Your ER policy on giving rides home

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Specializes in Emergency, Telemetry, Transplant.

I'll start off with a story that is mostly rant, but does have a question at the end of it. Recently our ER treated a 30-something pt who fell at home around 8am (per her account). Arrived at the ER via ambulance with a friend, who also took the ambulace, at 11am. CC of twisted ankle. Before anything else, she asks for a sandwich and ginger ale for herself and for her friend, saying "well, we didn't have a chance to eat breakfast before we came it." (my guess is somewhere in those 3 hrs they could have had a bowl of cereal) Anyway, the nurse (not me) tells the pt "no" (in a polite way). After xrays, pt dx with sprained ankle and given airsplint/crutches. On discharge, pt tells the nurse "well, I came by ambulace and you have to find me a way home." When told about taking the bus if no one could pick them up, the friend said "we don't have no money for the bus." (Meanwhile, when they were told they would no be given food, the friend went to the cafeteria and bought a large amount of food for the two of them). The nurse got the case manager involved. Pt tells the CM "the nurses here really have to work on their bedside manner." Not sure what was arranged for this pt, but this was my rant on the situation (thanks for reading!).

Anyway, now to the question: within the last year, our ER has posted signs that basically say that we are not responsible for providing you with transportation home. We had a supply of bus tickets, now that they are gone, they are no more. Obviously we would arrange transportation in extreme situation or if a pt is incapable of getting back home/to LTC/etc. The problem is, if people come by ambulance (even for a sore throat) they think that it is our obligation to find them a ride home. When I started in the ER we gave out bus passes like crazy, so many people think we still do this. Plus, I'm sure 'word on the street' is that we give rides home ("my aunt was here last year and she got a bus pass...I came by ambulace, I should get one too"). Does your hosptial have any written policy on arranging transportation home?

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Specializes in Rural Health.

We occasionally have a problem with this too. I work in a rural hospital and usually the people that do this are the ones that come in by ambulance for a UTI or didn't get their Albuterol refilled at the pharmacy and now it's sat. night and they need it. They call the ambulance only b/c they don't have a car, then walk out to meet the ambulance at the curb! I don't feel like I need to find them a ride home and that they can find a ride or walk, it's about 2 miles to their trailer park, but no one else seems to think it's ok to let a patient WALK home! We used to have a man that would come in the middle of night c/o chest pain, he was an alcoholic veteran with PTSD. He would ALWAYS show up wearing nothing but his boxers. The police gave him a ride home a couple times, but then called administration and said that they are NOT to be called to give rides home from the hospital! I'm not sure why they didn't just refuse to do it when asked if it was such a big deal?

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Specializes in Medical Surgical Orthopedic.

Buses are inconvenient and bus passes are not much of a reward. I would be highly annoyed if I had to waste my time "arguing" with people over whether or not they're entitled to bus fare. Giving it to them makes things easier on everyone- even if they're undeserving.

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Specializes in Emergency Medicine.

I love these posts.

"pt tells the nurse 'well, I came by ambulance and you have to find me a way home'."

... Um, NO and good luck with that. Better go make some calls. Here's the phone...

Not unless they have trashed their car, are from out of town, AND have no means to make arrangements.

I do not, will not GIVE a patient a taxi voucher, bus pass or other unless all means are exhausted. Sorry for your "emergency" but the hospital isn't picking up that tab as well...

(I have called for an ambulance to take patients home before. Because they think that they deserve it. I LOVE the expression when the ambulance company asks for the $450.00 up-front)

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Specializes in Emergency, Telemetry, Transplant.
Buses are inconvenient and bus passes are not much of a reward. I would be highly annoyed if I had to waste my time "arguing" with people over whether or not they're entitled to bus fare. Giving it to them makes things easier on everyone- even if they're undeserving.

While it is easier not to "argue" at the time, does it not set up for more problems later...i.e. more ambulace trips to the hospital for very minor issues (or things that aren't issues at all), with most expecting a ride home?

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Specializes in Oncology, Emergency.

If they are younger than 65; didn't get any Narcotics and ambulatory i gladly escort them to the waiting area and tell them to call a friend or family for a ride home.Surely there has to be one person who will show up. If they are not interested then they can watch re-runs of "Married With Children" in the lobby till morning( I work Nights). And management has no problems with that. If you got narcotics i will wait for the time frame given and once deemed safe i will walk you to the Lobby.

If they were in a car accident and ambulance brought them in i will gladly arrange a taxi voucher because i know they can't get to their phone or belongings.

