Hospitals doing Procedures on Gurney

Brydandon

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I've been noticing out here in Los Angeles County that hospital ER nurses are doing procedures to patients on gurneys that anchor the EMTs to slickly turn a drop off to the ER into a Wait and Return.

My EMT instructor long ago stated that this is not supposed to be going down, and that the patient should be given a bed and EMT transfers care but I've been seeing this happen more and more often.

What is the concensus on this? I personally see this as nurses pulling a fast one and I advocate for the patient to receive full care and not half-butt care.
 

Summit

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What kind of procedures?
 
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Brydandon

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What kind of procedures?
Phlebotomists taking blood, Nurses adding IVs and setting up drips on Gurney, Radiologists taking X-Rays with mobile carts, RTs setting up Vents, all of this stuff without transfer of care...

Personally I am wondering if I am still following sound advice from my instructor to not allow procedures to be taking place on the gurney at all until transfer of care happen with the patient in the hospitals care.
 
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luke_31

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Phlebotomists taking blood, Nurses adding IVs and setting up drips on Gurney, Radiologists taking X-Rays with mobile carts, RTs setting up Vents, all of this stuff without transfer of care...

Personally I am wondering if I am still following sound advice from my instructor to not allow procedures to be taking place on the gurney at all until transfer of care happen with the patient in the hospitals care.
They are in the hospitals care, just not on their stretcher yet. It’s not too uncommon in LA to have patients being treated on your stretcher.
 
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Brydandon

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They are in the hospitals care, just not on their stretcher yet. It’s not too uncommon in LA to have patients being treated on your stretcher.
Copy that thank you. The advice I was given gave the impression that EMTs could be held liable for whatever goes down on the gurney of we do not fully transfer the patient over to the hospital or next level of care.

I appreciate this. Thanks for the follow up.
 

luke_31

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Copy that thank you. The advice I was given gave the impression that EMTs could be held liable for whatever goes down on the gurney of we do not fully transfer the patient over to the hospital or next level of care.

I appreciate this. Thanks for the follow up.
No problem there is lots of bad information out there. Technically speaking you’ve turned over care as soon as you are within 250 ft of the hospital.
 

Summit

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No problem there is lots of bad information out there. Technically speaking you’ve turned over care as soon as you are within 250 ft of the hospital.
That IS bad information. You haven't turned over care until someone accepts the patient either officially with report or via their actions.
 

NomadicMedic

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That IS bad information. You haven't turned over care until someone accepts the patient either officially with report or via their actions.
That’s correct. It becomes the hospital‘s responsibility when you breach the EMTALA zone, and patients are required to have a medical screening evaluation, but you don’t actually transfer care until you give report and register a patient.
 

luke_31

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That IS bad information. You haven't turned over care until someone accepts the patient either officially with report or via their actions.
Probably should have explained it better but when you’re sitting against the wall and the patient starts having a seizure they do realize pretty quick that they need to start caring for that patient. I remember the days at County USC before the new hospital where you’d line up the patients on your stretcher or a hospital stretcher against the radio room wall and wait till they had room or your patient would finally deteriorate enough to require treatment and then they would acknowledge that you existed.
 
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Akulahawk

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Probably should have explained it better but when you’re sitting against the wall and the patient starts having a seizure they do realize pretty quick that they need to start caring for that patient.
Once you've given report, the hospital bears responsibility for that patient. Here's the problem: sometimes the hospital (literally) has no beds available for a patient of your patient's "acuity" level at that time. When that happens, it's a simple (but maddening) result: the patient has to stay on your gurney until a safe/appropriate location is found to put that patient. If the "acuity" changes, then things have to be reprioritized and sometimes that's when a bed is "found."
 

Akulahawk

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No problem there is lots of bad information out there. Technically speaking you’ve turned over care as soon as you are within 250 ft of the hospital.
EMTALA responsibility and you turning over care to the hospital staff are two distinctly different events.
 

