SavedYourLifeBitch

Perform that and a vasectomy at the same time, lovely balls and no more kids... hell of a combo!

Many ERs don’t have the ability to do a non-emergent MRI (emergent MRIs a typically done on rule out stroke pts, but are more common in pediatric pts since we worry more about radiation in that population). The ER/hospital I work at doesn’t have an MRI machine in the evenings/nights/weekends so we are able to handle non-emergent MRIs. Stroke pts are sent emergently to our nearest stroke center via 911.

Also, I hate to say, but insurance also plays a role too because if they deem the MRI as non-emergent the hospital will not be reimbursed for it and then the patient gets the bill. A “stat” MRI is usually a couple thousand dollars (seen as low as $1500 and as high as $5000 depending on the scans) plus the radiologist bill and the pharmacy/pharmacist if you received contrast dye, this is all on top of your ER bill for meds, labs, IV, room fees, etc.

Have to be super careful recommending that to pts! Some insurance companies might not cover your visit if you sign out against medical advice. Also, any IVs and ongoing therapies will most likely be discontinued and removed due to liability reasons. Finally, many hospitals will not immediately release records before the visit has been completed (labs, H&P, radiology reports, cd of imagining, treatments while in hospital). Signing out ama might have the family going to the other hospital without any medical records potentially causing a delay in care, increased risk of harm/discomfort, double billing, etc.

While I agree with some of what you said, emergency medicine is a completely different aspect from all other forms of healthcare. EMTALA laws created in the 80s regulate more what we can and cannot do than “board members and executives”. Emergency Medicine covers nearly every aspect of healthcare and regardless of complaint, we cannot turn anyone away. Don’t have insurance, still have to receive a medical screening by a licensed healthcare provider. You have a stubbed toe, still has to be seen. Sunburn that hurts, still has to be seen. Of course hospitals have different ways of mitigating these pts to facilitate better flow, eventually the system gets backed up. A 60 bed ER that sees 400 pts/day can only do so much to see all those people and with average ER visit time being 4-6hrs, it becomes a complex issue of not just space but staff and equipment as well.

I replied to someone else above but my response can answer you question as well-

Depends on the city/state you live in and if the Emergency response system is updated. In most cities I’ve worked (ER travel nurse) EMS calls to give the hospital a pt report so ER staff can be ready for a pt (important if pt is critically ill). If the hospital is on diversion, they let the EMS crew know at that time.

Some cities are better prepared, SoCal for example has a system that allows hospitals to communicate with EMS and vice versa for availability of beds. If EMS is dispatched on a multiple patient call, if that call overwhelms one ERs resources, EMS knows before transporting where to go and with how many patients. This same system also announces when a hospital is on diversion so EMS knows where to divert to without needing to call in. A Kaiser ER near where I currently work goes on diversion regularly due to being overwhelmed with pts (I believe when their ER lobby wait times exceed 8hrs is when they go on diversion).

The other aspect I didn’t address above is that some hospitals are designated centers that treat specific conditions. Heart centers have cardiac cath labs for heart attacks, stroke centers have MRI and interventional radiology, trauma centers have 24hr OR with trauma trained physicians and nurses. So while you might get called for a simple medical call such as nausea and vomiting, that call could easily turn to a possible heart attack or stroke once you arrive on scene. The last thing you want to do is delay appropriate medical care for a critically ill patient because this alone could lead to death.