911 call to nursing home at 3AM

[NOMedic119]

we get calls like that here in New Orleans, usually the nursing home will call their contracted ambulance service but due to the low acuity the private ambulance service will delay the transport. Maybe an hour later the nursing home calls 911 for some bogus reason, like pt. short of breath we arrive onscene to see the patient laying in bed completely stable. pt being transported due to lab work. pt is SOB but theyre always SOB due to some chronic illness. Ive found the best way to approach the situation is to stay professional and transport the patient as long as the patient wants to be transported. unless something about the patient is abnormal i transport BLS because the pt shouldnt have to pay more money for ALS treatment for horrible nurses at nursing home. AND DOCUMENT DOCUMENT DOCUMENT, Written complaint and pt report as well as verbal report to nurses at hospital. someone will do something eventually if it keeps happening.

[VentMedic]

Since this is a somebody told a friend of a friend of mine thing, pertinent facts could be missing. It could also be a crew from an ambulance, that may also do 911 calls as well as routine, that is pissed for being awakened from their paid to sleep time. They then only heard part of the reason why this "old person" needed labs and just thought they would bitch alittle to their friend at the ED who may or may not have anything to do with the patient. This happens occasionally in my ED but what the EMT(P)s don't always realize is they are seriously discredited because the NH RNs or doctor has already called a report with an assessment of things the EMT(P)s should have picked up on if they had only done a BP or checked a heart rate.

Reporting them for 911 abuse hasn't made a difference yet.

If this is actually an abuse of the system, just doing a little verbal bitchin' isn't going to cut it. You will have to document everything and get it to the proper authorities. You must also be able to back up with proof that the NH is committing fraud or abuse. If the oversight agency calls the hospital and the "old person" was placed on life support as you were leaving, you may look like you just have a grudge or is uneducated about the many disease processes that require labs. You may also be in some trouble with your ambulance service which has (had) a contract with that NH if you can not back up your words. Many talk a big talk but some don't take the time to look past their attitude or hate for NHs, its staff, particularly nurses, and "old people". Some also exaggerate their stories to get attention when they are awakened from their sleep or need an excuse for not doing an assessment when they have already diagnosed it as a BS call long before they get to the nursing home and actually see the patient.

AND DOCUMENT DOCUMENT DOCUMENT, Written complaint and pt report as well as verbal report to nurses at hospital. someone will do something eventually if it keeps happening.

It is your responsibilty to make the complaint to the appropriate agency. The nurses are not going to do your job for you. If they believe it is abuse, they may do their own reporting. However, just like the many threads on this forum, some are reluctant to second guess another provider's assessment since they were not there to see what the other person saw when they call for an ambulance. Many here don't want to criticize another EMT(P) for possibly being wrong either and especially in writing to an agency that will check up not only on the NH but also the person making the complaint. So, if you do file, make sure your own patient care report is perfect and without fault.

You can also address your concerns to your medical director who may have a chat with the medical director or owner of the NH. Just remember, your medical director may have to also scrutinize your documentation of the call to be politically correct especially if there is a contract involved.

If you really think you have a legitimate complaint against a nursing home, quit griping and find out how you can improve the system. Just make sure you are speaking out for the right reasons and not your dislike for routine "BS" nursing home calls, missing sleep or old people. I know there are those that abuse the system but some in EMS spend more time complaining than they do taking action or even finding out what can be done to make improvements.

[Jeepluv77]

Sounds like abuse of the 911 system. You could discuss the issue with the nurse, or the patient if he/she is mentally capable. Explain that this is not what 911 ambulances are for and recommend that they reconsider their request.

If they don't, well, follow your stubbed-toe protocol. Maybe online medical direction would be in order. My guess would be that if the nurse insists on transporting the patient, you will probably end up transporting him/her. Set up a line en-route, oxygen, make the patient comfortable. The nursing home director will be thrilled when he/she get's the invoice from your company...and additionally, hopefully, a fine for abusing the 911 system.

