What happened to the "Emergency" in "Emergency Room?"

beautyandbrains · Dec 17, 2015

Everyone's situation is different. People want treatment then and there. And if there's a high ER copayment, of course you can expect people to be demanding. My old PCP office wouldn't be able to give me appointments til the week or following week. So I ended up going to the ER for what they considered to be "minor", but I just couldn't wait a whole week to be seen. My ER co pay is $375. So of course I'm not forking out that much money if i don't really need to. My advice is just to be a bit more compassionate and do your best. You will have cases that are truly ER related. But you have to still provide care for those who you feel are only there for minor illnesses.

Emergency.RN · Dec 17, 2015

Everyone's situation is different. People want treatment then and there. And if there's a high ER copayment, of course you can expect people to be demanding. My old PCP office wouldn't be able to give me appointments til the week or following week. So I ended up going to the ER for what they considered to be "minor", but I just couldn't wait a whole week to be seen. My ER co pay is $375. So of course I'm not forking out that much money if i don't really need to. My advice is just to be a bit more compassionate and do your best. You will have cases that are truly ER related. But you have to still provide care for those who you feel are only there for minor illnesses.

Let me guess, you don't work in an ER?

I have to disagree with you on both of the points you're making here. Yes, maybe you could not wait one week to be seen. But the emergency room is for people who cannot wait one minute or one hour to be seen. If you can wait longer than 1 hour, whyare you not going to a minute clinic or Urgent Care? When wait times are over four hours it is because individuals choose to utilize emergency services for nonemergent conditions. And the truly sick, critical, or mentally ill suffer because of it.

Additionally, I disagree with your comment that we should "expect patients to be demanding" Excuse me? Nurses are professionals and deserve to be treated as such. You are the one who chose to utilize the ER for a nonemergent condition and that is why you have a long wait time. Not the nurses fault. Life-threatening emergencies are seen first, plain and simple. I cannot speed things up for you, even if your "copayment is high"

beautyandbrains · Dec 17, 2015

To answer your question, yes I have worked in the ER before at a Pediatric Hospital. So we did have a lot of parents bringing their kids in for "minor" issues. Ear aches, temps, you name it. And I had to deal with demanding parents who didn't want me to place an IV in their child. Or irrigate their child's ear of ear wax. I've been there. And I dealt with it. Didn't complain about it. I only brought up my experience because I've had moments where I've gone to the ER for a "minor" issue. Maybe the problem lies in there not being enough available appointments when you call your primary doc, that was my issue back then.

CountryMomma, ASN, RN · Dec 17, 2015

Let me guess, you don't work in an ER?
I have to disagree with you on both of the points you're making here. Yes, maybe you could not wait one week to be seen. But the emergency room is for people who cannot wait one minute or one hour to be seen. If you can wait longer than 1 hour, whyare you not going to a minute clinic or Urgent Care? When wait times are over four hours it is because individuals choose to utilize emergency services for nonemergent conditions. And the truly sick, critical, or mentally ill suffer because of it.
Additionally, I disagree with your comment that we should "expect patients to be demanding" Excuse me? Nurses are professionals and deserve to be treated as such. You are the one who chose to utilize the ER for a nonemergent condition and that is why you have a long wait time. Not the nurses fault. Life-threatening emergencies are seen first, plain and simple. I cannot speed things up for you, even if your "copayment is high"

Not going to jump in on the emergent vs non emergent issue. I just wanted to mention that in many locations there are no minute clinics, and in my area, all of our urgent cares/WICs close in the evening and 1/2 is not open on the weekend. Also, depending on the patient's insurance, they may not cover a trip to the urgent care if it's out of network, which many free-standing clinics are considered to be.

rearviewmirror, BSN, RN · Dec 17, 2015

It's an unfortunate reality of today's Healthcare as many of population in urban downtown settings are not only low socioeconomic, but also lesser educated in health, diet or self-management, causing them to have worse health overall, and as you know most people come to ER because they don't have a doctor or insurance. It's you and me the working folks who are paying for all their care, and I'm told to cater to these people??? I don't think so! I actually moved my job to northern part of the city, and naturally there are still people who come in for non-emergent things but good God the clientele is much more gentle than the downtown brood I almost miss the cussing, swearing in the waiting room and the police yelling at them to stop Hahaha. My recommendation is moving to "better neighborhood", and of course I'm not saying what I say is absolute truth, but it definitely worked for me; so please non of that "I worked in both settings and rich and poor are the same" argument I heard it before.

