Sent to ER when I got to ER found in parking lot.

MTonya

My mom has COPD now pneumonia.  The nursing home sent her to ER by herself when I got to ER there she was in the parking lot in a wheel cheer no coat temp is 45. Who is responsible for her when they send her in ambulance?

BethL

The ambulance crew are responsible to get her into the ER, turning her over to ER staff. From that point the ER staff are responsible. (My opinion)

jmlarue

I'd be livid. The hospital had no business discharging her in that fashion - an aid should have been with her until someone picked her up. If you don't get suitable answers and apologies from both the hospital and the nursing home, perhaps talking to a social worker with the State's Adult Protective Services agency would result in some correction.

MTonya

She WAS NOT discharged was in parking lots wondering around. Should the nursing home sent someone with her.. idk who is responsible.

jmlarue

Sorry. Your original post wasn't clear. Did you really mean to say that the nursing home told her to go the the ER by herself with no aid and no transport? Is she independent and able to make decisions on her own?

loveskitties

My dad as sent to ER several times from MC facility.  He was not accompanied by any staff.  They sent paperwork.  I confirmed with hospital that this is the norm.

Transport/EMS assumed responsibility when he was picked up.

ER assumes responsibility when the sign off on receiving patient.

ER hands off responsibility to return transport folks who then hand off to care facility.

At least that is how it worked in my area.

Crushed

My wife has formal orders that she is not to be transported under any circumstances in an ambulance without one of a list of specified persons being with her,  It is on a poster in her room just so  EMTs know.

The hospital ER tried to kill her last time and almost succeeded 

They put her in a chair and told her to stay there.  she walked out the door into the street
No one had looked at her documents 

I have taught health care risk management and I made an ENORMOUS Stink .  My wife was a very well known physician around the world. I made sure the hospital knew that would  hold both medical and administrative management  both civilly and criminally liable.  When she broke her arm I drove her 10 miles to Kaiser  emergency care to avoid the ER.   

I have been told that when I am in full legal fury I can be frightening  GOOD

Jo C.

To answer a question; no, NHs do not send staff with a patient who is transferred by ambulance or other type of transport to the ER.

Before I get into it, is it possible that your mother may have been brought into the ER, but wandered out the door into the parking lot?  You mention she was wandering in the parking lot, but she is also in a wheelchair . . . ambulances do not carry the patient's wheelchair, so was the chair one that belonged to the ER?  I am not clear on what actually transpired.

If she was transported in a non-emergency vehicle and checked into the ER at the front desk, she could easily have wandered from the waiting room.  If she was actually checked into the ER as an emergency transport she would be on a guerney, that would be a different story - if she was in the actual ER on a guerney, but wandered out, there would be ER notes addressing that.  That would seem least likely as they would have been looking for her as well as the fact she would not have been in a wheelchair.  If the wc was not hers, she may have been checked in at the desk as a non-emergent patient and sat in a wheelchair.   So much unknown by us readers at this point.

 Did your mother actually get sent to the ER in a regular ambulance - or was she sent in a transportation van or other type of vehicle?  No matter what, she never should have been left outside the ER door by herself, before being checked in if that is what actually happened.  The starting point with this is to find out specifically what type of vehicle transported - this will be in the transfer notes at the NH and should hopefully be in the ER notes.  If it was simply a taxi sort of transport, then the person driving may not have had a clue as what to do; still, common sense . . .  

If she was sent in an ambulance, the ambulance EMTs would have taken her into the hospital's ER and stayed with her until such time she was actually under the care of the ER staff who would have transferred her to a room on a guerney.

If the NH sent her in a transportation van or ambulance under a transportation non-emergent code, the dynamics may have been different depending on the type of transportation - BUT - it makes no sense if she really was actually dropped off at the door to the ER =- and where did the wheelchair come from?  If she was in a transport car, she could have been transported sitting in a wheelchair from the NH. 

You can report this to the Ombudsman office in the NHs area. In fact, by law, the NH must give you the contact number for the Ombudsman, but you can probably find it online using a Google search.  They will usually go to the NH within a day and begin an assessment of what transpired.  If something egregious happened, they are mandated to report it to the oversight professionals who would take action.

Also, if appropriate after you know more about what happened; you can notify the state's NH oversight department and make a detailed complaint yourself; send the photo if you can.  In our state, it is the California Department of Public Health that does NH oversight.  The Ombudsman Office can tell you where to make contact in your state.  When complaint is made, in my state of California, RN inspectors go out to the NH to address the complaint in full; usually within one working day.  Perhaps also a complaint to Medicaid if your mother is on Medicaid and even Medicare if she was abandoned outside the door of the ER.

