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

ERnursebyday · Feb 7, 2016

"Beautyandbrains" I have been an ER nurse for quite a while and absolutely love it. It is my passion!! I find it completely insulating saying "if there's a high ER copayment, of course you can expect people to be demanding". An EMERGENCY room is not an expensive restaurant where you feel that you are paying this much so have the right to be demanding and get whatever you want. Then you say "just be a bit more compassionate". You are most definitely contradicting yourself with that statement. Demanding in the ER is not appropriate just because one has a high copayment. We need compassion and understanding from our patients as well.

Not_A_Hat_Person, RN · Feb 8, 2016

My area has 1 hospital and 4 urgent care centers. All are open 8 am to 8 pm, but only the hospital-operated urgent care center takes Medicare and Medicaid. Both I and my husband have gone to the hospital's urgent care clinic only to be sent to the ER because the specialist we needed wasn't available during the weekend. My daughter's pediatrician once sent us the ER for a minor problem because it was the only way for her cardiologist to see her.

I was an ER volunteer in Boston, which had a huge PCP shortage and no urgent care centers or walk-in clinics (apparently a few have opened in the last few years). PCPs sent anyone with the slightest hint of illness to the ER. A lot of people came in, during business hours, for things like MRIs, abscess lancing, and sutures because their PCP sent them. When I was between PCPs, I almost had to go to the ER for a strep test. I was sent to the ER for x-rays after spraining my foot and another for splinter removal.

As nurses, we have a good idea of what constitutes an emergency. Laypeople are different. If their doctor tells them to go to the ER, that's where they'll go, even if the problem could be treated in an office visit.

brillohead, ADN, RN · Feb 8, 2016

"Brillohead". What do you mean " peeing blood"? Filling the toilet? Were you in any pain? Any symptoms the days before?

Just a standard UTI (constant urge to urinate, pain when stopping urination, blood in urine, urge incontinence).

It came on while I was at work, and by the time I was able to get seen (at 11pm on a Friday night), the ER was my only option besides waiting until my doctor's office to open on Monday morning. (I was a bank teller and a convenience store clerk back in that lifetime, not a nurse.)

If you've ever had a UTI, I think you understand why waiting 60 hours to start treatment wasn't a viable option.

ERnursebyday · Feb 8, 2016

I actually have had an extreme UTI when I was 26 (28 now) years old. It was awful. Feeling like I was peeing glass. Very uncomfortable. Not to undermine your decision to go to the ER, but I went to my PCP 2 days later when an appointment was available and was prescribed antibiotics. Going to the ER would have cost me a 75$ copayment plus bills to follow. I apologize, but a UTI is not an emergency. While it is uncomfortable (such as an extreme sore throat or a cough) it is not an emergency. There are urgent cares and minute clinics (i.e. CVS,Walgreens Ect.) open on the weekend if need be. The big problem is what one person thinks is an emergent vs another. I would certainly not go to the ER and spend 75$ (at the minimum) for a UTI.

michigansapphire · Feb 9, 2016

I've had to go to the ED for back pain ($250 copay). I live in a rural area where there are no minute clinics and the Urgent Care closes at 7pm. I was working nights at the time so I didn't wake up and try to get moving till 5pm -- by the time I could get out the door (in a cab, no way I could drive) it was 6:30. I did apologize to the NP who treated me. I think my exact words were "I'm sorry to have to come into your ED and ask for drugs, but I need drugs."

CountryMomma, ASN, RN · Feb 9, 2016

I actually have had an extreme UTI when I was 26 (28 now) years old. It was awful. Feeling like I was peeing glass. Very uncomfortable. Not to undermine your decision to go to the ER, but I went to my PCP 2 days later when an appointment was available and was prescribed antibiotics. Going to the ER would have cost me a 75$ copayment plus bills to follow. I apologize, but a UTI is not an emergency. While it is uncomfortable (such as an extreme sore throat or a cough) it is not an emergency. There are urgent cares and minute clinics (i.e. CVS,Walgreens Ect.) open on the weekend if need be. The big problem is what one person thinks is an emergent vs another. I would certainly not go to the ER and spend 75$ (at the minimum) for a UTI.

I strongly disagree. As another nurse that had to make the ridiculous and embarrassing trip to the ER for a severe UTI on a Friday night, UTIs can be urgent bordering on emergent. I got wallopped by one hell of a UTI starting Thursday evening. Had 3 12s in a row in front of me, and the urgent care had already closed Thursday evening. By Friday night I was grabbing the walls and whimpering in pain, and my urine had an awfully maroon hint to it. I finally broke down at the end of my shift Friday night and hit the ER. There wasn't a lab value WNL in that UA. I got 2 antibiotics, pyridium, and a lecture from the ER doc about new nurses not going to the bathroom enough and not drinking enough. He was particularly upset that I thought I could just tough it out until Monday AM and hit the urgent care if my PCP couldn't see me. It was his opinion that if blood is in your urine, and this is a new onset deal, see a doc sooner rather than later. He's not a fan of pyleonephritis, and neither am I.

