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.

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.

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.’

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.

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!

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.

Medication re-fill