That will certainly get the ball rolling and gain you the information you need.  I wonder what the nursing notes said about the transfer and what they actually ordered.  The company that transported would also have specific notes about what type of transport was ordered AND they will also have copies of notes from the transport driver and other EMT if there was one,and where they deposited the patient, etc.

Formal complaints will gain information and hold any patient dangers to answer.  The most important would be the Ombudsman's Office and the NH state oversight group.

Please let us know how you are doing and what happens, we will be thinking of you and we care.

J.

towhee

So sorry this happened. I agree with everyone that the nursing home does not send staff with a patient to the emergency dept. You should have been notified of this at admission. What they are supposed to do is call the family emergency contact either before calling 911, (in the case of palliative care or hospice) or very shortly thereafter. They are also supposed to let the ambulance personnel know that the patient has dementia and send a list of current medications, usually the Medication Administration Record from the last 24 hours. However, from your previous posts, I get the distinct impression your facility has a major problem with family communication, at the very least.

I also agree that ambulance personnel are responsible until she is checked in to the ED, and should make sure information from the nursing home is passed on. Whether they are a simple transport company or not. Then the emergency dept staff is responsible. But just because she might come in the ambulance entrance does not mean she will get a bed in the ED. They do triage and if they feel she is not serious enough she might indeed end up in the waiting area, and if she was trying to get off the guerney she might end up in a wheelchair. I think Jo C gave you good advice on how to get the facts.

I strongly suspect part of the dynamic here was short staff at the ED due to a major holiday weekend. 

Jo C.

Towhee is right on spot.  When transferred to the ER, the NH sends copies of the patient's record regarding meds, the current medication dispensing sheet, the person's allergies, a listing of all medical conditions which would include dementia, and a copy of whatever document states pertinent information that would include compromised ability to see, hear, move, and any other special information.

Such information is always sent with the patient when there is an ER transfer/transport in any kind of a transport and there are laws to cover that. Documentation of that type always accompanied my LOs in an ambulance transport to an ER and we had LOTS of transfers from different facilities over the years with both my mother and step-dad having dementia.  As well, the ambulance EMTs would be given a report of condition and especially would/should have been informed of the dementia.

She is also correct in that you would have or should have been notified of the pending ER before said transfer; or if a patient is a critical life or death transfer, they would/should call asap after the patient has been addressed.  However; it does not appear your mother was in a life threatening situation, so you should have been called prior to the ambulance pickup.  Don't know if you were notified in a timely manner, or until later.

I think there were other dynamics at  play with what happened.  In all my RN and RN Admin. experience of many years at various medical centers, I have never seen or heard of an ambulance or any transport dropping a patient off at the outside of an ER door.

With an ambulance transfer, EMTs always roll the  guerney out of the ambulance at a special ambulance bay door for the ER and enter the ER with the patient still on a guerney through the bay.  They then provide the paperwork from the NH as well as making a report to an ER RN who is accepting the patient.  (Clerks or other non-medical staff do not receive patients.)  The patient is then slid onto an ER guerney as soon as one is available. Sometimes the ER is crowded and there are no guerneys; sometimes, the ambulance EMTs are stuck there until the patient can be managed if the patient must be on a guerney.  IF and only IF the ER staff  has read the NH record and assessed the patient and took her vitals, etc.; there is a possibilty they had her transferred into a wheelchair until a guerney would become available if staff felt that was safe.  In such a situation, they should/would have assessed her and checked her vitals at intervals. If the transfer papers clearly stated there was dementia, an even closer oversight monitoring would be needed.

If that was what was done, there could have been a very long wait; (typical in an ER),  and somehow your mother, tired and bored may have got outside.  Some ER doors open electronically.  The ER record would show how your mother was managed at the time of her arrival and after her arrival.  I am so sorry this happened and can only imagine how stunned  you were when you found your mother in a wheelchair in the cold parking lot.

My LOs, mother and step-dad both had dementia.  They were both ER frequent fliers; so much so that I kept copies of their DPOAs for medical care in my car. Truly. I always was informed by NH staf  of their pending transfer to the ER and then drove with superman speed from work or from home; often in the middle of the night to get to the ER. Can only imagine what I would have done if I found my LO in a wc in a freezing cold parking lot.   Think of opera character Brunhilda with horned cap, breast plate and spear . . . . !

Please let us know what you find happened after you check everything out. I know it will take a bit of time, but we sincerely care and would like to know how everything unraveled so badly.  It will help us share our care with you as well as giving information that may be helpful to others to prevent similar circumstances.

From one daughter to another, warmest thoughts are being sent your way,

J.

harshedbuzz

MTonya-

I am sorry. Your poor dear mother. Ugh.

This is another reason why placing a LO in a facility near you is critical- you want to arrive at the ER before they do.

