SNFs dumping patients...

[VentMedic]

spenac,

I'm trying to get a gentler attitude. I must admit the expression on the faces of some EMTs and Paramedic students is priceless as they recognize me when I show up to teach a class. It is usually after they have tried to give me some sh*& attitude in the ED. Of course all of us hospital people look alike and are all nurses.

[Just Plain Ruff]

for the circling the drain comment, many times the nurse cannot get ahold of the doctor to get the order to transport unitl it's nearly too late.

If you think that the nursing home is putting the patient in jeopardy there are phone numbers to call to express your discontent but be sure to have all your ducks in a row. Remember, many times your nursing homes are your bread and butter and if they are pissed at you watch out.

Accusations of scam are hard to prove.

If you can't prove it, then stop bitching.

[VentMedic]

for the circling the drain comment, many times the nurse cannot get ahold of the doctor to get the order to transport unitl it's nearly too late.

I'm going to side track us a little. Everyone has brought up some valid points and there are plans of action in place now to at least prevent some errors, unavailability of doctor or doctor not responding to the urgency and many other potentially harmful situations. I am most familiar with those in place in the hospitals but I have heard about the LTC facilities now developing some of these plans. itku2er might be able to provide that information.

The programs are through the Institute for Healthcare Improvement.

http://www.ihi.org/ihi

This used to be the 100,000 Lives Campaign and it is now the 5 Million Lives.

http://www.ihi.org/IHI/Programs/Campaign/

The website is full of information about issues that affect the patient's well being.

In many hospitals, including mine, Rapid Respone Teams (in addition to Code Teams) have been developed to respond to patients before they code. We have a huge SNF and Sub-Acute attached to the hospital so the Rapid Response Team can go there as well as Dialysis and all of the med-surg floors. The team consists of a Respiratory Therapist and ICU RN. We essentially act as an EMS team carrying bags of equipment to set up a mini ICU where it is needed. The team acts under the extensive protocols of the ICU which is under the direction of the Intensivist who needs not respond unless requested by the team. We do whatever is necessary to stabilze, order labs and intubate if needed. We will remain with the patient until we can move them to a higher level of care. This may create another issue that may have caused this patient to fail or the system had failed the patient. There is no room in the ICUs and the least critical patient will have to be triaged out. Patients may not get an ICU room when they are needed and somehow get placed on med-surg. If they do make it to ICU they may get pushed out too early to make room for another patient from either the ED or the floors. Thus, the med-surg RNs who have a higher patient to RN ratio will now have high acuity patients.

It becomes a vicious cycle. We put the priority to get a critical patient from the med-surg floors but that may mean bumping a pt in the ED. Hopefully the ED has RNs capable of handling even a ventilator ICU patient for awhile longer. But, the ED staff is stretched and a back up happens. Yes, it is frustrating when something that seems rather simple comes into the ED but there are other frustrating events happening all at the same time.

RNs also kick themselves if they skip over a patient that they know should have gotten more treatment. Every RN knows the danger of a decubitus ulcer yet will also groan when someone presents with one or is at risk in the ED. That, too, is not the glamorous side of ED nursing but most still know what must be done and done correctly.

And no, when a patient codes in many hospitals, there is not always an abundance of help around. I would dare say there are more ALS providers on most prehospital medical scenes in Florida or California than available RNs and RRTs in a hospital. I say available because not everyone can abandon their ICU patients and run down 2 floors for a code. Often it may be just an ICU RN, RRT, CNA (hopefully) and the patient's nurse. The charge RN will be making phone calls and the others will have their own patients. The exception might be a teaching hospital but then the ICU RN and RRT will be carrying the load many times depending on the level of resident.

We are not oblivious to the problems and those of us who work in NHs, SNFs and hospitals are trying our best to provide quality care. But, sometimes it seems like the cards are stacked against us. Yet, dedicated staff still return to their work place to take abuse from all (patients, MDs, EMTs etc) while trying to smile for that little elderly person who had to give up everything including their independence.

So when you think you have it rough taking care of one patient, think about what goes on behind the walls of a hospital or SNF when it is only a handful of licensed providers for many patients with many different needs.

Back to the program.

