Walk-Ins with Chest Pain

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Specializes in Ambulatory Care/Community Health.

Alright, I've been working in the clinic setting for a while now, but what still drives me absolutely insane is how many patients walk-in to the Dr.'s office demanding to be seen because they are experiencing chest pain. Really?! Why not walk-in to the EMERGENCY ROOM that happens to be about 2 blocks away?! I can't believe how many people every week are showing up in our office this way. Because we are a FQHC, we can't turn anyone away (that includes calling 911 to get them to the hospital) without seeing them. So, they get put into the NURSE's schedule. Then, I get to assess them, perform an EKG, administer O2, etc. until an ambulance arrives. Thankfully, only 1 person so far has actually had a cardiac issue going on. But, SHEESH! Anyone else experience this at their place of work? It's terrifying!

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Specializes in Psych/Substance Abuse, Ambulatory Care.

Not at my current clinic, but at a family practice clinic that I worked at about 2 years ago. It was absolutely ridiculous and made me SO angry. And the patients kept doing it because we continued to accomodate them!

Is 911 called for every patient while the nurse is doing an assessment? I feel like even though patients kept coming with those complaints, it made me feel slightly better knowing that they weren't "avoiding" the hospital trip because they chose to walk into the MD's office unannounced (since we called 911 no matter what). I feel like that's the reason a lot of them walk-in in the first place...

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Specializes in Clinical Documentation Specialist, LTC.

I work in a wound care clinic so we don't get anybody in with c/o chest pain, but there is a heart clinic one door down. I'm curious now as to whether they see a lot of walk-ins with chest pain. I might have to stop by and ask them out of curiosity lol!

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Specializes in cardiac CVRU/ICU/cardiac rehab/case management.

I work in cardiac rehab and also counsel pts in hospital directly after their event. When I ask pt why they waited it out at home or went to their doctor the usual response is "I was hoping it was bad heartburn ", "I couldn't believe I could be having a heart attack"

While you might expect that someone having chest pain would at least consider it might be their heart surprisingly denial proves a stronger force. Several pt have (new onset )angina symptoms for over a week and continue to dismiss it as muscular pain,over working out,too heavy a meal,constipation etc.

The best way out of this predicament is teaching in particular getting accross that "time is muscle" I frequently tell pt the single worst reason to die is ensnarement....The pt who holds off going to a hospital for fear they are wrong and it's nothing. I tell pt to get the ER and if worst case scenario someone calls you an idiot ,you are an alive idiot!

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Specializes in cardiac CVRU/ICU/cardiac rehab/case management.

Sorry for above typo, It should read "single worst reason to die is embarrassement "

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Specializes in Oncology.

They come into my clinic like this ALL the time. I get so frustrated. Most don't speak English except to say "chest hurts" or something, then i'm scrambling to get an EKG, talk to a doc, etc. Half don't even see us before this so we have no medical history, and they've cut our interpreters so it's like, impossible to get one to come hang out with you for 30 minutes while you do a whole work-up, set up the antique EKG and let it run, etc., etc. I wish we could just say "call 911" or "go down the street a block to the ER" but we aren't allowed. Why, I don't know, because if they having cardiac problems the faster they are there, the better, but none of them ever have insurance and don't want to go. And none of our providers ever have an open appointment, so when 9 times out of 10 the EKG is normal, we have to make appointments for them to come back and be assessed for anxiety or whatever by a provider. Then they usually never come back and then I'm stuck wondering, well, what if there was an issue I missed (since I am not a doctor) and I sent the patient home for something terrible to happen. -sigh -

Chest pain in the clinic blows my mind.

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Specializes in Ambulatory Care/Community Health.

JZ_RN,

Thank you so much for sharing! Sounds exactly like what I deal with- at least I know now that I'm not alone!

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Yes, I agree. I've seen this several times in the clinic setting... It's dangerous as the clinic settings aren't as equipped at handling a heart attack, you have to wait for the ambulance to arrive, and it does interrupt the flow of the clinic schedule... It's frustrating.

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We have this happen from time to time. We get more phone calls than walk ins though, and then sometimes they will leave a message!! I dread getting a message from a pt stating they have chest pain. I have even had people leave a message stating they think they are having a heart attack! I realize our patients are often in denial or afraid but we clearly state on the message on our phone to call 911 in case of medical emergency. We are not an ER!! I am often the only RN at my clinic so messages can wait 40 min if I'm in the middle of a diabetic teaching or lactation consultation. Thankfully many of these pts are really having an anxiety attack but I know eventually someone will come in or call us and actually be having a heart attack.

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