Chronic illness in the ER

When home med plans fail, often those with chronic conditions need treatments that require prompt medical treatments not handled in the office. Specialists realize this and often write protocol letters listing when to implement treatment and how. Patients present to the ER where Dr are treating more unknown emergencies and dx problems. Issue is .. we are not looking for their dx skills or even their thoughts on our treatment plan. Both ER provider and patients get put at risk when plans are not in place. 

Recently we presented to the ER for our protocol which is one file and flagged and signed off on at our local hospital. This day however this dr either never pulled up said record or was going to a different way. This I understand, it’s on him. However he could have been upfront and honest I don’t feel comfortable with this, what do you think is best next step? If I had thought lesser meds were only option I would said ok but if that’s the case send us now to pedi floor where those who know him can manage. 

Nope they gave standard protocol and then wanted to discharge. I said he needs to pass the can he move without throwing up test. ( I did not say have your staff come in turn on all lights take blankets and yell migraine kid with autism he had to walk around and go home) I said before you take IV let’s see if he’s actually any better than when he when he got here (which he clearly was not). So he was asked talk which he did barely, and then forced to sit up and stand which of course he threw up. 

( side note after 70 ER and admissions both him and I know when it’s manageable at home home based on is he swallowing, can he open eyes, is he asking for food, is his heart rate below 100, what is his skin cool, and he motion with his fingers pain scale) he communicated all those things without being made to move.

Upon throwing up they handed him off to pedi team finally. Nurses asked why don’t we go to Boston hospital since they treat him. Well this local hospital has successfully treated him for 7 years here. All the pedi staff know him ( knowing he’s good to go when asks for ceremonious cheeseburger and chocolate milk indicating episode is over) why would I want to travel an hour for a staff that has no working knowledge of him?

In the end we were advised again when arrive to request pedi hospital staff to order manage his care. Updated files sent and hopefully next time will be better. I’m thankful we have a team that after 7 years will still go to bat for us and say to others we’ve tried that for years first hand we know it doesn’t work and requires this. We know if you do xyz mom is correct just send him to be admitted. Please help us help them and save us all time and frustration. 

There are those who do get it and those who will advocate for chronic patient care. It involves ER dr who really are needed elsewhere helping those who don’t know what’s going on..or those still searching for treatment plan. I do appreciate ER teams are treating high numbers of patients many psych and addiction cases who are dumped in ER as place to find help but that’s a whole other topic in itself. Let’s streamline chronic kids needs enabling them to stay close to home, and be treated by a team who become like family which removes a level of unknowns for both patient and providers.  

O