I'm not saying all UTIs are ER worthy, but if one is peeing blood and can't see straight from the pain, that's not the time to be all Rambo about it.

And again - NOT ALL COMMUNITIES HAVE MINUTE-CLINICS AND URGENT CARES OPEN ON WEEKENDS/24/7. Sheesh.

brillohead, ADN, RN · Feb 9, 2016

I actually have had an extreme UTI when I was 26 (28 now) years old. It was awful. Feeling like I was peeing glass. Very uncomfortable. Not to undermine your decision to go to the ER, but I went to my PCP 2 days later when an appointment was available and was prescribed antibiotics. Going to the ER would have cost me a 75$ copayment plus bills to follow. I apologize, but a UTI is not an emergency. While it is uncomfortable (such as an extreme sore throat or a cough) it is not an emergency. There are urgent cares and minute clinics (i.e. CVS,Walgreens Ect.) open on the weekend if need be. The big problem is what one person thinks is an emergent vs another. I would certainly not go to the ER and spend 75$ (at the minimum) for a UTI.

Well, for starters, this was back in the early 1990s, and urgent cares and minute-clinics simply DID NOT EXIST in my region -- which I clearly stated in my first post.

And even though I was young and working two jobs to get by, it was still worth it to me to pay $75 to both relieve the pain and also rid my body of the infection before it worsened. Even back in my 20s, I valued my own comfort and peace of mind and physical health more than I valued the almighty dollar.

I strongly disagree. As another nurse that had to make the ridiculous and embarrassing trip to the ER for a severe UTI on a Friday night, UTIs can be urgent bordering on emergent. I got wallopped by one hell of a UTI starting Thursday evening. Had 3 12s in a row in front of me, and the urgent care had already closed Thursday evening. By Friday night I was grabbing the walls and whimpering in pain, and my urine had an awfully maroon hint to it. I finally broke down at the end of my shift Friday night and hit the ER. There wasn't a lab value WNL in that UA. I got 2 antibiotics, pyridium, and a lecture from the ER doc about new nurses not going to the bathroom enough and not drinking enough. He was particularly upset that I thought I could just tough it out until Monday AM and hit the urgent care if my PCP couldn't see me. It was his opinion that if blood is in your urine, and this is a new onset deal, see a doc sooner rather than later. He's not a fan of pyleonephritis, and neither am I.
I'm not saying all UTIs are ER worthy, but if one is peeing blood and can't see straight from the pain, that's not the time to be all Rambo about it.

And again - NOT ALL COMMUNITIES HAVE MINUTE-CLINICS AND URGENT CARES OPEN ON WEEKENDS/24/7. Sheesh.

Amen, sister!

Heck, I've gone to the ER on a weekend (AGAIN -- NO URGENT CARES EXISTED AT THAT TIME IN MY AREA -- it's only been in the past five years or so that freestanding clinics have opened in this region) for a particularly nasty case of conjunctivitis on a Sunday. Based on the symptoms and the speed with which they had progressed, my PCP's phone triage nurse (whom I had called to see if I could just get a scrip phoned in for gentamicin drops) told me to go to the ER because I was in danger of losing the eye if I didn't get it treated that same day.

I'm not talking about a little case of pinkeye -- I'm talking copious streams of mucus running down my face. The ER doc actually jumped back and said, "YIKES" when he saw it. Rocephin injection plus oral abx plus gentamicin eyedrops plus orders to see my PCP within the next two days for additional followup. It was a big effing deal.

Emergency doesn't JUST mean heart attacks and gunshot wounds.... it's for anything that really can't / shouldn't wait until your PCP (or an urgent care center) is available to you.

A broken bone won't kill you right away if you're not hemorrhaging... but if it's not treated in a timely manner, it can result in loss of function or loss of the limb itself (plus the danger of fat embolism). My conjunctivitis (which was actually an infection of the sinuses and ears that spread to my eye) wasn't going to kill me, but it could have resulted in the loss of my vision. A UTI might not kill you right away, but it can result in kidney damage or sepsis if not treated before it worsens.

Emergency shouldn't just mean "life-threatening" -- it also applies to things that could result in damage to organs and limbs that will impact future functioning.

Not_A_Hat_Person, RN · Feb 9, 2016

And again - NOT ALL COMMUNITIES HAVE MINUTE-CLINICS AND URGENT CARES OPEN ON WEEKENDS/24/7. Sheesh.

