What to Expect When You Come to the Emergency Room

What to Expect When You Come to the Emergency Room

Coming to the emergency room isn’t fun for anyone.  Our hope, at MedicineWithout, is that we can at least explain a few things to set your expectations for your next visit.

“Hey, hold on! I’ve been waiting waaaay longer than that guy.  How come he gets to go first?”

The ER is NOT first come, first serve.  Everyone who comes into the ER goes through a process of triage.  During this process, a healthcare provider, usually a nurse, asks you a few questions and takes your vital signs (heart rate, blood pressure, temperature, oxygen level).  Using this information and the expected resources required to take care of you, the nurse assigns you a triage designation.  A commonly used scale is the Emergency Severity Index or ESI, which is a scale from 1-5, where lower scores designate patients who are sicker or who will require more resources.  Those with lower scores will be seen first.  

“What if I just need some stitches taken out or I sprained my ankle, do I really have to wait so long for the little stuff?”

It depends.  Many ERs have a designated “Fast Track” or “Urgent Care” type area to handle these more minor complaints.  However, these areas may not be open 24 hours a day, so sometimes your only choice may be to wait.  For more minor issues, you can also try calling your primary care doctor’s office to try to get a rapid appointment or go to an urgent care.  However, whenever in doubt, or you are uncertain, always come to the emergency room. 

“There’s an open room right there!  Why am I in the hallway?”

The assignment of rooms vs hallway beds is a complicated process.  Different rooms have different capabilities.  For example, some are negative pressure rooms which are needed for patients with airborne diseases such as tuberculosis or patients who are undergoing an aerosolizing procedure, such as intubation in the setting of COVID-19.  For this reason, you may see some beds with unique capabilities being reserved for those specific types of patients.  Sometimes rooms are also kept open as a dedicated “Resuscitation Room (s).”  This is to ensure that there always is a place to put a critically ill patient as one could come in at any time.  Other reasons why a room may be seemingly empty is that it may need to undergo cleaning, including special cleaning.  Depending on who was in the room before, the room may need to be kept vacant for a designated period of time for infection control purposes.  We don’t want you to leave with something you didn’t come in with!

“It seems like I have been here forEVER!  Why haven’t I heard any updates?”

The ER is a busy place, often overflowing with patients.  It may take awhile for you to get updates for several reasons:

1. No updates are yet available.  Depending on the tests you received, it could take several hours for results to come back. Your healthcare providers may be waiting for the results and therefore, haven’t come by to update you yet.

2. Your results might be available, but your doctor needs time to interpret them.  Medicine is complex and test results are often complicated to interpret. Your doctor may also need to call a consultant or specialist to help with parts of your care.  This takes additional time.

3. Your results might be available, but your doctors and nurses are tied up taking care of a critical patient.  Resuscitations are high stress situations that can take up to several hours sometimes.  Please be patient when this occurs.  If you or your loved one was critically ill, you would expect the same undivided attention of the doctors and nurses.

4. Doctors and nurses are human too.  They may be in the bathroom, trying to eat a quick meal, or taking a moment to process the death of a patient they just had to pronounce.  Please be considerate of this.

5. There are a myriad of other reasons that may cause you to feel like it has been awhile since the last update.  Keep this in mind, ER doctors are often graded on efficiency metrics which reward them for getting you to the next phase of your care with as little delay as possible.  That being said, they have every incentive to get you moving, so understand that if things are taking awhile, they want to get them going just as much as you do. 

“I only wanted to be examined by female doctors.  Can you honor this request?”

Sometimes yes.  Sometimes no.  In our ERs, we make every attempt to honor these requests and respect cultural practices, but pragmatically speaking, sometimes there is not a female doctor available on a given shift.  The converse is also true. On some shifts, there are no male doctors.  In this case, you may be faced with having to accept the provider available to you (male or female) or decline the exam.  You are permitted to decline the exam if you so choose so long as you have medical decision making capacity.  

“I’m starving!  Why can’t I eat?”

As a general rule of thumb, DO NOT eat or drink in the ER unless you are explicitly told it’s ok by your doctor or nurse.  There are many reasons why your healthcare providers may not want you to eat.  Here are a few examples:

1. Your doctor anticipates that you may need a surgical procedure (such as having your appendix out)

2. Your doctor is worried about your breathing and thinks you may need more respiratory support.  If this is the case, we want your stomach empty to minimize the risk of aspiration (sucking your own vomit into your lungs).

3. You may need sedation.  For example, you broke your leg, and the doctors need to sedate you to put it back. We want your stomach empty during sedation to minimize the risk of aspiration.

