ER hoppers

Lately there has been an explosion of ER hoppers in our ER. What are ER hoppers? They are those patients who yesterday, two days ago or whatever went to another ER but felt the need to come to our ER this time. They have various reasons for doing such an idiotic thing. The seven deadly sins. Among them:

1) I didn't get any pain meds for my neck injury from an MVA 2 weeks ago at the other hospital and I'm hoping you will be nicer.
2) I had surgery last week at another hospital, now I am having problems, and your hospital is closer.
3) I didn't like the way they treated me at XYZ hospital.
4) The wait was way too long at the other place
5) I want a second opinion.
6) They didn't do anything for me over there.
7) Family is not happy with care of other doctor, hospital, etc.

ER hoppers are sometimes dumb enough to tell us they were at another hospital. Then there are those who don't. They think we won't find out. But BEWARE, these days we can see if you have been to another hospital in our system. We are also connected to other hospitals as part of a network that shares info, with your kind permission of course.

When I ask people why they didn't go back to the hospital that treated them before, did surgery on them, they are often offended, like I shouldn't ask that. It should be okay to come to a hospital that has no records of your surgery, history, etc. Sorry if I think thats stupid.

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Martha Stewarts fat lip - its not a good thing

Poor Martha Stewart. Her dog jumped up and gave her a fat lip and a cut. What did Martha do? She called the police to give her a ride to the hospital. Apparently she couldn't drive herself or get someone to drive her. You know, I don't think the police would drive me to the hospital if I called them.

Another call Martha made was to someone else so they could have a plastic surgeon come to repair her laceration. I'm sure Martha went straight back, was seen right away....do not pass go, do not collect $200. I don't think I would have got back that fast and an ordinary ER doc would have stitched me up.

This is the kind of stuff that drives ER nurses nuts. Some people are given VIP treatment. We will get a call periodically about so and so is coming in and they just want to LET US KNOW. Or someone will call one of our docs and tell them some "VIP" is coming and we are supposed to take them DIRECTLY BACK TO A ROOM.

Our thought: Every body should be treated the same. We don't like treating certain people special. ER is one of those places where everybody should be equal.

20 lashes with a tourniquet

What is a nurses priority in a hospital? Giving great patient care right? Wrong. To me, these days, it feels like documentation is the most important part of my job. The emphasis now in the hospital is have you filled in all the blanks on the computer that you need to in order to be compliant with JCAHO, Medicare, etc. Have you documented location, quality, aggravating factors, level of pain? After giving pain meds did you revital and redo level of pain 30 minutes after? Did you do discharged/admission vital signs? Did you reconcile all meds and record last time the med was taken? Did you fill in all of the many blanks around conscious sedation? Did you do the proper trauma charting so that statistics can be gathered? Screen for MRSA, VRE, TB. Did you screen the patient for potential abuse, suicidal thoughts? And these are just a few.

I spend the majority of my time doing documentation these days, crossing t's, dotting i's, filling in the myriad of blanks that need to be filled in. My documentation is tracked and if I don't do it right, I am given a note. A naughty nurse note. If it happens again I am placed in the staff time out chair in the middle of the ER. A third time? 20 lashes with a tourniquet.

o if you wonder why the nurse doesn't come in your room that often it is because she is out there documenting all the things that are required.

home james!

I wonder if other states have this service: cab rides for those on medical assistance. Everyday in our ER there is literally a line up of people under age 30 calling to get a cab ride home from the hospital. Now mind you these are not disabled people. These are able bodied young adults who are eligible for MA.

They get on the phone and wait for 15 or 20 minutes for someone to come on the line. Usually we have to verify that they were really there. Then they sit there and wait for the cab. I am amazed at the time people will spend setting this up. They could have walked home before it was all complete.

If you are a working person who makes too much for medical assistance, sorry you are going to have to take a bus, get a ride or walk. You are chopped liver. I was telling a co worker that we should open a medical limousine service for those on medical assistance. All we would do is transport those on medicaid around in style. No doubt we could get a big fat contract with the state..

