Pt vs Medic knowledge of ER services

[Jeepluv77]

I just picked up the new issue of Reader's Digest because the cover said "50 Secrets ER Doctors Won't Tell You". Reading through, I came across something I found rather startling. An RN/Paramedic said patient's should know which ER they prefer because we may ask. Okay, that's a good point. However, she went on to say know "where the nearest trauma center is and with hospital has the best cardiac center". Our school teaches that it's our job to know this. So, I'm wondering, how many people feel that the patient should provide this info. I wouldn't expect someone in need of a trauma bay or cardiac services to even be able to think clearly enough to give us this info even if they are A&O. Any thoughts?

[FireMedic65]

It's no secret to non medical people that which facility has the best capabilities for which specialty. Although medical people will know this stuff, general public usually do as well. They know other people who have been to them, and they read the paper. People with an illness such as heart disease, will generally do some research to see who in the area will give them the best care.

[Kiwiology]

Generally speaking outside metropolitan Auckland we only one choice of emergency department.

Having spent time in metro Auckland I can tell you the destination is based upon patients condition, not where they want to go, it's a friggin ambulance not a taxi.

[armymedic571]

I think having a patient who is well informed as to the different medical services in the region is a patient that will want to be active their medical treatment. Although, I realize that this sometimes can be detrimental these people usually understand why your suggesting one hospital over another when it comes to the different specialty hospitals.. That is for those of us that have the luxury of having multiple hospitals available to us.

I think the important part is that if the patient is AOx3, the key is how you present yourself. People skills are still a very important part of this profession.

[Jeepluv77]

I agree that it could be helpful for a patient to know what is available. However, to make it sound like it is necessary for a patient to know is a little much. I had a friend(not in the medical profession) read it and asked her what her thoughts were on it. She said it was frightening to think that in an emergency the people taking her to the hospital wouldn't know the best place for her to go. That was my concern with it. By all means, it would be great if every patient knew exactly where they needed to be transported. That's not the case though. I live in an area that has several large hospitals available and a lot of different factors affecting which one to choose for a patient. Our top trauma center is an extremely busy hospital in a neighboring city while the Level 2 center(that operates level 1 during the day) in this city is usually well prepared, too. During the day, taking a patient to the one in this city is a good option. However, at night when some of there specialists aren't always there, it's not always a viable option. You're also looking at up to a 20 minute difference in transport time. Another example, one of the two major hospitals in my city doesn't have a maternity wing or NICU/PICU. Obviously, this may not be the ideal place to take a mother in labor or a very sick infant/child. However, in the case of that sick infant/child, if you pick them up 3 blocks from this hospital it may be prudent to bring them here for stabilization before making the 20-30 minute trip to the children's hospital(in a neighboring city) or level 2 center that has all services available. They do have ER doctors that hold specialties in pediatrics. For these reasons, it would be very difficult for a patient here to know where the best place for them to be in a given situation. It's often difficult for crews to determine that and units are often diverted for various reasons.

Note- The transport times listed are during good traffic conditions. During rush hours or with accidents on necessary road ways, these times are at least doubled.

[MS Medic]

There is a valid point to the idea of pts knowing which hospitals have what services. When I was going through basic school, I was doing an ER clinical at a hospital that had a world class obstetrics dept. but didn't have anything else going for it. A crew brought a STEMI pt in because he wanted to go to that hospital and the crew could not talk him out of it and other than lvl 1 trauma we transport to pt choice here. Well down the road about a 10 min drive were 2 hospitals with campuses butted up against each other who both had cath labs. This dude would not even stop at the er in either one of those places but coded in the ER because he insisted on that hopsital.

[cynical_as_hell]

Always transport to the closest most appropiate facility. That is our job. The way I look at it is, You called 911 because you felt that you needed our services so let us do our jobs and quite making requests. Like someone previously stated, we are not a taxi service. I have always felt that the people in our field are not going to intentionaly cause harm to a patient. If they transport to one hospital over another then there was a reason for it and that medic or emt only did what they felt was best for that patient at that time. The common community is full of a bunch of morons....that's why we all have jobs. Just like you can't believe everything you read on the internet, you can't believe everything you read in newspapers or trust that you will have a great experience just because someone else you know did. Circumstances determine everything.

[VentMedic]

The common community is full of a bunch of morons....that's why we all have jobs.

Actually it is because the people in the community are taking an active interest in their health care that these issues may arise. Insurances are also putting the fear of medical debt into their clients. For some cases such as a MI, you can asure the patient their emergent needs may be covered by their insurance at another hospital. People who have Kaiser insurance will be hysterical if they land in another facility regardless of how serious their emergency is. Also, as soon as the patient has had a cath or has been intubated and stabilized for whatever reason, Kaiser will insist their patient be transported to them.

Thus one has to be aware of the patient concerns and address them to the best of your ability but don't make promises. Granted insurance issues are not your concern except to complain about people who don't have any that ride your ambulance. Just considering the patient to be a moron and ignoring their concerns without at least expressing some interest in them even though you will still have to transport per protocols isn't exactly good patient care either.

My own insurance will not cover many emergencies if I go to a hospital out of network. It may be left up to me to prove I was going to die if I didn't go to the closest hospital. So your report had better reflect that since I will be sending out copies to the insurance and probably an attorney if the bill is significant to get copies of your protocol so the issue can be resolved. If I break a leg and cannot get to a network hospital by POV or taxi, I will be paying 50% of the bill. That may be 50% of $20k - $220k depending on the severity. If at all possible I would choose to be transported out of the ED by another ambulance to a network hospital but then that might not be possible without an accepting physician and bed availability. Since the ED also wants their bed back, I may be stuck at that hospital and going into serious medical debt.

Edited February 25, 2010 by VentMedic

[armymedic571]

let us do our jobs and quite making requests.

You know. I agree with you to an extent, but listening to our patients and letting them have input into their care is good health care. Fore Example:

You have a chest pain patient who needs a cath lab, but wants to go to a hospital that does not provide that service. It is better to help them come to the right decision by educating them, rather than hijacking them. Not only is that illegal, it would increase their anxiety level, which is just bad patient care.

It is your job to give the patient the best pre-hospital care available. But, it is their right to decide what care they do or do-not want.

[MS Medic]

Always transport to the closest most appropiate facility. That is our job. The way I look at it is, You called 911 because you felt that you needed our services so let us do our jobs and quite making requests

That statement is not always the case, per state protocols. In MS, with the exeption of trauma, a pt has the right to ask to be transported to any hospital they want that is inside the services transport radius, reguardless of the appropriateness of the choice. If you for force a pt to go to a hospital they do not want to, you can be charged with kidnapping. The only way around this is to have online direction telling you to go to a particular hospital. As long as the pt is A/O, you typically won't get those orders though.