Advocacy

Sasha

Sasha

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This probably will be more for IFT providers but anyone can chime in.

Do you think an ems provider fails to be a patient advocate if they leave a patient in a facility knowing that facility can't meet their needs? For instance a little old lady who tries to get out of bed but is a fall risk, previously restrained to the bed by lap belt, left at a rail free facility. A patient who has orders written for an air mattress due to skin break down or recent back surgery when the facility doesn't have an air mattress available? A STEMI to a facility with no cath lab?

Just a few examples.

What does patient advocacy mean to you? Do we have a moral obligation to violate Dr orders in favor of patient advocacy?
 
Sasha said:
Do you think an ems provider fails to be a patient advocate if they leave a patient in a facility knowing that facility can't meet their needs? For instance a little old lady who tries to get out of bed but is a fall risk, previously restrained to the bed by lap belt, left at a rail free facility.
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Depends on what the facility is doing to take fall precautions. A matress on the floor doesn't need rails.


Sasha said:
A patient who has orders written for an air mattress due to skin break down or recent back surgery when the facility doesn't have an air mattress available?.
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If I were to discharge a patient home with a prescription for an air matress and they didn't have one should they be prevented from going home?

Most people don't have a bunch of medical equipment lying around just in case. (Maybe we could start putting air matresses into personal jump kits?) Really though I do think it is reasonable to give a facility a day or two to procure what is prescribed for the pt.


Sasha said:
A STEMI to a facility with no cath lab?
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I don't think it is fair to compare transporting a patient to a care facility vs. a hospital. I think it is grossly negligent to take a patient to an ED that cannot help them.


Sasha said:
What does patient advocacy mean to you?
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It means doing what is in the best medical, social, and legal interest of the patient.

Sasha said:
Do we have a moral obligation to violate Dr orders in favor of patient advocacy?
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Violate is a strong term. Especially since the doc is at the top of the food chain and it is unlikely anyone in EMS would actually come out the better of that argument. The physician is also responsible for the long term care of the patient. So in that interest, having to occasionally choose between the lesser of short term evils may have to be done.

Is hindering the longterm outcome for a shortterm treatment patient advocacy?
 
Violate physician orders? I would never. However, a calm, directed, and educated discussion with the transferring physician is in order; whether in person via phone. If you can't contact them, call your medical control doc. I've arrived to many facilities with a patient they wouldn't handle (oh we can't restrain patients, oh we don't have an oxygen concentrator, etc). I'm positive that if the situation is explained well, no physician would argue that you should leave the patient in a facility that can't care for them and will be a detriment to their health.

I once transported a patient two times in one week out of an assisted living facility for a fall out of a chair or bed. I spoke with the facility manager each time and, to my disappointment, they never put in any effort for prevention/safeguards as to her fall risk. She was left alone in a chair all the time, and her bed didn't even have rails, let alone a bed alarm or mat on the floor. After I transported this lady back to the facility another time for a fall, I spoke with our medical director and my supervisor and subsequently reported them to the licensing board with our state. I think this was trying to "play nice" as a patient advocate, and eventually resorting to "extreme" measures to take care of my patient.
 
I've had to take patients back to the ED when the facility said they weren't eqiupped to deal with out pt. I tried calling the doc on the radio/phone, didn't get any answer so we just headed back to the ED with pt in tow.
 
A private EMS company primary goal is to make money. So as long as facility accepts the patients my hands are wiped and i do not care. This might sound harsh, immoral etc but at the end of the day it's all about money.
 
Reality Bites

You will often find yourself in situations where, having just made an incredibly effective move to enhance someone's life -- maybe even having saved it! -- you must discharge him or her into a nightmare.

(How many people do you know who you "brought back" that went on to live out their lives as "Cardiac Cripples"; forever tied to drugs, therapies and institutions, in constant pain and immobile? It's the ones we DON'T know about that would probably drive us to despair!)

The only key question to ask yourself when it comes to intervening is, "Is taking this action worth my job?" I've had more than one situation where I stood firm, knowing I'd easily be called on the carpet for it, but I would only stand firm when I was clear I could prove my action was in justifiable defense of my patient.

Welcome to the gray areas; where choices are made based on what YOU can live with!
 
looker said:
A private EMS company primary goal is to make money. So as long as facility accepts the patients my hands are wiped and i do not care. This might sound harsh, immoral etc but at the end of the day it's all about money.
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I can only hope that the organization you work for goes under and that you are foolish enough to express that opinion in any subsequent interviews. Are you just trolling?
 
