One of the main jobs I have in running the emergency department is what we call “disposition.” That means getting people out of the department so others can come in and be cared for. Most of the time, this is simple. They either go home or they get admitted to the hospital. Some times, it is not so simple and takes a lot of work, time, creativity and patience to find a good place for someone to go. Here is a story of one such patient.
A 68-year-old man presented from a board and care facility. He was reported to be hyperventilating and not able to talk appropriately. He had a history of developmental delay and schizophrenia.
I found him agitated and hyperventilating. I ordered laboratory testing and sedation.
After being sedated, he responded to questions with answers like, “Elvis Presley” and “Bing Crosby.” He also started singing Christmas songs and other songs like “When They Call the Roll Up Yonder” and “Mine Eyes Have Seen the Glory of the Coming of the Lord.”
Because he had caused so much trouble at the board and care home, the managers refused to take him back. I had to find somewhere else for him to go.
I will present a time line that shows what I had to go through and how much time it took in order for me to get this guy out of my emergency department that evening.
5:05 The patient arrived in our emergency department and his work up began.
8:40 His labs came back normal. He was calm and cooperative. I called Emergency Psychiatry and
with the charge nurse. He said he would call back.
9:00 The Emergency Psychiatry charge nurse never called back so I called him again. He told me to call
back and talk to the doctor.
9:10 I called back and talked with the doctor, who told me the patient was not a good candidate for their
facility and recommended I try to find another psychiatric facility that would take him.
9:30 I talked with the charge nurse at a local psychiatric facility. She said she would call me back.
9:50 I talked with that charge nurse again. They refuse to take the patient in transfer. They offered no
10:00 I talked with someone at another local hospital with a psychiatric facility. They said they would
get back to me.
10:20 I talked with them again. They also refused patient.
10:20 I talked with the patient’s doctor in a city about an hour away who refused to take the patient in
transfer. He recommended I send the patient to our psychiatric unit.
10:30 I talked, again, with the charge nurse at Emergency Psychiatry who accepted the patient.
10:40 The charge nurse at Emergency Psychiatry called me back and asked that I document all of my
efforts to place the patient elsewhere.
11:10 The patient leaves for Emergency Psychiatry.
So, it took six hours and ten phone calls to make sure this man was safe for discharge and find a place for him to go. You can imagine what a disruption this was to the care I was trying to provide to all my other patients and how frustrated I got. This is an example of what I have to endure to do my job.
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