PUH-LEEZE explain what is happening to my facility's ER. Here are just a few problems lately.
We got an admit last night of a 51 year old male, N&V, diarrhea, dehydration. No co-morbidities. Labs were straight down the line, couldn't even prove the "dehydration" dx by them. Non-tele (thank goodness). Why was he admitted? He was "too sick to make it back home" (patient statement) and the wife said she "just couldn't handle him at home anymore". (I am serious - that was her statement) I am saying this guy was A&O - wife just didn't want to listen to his whining anymore. Guess what SHE does for a living? She is a Home Health RN at our hospital! Do ya think the authorities will have a field day w this admit? What about the "meeting criteria for admission"? We were told to admit on observation status b/c the wife wanted him admitted!!! Well....the next time *MY* hubby has the flu and I am tired of dealing w it, I guess I know what to do...
Crap - 3 months ago I was in to ER w what I found out later, was pyelonephritis and bronchitis. Had SEVERE lower back pain (Yes you dumb a$$ - it's a *FREAKING 10 ON A 10 SCALE*) had dysuria, hematuria w frequency. N&V w diarrhea. Fever of 103.4F oral. Know what *I* got in the ER??? A FREAKING TYLENOL and a po BACTRIM and a script for Bactrim, and got told to go home! Never even got my fever below 103 while in the ER, never got an IV for fluid replacement, etc. My MD was furious. I was asked, "Why didn't you tell him (the ER doc) you wanted to be admitted?" I nearly blew a gasket....I don't think that was *MY* call! I WAS TOO SICK!!!
The ER has sent patient w FUO and then orders *NOTHING* for a fever!!! WTF!!
Two weeks ago, I admitted a 93 year old female who had fallen at home. This is a very A&O lady who is actually a volunteer at our hospital. She had fallen at home and had this **HUGE** hematoma over her left eye. CT of head and Xrays revealed no fx, bleed, etc. She was there for observation. Well, we walked her to the bed from the hallway, stood her to weigh her, etc. Got her into bed. I went in and did my assessment......Lo & Behold: She has this *ENORMOUS* swollen, bruising, solid hematoma injury as big as my outstretched hand over her left hip. Ahhhhh jeez...I'm thinkin' hip fx here, and I allowed her to walk...NO ONE said anything to me in the report I took about a HIP injury. I looked at the records and there was NO note about it, nor were any xrays done.
I called the ER supervisor, asked who examined this patient. She said, "Well, actually, I did it and Dr. XYZ. Why? What's the problem?"
I tell her what I found, and she said, "Well, the patient never said she was hurt anywhere except her head."
HELLO????!!!
Has anyone ever heard of this new thing called an ASSESSMENT?? I said, "Since when do we just take a patient's word for what their problem is? (I can see it now: "Hey Doc? I believe I have an intracranial bleed here...") What about undressing the patient and doing a physical exam, for crying out loud?
And do ya think the fact that she is *94 YEARS OLD* that she FELL and that she is FEMALE and takes FOSAMAX just *MIGHT* tell ya to have a look-see at something other than her bloody head?? DO YA'THINK, HUH????
I had to call her MD and get orders for a STAT set of hip xrays. Thank God she had no fracture.
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These are just a FEW things......I could go on and on....
It is not just one MD down there. It seems to be mass stupidity. We have several new MDs working ER and everyone is talking about this. I have written several incident reports, but nothing seems to be changing.
All I feel I can do is to continue to assess my pts carefully when they present to my floor and to document, document, document...
Well, thanks for allowing me to go on and on with my diarrhea of the mouth. I will get off here now.
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