patient right to demand ambulance transport

[usalsfyre]

The big issue that came out of the paper to me was the fact that medics undertriaged when there should have been significant overtriage.

A lot of it is "BSitis".

 

[abckidsmom]

This is why I am always more in favor of transporting to a hospital where the patient can have a workup and be monitored and assessed for more than 15-20mins.

And those are all examples from just the last week. There are too many shades of gray for anything more than the most clear-cut, most obvious things to be left at home.

I find that the more experience I get, the more my gut feeling says to just take them to the hospital in all but the most assinine cases.

 

[Shishkabob]

RNs aren't making admission decisions and the decision not to transport a patient could very easily result in a patient who needs to be admitted never making it to the hospital.

I want to see what their rate would be. It's the only fair thing if you're going to do a study.




The issue isn't so much saying "You're fine, you don't need to go", it's being able to say "You should still go, but not by ambulance." or offering an alternative destination such as an urgent care clinic instead of always and every time, the ED.


Most people don't need to go by ambulance because there is nothing we will do for them in the ambulance. Most with minor ailments won't deteriorate between their house and the ED if taking a taxi or bus... or one of the multitude of working vehicles in their driveway, driven by one of the dozen family members standing there staring at us.

 

[JPINFV]

The big issue that came out of the paper to me was the fact that medics undertriaged when there should have been significant overtriage.

A lot of it is "BSitis".

...which is why they didn't even bother to report negative predictive value or sensitivity in the abstract. In this case, overtriage and false positives aren't a problem, especially when compared to the issues of undertraige.

 

[abckidsmom]

The big issue that came out of the paper to me was the fact that medics undertriaged when there should have been significant overtriage.

A lot of it is "BSitis".

Absolutely. This is where the typical medic laziness comes in for me. On the 10th, 18th, or 23rd hour of the shift, these shades of gray are covered by the glaring red flashing light of "I don't wanna do any more work!"

Especially in our area, which has a 2 hour turnaround, minimum, on transports, the chances of getting a refusal go up exponentially during sleeping hours and in the last hours of a shift.

 

[usalsfyre]

I'd actually be VERY curious what the most commonly mistriaged complaint was.

 

[usalsfyre]

Absolutely. This is where the typical medic laziness comes in for me. On the 10th, 18th, or 23rd hour of the shift, these shades of gray are covered by the glaring red flashing light of "I don't wanna do any more work!"

Especially in our area, which has a 2 hour turnaround, minimum, on transports, the chances of getting a refusal go up exponentially during sleeping hours and in the last hours of a shift.

Very true. I consider myself a good clinician. But at hour 20 of wakefulness, I'm not the same provider as I am at hour 8.

Which is a reason I hate 24s actually.

 

[Shishkabob]

Very true. I consider myself a good clinician. But at hour 20 of wakefulness, I'm not the same provider as I am at hour 8.

Which is a reason I hate 24s actually.

My mom still wonders why we're allowed to do 24 hour shifts.



I, too, despise 24s.

 

[usalsfyre]

My mom still wonders why we're allowed to do 24 hour shifts.



I, too, despise 24s.

Tradition and it requires less personnel.

 

[abckidsmom]

Tradition and it requires less personnel.

My department staffs 24/7 coverage on a *1 man* engine (yes really- volunteers are counted on highly) and a medic unit with a dozen people at our station. You can't get more bargain basement than that.

It's an uphill battle, working for improvements in such a system, but it is nice working down the street from home.