Return Dumped Patient to ER

[TrudyRN]

I read a post here yesterday in which a nurse stated she had returned to the ER a patient whom the ER had stuck in a room on her floor, without first having given the nurse report. She notified the ER nurse and manager that she would report them to the state Board if such occurred again.

I would like to re-read it but can't take the time right now to search for it. If you know which thread that is, could you let me know?

Or, if you have ever done this, please share your experience.

I really admire this nurse's moxie. I feel badly for the pawn (patient) but really think that if we all did this and refused, in general, to be bullied and dumped on, we'd be better off.

Thanks for any help.

[UM Review RN, ASN, RN]

Hi Trudy, here it is. I just happened to recall the name of that thread.

https://allnurses.com/forums/f8/so-i-lost-am-i-out-line-233084-4.html

You want Post #32 on page 4, I believe. :)

[TrudyRN]

Thanks, Angie O. That's it!

[TiffyRN, BSN, PhD]

I really admire this nurse's moxie.

Sorry, can't go there with you. Yea, it would feel really good, really really good, but there is a real live human being that is sitting there (in that wheelchair) feeling very unwanted. I've had my share of horror stories in "wars between the floors". But nothing justifies acting ugly like that, especially in front of a patient.

[jojotoo, RN]

Two wrongs don't make a right. The floor nurse was just as wrong as the ER nurse. BOTH violated Joint Commission Safe Hand Off guidelines. Though I understand how it must have felt good, the floor nurse was lucky that she wasn't disciplined (as was the ER nurse).

In the end, we ALL have to remember - it's always about the patient.

[loricatus]

Hi Trudy, here it is. I just happened to recall the name of that thread.

https://allnurses.com/forums/f8/so-i-lost-am-i-out-line-233084-4.html

You want Post #32 on page 4, I believe. :)

If you are referring to my post (#32). It was not a patient sent by the ER to the floor. It was a floor patient sent to the ED holding area because of a downgrade from step-down to med-surg; and, the unit did not want to be bothered with a MS patient, so they thought that the patient should go through the ER process again. This was standard where I worked (to send patients back to the ED when there was a change in status). Nor, did I threaten to report them. You must be thinking of another post.

Just wanted to clear things up. Besides, I have never dumped a patient from the ED onto the floor. Fax reports are always sent after bed board has given us the bed assignment (and orders are picked up if at all possible). Nurses are free to call down to the ED if they have additional questions or if there is a real problem where they would want the patient held longer. The average ED hold time after admission is usually at least 6-8 hours-waiting for a bed to open up on the floor. The patient has to wait on a stretcher, rather than a bed, making them ripe for pressure ulcers (can't be avoided due to the configuration of the stretcher, if the patient is immobile). Since the ED is usually packed to the brim, we try to make room for others by getting the patients up as fast as possible. I have known a few ED nurses to attempt dumps; but, they are written up and suspended. The main dumping problem I was talking about was from floor to floor and floor to ED (at least in the hospital I formally worked at).

Also, It was actually safer for the patient to go back where they came from. We do not have the supplies and capabilities to handle the non-emergency longer term holds. It is just the way an ED is set up. Admitted patients that are sent back to the ED without report (and just left there) seriously have their safety jeopardized. This is why I was so infuriated. The patient was far better off where they were on the floor and that is the crux of my decision have them returned. Patient safety is a priority for me!

[jojotoo, RN]

The main dumping problem I was talking about was from floor to floor and floor to ED (at least in the hospital I formally worked at).

Sending a patient from the floor back to the ER to await a different bed assignment as an inpatient? This is something I've never heard of before. I'm sure this is an EMTALA violation.

[TazziRN, RN]

Nope, not EMTALA. EMTALA is "Emergency Medical Treatment and Labor Act"......affects ERs only. Once they are admitted to the hospital as an inpt they fall out of the jurisdiction of EMTALA.

[SuesquatchRN, BSN, RN]

That's not the right thread, anyway. I'll look.

[EmmaG, RN]

Nope, not EMTALA. EMTALA is "Emergency Medical Treatment and Labor Act"......affects ERs only. Once they are admitted to the hospital as an inpt they fall out of the jurisdiction of EMTALA.

We had a patient who'd fallen during the night and needed sutures. The admitting refused to come evaluate the patient, said that he wouldn't suture him anyway, and ordered the nurse to take the patient to the ER for the ER physician to do so. So she did.

Anyway, it caused quite the uproar. The ER manager and the ER medical director took it straight to the top...

It was deemed an EMTALA violation by the powers that be (including risk management and our hospital lawyers), as he was being returned to ER as a patient, and didn't go through the screening/triage process. In other words, once they are an inpatient, they cannot be returned to the ER without being admitted as a new ER patient (kinda sleepy, hope I'm making sense here).

A new policy was quickly implemented that should anything like this happen again at night, holidays or weekends, the plastics doc on call was to be consulted and provide the care on the unit.

I can't find anything specific online as to whether such a scenario violates EMTALA, but their reasoning made sense to me.