This has always been a problem but I've been seeing more of it lately. I'm talking about docs sending patients into the ED for routine stuff that should be done as an outpatient. Transfusions for chronic anemia and dialysis are the big ones but G tube, foley and PICC line placements as well as nursing home evals and studies like CTs and MRIs are all part of the problem. One especially irksome part of this is when the primaries are reluctant to admit the patients. "Just transfuse her and send her home. That's why I sent her in." I get that a lot. But the fact is that in the ED the non-emergent transfusion of a few units of PRBCs will take 8+ hours. That's too long to tie up an ED bed just so the primary doesn't have to be bothered by it. Dialysis is even worse. Anyway, I know this is a problem to some degree everywhere. I'm curious how EPs cope with it. I have seen everything from "If it's not emergent we don't do it in the ED period." to "What the heck it's another paying patient." How do you deal with these?