4. Your blood sugar may be high and your doctors want to control your sugar better before you eat.

5. Many, many  more. Again, DO NOT EAT in the ER until you ask your doctor or nurse.

“I’ve had enough, I just want to leave!”

ER’s are not prisons.  Any individual who has the capacity to make their own medical decisions is free to refuse any part of their care or sign themselves out of the ER.  Please be aware that your doctor will make a determination as to whether or not you have capacity. As a general rule of thumb, most patients have capacity.  Examples of patients who do not have capacity include but are not limited to: patients who are intoxicated or on drugs, patients who are a threat to themselves or others, patients with advanced dementia, or patients who otherwise have altered mentation.  If you decided to leave before your workup is complete, this may be considered leaving, “Against Medical Advice (AMA).”  When leaving AMA, your doctors will explain to you the risks and benefits of leaving and ask you to repeat them back indicating your understanding.  You will then sign a form indicating that you have been explained the risks and benefits and are choosing to leave anyway.  Your IV will be taken out.  Your monitors will be disconnected, and then you are free to go.  Please be aware that this may have unintended consequences regarding your insurance paying for the visit.  Some patients also have agreements with their subspecialty teams stating that they will not leave AMA.  This is often the case for patients with organ transplants or awaiting organ transplants.  If you fall into this category, talk to your subspecialty team about this.  

Of note, patients who leave AMA from the emergency room are encouraged to return at any time to complete their care.  You may return to any ER you wish, although it is often helpful to return where you started.

“My doctor is affiliated with X hospital.  If I have to go to the ER, should I go to X hospital’s ER?”

In a true emergency, go to the closest emergency room.  Otherwise, it is beneficial to keep your care within the same hospital system as it is simpler and more efficient to share records this way.  It also prevents duplication of testing.  Additionally, it is helpful to have your doctor around as he/she knows you best!

“What can I do to help myself get the best care possible in the ER?”

Here’s some DO’s and DON’Ts:

DO:

1. Bring a list of your medical history and currently medications list including names and dosages of medications.  Better yet, bring the bottles with you.  This is especially important if you take uncommon medications as we may not have them on formulary.  Don’t assume, “It’s all in the computer.”

2. Bring records from previous hospital visits or disks of imaging that you have had at other hospitals.  The picture is more important than the written report.

3. Ask questions about your care.  We want you to understand your care plan. If you don’t understand it, please ask us so we can better explain it to you.  

4. Tell the truth. Trust me...we’ve heard it all.  If you don’t tell the truth about something, you may get a  whole bunch of tests and exams that you don’t need.  If you did drugs, tell us.  New sore on your penis? Tell us.  Put something where it doesn’t belong?  Tell us!  Did something stupid, with your friends? Tell us!  It makes everything easier for everyone.

5. Follow directions of medical staff.  If we are instructing you to do something, there is a reason for it.  If you don’t understand the reason, please ask us.

6. Be polite and respectful of healthcare staff.  It goes a long way.

DON’T

1. Bring any weapons into the ER, including legally carried or owned weapons.  We take our own safety very seriously.  If you do have weapons, check it with security before you come in.  Some ERs, such as my ERs have metal detectors and mandatory security checks prior to coming in.  Please follow directions and be respectful of this.

2. Curse, spit, punch, kick, or threaten otherwise attack any healthcare workers. ,

3. Talk on your phone while your doctor is trying to talk to you.  It is incredibly disrespectful, and we need your full attention to examine you properly.  It delays your care, and everyone else’s care.

4. Have someone on Facetime, or some other videochat on the phone in the background without the knowledge of your healthcare provider.  If we don’t know they are listening, we may ask you sensitive questions without realizing or perform sensitive parts of the physical exam without knowing someone else can see or hear what we are doing.

5. Take photos,videos, or audio recordings of any part of your care without explicit permission from your healthcare provider.  In our ERs, this is strictly prohibited due to HIPAA laws.

6. Walk up to the doctors station to ask questions.  Hit your call bell and have them come to your room.  We discuss sensitive patient information in those areas and you are not allowed to eavesdrop or overhear those discussions as part of HIPAA law.  If you do this, we have to stop what we are doing.  This distracts us and delays everyone’s care.  

7. Leave with an IV in.  We will call the police who will find you and bring you back to have it removed.

8. Pull out your own IV or any other medical devices.  This is for your own safety and protection.  If you need something out.  Call your nurse.

That’s all folks!  Hope you found this helpful!