Second Shift had an interesting post up about an ER in Georgia with a novel approach to patients presenting with non-emergent complaints: they’re going to ask them to pay or prove that they can pay if they don’t present with an actual emergency. This could cause some problems with EMTALA but I like the idea of hassling people who come to the ED without an emergency. We need to find a way to discourage abuse of emergency services.
Personally, I have a different idea for those presenting to the ED with non-emergent complaints. You know how the police will fine or arrest people who chronically call them for no reason? I think we should adopt a similar system in emergency medicine.
My suggestions is that all EDs hire a couple of big burly foul-tempered guys named Vito to stand around near triage. Any time that somebody presents with a non-emergent complaint, The Vitos will inflict an emergency of their choosing on the patient to justify their admission to the ED. Come in without an emergency? No problem! An emergency of our choosing will be assigned to you so you can understand the difference between an emergency and an inconvenience.
After a few broken long bones, crushed skulls, popped eyes, or deeply stabbed organs, I suspect that many of our chronic ED abusers would simply decide to get their drugs from a dealer, stay at home, or maybe get a PCP like a responsible adult. I’m sick of seeing people in our ED who have no business being there, and I think my “Vitos” program would seriously discourage people from continuing to abuse our services.