Any down side to 0 wait at ER?

[pyroknight]

The one up side to "paperless" systems is the ability to quickly identify the system abusers. You still have to see them, but you can be much more stingy with narcotics (it is not uncommon for our docs to advise frequent fliers to use ibuprofen) and you can avoid repeating complete workups every single visit. If a patient has had the same complaint twice a month for the last six months and they've had a CT and an MRI and yada yada yada, you can run a couple of labs, tell them what the doc told them last visit, and send them down the road.

[Just Plain Ruff]

how bout this one.

patient calls the doctors office, they can't get them in for a sore throat or whatever and the doctor's office tells them to go to the ER.

It's not an emergency yet the doctor's office tells them to go crowd an otherwise crowded ER.

[pyroknight]

I just triaged a guy with Strep that had been discharged less than two hours earlier. This guy got 2 L NS, Bicillin IM, Rocephin IV, Dilaudid IV, and anti-emetic IV. He was discharged with a "pre-pack" of oxycodone and a prescription for more. Do you think he could suck it up and whine and snivel on his couch while popping oxycodone? Oh NO! He had to return to the ED because he was not miraculously cured within two hours of his first visit.

[rayemtjax77]

Talk about your abuse of the system.

[tniuqs]

I cant see any community or MD opening themselves up to litigation, by allowing their EMS personnel to treat and street.

whit72:

Look a bit futher NORTH, like beyond your Borders, it IS happening now... granted a different Legal System and fewer litigators too.

ps please keep them, (lawyers that is)

cheers

[tniuqs]

I just triaged a guy with Strep that had been discharged less than two hours earlier. This guy got 2 L NS, Bicillin IM, Rocephin IV, Dilaudid IV, and anti-emetic IV. He was discharged with a "pre-pack" of oxycodone and a prescription for more. Do you think he could suck it up and whine and snivel on his couch while popping oxycodone? Oh NO! He had to return to the ED because he was not miraculously cured within two hours of his first visit.

FOR STREP????? WTF?

OMG can you say ABUSER in so many ways! The ER doc needs HIS Head examined is he asking for an OD too or is this guy a roided out and a wrestler, perhaps with homicidal thoughts.. ???

Oxycodone and Dilaudid for a sore throat...yea keep the customer happy...right then.

So did this Patient drive home or take the red and white taxi as well ?

[Richard B the EMT]

Did you say a 60 something bed ED? My primary Trauma Center, counting all of the ED beds, doesn't have that many! And the 2 local EDs have 2 cardiac beds each, with one having 2 beds primarily used for fractures, the other has 2 pediatric beds, each totaling about 16 to 20 beds total.

My god, how much does that hospital charge, either the patients directly, the private third party insurers, and/or the public assistance?

[pyroknight]

FOR STREP????? WTF?

The patient WAS in obvious distress, but was also obviously a big pussy.

OMG can you say ABUSER in so many ways! The ER doc needs HIS Head examined is he asking for an OD too or is this guy a roided out and a wrestler, perhaps with homicidal thoughts.. ???

Her (a nurse practitioner and former flight nurse) head is usually screwed on pretty straight. This guy had little scabs all over his arms. I pegged him for a meth user, but she believed his story about bug bites and his adamant denial of illicit drug use. I still think the "bugs" were under his skin and in his head.

Oxycodone and Dilaudid for a sore throat...yea keep the customer happy...right then.

Our ED doles out oxycodone prepacks like candy. Hey, I only have RN after my name. What do I know?

So did this Patient drive home or take the red and white taxi as well ?

Ambulance transports out of the hospital (excepting to the airport for medevac) are, thankfully, extremely rare in this community. He ambulated into the ED both times. He had a friend pick him up after the first visit, so I presume he was at least securing his own transportation. Small miracle.

[Ridryder 911]

FOR STREP????? WTF?

OMG can you say ABUSER in so many ways! The ER doc needs HIS Head examined is he asking for an OD too or is this guy a roided out and a wrestler, perhaps with homicidal thoughts.. ???

Oxycodone and Dilaudid for a sore throat...yea keep the customer happy...right then.

So did this Patient drive home or take the red and white taxi as well ?

Maybe and then maybe not. We all know that some analgesics are given out easier on some instances than others. As well, Strep can be severely painful, and yes... I have seen analgesics administered and rightfully so. Remember strep can infect and yes kill.....

JCHAO and other well defined medical authorities have emphasized that patients should be .. as much pain free as possible, and directed to.... Patients are asked upon discharge pain level (0-10). Our policy is that anything greater than 3 has to be addressed by the physician before discharge, if analgesics are not administered or prescribed, then it has to be documented why it was not ... not why it was.

Also, it is much easier to prescribe and hopefully ..satisfy.... than to have to see them again the next shift. As we know, that does not always work.

R/r 911

[Just Plain Ruff]

FOR STREP????? WTF?

OMG can you say ABUSER in so many ways! The ER doc needs HIS Head examined is he asking for an OD too or is this guy a roided out and a wrestler, perhaps with homicidal thoughts.. ???

Oxycodone and Dilaudid for a sore throat...yea keep the customer happy...right then.

So did this Patient drive home or take the red and white taxi as well ?

Actually I was that patient about 6 years ago. I had strep, I had a nearly completely occluded throat which made it impossible to swallow. My temp was 104.3, my white count was 25000 and my strep screen was positive.

I got 2 liters of NS, no pain meds except toradol and Rocephin and Penicillin. I left the ER feeling so much better.

It did help that I worked there and had never taken a sick day in the 2 years of my employment so they knew if I would drive 60 miles to get there from my house(i lived in a different town than the hospital was at) that I was sick.