Yup--lots of fine folks using the ED for everything EXCEPT for what it was intended to do...
Yup--lots of fine folks using the ED for everything EXCEPT for what it was intended to do...
Facts matter...Feelings Can Lie
or for runny noses, mild rashes, non-urgent dental issues like a broken denture, post-operative visits, routine check-ups, etc.....
Facts matter...Feelings Can Lie
I read a similar article about a different city, where the top user had logged 400+ ED visits in a year. He was a homeless man with some chronic health issues. From a dollar standpoint, it was a lot cheaper to set him up in an apartment with a caseworker than to have him on the street being picked up every night.
I had a loser with a tooth ache that wanted an ambulance ride to the ER at 0300hrs. I just drove him there in the patrol car and dropped him off. It always seemed to go beyond being poor. There are a lot of poor hard working people that do the right thing. Then you have the parasites. They not only don’t have a job but they don’t have an alarm clock. Not to mention a garbage can, wash basket, or a bed. The mattress is on the floor, the garbage pile in a corner and the dirty wash is piled in another corner. But they have drugs, beer, 100 pair of sneakers, and a huge TV
Did I mention I'm thinking about anesthesia ?
As you mention, it is important to not forget that a lot of people who are ED frequent fliers are capital-S Sick. A lot of it can be sourced to a complex and unnavigable psychosocial morass (eg undocumented immigrants taking K+ supplements so they will be eligible for dialysis through the ED) . Hard to be mad at folks like that.
Sure there are the worried well but that's what triage nurses are for. The ED i am most familiar with does not get very many of the worried well. Anecdotally what ends up being a bigger issue are 911 calls on the homeless observed to be "found down" (aka sleeping where they usually sleep) and EMS brings them in after bystander 911 call, turns out they're intoxicated, need to sober clinically before they can be d/c'd....
The ED is also the front line for the overwhelming number of untreated psych patients in socioeconomic distress (homeless, institutionalized, disabled, all 3...), who place an identical burden on 1st responders; itself a massive issue.
Last edited by Nephrology; 05-30-2019 at 10:02 PM.
And some don’t know any better. My students thought nothing was wrong with going to the ER for minor complaints because such was the practice in their families and had been for generations. Also they did not understand the concept of triage and would express outrage when others were treated ahead of them.