Flash pulmonary edema would be a problem in any outpatient setting, that's not unique to this. Do you have the same reservations about a home health nurse administering IVF? I'm unclear, perhaps because to me this seems very much like HH (just for probably young, entitled, wealthy people), but you seem to think it has a lot more risk involved.

Some people just like to be Debbie downers and say no bc it's easy without justifiable reasoning- I too see this like home health nurses who administer a wide spectrum of fluids and meds in the home setting. This isn't something people are doing haphazardly- a lot of time and research go into implementing things like this. I doubt anyone just randomly said, "hey let me just go around putting PIV's in people and to hell with the rest! Let's roll those dice!" Nurses are far more intelligent than that- at least I am!

[Nurse Leigh]

A few posters have mentioned this being good for reasons other than hangovers. After some thought, I can see how this might be a good service for some PCPs to offer to established patients - maybe under certain circumstances the pt could be triaged over the phone and HCP could prescribe appropriate fluids and an RN could travel to patient home to administer and assess the treatment and outcome.

If someone has a bout of what is likely food poisoning and gets very dehydrated might be worth the extra cost to them to have treatment in the home instead of traveling to urgent care, their primary care office, or ED - especially if they have children and can't find care.

[Tenebrae, BSN, RN]

Some of our paramedics run a street hospital. Basically set up in downtown near the bars. Its basically a drop off point for anyone in trouble, drunken stupor, injury etc. The paralectic drunks generally get a litre of saline and medical monitoring til they sober up and can be sent home in a taxi. If there are any concerns the person gets sent through to the ED. And other injuries can either get treated at the mobile hospital or sent through to the ED if the injury is more serious. Personally I think its a brilliant idea as it helps take some of the load off the emergency departments.

That said, it needs close medical oversight, the idea of just starting an IV in someones home and leaving it to run through without any medical monitoring just sounds as dodgy as hell and open to sooo much going wrong

[Dogen]

Tenebrae said:

That said, it needs close medical oversight, the idea of just starting an IV in someones home and leaving it to run through without any medical monitoring just sounds as dodgy as hell and open to sooo much going wrong

What do you mean by medical monitoring? In the two cases I linked to, included in your fee is an hour of the RN's time to start the IV and stay until it finishes. Which makes sense for a lot of reasons, not the least of which is making sure the IV is removed before leaving. Are you suggesting something more?

To be honest, I have no idea if the RN checks a BP before starting the IV or not, so I can't say much more than what's available on the website.

[Farawyn]

D, I need an IV tomorrow.

[Dogen]

When you say you need an IV, you mean you need to be poked six or eight times?

I'm the worst IV starter ever. But if you need IM antipsychotics I'm your guy.

[ixchel]

Dogen said:

When you say you need an IV, you mean you need to be poked six or eight times?

I'm the worst IV starter ever. But if you need I'm antipsychotics I'm your guy.

Eh, just grab an IO. They suck to push stuff through but they'll do the trick.

Also, this comment just gave me the mental picture of a tiny little monk with war paint and a blow dart of haldol creeping through the woods.