HB

MTonya

Just in case I didn’t post before I had called the ER and let them know that she had dementia she would wonder and that’s was 45 minutes before I arrived to find her in parking lot

The manager from the emergency room called me back today. They Had security reviewed camera and found out my mom was outside the hospital for 35 minutes by herself with no one accompanied her outside the hospital but they assured me no one approached her. Because she was taken in by an ambulance it was the responsibility of the hospital to care for her. She apologized immensely.  She said that it would never happen again and the staff has been discipline and reprimanded and security and staff are getting additional training, education on patients coming from nursing homes should be put in a room not placed in waiting room  

Sorry original message was not clear I was so upset! 

This group has been so helpful in dealing with all the things that come along with dementia.  

Thanks everyone

MTonya

I sat down next to my mom in ER she took my hand and said is my baby okay.

Jo C.

MTonya, of course you were upset; we would all be if in such a situation. I am glad that you were able to find out what happened and that you received apologies and that the Admin. staff held the involved ER staff to answer and that there will be training so this does not happen again.

So glad your mother is alright; what a horrible situation.  Bet your heart rate was over the moon! 

Was your mother admitted to hospital or treated and sent back to the NH? 

My mother had FTD and became a behavioral nightmare.  One day in the hair salon, the owner gave me a cup with a saying on it . . . "If is isn't one thing, it's your mother." I started laughing and it took me awhile to stop.  So true.

Hope all is settled now and that you are feeling a bit better and that your mother is doing okay.

Big hug,

J.

Crushed

A number of posters have described emergency rooms operating under normal conditions. But conditions have not been normal for years in many places 

  https://catalyst.nejm.org/doi/full/10.1056/CAT.21.0217

  Emergency Department Crowding: The Canary in the Health Care System

  

 
The normalization of ED crowding by hospitals as a tolerable dysfunction had resulted in patient endangerment during “normal” times, and has contributed to capacity failure and affected the ability to meet the challenges of public health emergencies. ....

Prolonged boarding (more than 2 hours) of ED-sourced admitted patients in the ED effectively reduces ED capacity and capability.

 Note BOARDING   The primary cause of overcrowding is boarding: the practice of holding patients in the emergency department after they have been admitted to the hospital, because no inpatient beds are available. This practice often results in a number of problems, including ambulance refusals, prolonged patient waiting times, and increased suffering for those who wait,(from a different source)

Sorry trying to fix the diagram  essentially it says that as the hospital fills the ER descends in chaos due to boarding 

  

See also

 

Diving Into Dementia

Dementia and the ER—A Toxic Combination

https://www.hmpgloballearningnetwork.com/site/altc/articles/dementia-and-er-toxic-combination

toolbeltexpert

Crushed I wonder if there have been any more improvements since that article on the er and dementia. That was 2018 and I find it very confusing when they change the use if abbreviations from er to ed.  4 years is a long time in the medical world.

Jo C.

Pretty much still the same, toolbelt.  Even harder now since community based  "free clinics" in poor areas have mostly closed, so those who have no insurance and are impoverished in the poorer communities now use ERs as a, "clinic," sometimes traveling quite a distance to get to them and that is part of the problem issue in many areas.  Waiting areas for non-ambulance entry in many ER settings are jam packed shoulder to shoulder with people with problem issues - adults, children, extended family members for support; one huge petri dish.  If you weren't sick when you went in, you will be by the time you leave.

Overall; significant numbers of nurses as well as doctors have poor education for understanding of the various dementias, dementia dynamics and communication and management of persons with dementia which leads to more chaos delays in service, and preventable upsets affecting the delivery of care.  My being an educated RN of much experience am very aware of  this through both my profession and especially through personal experience.

Dreadful situation; difficult for patients but also very hard on the beleagured staff who are working as fast and hard as they can - day after day after day - and nights.

J.

DrinaJGB

This is both shocking as well as unbelievable. I would pull out all stops to get this reported.

Rennbird

I am reminded of an incident that occurred here in Northern Virginia during COVID.  A woman dropped off her father at the ER, but of course was not permitted to accompany her father.  He eventually wandered out of the hospital and his body was found approximately one year later.  It has been very interesting for me to learn how ignorant the medical community is about Alzheimer’s Disease, but then again basically no one except we caregivers understands.  In my opinion, each person with the disease needs to be watched at all times but our society does not want to pay for that kind of care. There should be sitters available on call at hospitals, especially those located near Memory Care facilities.  When My husband fell, I was phoned and I rushed to the hospital, this was pre COVID.  When my husband fell at a VA memory care facility on the other side of the Potomac River, I was not called.  It was the first night he was at the facility and when I arrived the next day he was bruised and battered.  I no longer have faith in any institutions.