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Old 01-18-2018, 12:08 AM
 
Location: colorado springs, CO
3,999 posts, read 1,778,146 times
Reputation: 13794

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Quote:
Originally Posted by imcurious View Post
What is interesting to me is that there obviously have been studies on the different types of cases that present at ER's . . . but evidently NOTHING has been done with this information. They should do a comprehensive systems review, specify the types of injuries that present, and have DIFFERENT protocols for the injuries.

Those with severe traumas should be taken to the severe trauma area . . .those with "doc in the box" types of issues - (slivers, coughs, non-traumatic injuries) should be taken to more of an "urgent care" type of environment ("urgent" being less severe than "emergency") . . .this would not necessarily take more personnel, but it WOULD take more efficiency - and hospitals are notorious for being inefficent . . .

The “protocol” you are speaking of does exist; it’s called Triage. The thing, is that Triage is a sort of “layered” process & many times; it’s done wrong:

The “ABC’s”. Airway. Breathing. Circulation. Meaning symptoms indicative of cardiac or respiratory distress. ABC’s should always have priority over almost anything else that comes in. Bleeding is considered part of “Circulation” , depending on severity & location.

The closer to the lungs & heart a bleed is, the higher the priority. A severed finger, on a hand wrapped in a t-shirt & controlled by pressure can be distressing but it is not a severed jugular or femoral. The majority of limb/ digit wounds will not require a transfusion.

Next level of priority is going to be LOC, or; level of consciousness. Meaning altered, as in found unresponsive. Slurred speech. Sudden confusion.

Almost everything else; abdominal pain, injury, fever, etc ... will come afterwards. BUT; this is where it typically goes wrong: Even if the complaint is non-emergent, a brief triage assessment of taking vital signs should be done before the patient waits for a bed.

This is important for prioritizing care: I have seen patients who insisted they “Feel fine, maybe just a bit dizzy” who’s blood pressure was 220/160.

I have seen patients who insisted they “couldn’t breathe!” but their pulse ox was 99%.

The times that I worked Triage, if I had a patient who complained of difficulty breathing despite having a high pulse ox, I would take another 20 seconds to listen to their breath sounds because some people are very good at “compensating”. Meaning; they are working very hard to move air so the numbers initially look good but when I listen? I can’t hear air moving & their lungs may be full of fluid.

No patient should be waiting hours for that first set of vital signs & it’s not a costly step to implement.

I would also point out that a crowded ER is not always due to uninsured illegals. Even during office hours, many doctors offices will instruct patients to go to the ER instead of coming to the office. Some insurance companies have policies about follow up care being provided at the same location emergency or urgent care was received. Meaning; if you had to go in to the ER for stitches, they might deny payment if you do not return to that same ER to have them removed a week & a half later.
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Old 01-18-2018, 06:57 AM
 
Location: northern New England
1,727 posts, read 702,077 times
Reputation: 6749
I've been a few times. Once, after a car wreck, in FL, care was immediate and good. Kind of put off when we had to go by the aggressive "How are you going to pay for this?" lady before leaving.

Another time, DH drove himself to the hospital after having a stroke (yeah, I know, crazy, and it was a manual transmission) and got seen right away.

And then he got taken by ambulance to the ER 15 miles away when he had trouble breathing. I followed in our car. He was seen and stabilized right away but they couldn't find a bed for him until 4AM (he arrived around 10PM). It was fine for him, he was lying down, I was sitting in a chair all that time.

This hospital was in a city known for drug use, and I noticed a permanent sign on the wall of the ER detailing exactly under what conditions they would give out scrips for pain meds. Never saw that before.

The nearest large medical center to me, I have never been to the ER but walked through it several times from the parking lot and it is always empty, or almost so. Perhaps that is because the doctors associated with this medical center have something called "Same Day Appointments", where, if you don't want to wait for a regular appt., you can come in sooner and be seen by a PA or NP. Gets you into the system if you need to be, takes care of your problem if you don't.
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Old 01-18-2018, 09:43 PM
 
Location: San Bernardino County (previously L.A.)
4,483 posts, read 7,535,028 times
Reputation: 3867
I've been to the ER I believe 4x's in my life, the last time being almost a year ago on Feb 1st, 2017. Overall, they all were about as good as an ER visit would go, I guess.

There was a massively long wait, you get seen, more terribly long waiting when you're lying in bed, then you go home in a hopefully better state.

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Since we're on this topic, I'll never forget the time I drove my mom to the ER, which I've had to do here & there. My dad went too so it was the 3 of us. After the initial LONG waiting rm wait when my mom was lying in the ER bed, my dad had to use the restroom. He tripped on this rug that was out in the waiting rm & in front of the security guard and many others, he hurt himself so badly that he had to be taken care of by the ER as well.

