turning non-emergent pts away

[Jennifer, RN]

Do any of your ERs turn non-emergent pts away, like toothaches, lice, STDs, etc? Rumor has it that this week, we in triage are going to start handing out cards to the local free clinics to pts with minor complaints and telling them that this is an emergency room and their complaint is not emergent and they will not be seen here, to make an appt at the local health clinic. I can't see this working.

[Sconna]

I would love to see this happen. When I triage, I usually ask...What is your emergency? The sad part is Most of the clients use the ER as their PCP office. Most done have a PCP. Then there are those that are drug seaking. Then there are the ones that just come off the boat, plane (non) american with years of complaints and want it all resolved now.

[Vito Andolini]

We triage the non-emergent to the clinic side. It is located around the corner from our ER, just past the sign-in desk, under the same roof. The NP's and docs there can send them back if they deem them to be ER material. The Clinic is open from 6 a.m. to 12 a.m. 7 days every week, excepting holidays. The plan is to extend it to 24/7 ASAP in the next couple of years, assuming financial viability.

As for totally turning people out of an ER to an off-site, totally separate clinic, I think it is very risky for the Triage nurse and for the hospital itself. What if the client suffers harm?

[Vito Andolini]

Under EMTALA, ERs are required to screen and stabilize. If the screening shows that an emergency medical condition does not exist, happy trails. So, the foot fungus x 1 year that is screened by a provider and determined not to be an emergency, does not have to be treated. So, yes, you can definitely ask for a fee up front after the MSE is done, and I think it's a great idea. You just have to get everyone on board. I had a lady the other night that showed up in my ER 4 hours after she left our sister hospital with pink eye. She was given antibiotic gtts but they weren't working fast enough. (Oh, Sweet Jesus, what did I do to deserve triage tonight?) I brought the doc out to screen her and get rid of her, and he figured it was just easier to see her AGAIN and give her the Tobradex gtts that she wanted. He figured if she wanted to pay for a 2nd ER visit in 4 hours, more power to her. I'm here to tell you that we are not going to see dime one of either one of those visits. Now if $250 up front won't discourage that kind of nonsense, nothing will.

Sounds like the lady knew, maybe from past experience, that Tobradex would help. Please remind me - does Tobradex have a steroid component that maybe the drop she was originally given did not? I once was given a drop with cocaine in it, made personally for me upon prescription by an allergist. No wonder it worked immediately.:loveya:I had been in agony with the worst explosion of intense itching in my eyes that you can imagine and this took care of it in 1 dose!