*Surviving a Visit to the Emergency Room*
By: Leslie
07 December 2012

I work in the emergency room at a local hospital. I worked as a firefighter/EMT for many years. Prior to working for the fire department, I worked at a hospital either in the emergency room or in the business office for six years. The following bits of information seem like common knowledge to me, but maybe they are not common knowledge to everyone. There are things you can do to get into and out of the ER quicker. There are things you can do to make your visit to the ER yield better results. This list is not designed to address every single thing you will encounter at the ER. It is a generalized list of tips that I hope will make your visit go smoothly.

First: The ER does not take reservations. The hospital tends to staff for the median, which means the time you spend waiting to get into the ER, and the amount of attention you receive will depend largely on how many other people visit the ER at the same time you do. The hospital may call more staff in to cover on a busy day, but there are still only so many rooms. Be prepared to wait. Be prepared to wait a long time. Most people visiting the ER are not having a life and death emergency. They may need to be seen, but they are not going to actually die within a short period of time. All of the people visiting the ER have to be assessed. They all have to be prioritized. The priorities change constantly.

Hospitals keep records about the registration time, the amount of time between patient contacts, and the time of discharge. Hospitals want to get you in and out quickly. Hospitals want you to be satisfied with your visit and they understand that waiting makes you less happy with your visit. However, Hospitals have to make money, and Hospitals are institutions not individuals. The individuals working in the ER want to get you in and out quickly as well. Less patients to take care of means a lighter work load. At the same time, rushing you in and out is not good for patient care. Please be patient. We want you to get good care and we want to send you home happy. That almost always takes longer than you want it to take, and almost always takes longer than we want it to take.

Second: Be honest with the registration clerk about why you want to be seen in the ER. Some people are embarrassed by their reason for visiting the ER. Trust me, we have heard it all. The registrarís comments can get you in quicker, or delay your entry depending on what you tell them about why you are here. Donít underestimate or overestimate your need to be seen. Donít exaggerate, and donít make comments like ďI probably donít need to be here.Ē Also, donít bother to ask the registrar if you need to be seen. He or she does not know. No one knows that except you and a qualified person who has assessed you medically, and that person only knows if you needed to be seen in hindsight.

Third: Donít drink or eat anything while waiting to be seen, and be prepared to not be allowed to eat while you are waiting to be treated. Some tests may be affected by you eating or drinking. Accurate results are not always easy to get in unscheduled tests. If you are having some tests run at your doctorís office, he or she will tell you not to eat for several hours. If you have abdominal issues, you should not eat. If you are vomiting or have diarrhea, you should not eat or drink until that issue is dealt with. You can actually make yourself more dehydrated by drinking if you simply vomit everything you just drank, along with other fluids. If you have an injury that may require surgery, you should not have anything to eat or drink in case you need anesthesia. Some medication causes nausea. The above reasons are a short list. There are many other reasons that you should not eat or drink as a patient in the ER. Once you see the doctor, you can ask him or her if you can eat or drink, if you really want something, otherwise, wait until you are done.

Fourth: The ER will almost always ask you to pee in a cup. The ER may need a urine sample to determine if you have an infection. The ER may use the urine sample to determine if you have any drugs in your system. The ER may need a urine sample to determine if female patients are pregnant. If you are a female of child bearing age, donít waste your time telling the staff that you are not pregnant unless you have had a hysterectomy. There are drugs and tests (X-rays) that are not good for pregnant women or their unborn children. Many women swear they canít be pregnant and yet they are. Whether you are a man or a woman, plan on giving a urine sample. If the wait in the lobby is long, and you feel the urge, ask the registrar if you can have a sample cup. Clean catch sample involves wiping, peeing a little, then peeing in the cup. I canít tell you how many people have had to sit around waiting to be able to produce a urine sample in order to be treated. Or worse, if time is critical, a catheter may be necessary.

Fifth: Yes, we want you to wear the gown. We canít treat what we canít see. If you are only in the ER to have your finger stitched then maybe you donít need to put on a gown, but reallyÖ your goal as a patient is to get in, treated, and out, as quickly as possible. Why waste time arguing with the staff about a gown? Yes, some ER staff are just being obstinate, but the gown is used for a few reasons. The gown makes it easy for you to be examined. The gown keeps your clothes from getting blood and other body fluids on them. The gown makes it easier to get X-rays. The gown gives the staff access to check your blood pressure. If you get an IV, and need surgery, getting undressed from your clothes is much more difficult than undressing from the gown. Just put the gown on. Consider it your ER patient uniform.

