Forums » Smalltalk » AMA: I was an ER Admissions Clerk for 4 1/2 years

I figured I would throw this out there for this year's AMA; I worked for 4 1/2 years in my local ER as an Admission's Clerk. From June? July? 2017 to November of last year (2021), meaning I worked through the beginning of 'rona and through some of its peaks and downfalls until I quit.

Do note: I live in a small(er) city, <25,000 people as of the last census. Things may be different than how a bigger city, such as a metropolitan area, might function.

Do note, I cannot answer questions regarding any direct patient information due to HIPAA laws.

Wow, that sounds like a super intense gig!

As someone who has been through mental crises and reported to the ER before, I'm curious as to what the procedure is for handling that kind of situation. I've had some hospitals take me back into an isolated pod, I've been on a gurney in a hall waiting for bed search, and I've even been left to just... chill in the ER waiting area.

What does that sort of situation look like on your end, and what are the safety measures taken for both you and the patient?

Most (not all) patients in the middle of a mental health crisis were brought in through our ambulance bay either through EMS or through our local police department. Sometimes police would bring in patients that were actually under arrest, meaning we legally could not tell any family that they were there, which was always interesting when family came in looking for them.... and they called to tell them they were heading to the hospital. Even more interesting when it was a minor. If someone was under arrest, they had to be marked as confidential.

There is one room dedicated for any potential psych patients, which is right in front of the nurses' desk. Alternatively, there is another that they try to keep open, though it's more for nursing home patients that require close supervision, and there are a couple to the side that is within close proximity to the nurses' desk as well should they need it (our ED has a total of 12 main rooms, 2 trauma rooms, a consultation room, and a triage room, all of which can have a patient in them depending on their initial complaint and severity of their situation.)

The main room dedicated for psych patients had a nice change to it not long after I started working at the hospital; it was originally built like the rest of the rooms - open spaced, no where to move cords, easy access door handle where you could, theoretically, hang something off of it. They had changed it to have what amounted to a garage door, where cables and equipment such as computers could be shoved behind it and locked down. The television had been mounted behind an unbreakable panel (plexiglass, maybe?), and the cabinets had a special lock on it that only the house supervisor could open, I believe. Very small lock, hard to access. The door handle had also been changed to one of these guys. Anything that could potentially be picked up and thrown, such as a bedside tray or trashcan, was always removed from the room, usually before the patient was ever brought back. I learned very quickly that I wasn't allowed to give individuals there for mental health reasons a pen or anything like that. Typically dispatch from either the police department or EMS would inform the hospital that someone was en route with a mental health patient, so the heads up gave the nurses time to prepare.

Having someone walk in through the lobby doors was a different story. The admissions desk is completely blocked in with bulletproof glass, and entrance to the emergency room requires access through either a badge, or admissions clerks have a button to allow someone to walk in or out. Very rarely did I have someone with an actual mental health crisis come in aggressive (though I had plenty come in aggressive and try to charge at me for other reasons - we did have 24/7 security via officers from our local PD though.) Usually the process would be the same as any other patient. We would register them as usual, get them to sign their consent for treatment, and ask them to have a seat. If they're feeling up to it, we might have them provide additional information (such as emergency contact - legally, insurance and payment cannot be asked for until after they have seen a doctor due to EMTALA. I think private emergency rooms may be exempt from this though.)

Typically, I would call the nurses and give them a heads up that there was a psych patient out in the lobby though in an effort to get them back faster. I know it takes a lot of strength to go looking for help, and sitting around waiting doesn't help... unfortunately not much can be done when the ER is slammed. There would be times when individuals would still have to wait in the lobby. Sometimes they would only take them back to triage or the consult room and leave them there.

If the criteria is met and the doctor or nurse deems them a harm to themselves or other, the nurses can call the local police department and request an 'EDO' be signed - this prevents the patient from leaving until they are cleared by a mental health counselor. (might be called something else in other states) From there, the mental health counselor from the local facility either says they can go home, or they have to be sent to a facility.

Usually, there wouldn't be an issue with me obtaining information from psych patients. If they were aggressive or were proven to not be in the right state of mind to where it would be a liability later on, I would usually just ask a nurse or another admissions clerk to sign behind me so as not to get myself in trouble for not obtaining consent and the most up-to-date information. Same goes if they simply refused to talk. A good rule of thumb was, if they didn't have any discharge papers in hand, not to let them out through the door.

I'm wondering what the burnout rate is like in this profession?

Oh, high for sure. Especially post pandemic; we had plenty of people in and out the door during my 4 1/2 years - there are only two individuals that are still working there that have been there for quite a while, and I only think it's because they pay and benefits is probably the best you'll get in the area without any kind of certification or high education - one is going on nine (?) years, the other seven or so. Everyone else seemed to last one-two, max, some only a few months... it was very mentally taxing and a lot to do for little pay (running insurance, updating patient information via an EMR system, answering and redirecting phones, obtaining patient consent forms, collecting payments, running to the back of the ER to get ambulances that came in - if you were a night shifter like I was, you had someone with you for maybe 2 hours, then were left alone, so when you got slammed, you were the only one doing all these things for another 8-10 hours.) Unfortunately, there isn't a lot of support in the hospital for the unit, and since it is often the first place people will see in the hospital, regardless if they're there for the emergency room or not, hostility is common. I was ready to leave within my first year. The only reason that I stuck around was because it was, again, one of the highest paid places in my area with the best benefits for someone who only has a high school diploma. I left due to burnout, poor mental health, and the fact that I'm going back to school and couldn't balance night shifts with going to school several times out of the week.

What would have to change to make it a better environment for the staff? It sounds like more staff is an immediate need, but I bet there's more you could pinpoint