Just wanted to highlight that, as a nurse who lived in a major city with several hospitals, no Minute Clinics (the mayor publicly vowed to block them) and no urgent care centers.

ERnursebyday · Feb 10, 2016

*Brillohead* When I asked a few valid questions regarding your UTI you replied "Just a standard UTI (constant urge to urinate, pain when stopping urination, blood in urine, urge incontinence)". Another post later discussed after my response "not being able to see straight from the pain". Brillohead did not state such a discomfort as that. In that case it should not be described as a standard UTI. I would also like to note that in the original post it did not state "it was in the 90's". I understand there was no urgent cares, however, minute clinics, as I stated, are not the same as urgent cares. There are quite a few differences. And again there was no mention of the 90's in the original post indicating there were no such clinics.

As far as a "broken bone or copious streams of mucus running down ones face" from an eye infection are completely different scenarios than a "standard UTI" and would require immediate help. I respect everyone's different thoughts and comments, however, a standard UTI (not an advanced UTI) does not define emergency.

vintagemother, BSN, CNA, LVN, RN · Feb 10, 2016

I called my PCP provider (a large HMO) a few weeks ago because of severe abd pain. They wanted me to go to the ED. I refused. I am a nurse and I believed EDs are for people who are acutely ill.

I simply had an ongoing, intermittent pain in my lower abd which radiated to my back and left me unable to stand, or sleep or think.

I, thankfully, was able to secure a same day appointment with my PCP. She drew labs and discovered I have H Pylori and an ulcer!

It's a tough decision to decide whether to go to the ED or not. Most people who go to the ED are desperate. I've definitely BTDT, in the 90s. But the 6 hour wait times really wore at me and I won't go now.

I don't know if my post is helpful, but it's my experience as a person whose trying not to abuse the ED, yet, at times, needs urgent/emergent care due to intense pain.

brillohead, ADN, RN · Feb 10, 2016

*Brillohead* When I asked a few valid questions regarding your UTI you replied "Just a standard UTI (constant urge to urinate, pain when stopping urination, blood in urine, urge incontinence)". Another post later discussed after my response "not being able to see straight from the pain". Brillohead did not state such a discomfort as that. In that case it should not be described as a standard UTI. I would also like to note that in the original post it did not state "it was in the 90's". I understand there was no urgent cares, however, minute clinics, as I stated, are not the same as urgent cares. There are quite a few differences. And again there was no mention of the 90's in the original post indicating there were no such clinics.
As far as a "broken bone or copious streams of mucus running down ones face" from an eye infection are completely different scenarios than a "standard UTI" and would require immediate help. I respect everyone's different thoughts and comments, however, a standard UTI (not an advanced UTI) does not define emergency.

Sorry, but in most people's minds, an urgent care clinic and a minute clinic are the same basic thing -- someplace you can go for things that are not ER-worthy but still need medical intervention. I specifically stated that there were no other options available to me -- it doesn't matter if it was in the 90s or last week.

NOT EVERY COMMUNITY HAS MINUTE CLINICS AVAILABLE.

Seriously, I guess we can't repeat that enough. Heck, my husband actually worked as a project manager installing Minute Clinics in other states for a couple years, and I had to have him explain to me what they are, because they SIMPLY DID NOT EXIST IN MY AREA.

As for your judgment that my UTI was minor and had absolutely no chance of developing into something major in the next 72 hours, we'll just have to agree to disagree on that. When I have blood coming out of my urethra, I think that is my call whether or not I want to take the chance of it developing into a kidney infection or sepsis. I was willing to pay the extra money for the ER copay rather than take that chance, and my insurance company was also willing to pay the extra money for the ER visit (an ER visit for a UTI is a heck of a lot cheaper than a hospitalization for sepsis or kidney infection).

ERnursebyday · Feb 10, 2016

Well if we are going to continue repeating ourselves as if that provides any extra credibility, let me then once again include " Just a standard UTI (constant urge to urinate, pain when stopping urination, blood in urine, urge incontinence)" is interpreted by an ER nurse as minor. If you come into my ER and explained your symptoms as such we would send you to fast track obtain a urine and send you home. If you came into our ER stating pain so bad you can't walk straight Ect Ect you would be evaluated in a regular room. So once again as I stated before (WHICH I CANT REPEAT ENOUGH) is that your ORIGINAL post (let me repeat ORIGINAL post), did not indicate anything to a triage nurse that she would jump up and down about. I am only able to interpret your situation from what you simply stated. Now after my response from your ORIGINAL post (let me repeat ORIGINAL post) you became defensive and started to include sepsis and pylonephritis. Please reread your original description of your UTI and calm yourself down. You are grasping at straws here.

I will gladly discuss sepsis and pylo, but, in a separate category than "standard UTI" as you stated. Thank you.