Patient Refusals

Does your agency review patient refusals?

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Permalink Reply by Chris Azevedo on February 24, 2013 at 6:35pm

You can. It's called: building a better machine that reduces the workload.

Even combat soldiers get fatigue and get pulled from the line. During the battle, perhaps not. But they do get pulled off the line and given R&R, leave, and other things that help them decompress, relieve stress, and be ready to do their jobs again. In EMS, you're told "...if you don't like it, find another job." I must disagree with you on another point. A "PRO," just like a combat soldier, DOESN'T always recognize whether he or she is "getting hypoglycemic" (speaking figuratively). Very often, others will recognize it first, and the one so affected won't realize how bad it was until they're removed from the situation. A good manager, be it a First Sergeant, a Company officer, or a Line Supervisor will recognize it and intervene in a way that allows the affected individual to still be productive later on, while mitigating the present crisis.

A machine won't. A machine will go on until it breaks, instead of preventing the break in the first place. Human element is human element, whether it's customer, or service provider. History has proven that time and again.

Skip Kirkwood said:

If you can build in mechanisms to take out the temptation to engage in "workload reduction" then we may have a place to start.

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Permalink Reply by Skip Kirkwood on February 25, 2013 at 5:55am

I'm not sure the "combat soldier" analogy works for me. Combat soldiers don't work shifts, and don't get days off. There are very few EMS organizations where medics run from call to call with no down-time in between. Also, in EMS, we don't work in groups, with the regular presence of a supervisor. It's you and your partner. So, you've got to take care of yourself, and look out for your partner. And if you don't feel well, say something, and take care if it. And (being a diabetic I have learned) you can "take care of the machine" by providing preventative maintenance at regular intervals (like eating a bar or fruit between events).

Of course we need to take care of each other. But I'm still caught up on the "excessive workload." There are few EMS agencies where the UHU is 1.0, or even close. There is down-time between calls. And payment (for most companies) is piecework - no production (calls >> transports), no income. What happens then? If you reduce workload, many agencies go out of business. Is that in our best interests? Or do people really sign up because they believe that EMS should mean "earning money sleeping"?

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Permalink Reply by Chris Azevedo on February 25, 2013 at 3:26pm

It was your analogy, so I ran with it!

.....Yeah! We find ourselves discussing that one a lot, don't we? LOL!

To get back to the thread, my jurisdiction reviews every refusal at the Field Supervisor level--every one of them. Like many folks, we feel it is just as much of a critique of our services as it is of our providers, and it's a great way to catch negative trends, commonalities, and to keep an eye out for "frequent flyer" patients who may, in fact, be missing out on medical care they truly need, but don't get.

To be sure, this area seems to be most commonly the subject in class that students are most likely to SLEEP THROUGH because they feel "it doesn't help us save lives," because they don't regard this topic as important because it's not a skill, or otherwise, something tactile they can "do" to a patient. This is sad, because if you don't know what you're doing, you can not only hurt your patient, you can hurt yourself, your colleagues, and your organization.

Skip Kirkwood said:

I'm not sure the "combat soldier" analogy works for me.

....... But I'm still caught up on the "excessive workload."

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Permalink Reply by Nathan on February 26, 2013 at 8:06pm

I dont usually realize it until I wonder why someone or something is unusually annoying to me! :) I prefer applesauce cups.

Skip Kirkwood said:

Ones' mood surely can be influenced by lack of food. But whether you're a medic on duty, or soldier in combat, or a cop on the beat, a pro will recognize when he or she is getting hypoglycemic and do something about it. The ever-present cereal bar or power bar in the pocket should handle that trick!

Im not advocating for reduction in work load! Thats NOT in the future of EMS.