[Don1977]

Uh yes nursing homes, dont get me started, I deal with them everyday at work.

[Richard B the EMT]

Circa 1975-1977, the ambulance service I was then with did a lot of inter facility transfers from nursing homes to hospitals.

One in Manhattan sent out one patient for a supapubic (spelling?) tube to be changed. The ER nurse at triage told us they'd push us into "fast track" to do the replacement, and as the procedure was done on our ambulance gurney, another ER nurse said to me,

What is wrong with those (facility) nurses? Couldn't they do this themselves?

Then, with the patient remaining on our gurney the entire trip, treatment, and return trip, on arrival back at the sending facility, a facility nurse commented to me, about the ER nurses,

What is wrong with those (ER) nurses? Can't they see how sick this patient is?

For once, I kept my big mouth shut.

A side note here: this was one of the bad facilities, where you could smell the urine stink from the patient floors before the elevator doors opened onto them.

[john_boston]

Note I said nothing about lab results, nor my (nonexistent) qualifications to interpret them. I specifically complained about BS reasons for calling an ambulance, not about the very idea of doing interfacility transfers.

Also please note that I wrote "and, worst of all, the patients have to suffer the agony of being loaded and unloaded repeatedly, coming in and out of all types of weather, and wondering what the hell is going on the whole time." My point was that it's the patients that suffer most when corporate SNFs dump patients to the ED without a valid complaint.

How so much I didn't say could be magically inferred from what I actually did say...I do not know.

[VentMedic]

Note I said nothing about lab results, nor my (nonexistent) qualifications to interpret them. I specifically complained about BS reasons for calling an ambulance, not about the very idea of doing interfacility transfers.

Also please note that I wrote "and, worst of all, the patients have to suffer the agony of being loaded and unloaded repeatedly, coming in and out of all types of weather, and wondering what the hell is going on the whole time." My point was that it's the patients that suffer most when corporate SNFs dump patients to the ED without a valid complaint.

I guess you don't have much experience yet with elderly or confused patients.

If you know nothing about lab values or if the patient has altered mental status, how are you the one to determine it is BS?

Also, did you know that many facilities may be obligated to hold a bed for 7 days for a patient AND NOT get paid during that time. It is not always in their best interest to ship patients out unless it is necessary AND ordered by the physician.

Again, if you want to file a complaint, go ahead. But, as stated before, you better have your ducks in a row. Lab values will also be part of the file that will be in question. Hopefully your extensive understanding of medicine from your 110 hours of EMT-B training will be of use in court against the orders and education of a physician.

BTW, my previous long post would probably have been better under the crowded ED and pts in the the hallway thread but that article had not been published when I wrote that post. I just know that it is a problem we have been trying to cope with for a long time. I also know it doesn't help matters when some hospital staff keep going on strike, in union country, for as long as 10 days which delays many procedures and further extending the patients' hospital stay.

[spenac]

I guess you don't have much experience yet with elderly or confused patients.

If you know nothing about lab values or if the patient has altered mental status, how are you the one to determine it is BS?

Also did you know that many facilities may be obligated to hold a bed for 7 days for a patient AND NOT get paid during that time. It is not always in their best interest to ship patients out unless it is necessary AND ordered by the physician.

Again, if you want to file a complaint, go ahead. But, as stated before, you better have your ducks in a row. Lab values will also be part of the file that will be in question. I wish you luck taking your 110 hours of EMT-B training into court against the orders and education of a physician.

BTW, my previous long post would probably have been better under the crowded ED and pts in the the hallway thread but that article had not been published when I wrote that post. I just know that it is a problem we have been trying to cope with for a long time. I also know it doesn't help matters when some hospital staff keep going on strike, in union country, for as long as 10 days which delays many procedures and further extending the patients' hospital stay.

OK Vent again in defense of John at times BS is just BS. Often there are no labs, nothing. Then get to the ER and they have no clue why patient was sent by the nurses. Here nurses can call w/o waiting for the doctor to tell them to call. Sadly it is usually the mentally challenged patients that the nurses and nurses aids are frustrated with. The patient suffers from all the extra handling. Myself I treat the patients as if they are my family because it is not their fault that the nurse is not willing to do their job. No this is not a bash of any type of nurse except the bad ones. There are bad lazy nurses, doctors, paramedics, emts, plumbers, fire fighters, etc. So sometimes BS is just BS. John just wanted to vent his frustration at some bad calls by the nursing homes. He never said or at least I never took it that he felt all were bad nurses.