If they are over 65; ambulatory and no family around and not a regular i will call for a cab; depending on their situation i will arrange for a taxi voucher. I have a soft heart for seniors. If there is someone at home who can pay for the cab i will let them know you are coming back and still make sure you get a cab. 99% of the time i have no problem with our fine senior citizens. Safety is always my number one concern.

If they are going back to a SNF we get them an ambulance and the pay is waived by ambulance company if they qualify; e.g Special positioning; non-ambulatory; oxygen e.t.c

If you passed 3 hospitals to get to My ED by ambulance and live 45 minutes away...yes people do that...and you have been discharged i bet you i am not getting that taxi voucher. If you got narcotics i will let them wear out and then you can hang out in the lobby.

And when you have hopped through 5 hospitals seeking pain medications and the you turn into my department and start asking for rides i will practically kick you out. How i am i supposed to get you home by taxi voucher 100 miles away? The nursing supervisor bites my ass when i ask her for a voucher and i am not in a mood to get chewed for something i didn't do. For those in the Bay Area i have seen a patient start in San Francisco and end up in Antioch and not the first time for the patient. If that's not ridiculous then i don't know what to say.

In short, everybody needs to be responsible for their ride home and it ****** me off when people start screaming/demanding for the taxi vouchers. If you demand trust me you are not getting any and when you present your request in a genuine and polite way people are understanding.

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I had not eaten all day when I last went to the ER. As a matter of fact that probably contributed to my problems. I didn't get a meal in the ER and I didn't get offered a ride home. It never occurred to me that they give taxi vouchers or serve meals in the ER. I got a relative to come get me and then I had to figure out a way to return to get my car out of the hospital parking garage. I also got a relative to come get me one time when I went by ambulance and another time I got my own taxi when I went by ambulance. I was lucky to have enough money to pay for the taxi because usually I go around close to broke.

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Specializes in Oncology, Emergency.
I had not eaten all day when I last went to the ER. As a matter of fact that probably contributed to my problems. I didn't get a meal in the ER and I didn't get offered a ride home. It never occurred to me that they give taxi vouchers or serve meals in the ER. I got a relative to come get me and then I had to figure out a way to return to get my car out of the hospital parking garage. I also got a relative to come get me one time when I went by ambulance and another time I got my own taxi when I went by ambulance. I was lucky to have enough money to pay for the taxi because usually I go around close to broke.

Caliotter ask and it shall be given:D. I have no problems giving food once all the diagnostics are done. I proudly provide food and drinks(juice or water ) and not ginger ale or the seven up people want and which we never have. For your guests i will gladly provide for your kid/s but some people expect me to feed their whole posey and get attitude when we don't. My department gets charged expensively by the dietary department for the trays. And some visitors are just rude and that makes me direct them to the cafeteria or vending machines. Coffee is readily available as part of the night shift.If i have dosed you enough for you not to drive and you have no means to get home i will try arrange that transport since the last thing i want is a driver under the influence.

There is one basic rule in the ER; no matter how tired, mad, angry you are about the wait or delays just be friendly with the staff and things will roll your way.

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We used to give rides home, and people took advantage of it. So now we dont. As far as i'm concerned, you knew you were gonna need a ride home and you have had plenty of time to find one. Too bad, so sad...hope you like those chairs out in the waiting room until your ride shows up. Its amazing how those who "absolutely have no friends,family, or anyone to pick them up" magically find a ride when that happens.

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Let them sit in the waiting room. Somehow, people who couldn't get a ride home before always "magically" find a ride home when faced with sitting in the waiting room for hours...

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Specializes in A and E, Medicine, Surgery.

It can be a tricky one because I usually find that the patients most vocal about "our duty" to get them home safely and their "right" to have an ambulance back are often those that clinically have the least need.

We have a small budget for hospital funded taxis. I advocate long and hard to have this resource for elderly or chronically unwell patients or simply those patients that find themselves in an emergency department in the early hours of the morning with genuinely no way of getting home.

With the rest I happily offer them the use of the phone to arrange a lift or say I am more than willing to speak with the local taxi firm and arrange for them to go home via a cash point. Failing this I say I have no objection to them waiting in the waiting room or lastly I offer to send them home in a hospital taxi on the basis that they will be billed at a later date. In my experience any one of the above tends to work. In truth, although we could argue long and hard about personal responsibility I don't want a scantily clad young patient walking home along dangerous roads in the middle of the night and will do whatever I reasonably can to get them home safely.

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Specializes in Emergency Dept, ICU.

What I would give for signs in our waiting room!! generally we don't give rides home for more than 10 miles and luckily buses come right in front of the hospital so a bus pass is often cheaper for us.

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