Sixth A: You will not get pain medication until the doctor has seen youÖ.and you may not get it even then. The ER does not treat chronic pain. The ER doctor does not write prescriptions for chronic pain management. The ER will check a Department of Health and Environmental Control data base for information about how many prescriptions you have received for narcotics and from which doctors you have gotten those prescriptions. If you have a chronic pain condition, but are being seen for another problem besides the chronic pain, make sure you are clear about why you are being seen. If you do receive narcotic pain medication, you may want to ask if it is likely to make you nauseous. If it is, then ask for nausea medication. If you do receive narcotic medication, you will need to have a ride home. The ER canít let you drive home if you have received certain medications.

Sixth B: You will be asked a pain score. On a level of zero to ten, with zero being no pain, and ten being the worst pain you have ever felt in your whole lifeÖ What number would you give this pain? If you walked into the ER on your own two feet, and you can think clearly, please donít say that this pain is a ten unless you have never had any major illness or injury in your entire life. Please donít say ďI have a high tolerance for pain and this is a ten.Ē Likewise, donít say the pain is a 20. The staff will not believe you because we have seen severe traumatic injuries. We understand that you are in pain, but exaggerating that pain wonít get you any sympathy. If you are overly dramatic, we will immediately distrust your assessment of your pain level. At the same time, pain medication is administered PRN. PRN means as needed. If you donít ask for pain medication, you wonít get it. If you are in serious pain, donít wait until the pain is bad to ask for your medication. Stay ahead of the pain. If you are given pain medication, ask how long before it should take effect, and how long it will last. If it hasnít worked within a reasonable time frame, or you are still in the ER and the medication is starting to wear off, let your nurse or doctor know.

Seven: You may have to have blood tests. It does not matter if you had blood tests at your doctorís office yesterday. The ER cannot base its diagnosis and treatment on test that were done prior to your current visit. The ER would be liable if there were changes in your blood work and we didnít check for those changes. Please donít say that you hate needles unless you are prone to passing out when you see a needle or have a genuine phobia. We already know you donít like needles. If you do like needles, then there is probably something wrong with you. If, however, you are genuinely scared of needles, please let us know and we will take more time. We canít make it hurt less. If we could make it hurt less, that would indicate we deliberately make it hurt more for people who arenít afraid. We donít want it to hurt. We want to stick you once and once only. We donít want to miss the vein. It is often more difficult to draw blood and/or start an IV on a patient who is sick and dehydrated. A lot of the patients who are seen in the ER are sick or dehydrated, so it is not unusual for it to be difficult to ďstickĒ ER patients. Ö. Also, if you have tattoos, especially if you have a lot of them, we donít believe you when you say you are scared of needlesÖ.. Just saying!

Eighth: You are not the only patient in the ER.There will most likely be patients in the ER who are much less sick than you. There will likely be patients in the ER who are much sicker than you. You do not have that information, and it would be a violation of the privacy of those other patients to give you details about those other patients. Thatís just part of being seen in the ER. It goes back to my very first point. Be patient.

Ninth: Make the staff see you as an individual. The staff at my hospital, and Iím sure every other hospital, are required to ask your name and birthdate in order to identify you. However, we donít remember your name. We identify you by your room number and the reason you are there. We might include your age. For example ďThe 76 year old female in room 12 who has difficulty breathingĒ That is your ďnameĒ to the staff. If you want to make sure that you get the very best treatment, make sure the staff sees you as more than ďthe 76 year old femaleÖĒ. The staff will probably not remember your name, and you probably donít want them to remember your name. You want us to see you as a person. Find a way to connect. Make no mistake, it is the responsibility of the staff to see you as a person, but if we are busy, we may not be able to do that. You, as the patient, can make that happen. You most likely only have one nurse and one doctor; however, your nurse and doctor have several patients.

Finally: Some things to bring to the ER:

These are just a few things that you can do to make your trip to the ER go quicker. There is no way to list every single thing that you can do for every particular complaint. The most important things are to be patient and to connect with the staff. If you do those two things, your visit will be much more pleasant.

Leslie


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