First off, thank you ak and itk for pointing out the issue with the iv. That would definitely be assault. I'm also wondering though why you would take it up with the patient. They themselves just got woken up at 3 am and had no say in this decision. They are every bit as confused and tired as you are.

As for whether or not to transport, locally we are supposed to transport everyone that calls and asks to be transported. Regardless of how asinine the reason. And we are a volunteer service and do not charge for treatment or transport. This is a perfect example of why the possibility of some kind of a charge is being looked at. From what I've heard it could be anything from an itemized bills for supplies, etc to just a flat fee of say $100 to discourage people that seem to think a rescue squad is just a free cab and that emt's have nothing better to do than drive them a few miles closer to the bar/shopping district/friend's house/etc.

[brentoli]

I am not asking anyone to second guess anything.

I am not complaining or griping about anything.

I was just throwing this topic out here for discussion amongst the members.

Just a little further on facts... this incident was a couple of years ago, I was talking with the same nurse today about it after I read where this was going. It was a 911 only ambulance service that transported. The reason the call stuck out amongst the others, was the pt was transported on standing bi-weekly bloodwork orders. She remembers the doctor calling the NH to get clarification on the reason for transport thinking they sent the wrong orders, and thats when they found out the pt was just being transported for bloodwork to CYA dayshift.

Edited April 14, 2009 by brentoli

[HERBIE1]

This is SOP for most nursing homes. How many times have you been called for a cardiac arrest and the staff insists the patient "just stopped breathing" when it fact they have rigor and dependent lividity. I recall one time when the staff was doing CPR to beat the band as we arrived. Sadly, this poor lady was so stiff her entire body rocked like a see-saw with each compression. The person had been down so long you could move their entire body by a finger. They will give you a set of vitals that aren't even close to being accurate.

The problem is, unless it is an ultra fancy facility, the folks who work there generally aren't the cream of the crop in the health care field.

Obviously things change if this is a contract account and you are their private provider. You would need to tread lightly and let your management handle your beefs. Bosses don't take kindly to an employee losing an account because they bitched at the NH staff. In the case of 911, we always have to respond- even if the case turns out to be total BS or a chronic problem. Is is abuse of the system- of course, but when staff at these places turns over almost daily, "education" is almost always a waste of time.

Years ago when I was in management on the privates, part of my job was providing CPR training for all our nursing home accounts- that was quite an adventure. While I was there, I also took the opportunity to explain about proper use of EMS resources- ie use a medicar when possible, request the proper type of unit, the importance of accurate info, etc. Trust me, with some of these places, much of the staff couldn't spell CPR, much less perform it effectively. I was more than happy to work extra with anyone who wanted help but few took me up on that and I certainly was not overly strict with my expectations. As a result, I failed a few of these people and the administration complained to the owners of my company. I was essentially told to pass these folks no matter what because their CPR card was a job requirement. I refused, they got someone else to provide the training and suddenly everyone passed. Soon after I resigned my position in management for these- and other reasons.

Point is, realistically, there is probably not much you can do about this abuse issue.

[cynical_as_hell]

sounds like just another bs call and abuse of the 911 system. If i were on this call I'd make sure the nurse lost their job. And nursing homes wonder why ems has such a bad attitude towards them..... Let me wake you up at 3 am for a bs reason and see how you like it!!!

[Just Plain Ruff]

Let me tell you, my grandmother was in the nursing home until she passed away a month ago.

My mother shows me all the medical bills that they get because well she is sort of clueless when it comes to what a cbc is for and all that.

My mother also knows when an ambulance call is made and why it's made. If she had asked me why a ambulance crew started a line and put my grandmother on oxgen then I will request the report from the ambulance service. If the report is written in a way that makes me think that they medic started a Line just to stick it to the nursing home then I'm gonna be down at the local ambulance service discussing this with that medic's supervisor. I am going to advise my mother to refuse to pay for the IV which is what medicare will have already done.

To start an IV on a patient just to stick it to the nursing home is shitty piss poor treatment bordering on abuse or assault and I'm probably going to go to the state on this one.

