Hmmm. How many cases are a waste of time (and money) during a typical shift? I am curious so I am going to take a pol. All you RN’s, EMS workers, Docs, and other health care workers, tell me how many calls/cases/visits during a typical shift. When I say waste of time, I mean a complete waste. Not something like a minor laceration or URI symptoms (which although simple to deal with, technically is not a waste if you actually perform a procedure or make a diagnosis that you can treat). Tell me what sort of things are total wastes - where literally you can do nothing for the patient but you have to spend time that could be spent accomplishing something productive. The reason I am asking is that lately I have had a run of two types of patients - those that you have real complaints, real diagnoses, and real reasons to be seen in the ER, and those that really have no business being there. These time-wasters I think are a huge percent of our visits. Perhaps 30-40 percent on some shifts. God knows how much money eliminating even half of them would save.
For example:
Floor staff that have to be evaluated in the ER to “make a report” of an incident on the floors - like a tiny scratch from a demented patient or for getting spit on by the same old demented guy. Waste of time - you don’t need to be seen in the ER to make a report - go to employee health next time they are open.
Patients who come in to be admitted for elective procedures - but insurance won’t pay for it unless it is an “emergency”.
People who need a work note when they missed work for some minor reason
Drug Seekers - don’t get me started
Young healthy psych patients who need to come in for “medical clearance” - Bah!
People who stub their toes but can still walk on them. Sorry kids, there is nothing to do except buddy tape them even if they are broken!
Nursing home patients who are DNR getting sent in to die. So the home’s in patient death rate stays low.
People with chronic medical problems who need to be seen in the ER first so they can be referred to the clinic.
Patients sent from their FMD office on Monday at 4:30 pm for a cold they had over the weekend
Medication re-fill
Pts who have already resolved the problem at home but still come to the ED anyway… e.g. kid had a temp of 100 at home, gave tylenol, temp came down to 98 but mom wants to be sure so brings kid in anyway.
In defense of the floor staff - when I was bit by a patient many years ago (on my first day as a CNA), they required me to go to the ER. I thought that was a bit silly. I went in, the doc looked at the bite and said “Looks painful. Go to employee health and get your blood drawn. Bye.”
As for the lacs and URIs: I absolutely think they belong in the waste of time category in most cases. These are problems that should be followed by a PCP or Urgent Care Center - not an ER.
In my experience as a nurse, I think that I could probably count about 35-40 percent of my patients as official wastes of time. When I’m working in Fast Track that number goes up considerably.
Interestingly, it seems to be the wastes of time that manage to come in by ambulance, while the real emergencies meander in POV 2 days later.
biggest waste in our ed is toothaches. haven’t seen dentist for last 5 visits for same problem. some even call ambulance.
defacs checks. mom gets certified letter and visit from social worker on friday and tells her that she has to have child eval. before monday appt. mom brings child in sunday pm during mass influx of other non-urgent, need work excuse for tomorrow pts, and then proceeds to gripe about the wait time. one mom even literally said that she was going to tell defacs about how long it took to have child’s physical!
Hey, I went to the ER for a stubbed toe a couple years ago! Yes, it was broken, but I thought it was a metatarsal that was broken. I put on a shoe to mow the lawn (as you all know, wearing shoes would prevent a huge percentage of lawn mower injuries) and something bent that wasn’t supposed to. I cringe just thinking about, although the endorphins weren’t bad. lol
Has anyone encountered someone like this? I have a relative who got a divorce some years back and her ex-husband had to pay the kids’ medical bills. So, she would find a way to take the kids to doctors almost every day (among other things, she found a doctor who diagnosed them with ADHD without examining them - every city has at least one - and insisted on weekly visits and refills so he would have more copays) and would take them to the ER, even if they weren’t sick, just so he would have a bill to pay.
