Corpsman2PA Posted September 3, 2011 Share Posted September 3, 2011 Just wanting some feedback on a situation at my new job... I just started as an MA at a local Urgent Care facility. I was to shadow an MA the first day and learn the ropes. One of my first tasks was to walk out some paperwork to a guy who injured his leg and was sitting in the lobby. I noticed his left lower pant leg was ripped and saturated in blood. I walked back to the MA I was shadowing and told her "That guy looks pretty hurt." To which the reply was "Well our provider is going on lunch, so he'll have to wait. He says he feels fine." Soon after, the office manager instructs one of us to put a chux pad under his foot so the blood leaking out of his leg wouldn't get on the floor...Now I was an FMF Corpsman for 6 years and have seen enough to know that this guy needed some immediate attention. BUT, it was literally my first half-hour on the new job, so I didn't pipe up too loud because I figured they'd already triaged him to some extent and knew what was going on, and I didn't want to step on any toes. I couldn't help but wonder what all the other waiting patients were thinking, especially the two little girls waiting with a guy actively bleeding in the same waiting room as them. Finally we take him back (After nearly an hour of him waiting) and expose the wound...he'd already put a pressure dressing on it, but it was clear he had nicked an artery during his chainsaw accident. To make the situation worse, the MA I was shadowing after exposing the wound gasps, "Oh sh*t" Which then got the patient worried and worked up. Our NP came in, and immediately called the ambulance to transport him to our local ER, said "good job for catching that you two." End of story. I was left perplexed wondering 1) Is this normal practice not to triage a patient at Urgent Care? (I understand the guy should have went to the ER in the first place, but still) 2) How can the provider possibly think that was a good job when somebody was bleeding in the lobby for an hour? 3) I don't know what three is, but I just put it there anyway. Any thoughts, feedback or similar experiences? Just wondering if this is abnormal or normal for Urgent Care facilities. Thanks Link to comment Share on other sites More sharing options...
d2305 Posted September 3, 2011 Share Posted September 3, 2011 I would never fault a MA for at least looking at the wound, and stopping the bleeding. We lock the door during lunch at my ACC. Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted September 3, 2011 Administrator Share Posted September 3, 2011 In my mind, the occasion of putting a chux pad down because of excessive bleeding is almost certainly grounds for patient (re-)exam. But that's just me, I suppose. :-) Link to comment Share on other sites More sharing options...
Corpsman2PA Posted September 4, 2011 Author Share Posted September 4, 2011 did the provider know the whole story when he/she said "good job"? probably not. so it sounds like your MA coworker sucks. thats the story here. and you get to deal with that on a regular basis now. Not sure if the provider knew the whole story or not, but I'm assuming they didn't. I showed up after he already checked in, so I just figured they'd triaged him already...obviously not. I'm gonna pipe up from here on out if I get the feeling someone should be seen right away. Link to comment Share on other sites More sharing options...
Just Steve Posted September 4, 2011 Share Posted September 4, 2011 I'm not telling you anything you don't know, just a reminder...patients are in a constant state of triage. Things change, circumstances evolve. Hard part is being the FNG and not stepping on toes right out of the chute. I am one of those guys who think if you're gonna walk on thin ice, you might as well dance. The art of tact will be a valuable lesson for me in PA school..I hope they teach it well. Sitting out there in the cheap seats of the peanut gallery and having the gift of retrospect and time...I am thinking if you were put in similar circumstances maybe you could put a bug in the guy's ear...let them know that their wait will be a bit as the provider is tied up for about an hour and ask if the patient would like an ambulance called? That way, if the patient states he wants an ambulance 1. He may get a second peek by the triage person. 2. The provider may put down their BLT and poke their head out the door for a peek 3. Dude gets a ride to the place that can help them. Chainsaw, blood, leg, urgent care clinic...one of those doesn't fit in the equation. Good luck to you. You now know your trauma assessment is far beyond the folks you work for. I hope your transition to PA school comes fast for you. Link to comment Share on other sites More sharing options...
Hemegroup Posted September 4, 2011 Share Posted September 4, 2011 There's a philosophy I've always stuck to in patient care, whether it was as a volunteer, EMT, student or PA. The patient always comes first. There have been a couple of times where that hasn't worked out in my best interests, but it has always worked out for the best interests of the patient. I'm proud of that. That being said, if you adhere to my philosophy actively, you have to be prepared for the possible scenarios that can result ... including termination. You'd be surprised (or maybe not, I don't know) to learn that there are so-called 'medical professionals' out there who care more about their own ego and saving face than they do the people they 'care' for. In the end, unless it's a life or death situation, I wouldn't sweat it. Link to comment Share on other sites More sharing options...
Corpsman2PA Posted September 4, 2011 Author Share Posted September 4, 2011 You guys obviously know what you're talking about. Just Steve, Your input is always accepted. The equation didn't fit, and I was the FNG and was talking to myself the whole day like a monday morning quarterback. I wanted to shout so much about the situation, but like Hemegroup said, to adhere to his philosophy that the patient comes first, means to prepare for the worst. I can't imagine putting the patient anything but first. Why else would one pursue healthcare if it was not to care for another one's health? Thank you all for your great input. I go in tomorrow for day two...i'll keep you posted... Link to comment Share on other sites More sharing options...
RetNavyPAC Posted September 8, 2011 Share Posted September 8, 2011 There's a philosophy I've always stuck to in patient care, whether it was as a volunteer, EMT, student or PA. The patient always comes first. Hemegroup's right. I would just add to always go with your gut if something doesn't seem right. It's never led me astray. Link to comment Share on other sites More sharing options...
paleanne Posted September 8, 2011 Share Posted September 8, 2011 If I were the provider and knew the situation I would have certainly held off on lunch and evaluated the guy...sounds like the provider wasn't aware though. I once worked at a urgent care facility and a patient came to the window sob after a bee sting..I should have been immediately notified, but the receptionist proceeded to take all his insurance information, get his copay, etc...when I finally was made aware of the situation the guy was in distress in our lobby ! Needless to say the receptionist was re-educated on proper procedure. The guy was fine after an epi injection, but still..what if no one had made me aware?? Link to comment Share on other sites More sharing options...
Corpsman2PA Posted September 19, 2011 Author Share Posted September 19, 2011 All good points, and thank you for the input. Update: Turns out the provider instructed the staff to inform all incoming patients they would have a 30 minute wait. I was so lucky as to show up during that 30 minutes for my first day on the job. Of course, there was a lack of triage at some point, and he (the provider) should have been notified. Nevertheless, the patient after being taken to the hospital became hypovolemic and started to lose consciousness. After some emergent surgery, etc. he was fine. Still, I've brought up to my manager that there needs to be better triage at the door for a multitude of reasons. Our receptionist has 0 medical experience, and constantly has people with ''chest pain and tingling arms" waiting in the lobby while she takes her time running the insurance and taking co-pays...I understand these people shouldn't be coming to urgent care in the first place, but still they do nonetheless... Link to comment Share on other sites More sharing options...
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