Educating patients on ER use

[anh06005]

Parents might need to think twice before bringing their child to the E.R.

A hospital in my state is the topic of this article about using the ER and when it might not be the best option. There are family members points of view in the article and many comments as well that make me realize some people just don't get it (true reasons for an ER visit).

How can we do a better job at educating patients and families on emergency vs non emergency?

Does your doctor have a paging system for after hours? Do many know about it?

Just wondering what some of you more experienced people have to say. I'm not meaning to start any arguments but ideas on how I can help my patients understand.

[anh06005, MSN, APRN, NP]

I'm enjoying the insight here. I've never worked ER but have read some stories and patient complaints on here and can't help but think if common sense has gone out the window for some people.

I'll be FNP soon and was just curious on how I might can do my part in preventing frivolous ER use. Even if one patient listens then, hey, that's one ER visit yall don't have to deal with!! Lol

[toomuchbaloney]

I have a friend, who is an RN in Fairbanks who was unemployed and uninsured for a short spell in the recent past. During that time she suffered a medical emergency that required sugery. The surgeon agreed to provide the care knowing that the woman had no insurance. The surgeon has a private practice in the same clinic that houses dozens of health practioners including the office of the MD who is the PCP for my friend. It is part of the Banner Health System.

Currently my friend is employed, has health insurance, and is receiving care for kidney infection and kidney stones through the ED. The clinic will not allow her to schedule a visit with her PCP until the outstanding bill (~$15k) is paid in full. That is not a typo and is not an error; payment in full not a payment plan or no MD visit. It is not easy to establish a PCP relationship during a major holiday season when one needs care immediately, it's much easier when one can wait weeks for the first appointment.

So, her care is being managed through the ED. They scheduled her PICC line, they scheduled her OP antibiotics, they scheduled the CT for ongoing flank pain and dx the stones, etc. She would much rather visit her PCP but...

[pfongk]

I am so glad I live where I live. The last time we did a hospital trip was for croup as my son stopped breathing for about 2 minutes due to croup. All the other stuff if we can't see our regular doctor we go up to the local bulk billing 24 hr health centre or use a service called dr to your door who do home visits out of business hours and they bulk bill unless it's between midnight and 0800 when they charge $400.00 which goes to charity.

[Nibbles1]

I thought some States will not pay (if on Medicaid) if it's not a true emergency. I remember a peditrican telling a mother one morning that Medicaid wasn't going to pay for her sons ear ache. That it wasn't what was considered a true "emergency." This was 3 yrs ago in Arkansas.

[SubSippi]

Personally, I think a large part of the appeal of ED visits comes from the fact that going to the ED involves no planning or commitment on the patient's part. They don't have to be there at any certain time, they don't have to make any pesky phone calls to schedule appointments...just show up when you feel like it. I know that a lot of PCPs have walk in hours, but those hours usually seem to be pretty limited. I wonder if people were allowed to just walk in to their PCP at any time would cut down on unnecessary ED visits.

There is also most definitely a cultural aspect. Your mom took you to the ED for a fever when you were little, so that's what you do with your own children. It's hard to break a habit.

[LadyFree28, BSN, LPN, RN]

I thought some States will not pay (if on Medicaid) if it's not a true emergency. I remember a peditrican telling a mother one morning that Medicaid wasn't going to pay for her sons ear ache. That it wasn't what was considered a true "emergency." This was 3 yrs ago in Arkansas.

Some states have been cutting Medicaid to the bone and will alert recipients that they are only billing for "true emergencies"; unfortunately, that's running the risk of what would constitutes as an "emergency" since some of the simplest, vaguest complaints can be potential illness that are "emergencies".

[THELIVINGWORST, ASN, RN]

Some people simply can't afford it and I have been one of them. If you're poor and have no money and can't go to the doctors then what other choice do you have? How would you feel if someone told you that you need to suck it up and deal with the pain that's keeping you from living your life because it's not a REAL life or death emergency?

[ComeTogether, LPN]

I think a lot of people are misinformed in general about the care received.....

Some people think that because they wen't for a sprained ankle, they have a clean bill of health, since the docs would have caught their cancer, if they had it, while they were there. Somewhere along the way, society has learned that doctors know everything and are super human with super powers. Also, that the hospital is this magical building where they fix everything.

I think patients need to realize that doctors are human and don't have x-ray vision, that proper treatment is a process and not a one stop shop.

How about signs that say," The Emergency Department is here to keep you alive until you can see someone with office hours"

[ComeTogether, LPN]

Our insurance charges a $125 co-pay if we're not admitted. If we are, they pay 100%.

[Milysa]

I work in an ER. A lot of times we will ask patients why didn't you go see your PCP and more often than not their response is "my PCP told me just to come here". The second most popular response is "they told me they couldn't get me in for 2-3 weeks!" So we end up with a lot of minor sniffles. Our ED does have a more Urgent care type area but that area and the main ED become blurred when we are really busy. The major hospital system in our area promises "same day appts" but that doesn't mean with your PCP or even in your community. I tried this system once when I didn't have a PCP and the only appt they could offer was 45+ minutes away! For those who rely on public transportation that's not going to help them, so they end up in the ED. This week we were super busy and a 2-3 hour wait all of a sudden made people decide maybe they really didn't need to see the doc :)

[Not_A_Hat_Person, RN]

PCPs are part of the problem. Too many send any patient with the slightest hint of illness to the ER, even if you call during office hours. As nurses, we have a good idea of what is truly an emergency. For most nonmedical people, if their doctor tells them to go to the ER, they go.

[BlackMagicGypsy]

How about signs that say," The Emergency Department is here to keep you alive until you can see someone with office hours"

I tell all of my friends, family, and patients this!!! The ED is only there to stabilize, treat & street you! That seems to get the point across pretty well.

My mother has gout flares and would only go to the ED for tx when the pain occurred. She did this for months without once calling her PCP...I've managed to break her of that habit.