I’m guessing she stopped doing this because the kids said they would rather do other things besides go to doctors all the time when it wasn’t necessary.
p.s. As for toothaches, we’ve had several patients in the ICU in recent weeks with dental infections. Makes me wonder if they preferred their iPhones, cigarettes, sculptured nails, etc. to seeing the dentist? I don’t know if these people had “meth mouth” which is a huge problem in this area.
The private EMS service I used to work for thrived off of nursing home calls. A typical shift would include 12-16 nursing home patients sometimes, half of which were being sent to die at the hospital. The other 25-percent were drug seekers and the rest had chronic illness.
My blog is loosely devoted to answering to this question…
LOL! Indeed, Nurse K!
RE: Mortality rates and nursing homes:
To assume that is why nursing homes send patients to the ED takes a lot of assuming. How are you going to know the potential administrative reasons from your perspective in the ED? It is impressive that you know what the Nursing home administration is thinking from the ED. Or is this just some wild speculation without a basis in reality? Have you worked in a nursing home? Do you talk to the people who work in nursing homes to truly find out their thought process, or do you just skim the paperwork as the ambulance rolls thru the door?
There are several other plausible reasons for why imminently dying patients from nursing homes get sent to the ED:
Lack of staff at the nursing home
Lack of hospice involvement with that patient
Believing there may be something reversible
Having a transfer demanded by the family
Having a doctor who does not know the patient well on call and makes an ‘easy’ decision to transfer to the ED rather then think through the problem. Why don’t you place some of the blame on him?
etc. etc.
The ED always forgets how many patients ‘could’ have been sent there but were instead kept and well cared for at the nursing home. Please open your mind next time before thinking the worst of your health care brethren. It is this sort of divisiveness in the medical field that contributes to the inefficiencies in our care. Maybe consider being proactive with some of your local nursing homes to come up with some ideas to prevent what you deem as ‘unnecessary transfers.’
Yes, NH RN, I know that we never hear about the ones that weren’t sent in (just like PMD’s who get annoyed with a late night phone call never know about the ones we dealt with ourselves), but my point is that with some degree of certainty, I can expect to see at least one or two severely demented, bedbound, decub-ridden, DNR (and occasionally Do Not Hospitalise)patients during a shift. In most cases, when I call the family about the impending demise, they were never informed by the NH about the transfer. They arrive just as their loved one is leaving this earth. This could have easily taken place in the NH which I am sure is a more pleasant surrounding than a noisy ER with drunks and psych patients shouting about. It’s not like the family requested the transfer or rescinded the DNR. I suspect ulterior motives….
NH transfer of the century:
NH sends a short-stay rehab patient in **BY COPS**, in handcuffs, (not EMS) on a psych hold for “agitation”. He’s acting all crayzee and yelling and whatnot. No history of agitation nor psych issues (not that I’d know because they didn’t send any paperwork with except a transfer form which said “agitation” as reason for transfer and a blank vital sign section), and the patient was just admitted there earlier in the day. I plop him down at my desk and, hm, sats on room air=75%. Agitation resolved with administration of O2.
He was just admitted to rehab after d/cing from the hospital with, you guessed it, CHF and pneumonia (including 2 week ICU stay).
God, NH nurses can be so stoopid. Sorry.
“As for the lacs and URIs: I absolutely think they belong in the waste of time category in most cases. These are problems that should be followed by a PCP or Urgent Care Center - not an ER.”
I agree, BUT…the medical care and employee system is not set up to use common sense.
It is common to wait 5 days for an appointment with a PCP. Also, my town (2nd largest in Michigan) just got an Urgent Care center just 4 years ago. We never had one before. So, in some cases, an ER is all that’s left.
In many employee situations, if you miss work 5 days in a row, you’re fired. Thus they need to get the URI taken care of right away. If you try to stay at home for 5 days waiting for your PCP, or to get better on its own, your employer can accuse you of “ignoring the issue”, and claim you were just at home for no reason. No doctor note = no proof of illness.