Perhaps the government could stop this kind of stuff to reduce the deficit. What a country.

the ER patients creed

What a winter. There has been snow on the ground since November. Some of it melted earlier this month but was replaced sunday and monday with another 14 inches. Whoopee. Of course I had to work Monday. Even though I live in a state where this goes on every winter, lots of people call in to say that they can't make it in to work. I don't have that option, living in the city and only about 10 minutes away.

You would think that people, especially those from the neighborhood who walk to the hospital, would stay home unless they were having a true emergency. Au contraire mon ami. They make it there with there silly complaints. THey remind me of the postman.

"NEITHER SNOW NOR RAIN NOR HEAT NOR GLOOM OF NIGHT STAYS THESE CHARACTERS
FROM TAKING THEIR GOOFY SELVES TO THE ER FOR THEIR PERCEIVED EMERGENCIES."

Perhaps that should be engraved somewhere. I mean really would you tromp through the snow, spend a couple of hours in the waiting room, for a cold? Of course you wouldn't because you are normal and you have a life.

naughty little monkeys

TO ALL STAFF:

You are naughty little monkeys. Complaints are coming in left and right about how you are treating the patients and visitors like shit. Your attitudes stink. Your behavior is abominable and you are rude little jerkwads. What am I going to do with you? This is an order to cease and desist. It is not an option to continue to act like you loathe our patients, even if you do.

Excellent customer service is the hallmark of this institution. When you are busy, all it takes is a smile to reassure that troubled individual screaming at the triage window. That smile tells the patient you are doing your best.

If you have any questions, suggestions, comments, sarcastic remarks, I am available from 6:30-6:45 AM Tuesday February 29. Meanwhile, I'll be in my office.

As always, thank you for all you do for our patients.

THE MANAGEMENT

medicare fraud in your town

there was news last week about 111 people arrested around the country for medicare fraud. Read about it HERE. Aren't the unnecessary tests we see ordered in our emergency rooms every day fraud? Medicare defines one area of fraud as inappropriate or unnecessary testing......

integrity thy name is madness

Well imagine my surprise last week when I was called into work for a "meeting". Naturally I thought: uh-oh I am finally going to get fired for my attitude. So I arrived at my managers office and he took me to a small conference room in our department. I thought, geez, do they need a committee to fire me? Why do we need more space? I opened the door and a flashbulb went off and there stood the CEO with a big smile on her face. She was holding a trophy. What's this? I am being awarded a trophy for character and integrity?!! Yup its true, me, old madness was finally, after all these years, getting the recognition for the impeccable way I have tried to conduct myself for years. There were many times I could have done the wrong thing - I had many moral choices to make in my career - and damn it if I didn't always choose the path of integrity. As you can see I was stunned with this development and maybe a little suspicious. It is so nice to be recognized after all these years. I especially like the little tiara they provided.

code brown

What's better really than cleaning up a giant pool of diarrhea from under the body of a 300 lb man or woman? This is why I went to nursing school. This is why I worked hard to pass chemistry and microbiology. So I could hold my breath while I sopped up your poo poo.I live for this shit (pun intended). There are worse jobs than mine - I could be working in the laundry that receives the linens from the poo poo patients. There is a BAD job. There is always a job worse than your own.

Can you tell its been a bad week? Every day worse than the next. People in the hallway. People being held in the ER. Waiting room full of PEOPLE. PEOPLE, PEOPLE, PEOPLE. Just when you think you are caught up in triage, a few more PEOPLE. Go away PEOPLE. Go home to your own toilets. You have a virus. It too will pass, There is no need for you to come to the ER for your VIRUS. Tough it out at home. You can do it. The world is not ending because you vomited a few times, made a few trips to the bathroom.

If the world did a simple thing like WASH YOUR HANDS a lot of money would be saved and a lot of poo could be avoided and a lot of ER nurses could be happier. And believe me, you want the ER nurses of the world to be happy.

How was your week?

machine gun kelly and choclate chip cookies

ER docs come in many different varieties. Some of them could sell ice to an eskimo. Some of them pull up a chair to "talk". THen there is the machine gun kellys.