That is just the impression we as providers give when we do this and it makes ALL of us look like fricking morons, no better than those slack jawed nursing home idiots one person referred to earlier.

Remember this people, the nurses do not just decide to send the patient. They call the doctor and get his order to transport so why don't we put the blame on where the blame needs to go - the physician for ordering the transport. I know many nursing home nurses personally and they don't call us just to wake us up, well maybe some of them do in order to return the nastiness that we sometimes give them.

Many of my nursing home friends tell me that they are to call the physician for everything from a slight fever up to cardiac arrest. Some of them tell me they cannot even call EMS for a patient in cardiac arrest, they have to get ahold of the doc and then the doc says go ahead and call ems or just let the patient pass.

When your hands are tied like some nursing homes hands are tied they don't have much of a choice of when they call you.

Cut these people a little slack. Besides, these same nursing homes may be the one taking care of you when you get old and gray and what comes around goes around, if you are an asshole to their staff they might not be so kind to you when you arrive as a patient.

"Hey Mabel, this new patient, he's the asshole who kept criticising us for calling his ambulance and interrupting his precious sleeping time while we were awake. Let's let him sleep in his urine tonight and say we didn't find it till this morning"

Edited April 14, 2009 by Ruffems

[VentMedic]

sounds like just another bs call and abuse of the 911 system. If i were on this call I'd make sure the nurse lost their job. And nursing homes wonder why ems has such a bad attitude towards them..... Let me wake you up at 3 am for a bs reason and see how you like it!!!

Here's a news flash for you: Other health care professionals don't get paid to sleep.

You are actually very lucky that hospitals are understanding or just take it as "normal" for some in EMS to piss and moan every time they have to touch a patient. Maybe those professionals in the ED should complain more about some of the sloppiness of those in EMS so more can get weeded out and it might actually become a profession. Take a look at yourself from the other side and see what those in the nursing homes and hospitals have to put up when dealing with some of the bad attitudes of EMT(P)s with before you start casting stones to cause someone to lose their job.

To want someone to lose their job because you were awakened while on duty or had your internet game interrupted is a harsh statement when you may not know all the facts from an incident that happened two years ago. You may also not have enough education as it pertains to various contracts between LTC facilities and ambulances services, including those that do 911, to even make that call. Get over the BS mentality and do patient care. It is a shame when those in EMS perceive they patients as just BS. It doesn't matter if you are just referring to the "call", there is still a patient involved. They are the ones who are caught up in a crappy healthcare system. If you are not in it for the patients, find yourself another job that doesn't deal with humans or animals.

[Kiwiology]

We'd take the patient probably and send the nursing home a large bill for whatever unscheduled patient transfer is .... it's not cheap.

[HERBIE1]

Obviously nursing home staff must abide by their own rules and regulations. Many times, the majority of care is provided by CNA's and LPN's- NOT registered nurses. As such, many do not have the knowledge to make any decisions on their own. Yes, the doctor is the one who has the ultimate say so, but it is up to administrators to work with their staff and docs to come up with policies that work for everyone.

The health care system is broken in so many ways it's difficult to know where to start. Private docs use ER's as their own personal labs and to screen their patients. They send people for routine tests vs to an outpatient clinic because they get the results immediately. It used to be many docs would see a patient in their office and if they require admission, set up a bed and the person would undergo the needed workups while an inpatient. Now, they want to limit hospital admissions so the sooner they get someone discharged, the better. Go to the ER, get a stat EKG, a couple Xrays, a CT, and bloodwork and the patient does not need an extended stay. ER's OR's, and ICU's get priority on all tests and procedures while inpatients must wait- they are considered "routine" labs.

Same with nursing homes- bloodwork drawn at a nursing home may take several days to get back and any treatment needed gets delayed. Much easier to send the patient to an ER, get the requisite tests and begin treatment right away.

I agree, you can't blame the nursing home staff for following protocols, but you can and should blame them for incompetence.