8jimi8 said:
I can only hope that the organization you work for goes under and that you are foolish enough to express that opinion in any subsequent interviews. Are you just trolling?
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Actually I believe he owns an EMS company
 
it does bother me sometimes that i leave the patient in sometime a horrible facility, but if i refuse transport, or tell the nurses how to do their job, they will take my job and licence.

Unfourunatly in LA County in the IFT realm, the Nurses run everything, they have the ultimate power. if they dont like you they will have your head and your job. no matter how incompetent they are.

i guess the best we can do is call DHS (Department of Health Services) and file an Anonymous complaint
 
8jimi8 said:
I can only hope that the organization you work for goes under and that you are foolish enough to express that opinion in any subsequent interviews. Are you just trolling?
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Unfortunately there are many IFT companies that are really trucking companies with EMS logos. We have a nightmare of one here that gets shut down for violations every now and again to spring up with a new name. same location and all.

sooner or later medicare is not going to be able to pay what it does for a horizontal taxi, and most of these problems will be solved.
 
looker said:
A private EMS company primary goal is to make money. So as long as facility accepts the patients my hands are wiped and i do not care. This might sound harsh, immoral etc but at the end of the day it's all about money.
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Hopefully your state has no required reportables. In my state, they can revoke my license and hold me responsible for not reporting elder abuse or neglect, which much of this can fall under.

My private will support me in being a patient advocate, perhaps you should think about doing the same. With good patient-focused providers comes a good reputation and worthwhile well-paying contracts.
 
sooner or later medicare is not going to be able to pay what it does for a horizontal taxi, and most of these problems will be solved.[/QUOTE]

+1
Acutally alot of IFT companies here in So Cal are hurting apparently because of the Medicare, Medical cuts earlier this year...

Stricter regulations are needed though from both Medical and EMS Offices
 
looker said:
A private EMS company primary goal is to make money. So as long as facility accepts the patients my hands are wiped and i do not care. This might sound harsh, immoral etc but at the end of the day it's all about money.
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On the other hand, every service has to take in more money than they spend. The question is whether that money comes from taxes, donations, or fees for service, or where that money goes. I see little difference between EMS funds going to purchase a BRT or going to pay a service owner.
 
8jimi8 said:
I can only hope that the organization you work for goes under and that you are foolish enough to express that opinion in any subsequent interviews. Are you just trolling?
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I own the company and no i am not trolling.
 
redcrossemt said:
Hopefully your state has no required reportables. In my state, they can revoke my license and hold me responsible for not reporting elder abuse or neglect, which much of this can fall under.

My private will support me in being a patient advocate, perhaps you should think about doing the same. With good patient-focused providers comes a good reputation and worthwhile well-paying contracts.
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Unfortunately in CA, and especially in Los Angeles County, IFT Companies are dime a dozen, and will do anything to get money. Patient advocacy is in the backseat. (or not even existant) in alot of these companies. Nurses control who they want to call, and so a lot of these companies go out of their way to please the Nurses and not the patients.
 
MusicMedic said:
Acutally alot of IFT companies here in So Cal are hurting apparently because of the Medicare, Medical cuts earlier this year.
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Unfortunately or not, they just approved extension of the higher rates. All runs done in the meantime are eligible to have the correction/difference paid to the provider...
 
MusicMedic said:
sooner or later medicare is not going to be able to pay what it does for a horizontal taxi, and most of these problems will be solved.
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+1
Acutally alot of IFT companies here in So Cal are hurting apparently because of the Medicare, Medical cuts earlier this year...

Stricter regulations are needed though from both Medical and EMS Offices
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I am always confused on why any ems deal with medi-cal unless they do 911. I personally do not even bill med-cal share of cost portion because of all the bs that you get with it. It's very rare that i get a patient that is medi-cal only.

In reality on bls you need to transport one patient round trip to cover the cost of that day. If you think EMS are hurting in Socal, just look at the request that they put in for more vehicles in la and that should tell you pretty much everything.

Also EMS in California do not regulate companys them self just emt,medics. Now an exception today is those city that have DOT, such as L.A county, City of Los Angeles etc. Even then they do not really regulate them.
 
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redcrossemt said:
What company do you own?

If you think what you are doing is right, then you shouldn't be afraid to tell us...
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I have never id my self on this board and have no intention of ever doing it. I will not ever reply to a thread that have my company mention and i will never take any action against any employee that are ranting about my company.
 
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