99% of the time? That is very exaggerated, as most pts can be handled appropriately within the SNF.
Do you really think when some MD or DO nursing home jockey gets a call at 2 am from a nurse his response isn't send them to the ED 99% of the time no matter what the nurse says?
I stand by my statement.
Most nursing home docs I know just do it for extra cash. It is not their primary job, and just like many EMS medical directors, want to put as little effort into it as possible. I also know they do not visit the facility everyday.
I also think it is a responsible choice.
If somebody calls about a SNF patient in the middle of the night, the only responsible things to do is drive out there and evaluate the patient or send them for evaluation. There may be some treatment ordered in the meanewhile.
Given the level of neglect in any SNF I ever saw, in 7 states and 4 countries, no way in hell would I accept a nursing assessment over the phone, order treatment over the phone, and consider the matter taken care of.
There are simply too many variables.
I also read earlier where you said its the hospitals job to get pt paperwork sorted. You would get an absolute tounge slashing from the ER team for bringing a no transfer order pt into the ER without atleast a med list, while they wait for it to be faxed over.
That is location specific, and I will draw upon my ED experience in a 94k+ patient yearly census ER.
If the patient doesn't need a relatively simple procedure like replace a peg tube, drain a cyst, etc. the goal becomes rule out acute pathology and admit to the proper service.
Usually the diagnostics for a new onset acute event began before anyone even looked at the nursing home packet. (around 2 hours) that is quite enough time to have the secretary call for a chart.
If you are lucky, you don't have to sift through 200 pages of mismatched papers trying to figure out what the most current pathologies and treatments are.
A patient with previous neuro deficits is not immune from having new onset CVAs, infarcts, sepsis, etc etc.
The patient is likely going to get a CT head, certainly new heme and urine labs, an EKG, and whatever diagnostic seems to be indicated regardless of what is on the chart except a DNR.
I think many of the problems are simply from the system. Having agency nurses who change every few shifts.
Too high of nurse to patient ratios.
Too many ancillary tech staff and not enough nurses.
Way too much paperwork for the nurses which is required for billing but keeps them away from the bedside where they belong and do the most good.
I have had my fair share of run ins with SNF staff. I understand what level of quality is expected. But I have been around EMS for a considerably longer time, and I can say they are not without sin either. More than a few crews I know never make any effort to engage the nursing staff. Worse they are minimum ability/interest providers who probably contribute to nurses not even knowing what EMS expects of them.
As for the BLS/ALS thing. It may be a bit shocking, but when a RN from an SNF calls a private transport dispatcher who advises that a BLS squad is available in 10 minutes and an ALS in 40, the patient may warrent being transported by BLS rather than waiting. (especially when private companies have a habbit of exaggerating response times)
I also can't blame nursing (and I waste no opportunity to) for not knowing what different level EMS providers can do and can't. With 3 levels, treatments that vary with each agency, the personality types and level of competency variations in EMS, on any given day who can say what type of EMS service is needed in any given location on any given day?
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