Ambulances held hostage

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DrParasite

DrParasite

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Is there any need to prove this?
I mean, as long as no one questions it, no. When you are called into court, how do you "prove" that you didn't falsify your documentation, and didn't just dump the patient (who later died) in the waiting room?
I document who I turned the patient over and what location that occurred at. Not sure how an RN scribbling on the tablet would change anything.
my first paid job said if RN simply wants to scribble on the tablet, that's cool; if their signature wasn't legible, then fell to me to get and document the full spelling of their name. It is, after all, a legal document. not saying what I was told was right or wrong, just that's what we did. subsequent employers did not require receiving signatures
 

Jim37F

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I’m not suggesting just dumping the patient in the waiting room and dipping out. But where is the burden of giving the charge or triage nurse handoff, them agreeing that the patient can sit out the waiting room, and then clearing?
The triage nurse simply refusing to accept the transfer of care on the grounds that you can't just say "I'm transferring care to you" anymore than any other random nurse in the ER you came across instead of the charge nurse or whoever is in charge of receiving the ambulances
 

Tigger

Dodges Pucks
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I mean, as long as no one questions it, no. When you are called into court, how do you "prove" that you didn't falsify your documentation, and didn't just dump the patient (who later died) in the waiting room?

my first paid job said if RN simply wants to scribble on the tablet, that's cool; if their signature wasn't legible, then fell to me to get and document the full spelling of their name. It is, after all, a legal document. not saying what I was told was right or wrong, just that's what we did. subsequent employers did not require receiving signatures
I document their full name, title, and signature. All of which could be falsified too, if you really want to play that game.

The triage nurse simply refusing to accept the transfer of care on the grounds that you can't just say "I'm transferring care to you" anymore than any other random nurse in the ER you came across instead of the charge nurse or whoever is in charge of receiving the ambulances
My point is that there really is no more burden on the hospital itself for putting a BLS patient in the waiting room than having them sit on the stretcher in the hallway. The patient is going to be seen in the ED one way or another, it makes no sense to make EMS babysit a patient that requires minimal if any more monitoring than what exists in the waiting room ("um hey nurse, this man's unresponsive.") Is EMS obligated to treat the patient if any sort of condition change occurs while in the ED? That seems like a nightmare for the ED too.
 

MonkeyArrow

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This is fascinating. Just goes to show regional differences in EMS.

I’m not going to comment on the merits of holding the wall with a patient, but I can see the need for signatures to verify that the patient was appropriately handed over to whomever.

2 in hospital examples from recent memory. The first: a nurse transported a patient from the ER to an inpatient bed. The only catch was the unit was closed. Somehow, the room assignments got mixed up, but this nurse left a patient in an otherwise empty unit, and this wasn’t discovered for several hours. Luckily, the patient was not harmed. Now you may be asking very reasonable questions like “MonkeyArrow, how did this nurse not see that the unit was empty, and there weren’t any patients or any staff around? Shouldn’t this have been prevented if someone just used common sense?” Obviously, reliance on what I feel to be basic skills adults should possess is inadequate.

The second: a patient was transported back from CT to their ER room, and not hooked back up to cardiac monitoring. The nurse came in to find the patient in cardiac arrest. There was a large he-said-she-said of whether transport did or did not tell nursing that the patient was brought back and in what condition the patient was returned.

You or I may feel that a signature to confirm that the patient has been delivered to the right place and with their condition appropriately communicated (I.e. not in need of chest compressions) is elementary. However, from a systems perspective, there is always someone out there that will prove you wrong…
 

Capital

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As the charge nurse at a busy level 2 trauma center, I can honestly state I've never held a crew longer than 15 minutes. We've been using our triage and fast track area for all EMS that isn't a trauma, MI, or critical patient. We funnel everyone there and have a designated paramedic that takes the report, and then a nurse and mid-level do the triage together. If the patient is stable they are moved back to a fast track chair and line/labs done. The patient goes back to the waiting room to wait for X-ray/CT etc. Once everything results they get the next designated bed in the back. That way my 50 beds in the back are not tied up while tests are being done, waiting for results. It's working pretty well. It also allows us to catch the more critically ill patient quickly because a paramedic, a nurse, and a PA or NP see them within minutes of arrival.

