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Comment by Scoundreller | Hacker News Reader

I can’t figure out why the Nurse Practitioner didn’t send the patient to ER?

Are direct admits to hospital that bypass ER common outside of, say, fractures or elective surgery?

I bet it's because they system is very hierarchical. Once a doctor says something the nurse can't really override it.

The hospitalist is acting as the “gatekeeper” to admission here, so they decide if the hospital will take the patient or not. That doesn’t stop the NP from shipping the patient straight to the hospital’s ER. By federal law, emergency rooms must see every patient who comes in their doors.

The NP absolutely could have sent the patient to the ER. The vast majority of patients admitted to a hospital come in through the ER.

From what I know about hospitals the NP is supposed to defer to the doctors.

I think there’s big variation state-by-state in terms of NP independence.

I think the problem is she brought it to her organization's doctor that often does the ER admitting in situations like this and that doctor overruled her.

The NP could still have done it, but it would have been against two different doctors and the organization who employs her practices. The sad thing is that this probably happens often, this is just the first time someone sued over the death.

Or the first time it got taken to court instead of settled by everyone involved.

The NP did the right thing in a sense though - she went up the chain of command. The person up the chain, however, did the wrong thing.

edit to add: possibly the NP went up the chain of command precisely because the doctors there wanted veto power on hospital admissions. they didn't want pesky underlings getting in the way of whatever motivated their decisions.

Yeah, from what I have seen an NP overruling a doctor is a big No, No.

Once a doctor says something the nurse can't really override it.

Once two doctors say something.

Direct admits are falling out of favor, this case is likely to propagate that trend. The NP absolutely should have sent the patient to the ER. That fact doesn’t absolve the hospitalist but it’s worth noting.

I have been admitted 3 times this year without an ER visit. The other two times I was admitted via the ER but that was basically to speed up the process and getting priority to a room and bed.

I have an appointment tomorrow and as usual will be taking a bag, I'm expecting a 50/50 chance of being directly admitted or going home.

They probably should be more common. The ER is expensive and there are plenty of cases where admitting is obvious.

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