It is obvious that when ER docs train they learn to rule out the worst first (hey that rhymes) They want to know right off the bat whether you got something that could kill ya. Once they determine you ain't gonna die in the next five minutes they can relax and go to the doctors lounge for some cookies (har). Apparently they have to memorize a series of questions about stuff like chest pain, breathing, black or blood stools, headaches, unusual rashes, etc etc etc. I have heard the litany of questions too many times to count.

THe interesting part is how these questions are presented. Sometimes they are presented so fast that they can make the patients headspin:"doyouhaveanychestpainshortnessofbreathblackorbloodystoolsunusualheadachesrashesetcetcetc". Some doctors don't even have to take a breath during this recitation. The patient is left saying: "huh? what?" at the end. One doctor in our ER is like a machine gun. Its really kind of comical. Hey Dr Machine Gun I like chocolate chip cookies.

trash talking the boss

Here's an interesting case of someone who trash talked the boss on facebook (calling him/her a pyscho basically, was fired and the National Labor Relations Board ruled that her firing was not justified and interfered with a workers right to free speech. Did she get rehired? No. Will she have a hard time getting another job? Yup. SO will it be open season on bosses online? Who knows.

Here's the article from CNN Money dated February 8, 2011 by Julianne Pepitone

NEW YORK (CNNMoney) -- A Connecticut ambulance service that fired an employee for posting negative Facebook comments about her boss has settled with its former worker, resolving a case that was poised to test new legal ground in labor law.

In October, National Labor Relations Board filed a complaint against American Medical Response of Connecticut over the firing of employee Dawnmarie Souza. A hearing in the case had been scheduled for this week.

The case received widespread attention for its groundbreaking attempt to set legal limits on employers' Internet policies.

The NLRB said AMR's Internet posting policy was "overly broad" and "contained unlawful provisions." The complaint called out a specific AMR policy that prohibited employees from making negative remarks on the Internet about the company or its employees.

The NLRB said that policy was in violation of the National Labor Relations Act, which gives employees the right to discuss "the terms and conditions of their employment with others."

As part of the settlement, AMR said it would revise its policies so they do not "improperly restrict" employees from discussing their employment outside of work.

The allegations involving Souza's firing were resolved in a separate agreement. Details were not disclosed.

rich ER, poor ER

Another "free standing ER" has open in our metro area. This one is owned by a hospital in the area but is not affiliated with this hospital. Another place opened in the last 6 months but it is only open 12 hours a day. This one will be open 24 hours a day.

I am fascinated by all of this. Is the move to a two tier medical system? These places are in the suburbs where people tend to have insurance. Because they are freestanding they are not subject to EMTALA regulations, in other words they can refuse to see you or they can make you pay up front. These places make more money than the other ERs because insurance pays more than medicaid/medicare.

The thing is if this is the future of emergency medicine, will hospital ERs become the place for the poor to get care and the free standing places for those with insurance?

Shouldn't these kind of developments be a sign to legislators that EMTALA needs to be revamped?

a new day dawns at the madness blog

All previous posts have been eliminated. Why? I have decided to turn over a new leaf and become a nice nurse who never says anything bad about anything or anybody. Yes I intend to take on the persona of one Florence Nightengale, champion soother of brow, well known reliever of pain, and general righter of wrongs. I shall go forth from this day to heal the sick, comfort the dispossessed......Im sorry I jus' ain't got it in me, I can't do it. I am evil at heart..rotten to the core as it were.

You may have made your daily foray to the madness blog earlier today and found that it was unavailable. During that time, I was contemplating the meaning of blog life. I came to no conclusions...anyway...moving on..

So today sucked. Big time. I got there and there was chaos in triage and it only got worse as the day went on. People were coming out of the woodwork with their tales of woe, tragedy and general mayhem. These people were sick. They weren't your average stubbed toe or puncture wound. At one point I had four people who NEEDED to go back and there was absolutely no place to put them. That's a really bad feeling for a triage nurse. Its a shit, what do I do now feeling? Its a please nobody go down the toilet feeling. We somehow managed by going on divert. By the evening it was dead.

Now it can be complete chaos and you will always have that one person appear at the window to ask why they haven't gone back yet. Usually they are the one with the stubbed toe. When you tell them the whole "triage" concept, they look at you like you are from outer space, can't quite grasp it.

And so another day in paradise...can't wait til tomorrow...