Uncooperative Patients

[Aidey]

If they want to leave and are competent then I just document what happened. Patient left private auto stating they did not wish to wait to be seen etc etc. Not going to hold then against their will if they are of sound mind.




Ya im thinking perhaps my idea of triage is not the same. What i mean is i walk into the ED. Nurse asks what we have. Report is given and put in the computer. C/C history allergies, meds, interventions, vitals etc and the nurse either gives us a bed right away or we hold the wall until one is available and based on priority of the patient relative to others who may be waiting.

No, your idea of triage is what I was imagining. Here that is considered taking over care of the patient. I would be totally within my right to leave the pt sitting in a chair and walk out of the building. As I said before, if we get stuck boarding a patient in the hall we say nothing to the ED staff about the patient. The pt is not put into the computer. No report is given. We continue to administer treatment and monitor vitals if needed. I would honestly be surprised if the way the hospital there is doing it is legal.

 

[Anonymous]

What the ED is doing is called "patient parking" and I believe there was a directive from CMS (Center for Medicaid/Medicare Services) that this is not allowed.

I looked it up and you are right about the directive. However, there seems to be some confusion/controversy surrounding it so I will be doing some more homework and maybe talking to my managers regarding the directives interpretation.

Do yo mean you are not allowed to get an AMA signed, you can't get the patient to sign one, or you aren't allowed to do a witnessed two-party AMA?

I do not have any AMA form for anyone to sign. It is not really an option for me other than documenting AMA in my report as suggested.

Write the report stating patient refused to cooperate, radio dispatch saying patient went AMA without signing and go on your way.

He is there voluntarily and can come and go just the same. If he walked on me, I would have told the charge nurse he bailed then gotten in the bus and left.

If necessary, call your sup and/or base. Documentation is key here to avoid further issue.

Thank you. That is what I wanted to do but was not sure if this was abandonment because in my mind I had not transferred care yet, which it seems I was wrong about.

No, your idea of triage is what I was imagining. Here that is considered taking over care of the patient. I would be totally within my right to leave the pt sitting in a chair and walk out of the building. As I said before, if we get stuck boarding a patient in the hall we say nothing to the ED staff about the patient. The pt is not put into the computer. No report is given. We continue to administer treatment and monitor vitals if needed. I would honestly be surprised if the way the hospital there is doing it is legal.

Got it.

 

[mycrofft]

Spineboard everybody and that walking away thing gets less frequenth34r:

 

[JPINFV]

Spineboard everybody and that walking away thing gets less frequenth34r:

For that comment, I hate you so much that flames... flames on the side of my face....

 

[Aidey]

I LOVE that movie. Just watched it last night in fact.

I'm so proud I got one of your references without having to look it up

 

[mycrofft]

Sorry I'm CLUELESS........

 

[JPINFV]

Sorry I'm CLUELESS........

:huh::unsure::huh::unsure:

 

[DrParasite]

Not uncommon for my company to have multiple units holding the wall for several hours at a hospital.

several hours???? I'm sorry, but this still blow my mind. esp if you are a 911 truck babysitting a stable patient for hours due to poor staffing in the ER.

Currently its either AMA on scene or at the hospital after i have transferred care. If a patient absolutely refuses during transport then I notify operations. I think its worth noting i work for a private BLS company who has the 911 contract for county so we may operate a little differently?

We have RMA (sign here) RMA-AMA (sign here,we really don't think you should, but ok), RMA-AMA w/Sup (sign here,we really don't think you should, the supervisor tried to convince you, but you have the right to do something stupid) and RMA by action (pt says "Go F$*k yourself, I don't want an ambulance, get out of here" or walks away from the EMS crew, no signature is needed).

I agree with what everyone else said, if he hops off your cot so he can go out and smoke and you told him not to, he eloped, and let security deal with it. if you want to be technical, and say he was still under your care, call local law enforcement and let them get involved.

But based on what you said, he either eloped from the hospital (making it security and the ER's issue), or he RMA by action, making it not your problem. either way, pack up your things and go on the next job; once he is done with his cigarette, he will just have to have to wait in the triage room with all the other walkins.

 

[JPINFV]

I agree with what everyone else said, if he hops off your cot so he can go out and smoke and you told him not to, he eloped, and let security deal with it. if you want to be technical, and say he was still under your care, call local law enforcement and let them get involved.

What are you expecting law enforcement to do with a patient who has capacity who eloped?

 

[DrParasite]

What are you expecting law enforcement to do with a patient who has capacity who eloped?

not a damned thing. just another person who will say "yep, he eloped," and file a reporting stating jus that.

but if you think he should be brought back against his will, typically it's a law enforcement call, (or a LE decision to enforce your decision) since security has no authority outside of the hospital.

 

[mycrofft]

Shoot them

 

[martor]

I had a patient that had a c/c of SOB. She was on 15 LPM. En route she tried lighting a cigarette. As soon as we got to the Hospital she unbuckled herself and jumped off thee gurney. Had a nearby nurse sign that patient went AWOL. So far didnt get any heat for that.