Your ER policy on giving rides home

[psu_213]

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?

[Veldtor, BSN, MSN]

If they can't have friends/family pick them up, we try and find out if they are eligible for a Medicaid taxi. When they are not eligible for that, we can escalate to house supervisors to possibly get cab fare for the patient.

[JonathanClouse]

I am not a nurse, but I work at a grocery store that just a few blocks down the street from a hospital that doesn't provide cab vouchers for patients released from their emergency room. I am fine with that, as that is the hospital's policy. My worry is that my blood pressure sometimes runs on the low side (I think the lowest I've seen was 93/62), and as such, I have occasionally passed out because of it. So I am making it clear to my coworkers that if I ever accidentally pass out at work, I DO NOT WANT my employer to try and send me to an ER afterwards. Especially on a Sunday evening as the last bus stops running at 9:20, and on a tight budget, I can't always afford a cab. I know in that situation, management might insist that I go just to cover any fears, but if I refuse, what are they gonna do...fire me? In all honesty, I'm too valuable an asset.

[optimis]

I’m at an inner city ED and I refuse to give taxi vouchers but I will give you a bus pass to get you out of the room (this is especially useful with our large homeless population). I figure that the $2 bus pass is cheaper than them holding up a room for another hour or so. Our state Medicaid program also has a transportation service, so we use that A LOT. They can wait in the lobby.

We had one girl refuse to leave until we got her a ride to Colorado (from TN). Another RN went in and explained that it is the responsibility of the ER to save lives, not to be a free travel agency. He then gave her resources for the local homeless shelter that can provide traveler’s assistance and proceeded to carry her bags to the lobby where she can use the phone to call those resources. It was masterful.

[mlalte]

I work at a very rural Critical Access hospital. We do not have a bus service. Nearest taxi can come from about 20 miles away and costs about $70 for a ride. Also no Uber drivers in the area. We are several miles from town on a busy highway.

Occasionally we are able to talk the local police department to take patients home on the night shift...but there are only 2 officers on patrol and they cannot always do this for us, and they will only give a ride within the city limits. On day shift, there is a community transport van that is available to be called.

One of the first things I ask the patient is if family is coming, and if not - how do they plan on getting home. I routinely discharge patients to the waiting room with a warm blanket to sleep until morning.

[skylark, BSN, RN]

On ‎8‎/‎28‎/‎2011 at 10:59 AM, psu_213 said:

Another real life example...a patient was being discharged. Came out of her room and asked for her nurse. That nurse was't there, so I asked if I could help her with something. "Yeah, I need to talk to a social worker." (this was around 2 pm). I asked her what she needed to talk to the SW about..."I need her to find me a ride home." When she went back in the room, I hear her say to her friend "Yeah, you just have to learn how to work the system...."

We get a lot of that. They show up, having managed to get a ride TO the hospital, and then suddenly all their family and friends are busy and can't get them home again, but its ok because its the social worker's problem.

I understand not wanting to ride the bus at night, but in the middle of the day there is no reason for a patient to get a ride, unless there is a physical reason for needing assistance.

If I'm in triage I remind them at the start that they will need to start planning how to get home again.

[JBudd, MSN]

Although our economy is very heavily based on tourism, we don't have a taxi service anymore. And there aren't many Uber drivers available in the small hours of the morning. Most of those are becoming leary of picking up ED patients that time of night if we are the ones calling as well.

It amazes me how many demands there are for Ubers to the homeless shelter. Ah, the doors are locked this time of night anyway!

Our bus system doesn't run from 2200 to 0600. I let people stay in the lobby, but the minute you start abusing me it becomes a one way escort by security off the property.

[Guest219794]

In my place it is completely random.

What I found was that anybody who put up a big enough stink would get a pass, while a polite, reasonable person might not. Or somebody would know the system, and give the right answers. My decision was over ridden once or twice, and I changed my practice: I give them to anybody who asks. You could tell me that you have just enough for a bag of weed, and don't want to waste it on cab fare, and I will give you a cab pass.

My hope is that my privilege to give cab passes will be revoked, and I can just turf these decision to charge or admin. But having abused this system for years, I am still doing it. I really need better supervision.