As for patient calls in hospital parking lots, that is a huge EMTLA violation for the hospital to not respond. We are federally required to cover 250 yards out from the hospital property in all directions. Now I have called EMS for a lift up the big hill in front of our ED with an OD (after I put in the IV, gave the narcan and I'm bagging). It should be illegal to put ER entrances on hills! My company responded and I caught **** forever about it :p
 

EpiEMS

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The triage nurse simply refusing to accept the transfer of care on the grounds that you can't just say "I'm transferring care to you" anymore than any other random nurse in the ER you came across instead of the charge nurse or whoever is in charge of receiving the ambulances

Don’t think they can do that. They’re at the hospital. There are EMTALA obligations.
 

Tigger

Dodges Pucks
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You or I may feel that a signature to confirm that the patient has been delivered to the right place and with their condition appropriately communicated (I.e. not in need of chest compressions) is elementary. However, from a systems perspective, there is always someone out there that will prove you wrong…
I guess I don't see how a signature fixes any of these issue. Lazy people are also likely to be lazy about documentation and falsify or otherwise manipulate such procedures. Maybe it's different with Epic and RFID badges, but there's really nothing to stop people from falsifying these signatures.

I am not aware of any issues with abandonment in our system and lord knows we get plenty of feedback from the hospitals about what they want us to do differently.
 

FiremanMike

EMS Coordinator
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FWIW my usage of "signing off" had less to do with the physical act of getting a signature and more the act of giving report and turning the patient over. As long as I can tell a nurse/doc at the hospital "hey I brought you this patient complaining of this and my assessment showed that" and they say "sounds good" then I'll drop them in the gift shop if that's where they tell me to take them..
 
OP
DrParasite

DrParasite

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The hospital face sheet is how we do it. It's proof that the patient was registered. We don't leave a patient until they're registered.
I had an issue where registration refused to print out a hospital face sheet for me, citing HIPAA... even better, the information on the face sheet was exactly the information that I just told her so she could type it into the computer... had to have the ER director call the registration director, who agreed that it wasn't a HIPAA violation.... good times
 

NomadicMedic

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I had an issue where registration refused to print out a hospital face sheet for me, citing HIPAA... even better, the information on the face sheet was exactly the information that I just told her so she could type it into the computer... had to have the ER director call the registration director, who agreed that it wasn't a HIPAA violation.... good times
Most of our hospital systems have a method to assign the face sheet to our agency and we can access EPIC securely and get an it to attach to the PCR for billing. It has mostly eliminated lost paperwork.
 

GMCmedic

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For those that don't require a signature. how do you "prove" that you transferred patient care to another provider, vs simply "just dumping the patient in the waiting room and dipping out"?
Around here, waiting room patients are registered.


ETA: all hospitals I've been too, track which service brought the patient in. Errors are made, but for the most part accurate. There is always something to trace it back.
 

Tigger

Dodges Pucks
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They are registered as agency specific EMS arrivals when we take them out front as well.

Every report I write needs an MRN documented as well.

Also of note, one of our receivings is out of staffed beds and has been for days. And now they’re closed to ambulance traffic which seems appropriate to me, no reason to take someone to a full hospital. Obviously not helpful if every hospital is full, but regionally we’re not used to hospitals being full for weeks at a time.
 

NomadicMedic

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Another big issue is the “divert is a courtesy “ BS. If the hospital is saturated and there is no staff and no beds, don’t bring people there.

We frequently have hospitals on saturation divert and there are platt of crew that will simply ignore that message and go there anyway. If you hold the wall for 3 hours, that’s you’re fault bro. Hospital x is 30 minutes away with no waits.
 

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