So, here I am (an only child) sitting pretty much in between BOTH my (elderly) parents each lying in a bed.
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Old 01-19-2018, 03:51 PM
 
Location: on the wind
4,143 posts, read 1,546,813 times
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I've been to one three times. One was after a head on car crash in a blizzard 1 week after moving across the country for a new job. Had chest pain, but I was obviously not in a life threatening situation while there, so triage did what it is designed to do. Uncomfortable wait, but there were more urgent cases resulting from the storm (including the person who caused my accident) but not unreasonable and the nurses were kindly. X-rays reviewed the next day showed a broken sternum and a cracked rib. Made me feel a little better that I was not simply being a wimp about the pain . Not much to do about that but pain meds and time. The others were situations where I didn't have a local provider or couldn't get to one. Again, care seemed pretty reasonable and expected.
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Old 01-20-2018, 08:18 AM
 
33,139 posts, read 39,090,825 times
Reputation: 28489
Went to emergency room this week,got there around 6am,there were only 3 other people there,got to see triage nurse within a half hour,an hour later saw a doctor who did blood tests and put me through two types of Xrays, i was home by 2pm with a couple of prescriptions and an appointment with a chest specialist that i saw yesterday,he prescribed some stronger inhalers and told me to lose weight
While the experience was inconvenient it went as well as could be expected.
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Old 01-20-2018, 08:50 AM
 
6,124 posts, read 5,151,071 times
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Our small town hospital's emergency room is almost always criticized. However, last May, DH was doing yard work and suffered the symptoms of what he suspected was a heart attack. He drove HIMSELF to the ER, about 3 miles away.

I was at work when I got the call, and a co-worker drove me to the hospital (5 minutes away). When DH started feeling the symptoms, he called our oldest daughter at her business, about a half hour away. She was there alone with her two small boys (9 months and 3 at the time), and was ringing out customers herself because she had a call off that day. Oldest grandson had to go "potty" and couldn't find his bench that he uses to reach the toilet. He couldn't wait for her to help him, and had an accident in his pants. That was when she got the phone call from her dad. She told the customers she had to leave for a family emergency, put up a sign, cleaned grandson up, and rushed out the door. When she arrived at the hospital parking lot, I went out to help her with the kids...and youngest daughter came running out yelling that DH was having a "full blown heart attack". They were on the ball, attended to him, diagnosed him immediately, stabilized him, and life flighted him via helicopter to the closest hospital that had a cardiac unit. We followed in the car, almost an hour's drive.

They saved his life...we found out that day that it was a "widow maker" heart attack with a very low survival rate.

However, one Saturday night about 15 years ago, I had to go to the ER with very severe abdominal pain...I thought it was appendicitis. The doctor on call was a Doogie Houser (very young) and asked me if it could be menstrual cramps. I angrily told him I knew what menstrual cramps felt like, I'd been having them more years than he'd been alive. Rude, I know, but the pain was horrible. Turns out, it was a bladder infection.

A funny experience...on another Saturday night, later that same year, youngest daughter (11 at the time), looked in the freezer for some ice cream to find that it was all gone. A few hours later, DH awoke with a kidney stone attack (he'd suffered with them for years). Oldest daughter drove him to the ER, and I followed with younger daughter. With oldest daughter supporting him, DH got to the ER entrance...where he threw up in the flower bed right outside the door. Youngest daughter looked at the vomit and said, "Oh, it was DAD who ate all the orange sherbet!" This was overheard by some other patients who cracked up laughing. I hope it helped relieve their pain a little.

Last edited by Mrs. Skeffington; 01-20-2018 at 09:18 AM..
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Old 01-20-2018, 01:31 PM
 
9,454 posts, read 15,020,411 times
Reputation: 15409
Quote:
Originally Posted by Rathagos View Post
I won't go to the emergency room unless it's life threatening, here in West Texas. All the low-income people who refuse to make a doctor appointment (even though it's free to them with Medicaid/Medicare) use the emergency room for their convenience. They bring their kids in when they want to, so they don't have to wait to see a pediatrician. This holds true for most other illnesses they have.

It's like they say, "Hey... my son/daughter has the sniffles. I'll call the doctor." Then the staff can't get them seen until the following day or two. So, they pack them up and head to the emergency room. What do they care? It's my tax dollars paying for their visit.
Call the doctor? Many ER users don't have a doctor! Even if they did, they're not going to be seen after hours, weekends, etc. We use Urgent Care type clinics if its an urgent matter that can't wait. However, you need to pay upfront for them to unlock the door and let you go back to the exam area! Even with insurance (for which we pay about $650/month for a family of four), they still want a copay of about $40, depending on your insurance. You get what you pay for!
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Old 01-21-2018, 11:01 PM
 
5,421 posts, read 3,392,418 times
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Our HMO, Palo Alto Medical Foundation, has Urgent Care until 9 pm. We usually go there if the problem won't wait for an appointment. If it's something serious that they can't handle, they call an ambulance and have the pt taken to Stanford.

But for breathing problems at inconvenient times, DH takes me directly to Stanford's ER. Often turns out to be pneumonia in addition to asthma. They have terrific respiratory therapists. It is usually a long wait to be discharged after treatment, but hey, they have valet parking. You can't have everything.

A tech billionaire donated $27.5 million to Stanford for its Emergency Department. I'm no medical professional but it seems very well-equipped. It's one of the few things I'll miss when we move to AZ. I hope the Mayo Clinic can measure up.
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