I'm going to suck it up for 1 or 2 more years and go to insurance or case management where I don't have to see patients, I just like working in business or corporate setting in business attire, appropriate lunch, etc and work on my MBA. Nursing is not for everyone and it's good first step to acknowledge that it is not what you want. Good luck.

OldDude · Dec 17, 2015

I think one of the reasons for such an increase is, nowadays, it's rare to get any advise from an after hours, on call, Doctor other than , "go to the ER." Another reason is physician offices frequently don't triage their patients, but just line them up, and you get the, "our next available appointment is August 7, 2017." But I think the predominant reason, and this is controversial, is if there isn't any investment in the visit by the patient, or the patient's parents, the visit has no value to them and scheduling a doctor visit isn't a priority, it becomes simply a stop off when it's convenient, considering the ER is always open. Yes I know there are real needs and exceptions. I too worked in a pediatric ER and have witnessed it first hand. I currently work pool in a pedi Urgent Care. It's no different. We frequently go through an entire shift without seeing a "new" patient. 95% Medicaid, all who have a PCP.

offlabel · Dec 17, 2015

Since when is the ER not anywhere near as much bona fide emergencies as routine complaints? It's always been that way. Even in the late 80's during the 'crack wars' in inner city hospitals it was still 10:1 routine to emergency if not more.

Editorial Team / Moderator · Dec 19, 2015

It's an unfortunate reality of today's Healthcare as many of population in urban downtown settings are not only low socioeconomic, but also lesser educated in health, diet or self-management, causing them to have worse health overall, and as you know most people come to ER because they don't have a doctor or insurance.

The ENA has acknowledged that insured people are also a growing factor in ED overcrowding â€” like their uninsured counterparts, they often have a lack of access to primary care. In the military health system, 99% of our patients have a primary care provider, yet they present to the ED because they cannot secure an appointment. In the civilian EDs where I worked in Virginia, it was often the insured patients who were more self-entitled because they felt their visits were "paid for" and they should get everything they want, and right away. Meanwhile uninsured Joe Schmoe over in room 4 with his chest pain and positive troponin is signing out AMA because he says one hospitalization will leave his family in an insurmountable debt that would cost more to pay back than his funeral.

Funny story â€” I had a very nice patient with chest pain in a hall bed at a city Level 1 trauma center, and she was awaiting an inpatient bed when a friend came to visit her. I was charting nearby when I heard him whisper in a horrified tone, "What are you doing in the hallway? Didn't you tell them you have insurance??" Oh, honey... Bless your heart! If only it was that simple.

Our system is a mess. We in the ED are often victims of our own efficiency and ability to provide a wide range of testing and treatment; people come to us because they know they will get everything done in one day that would take weeks as an outpatient.

Anna Flaxis, BSN, RN · Dec 19, 2015

Our system is a mess. We in the ED are often victims of our own efficiency and ability to provide a wide range of testing and treatment; people come to us because they know they will get everything done in one day that would take weeks as an outpatient.

Exactly. Having worked in an outpatient setting, I have seen the hoops people have to jump through to get their needs met. I don't blame people for coming to the ER for things that seemingly could be handled at a clinic or by their primary.

What I find even more disturbing is the frequency with which the primary care providers themselves use the ER as a service of convenience.

*Post-Op pt with DVT sent in by PCP- you can call the surgeon and set up Coumadin bridging just as easily as the ER doc can.

*Pt with history of liver disease with new onset ascites, not on any diuretics. You can call theGI doc and prescribe a diuretic just as easily as the ER doc can.

*Pt with history of complex migraines, now c/o 10 day migraine (no focal neuro deficits), sent in for evaluation. You can call the neurologist and order an outpatient MRI just as easily as the ER doc can.

All on the same day.

Lots of people try to do the right thing and have their PCP handle things that can be handled on an outpatient basis, but then their PCP sends them in to the ER anyway, burdening the ER staff with non-emergent clinic visits.

chare · Dec 19, 2015

...But the emergency room is for people who cannot wait one minute or one hour to be seen...

1. How do you define emergency (worthy of being seen in the ED)?

2. How many beds are in your ED?

3. If your ED restricted service only to patients defined as "emergent" by tour response to question 1, how many of ypur ED beds do you think you would lose?

beautyandbrains · Dec 19, 2015

1. How do you define emergency (worthy of being seen in the ED)?
2. How many beds are in your ED?
3. If your ED restricted service only to patients defined as "emergent" by tour response to question 1, how many of ypur ED beds do you think you would lose?

Thank you. This is what I was trying to explain. Everyone's situation is different. We all have our reasons for going to the ER.