Akulahawk

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I've been noticing out here in Los Angeles County that hospital ER nurses are doing procedures to patients on gurneys that anchor the EMTs to slickly turn a drop off to the ER into a Wait and Return.

My EMT instructor long ago stated that this is not supposed to be going down, and that the patient should be given a bed and EMT transfers care but I've been seeing this happen more and more often.

What is the concensus on this? I personally see this as nurses pulling a fast one and I advocate for the patient to receive full care and not half-butt care.
Where I work we call this "quick care" in that a patient that meets certain criteria can have an evaluation or a quick procedure done right on the EMS gurney and then the patient can be discharged and returned to wherever they reside. One of the criteria is that the patient can't be a "911" system patient. Most frequently I see trach replacements, G-Tube replacements, and Foley Cath replacements being done with these patients. Once the procedure is done, there's no further need for that patient to be in the ED so the patient can be discharged immediately. The provider has seen the patient, a staff nurse has seen the patient, both have done their assessments, and both agree quick-care is appropriate, and the company dispatch and crew is advised, and upon discharge, the patient gets a return trip and the patient doesn't have to get off the gurney. The care the patient receives is exactly what they'd get if they were taken off the gurney, placed on a bed, had the procedure/evaluation done and then get discharged. However now you have an added complication in that this patient can't just walk out, this patient is taking up a bed while waiting for a discharge return trip, which could take HOURS to arrange, resulting in a horrible waste of resources in the meantime. The other option is do the "thing" and get the patient going home quickly, which frees up resources for a patient that actually needs a bed. Either way, the patient gets exactly the same "full" care and not "half-butt" care.

If 911 crews could do wait/return for certain patients, that would make their times drop too... but they usually only take patients TO the hospital, not FROM the hospital.
 

chriscemt

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In Kansas City, we have done this all the time. Depending on the procedure, it's to the patient's interest to remain on our cot. I have been told my various supervisors that they want to request us to provide a down time < (less than) 20 minutes, but I routinely have extended that, again, in the patient's interest.

(I would think this is relatively standard across the US, given similar size cities)
 

DrParasite

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I can't speak for LA county, but in general, I was told the same thing. Hospital staff shouldn't be performing procedures on our cot. However, I would be lying if I said it never happens, and it shouldn't happen.

I think @Akulahawk has explained it well; if the staff can provide a quick intervention that couldn't be provided prehospitally, and fix the issue, it's in the best interest of the patient to do so. So if your ambulance doesn't carry Narcan (we didn't back in the day), and you are bringing in an OD patient, giving Narcan in the ER might quickly change the patient's condition and criticality.

If the patient needs lab work, blood draws, x rays, or extended monitoring, that's a different story... but for a quick intervention, I wouldn't make a big deal about it. Now, if the ER attending is intubating the patient, I might ask for them to put the patient on a hospital bed first
 

Tigger

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Turning something into a wait and return at the ED is a win for the patient and ED, but probably not the ambulance company. I would imagine that throws some issues into scheduled IFTs.

I used to work for a service that brought stroke alerts into the local ED and the patient would remain on our stretcher aside from the time they were in CT. They would get tPA if indicated on our bed and then we would transfer them to an actual neuro receiving facility. Apples to oranges to the OP, but we certainly liable for the hospital's care while on our bed.
 

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Martyn

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No problem there is lots of bad information out there. Technically speaking you’ve turned over care as soon as you are within 250 ft of the hospital.
So...no more queuing up in the ER. just dump them in the coffee bar round the corner...it's only 50 feet from the ER entrance!!!
 

Akulahawk

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So...no more queuing up in the ER. just dump them in the coffee bar round the corner...it's only 50 feet from the ER entrance!!!
But you also commit patient abandonment in the process... Even though EMTALA applies, it doesn't absolve you of your patient care responsibilities.
 

Akulahawk

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