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

Susie2310 · Dec 19, 2015

In some areas, as mentioned, the Urgent Care, if there is one, closes in the late evening. On a Saturday night, when one cannot see their PCP until Monday at the earliest, it is understandable that some patient populations, for example, the elderly, who often have numerous co-morbidities, may have learned the wisdom of seeking medical care sooner than later. They may sensibly present with problems such as UTI's, respiratory infections/coughs/colds, hoping to avoid complications of their illness that will be much harder for them to cope with if the UTI progresses to sepsis, or if the respiratory infection turns out to be pneumonia.

It is understandable that elderly people, very young people, or people with serious co-morbidities may seek care sooner than later for illnesses that can can have serious consequences for them if treatment is delayed until they are "very" sick, and I believe they should do so. It is appropriate for people to use the Emergency Room for this purpose.

Anna Flaxis, BSN, RN · Dec 19, 2015

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.

Which is fine, so long as you understand that emergencies will always be the highest priority, and that if you have an appointment, have to go pick up the kids, need to get home to let the dog out or whatever, I'll do my best to get you through as quickly as I can, but that again, the true emergencies will always get my immediate attention. You may miss your appointment or have to ask someone else to go pick up the kids or go let the dog out. Your schedule is not my priority. I didn't drag you in off the street and force you to come to the ER for your minor complaint.

Also, if your doctor does send you in, you will still go through triage and wait your turn just like everybody else. You don't get to the front of the line just because your doctor called ahead.

I don't mind taking care of minor illnesses at all, so long as the people behave appropriately and respectfully. Just because you have a busy day, have somewhere else you need to be, or just hate waiting, doesn't make it an emergency.

Jensmom7, BSN, RN · Dec 19, 2015

The more things change, the more they stay the same. This behavior is not new, believe me.

Fifty years ago, my aunt used the local ER as her own private Pediatrician's office. Any time one of my cousins sniffled or crossed their eyes once to often, off they went.

Insurance and access to health care had nothing to do with it. My uncle was a nuclear engineer. She just saw nothing wrong with taking up time and space when her doc couldn't see them immediately.

Nonyvole, BSN, RN · Dec 20, 2015

Or there's my favorite. PCP was leaving 15 minutes after pt's scheduled appointment, so they just send the pt to the ED.

allnurses Guide · Dec 21, 2015

An emergency is what a reasonable person would consider it to be. That's what EMTALA is all about. However, there don't seem to be very many reasonable people out there when it comes to their own comfort.

I do get a fair amount of people in who say they tried to get to an urgent care, but there aren't any open late night. We have a system to get the lower acuities in and out, using PAs or NPs mostly, with a fully board certified ER doc to back them up (and the collaboration is great). The middling ones, that need a workup but aren't going to die in the next few hours are the ones that have to wait quite a while, in general. After midnight the fast trackers get held up longer as the PAs leave, and the middling ones finally get caught up on.

But all of those are our bread'and'butter, without them there would be no large department, probably 2/3 fewer beds, nurses, etc. They all get charged at the ER rate (we don't have an official urgent care center, just an efficient triage system). The big traumas, the MIs, the surgical bellies, are not so common.... but we have to be ready. We rule out a lot of abd or chest pain, but better they come in so we catch the minority.

People of all walks of life are rude or polite, I used to get upset, but you know what? I don't give them space in my head much anymore, and I certainly don't take them home with me. Might gripe briefly, but that's it.

**NickiLaughs, ADN, BSN, RN** · Dec 23, 2015

I'll trade you my last four shifts have be insanity and I would love a simple earache to break up the constant sepsis and resp distress and DKA.

emtb2rn, BSN, RN, EMT-B · Dec 23, 2015

An emergency is what a reasonable person would consider it to be. That's what EMTALA is all about. However, there don't seem to be very many reasonable people out there when it comes to their own comfort.

EMTALA is actually about ensuring that anyone presenting to an ed gets a medical screening by a licensed mid or higher level provider regardless of their insurance status and that any life threatening conditions are treated. Again regardless of insurance status.

allnurses Guide · Dec 27, 2015

EMTALA is actually about ensuring that anyone presenting to an ed gets a medical screening by a licensed mid or higher level provider regardless of their insurance status and that any life threatening conditions are treated. Again regardless of insurance status.

Yes, and the definitions within EMTALA define an emergency from a lay point of view, so that people can come in and even though we don't think it is an emergency we still screen for one. The history behind the EMTALA bill was fascinating.

needlesmcgeeRN, ASN, RN · Dec 27, 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.

The PCPs I work with have slots on their schedules for same-day appointments...but when this isn't an option for you, the next stop should be Urgent Care or After-hours clinics. We send out letters to our ED frequent-fliers explaining when a person should be seen in the ED. It's crazy...of course, the thing is...if a pt.'s medical coverage is Medicaid, there's really no incentive for them to properly utilize the ED.

CountryMomma, ASN, RN · Dec 27, 2015

Yes, but please see above. In many areas, WICs and UCs are either not available, or close evenings, weekends, or both.

ArrowRN, BSN, RN · Dec 29, 2015

I'm not an ER nurse but often wonder the same thing. What is most confusing is the monetization tactics being used by hospitals. They have huge electronic billboards advertising their ER wait times...practically encouraging people to come. I've even seen hospitals that allow you to make an appointment to the ER so you can do your waiting at home..seriously? you got an emergency but can sit at the computer and make an ER appointment? :madface:

Editorial Team / Moderator · Dec 30, 2015

I've even seen hospitals that allow you to make an appointment to the ER so you can do your waiting at home..seriously? you got an emergency but can sit at the computer and make an ER appointment?

They are really making urgent care appointments. From what I understand of those scheduling systems, they won't allow people to schedule "appointments" for things like chest pain.

Wasn't there some litigation or issue with the billboard ads? I see them in Florida a lot.