While education is very lacking in EMS it doesn't take a rocket scientist to understand that some things are just plain BS.

So play nice Vent, if I can do it so can you.

[VentMedic]

spenac,

I'm sure he appreciates your support. But, have you ever been on the other side to hear the dumb arse comments that continuously escape from some that do drag down EMS professionals?

We may see easily 75 ambulances with NH/SNF/SA transports in one 12 hour shift. Majority of them are minor BUT THE PATIENTS STILL NEED CARE THAT CAN NOT BE PROVIDED AT THE NH OR SNF. BS comments are not always warranted if you do not have the whole picture or can even carefully evaluate a small part of the picture.

As someone who can be involved in sending patients and receiving patients by way of EMT(P), I would also like to vent my frustrations and that of the RNs who work with me who must take crap from EMT(P)s at least 10 of those 75 NH/SNF/SA transports every shift. I am embarrassed for the EMS profession when they come up with excuses and comments that have NO PLACE as a medical professional and are just showing how little education/training they have in many cases.

Yes, a foley catheter change might seem like bullsh&* to you but it is definitely not BS to the welfare of the patient. Yes, a temp of 38 may seem meaningless to you but may not be in the broader spectrum of things. Altered mental status may seem like BS to an EMT(P) but it can mean something else needs to be examined. If the EMT has never met this patient before, how do they know what their mentation is like yet they continuously argue with RNs who have been with the patient every shift and maybe for several years.

Yes, I know there are lousy care givers in all professions but that doesn't mean we give people the license to bash other professionals especially if their own knowledge of medicine is incredibly limited to just a few hours of "training". Even if I'm wearing another patch in the hospital, I still have a vested interest in this profession. The next day I may see these same doctors and RNs when I'm wearing my Paramedic patch and do not want them to think all of us in EMS are going to display the same lack of manners and intelligence.

From the posts, John_Boston seems to be just starting his career and is too new to start with the BS crap and sound so frustrated. It makes me wonder what type of "postive" mentoring he has had. Maybe when he is your age :wink: he might have a little more experience and knowledge to his credit. Until then, he should be focused on learning as much as he can, including lab values, and not waste so much effort finding fault.

As always I do respect your opinion spenac and I will try to play nice in the future.

[spenac]

We may see easily 75 ambulances with NH/SNF/SA transports in one 12 hour shift. Majority of them are minor BUT THE PATIENTS STILL NEED CARE THAT CAN NOT BE PROVIDED AT THE NH OR SNF. BS comments are not always warranted if you do not have the whole picture or can even carefully evaluate a small part of the picture.

From the posts, John_Boston seems to be just starting his career and is too new to start with the BS crap and sound so frustrated. It makes me wonder what type of "postive" mentoring he has had. Maybe when he is your age :wink: he might have a little more experience and knowledge to his credit. Until then, he should be focused on learning as much as he can, including lab values, and not waste so much effort finding fault.

As always I do respect your opinion spenac and I will try to play nice in the future.

First I have transported several patients that the nurses could have done what was needed for the patient. So this means the call was total BS. The only one that truly suffered was the poor patient that spent so much time in the vicious yo-yo. Now attacking the nurses or even complaining at the hospital doesno good. Sadly though we are often the ones that are chewed out by the ER doctor for wasting ER resources on patients that need nothing, but sadly I now primarily work at a you call we haul service. I miss my old job where I had the right to tell the doctor that came once a week to the local clinic no if his patient was not a true emergency. Sorry drifted for a minute.

You are right though our young friend may have been badly influenced by providers that think all nursing home calls are a waste of time and our skills. I have seen medics that think that way and it makes me mad. What if that was my parents? Treat all patients, especially those that no longer control their lives with love and respect. Do not let your anger at one of the bad nurses, doctors, vent techs , fire fighters, etc, cause you to ever take a patient for granted and miss something that could cause patient to suffer.

Respect me :shock: . LOL. Thank you.