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I work in the ED where some procedures and tests happen because "that's what happens in the ED" even though some are unnecessary. How do you deal with personal thoughts on over testing and over medication and invasive procedures?

June 2nd, 2022

Difficult question...

1. Do some research on current clinical guidelines. Identify items that are no longer recommended.
2. Talk to you local ENA and look at their books.
3. Talk with your supervisor.

Having all your ducks in a row is the first step.

I worked in a military ED where we had a lot of special kids. We had one child that came in frequently by ambulance and the residents always wanted to do a full court press before the parents got there. I talked with the ED Staff docs, my supervisor, and the parents. We had group meeting as they actually knew what was best and needed and we developed a protocol just for this particular child. Physical exam yes...labs, catheter, IV, and spinal tap was a no unless parents approved or child was coding. It was a win all the way around.

June 18th, 2022

I have a background of 13 years as an ED nurse. I suppose my best answer is it truly depends on the patient and situation. I guess my thoughts are what is the provider trying to rule out, are they liable and trying to cover their butt, etc. In our department, there are some providers that tend to order the million dollar work up on everyone(maybe more because of a liability or being unsure of a differential diagnosis) while other providers are minimalists. There are definitely times I’ve though the testing was over the top and unnecessary. There have been a handful times I’ve actually asked the provider why they were doing ordering something, while trying remain respectful. Typically these instances aren’t well received and the provider justified their choices. I suppose if it were a question of harm or negative outcome to the patient I’d say something otherwise, I keep my mouth shut. If the patient doesn’t want something they do have the right to refuse. Unfortunately, there is a lot of grey area with this and as the majority of liable is on the provider if they misdiagnose or miss something and harm comes to patient, I think they are the one that should make that judgment call.

June 25th, 2022

This is a CYA culture. Doctors need to cover all the bases to avoid litigation. E en then, it doesn't work. We also have pay to play. Doctors are Insentivitized to do more. Like they said, each is individual

October 10th, 2022

There are many tests in the ER that may seem irrelevant at the time of admission, but could have a huge impact on the discharge disposition. Having worked both as an ER/Trauma staff nurse, as well as an ER/ICU Case Manager, I have personally seen both sides of the argument. I have worked as a RN for 24 years, and in EMS for the 10 years before that. If there are tests being run the seem "Questionable," my advice would be to ask the question, -Why Are We Doing This Test? To be told that "this is what we do in the ER" is not a legitimate answer.
If the ER Doc who is ordering the tests will not give you a better answer, ask your ED Nurse Manager. I hope that this helps.

June 4th, 2022

Hello. Please analyzed this situation; is this really personal or professional? If you are working in a situation and you actual observed unnecessary procedure or medication given you can be held liable as well. I worked in special procedure and I observed that a patient was been scheduled for EDG repeatly. My observation was not based on my personal feeling but professional observation. I bought this matter to my nurse manager and chief of GI. This facility was a teaching hospital and residents needed practicing doing an EGD. However, thru my action has a patient Advocate this process is not longer in existence

July 1st, 2022

It is no longer simply about the ethics behind decisions. Its litigation and covering your ass. Its insurance, its providers, its ego, its a small part of a much larger problem. Some of the smallest 'procedures' insurance will reimburse the most. This may not be the most helpful answer but my solution is acceptance and then getting the hell out of the ER.

May 22nd, 2024

You have no choice to ensure that every probable condition is explored. ANY patient can sue the hospital if harm is done secondary to not performing a test.

November 6th, 2023

IF a person comes in, no diagnosis and life threatening symptoms that could be anything, what is unnecessary? Insurance pays in full for ER visits except for the copay. Do you want to tell the MD that the bleeding patient doesn't need the test this time? Personal thoughts are put aside: we have a duty to save the patient or at least stabilize them. If you are thinking about that question, your mind is not on properly triaging the patient

December 24th, 2022

Tread very carefully. The residing physician might not think you're in the position to question. I would have a chat with my manager/ director and leave it in their hands. Yes, some physicians go Gaga, overboard. It's not neglegence, it's a bit of " covering all my options" thing.

December 4th, 2022

Yes there's many Dr's who over order unnecessary treatments, tests. I know it drives nurses crazy! And as an ED nurses,, IVE SEEN' some ED RNs experienced and knowledgeable. Thank God for nurses seriously..and such wasted money equals increased Healthcare for working and elderly who can't get assistance. I agree

November 30th, 2022

If you have a concern about over-testing etc then you can always report to your ethics line or compliance hotline.

September 6th, 2022

There's allot of layers. Why are they being ordered? My guess is not because of physician opinion exclusively. Some times their decisions are made for them by DRGs from CMS. It may not actually be necessary but it also may not be the doctors preference either. Often times in order to get paid the complaint must be matched by a certain number of tests to "prove"it to the payers (sometimes this is the case....). It is absolutely your place to ask questions. It may not be your place to make changes. As for me? I wouldn't be personally bothered by it honestly. Unless of course it's clearly uncalled for, like an opioid for a drug seeker. I don't practice medicine and deciding which labs to draw isn't part of my scope.

August 9th, 2022

I work in the ED and have not experienced unnecessary testing or procedures. It’s possible that you have gotten an adequate explanation for what is being done. If you truly believe that the patient care is bad then you might want to work somewhere else.

May 31st, 2022

I would consult with my supervisor for advise pros and cons.

May 31st, 2022

Depends on what it is, what was their perspective. Maybe they saw or thought something different and, if you asked they could explain why they placed it. Maybe it’s policy somewhere that he knew and he was following as long as I didn’t hurt the patient. Every scenario is different. I would investigate before I decided it was unnecessary. Maybe they are following the person that trained them and if that person wasn’t following policy and he was trained to follow his preceptor. At that point he should stop until the policy itself it’s reviewed and you can decide to willow ot fight it. Maybe they haven’t read the latest and greatest. I believe you get a choice once you investigate and reside for yourself.

I hope this is making sense. Basically make your own educated decision, and the make a choice and stand by your own ethics.

July 9th, 2022

You don’t deal with it. We aren’t the docs. We are nurses. We are advocates. You can do something in that sense. But really that’s it. Other than leave that job or avoid the problem docs.