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What to Expect in the ER

As an emergency room nurse I am accustomed to dealing with frustrated patients. They want to be seen by a doctor now, want their test results yesterday, and want their cure two weeks ago. Their nurse is nowhere to be seen, they don’t know who their doctor is, they don’t know why they have to have all of this blood work done, and they don’t know why they have to wait five hours to find out if they have a broken bone. To remedy some of this impatience, I believe it is beneficial to know what to expect from your ER visit before stepping foot in the door.

*Your Complaint in Five Words or Less*

If not arriving by ambulance, the first person you will encounter when coming to the ER is typically a registrar. This is a non-medical employee who will ask for your name and date of birth, give you a hospital bracelet, and ask why you came to the ER. Keep it brief. In a few words, tell her the main reason why you came to the ER. This informs the triage nurse (I’ll explain that next) how urgently you need to be seen. For example, if you say “I have excruciating chest pain”, you will be seen by the triage nurse prior to the patient who has a cut finger. However, don’t think that you can give a more severe complaint in order to be seen by a doctor sooner. If you have a severe complaint, a nurse will give you a brief assessment and this will determine the need for immediate intervention.

*Triage*

The triage nurse is the second person you will see. She will determine your acuity’ which is how sick you are, how soon you need to be assessed by a doctor, and how many resources will be required for your treatment (i.e. medications, x-rays, blood work). She will take your vital signs (blood pressure, pulse, temperature, respirations) and ask you several questions. Make sure you have a list of your medications readily available.

*The Waiting Room*

Following triage you will be asked to sit in the waiting room and depending on what city you live in, the time of day, the season, the day of the week, and whether it is a rural or urban hospital, waiting time varies greatly. I work at a suburban hospital in the second busiest ER in my state and the average wait time tends to be two to four hours. Some hospitals have a “fast track” department in the ER that handles minor injuries such as lacerations and broken bones. The goal of this department is to get you in and out within two hours.

*The Main ER*

So you have survived the waiting room, your name has been called, and now you will be escorted to the treatment area of the emergency room. You will be put in a room or a curtained area and asked to change into a gown (it opens in the back), and again you will wait.

Typically a nurse will come assess you first. Depending on your complaint she might start an IV and draw your blood before the doctor comes to see you. Nurses have what are called “standing orders” or things that he or she is permitted to do, depending on your complaint, before a doctor comes to see you. If you are having shortness of breath, chest pain or any other cardiac, respiratory, or neurological complaint you can expect to have an EKG done (stickers are put on your chest and you are asked to sit still for a minute while it reads the electrical activity in your heart) and to be placed on a heart monitor (again stickers are placed on your chest and your heart is continuously monitored during your stay).

*Seeing the Doctor (Finally)*

Next an emergency room physician will come assess you and determine what tests need to be performed to appropriately diagnose and treat you. Expect the doctor to be in the room for less than five minutes. They are trained to do rapid assessments and have standardized tests to diagnose every complaint imaginable. Any additional tests that are ordered will be carried out within the next hour. You might be taken to radiology for an x-ray or CT scan, additional blood work might be done, you may need a sonogram, or a nurse will administer medications as needed. All of these tests are dependent on your complaint and will be explained by the doctor or nurse.

*More Waiting*

Your tests have all been done. Now you can expect to wait and then wait some more. Unless you are in the ER in severe distress such as profuse bleeding or not breathing, expect to wait at least another hour for test results. Remember results take time. The test has to be done, someone has to enter the results into a computer, a technician has to read the results followed by the physician then they will be portrayed to you. You are not the only patient. We are dealing with hundreds, all who are sick, all who have pending tests.

*Registration*

During this waiting period you can also expect to have someone from registration come in to see you. This is a person who will ask for your insurance information and possibly a co-pay if your insurance policy requires one. Have your insurance card, driver’s license or other photo ID readily available. Do not panic if you do not have insurance. Hospitals are required by law to treat every patient regardless of financial status and the registrar will assist you in the financial planning related to your hospital visit. She will also give you a copy of the patient’s rights and responsibilities while in the hospital. Be sure to read this carefully so that you know exactly what your rights are when receiving medical care.

*Where Has My Nurse Gone?*

Unless you are very ill often you will not see your nurse more than every thirty minutes to an hour and your doctor more than twice during your ER visit. Keep in mind that your nurse and doctor may have a patient next door who is not breathing and that person takes priority over the patient who is vomiting or in pain. This does not mean that we care less about you or do not want to treat you, we simply have to prioritize based on how sick people are.

*Discharge or Admission*

Your results are in and the doctor has checked them and has decided on a treatment plan. For most patients, this is the only other time they will see the doctor unless they are being admitted to the hospital. He will again come in for less than five minutes, inform you of the plan and if you are not being admitted, he will leave the room to write your discharge instructions. This could take up to thirty minutes depending on how busy the ER is.

If you are going to be discharged the nurse will come in, remove the IV and heart monitor if you have them, review the discharge instructions and prescriptions with you and ask if you have any further questions or concerns. You will also be given referrals for specialists if necessary. At this time, if you have not met with the registration person to give insurance information, you will be asked to step into the discharge area to give this and then you will be able to leave.

No one wants to be in the emergency room but knowing what to expect can ease some of the frustration. Depending on which hospital you go to expect to wait, and wait, and wait some more. Bring a book or a friend. Try not to take your frustration out on the employees and remember that they are only human, occasionally make mistakes, but that they are there to help you and to offer you the best care possible.