Improve Your Trip to Emergency

Patient Filling in a Form

Every dreads a trip to emergency. Here’s how to improve your chance of a great ED visit.

1. Avoid busy times – Never go on Monday, the first day after a long weekend, and Sunday evenings, if possible.  ED visits surge from 11:00 am until late evening.  It takes another 3-6 hours for an ED to clear out.  Aim for early morning or after midnight. Even the worst ED provides great service some of the time; make sure you arrive at those times.

 2. Prepare your chief complaint – Do you tell your whole life story at a job interview?  Don’t tell it in the ED.  Summarize your concern in a few sentences.

 “My stomach started to hurt after supper. It became sharp and constant overnight, and now I have a fever.  It really hurts when I push right here.”

What would you ask if your child had a ‘tummy ache’?

Where does it hurt?

When did it start?

What does it feel like?

Did you get hurt? etc.

If it’s too long to memorize, it’s usually too detailed. If you were just discharged from hospital, say that first.  Hopefully, you got a discharge instruction sheet.

3. Prepare your past medical history – Practice listing your diagnoses.

“High blood pressure, high cholesterol, borderline diabetes and mild asthma.”

If you had major surgery in the last 6 months, say so.  “I had a kidney transplant in May.”

4. Know your medications and dosages – Memorize or write them down on a wallet card. “The little white pill,” does not help.

5. Memorize true allergies and reactions – Swollen lips with penicillin needs to be told.  Find out from your family physician which things you react to, if you don’t know.

6. Bring your Health Card (Canada) – Cards expire.  Update it, if you change address.  If your card is invalid, you will be billed by your physician(s) and separately by the hospital.

7. Bonus points – Old ECGs, notes from your doctor(s) or hospital, X-Ray reports, descriptions of rare medical conditions…anything special about you.

Things to do after you’ve been seen, but are still in the ED:

1. Call for help if you or your family/friend gets worse.  Many patients get worse.  Speak up!

2. Minimize questions.  Staff should have told you how long things will take.  If not, ask once.  Let staff work; wait until they said everything should be done (4 hours, etc).  Do not ask “Are my tests back?” “When is the doctor coming?” “Where is the coffee shop?” etc.

3. Stay in your care area.  Hovering at the doorway is dangerous, impolite and does not make things move more quickly.

4. Don’t take your anger or frustration out on staff.  If they are rude, by all means write a letter.  That will do more than getting upset at the moment, and it strengthens your feedback to leadership.

Things you can do after you’ve left the ED:

1. Call your Family Physician and deliver lab and X-Ray reports from your ED visit.

2. Let your family/friends know you were sick, so they can help and be there if you get worse.

How can you tell if you’re not an average patient?

A.  You are on chemotherapy, have had an organ transplant, have an extremely rare condition cared for by sub-specialists in another center, are on a study drug, have more than 5 medical conditions, etc.  Most complicated patients know they’re not average, and are professionals at navigating the healthcare system.

Patients improve the performance of even the best teams using the pointers above.   Share your favorite tips for a visit to the ED by clicking on Leave a Reply or # Replies below.

4 thoughts on “Improve Your Trip to Emergency”

  1. Thank you for an excellent list of ideas that encourage the patient to be engaged in his/her own care and to expedite and make safer, a trip to the ED. What if there was a way for the patient or family member to input all of the information you suggested into a computer terminal (or from a downloaded app) while they wait to be seen? If this was possible, a program could be developed that provided the information to the doctor in a standardized format and also alerted him/her to certain risks. It seems to me that patients/families sitting in a waiting room for an hour or more are an untapped potential.

    1. Thanks for a brilliant comment, Barb.

      I bet there’s a market for an ED app. Self registration Kiosks seem to serve some of this function in some EDs.

      Ideally, there’d be no wait rooms anywhere. I still dream of eliminating waiting entirely…

      Thanks again for taking time to comment!

      Warm Regards,

      Shawn

      1. Shawn, consider the airport check-in as an example. Now, a passenger obtains his/her own boarding pass and sometimes baggage tags too. So why shouldn’t a patient who is willing and able (most of them) type in all their own information?

        Why not do some preliminary testing while waiting? Would a blood pressure machine and HR such as they have at the drug store provide helpful data that the patient could do and record? Spot-check oxygen saturation rate from a SAT monitor? What about urine tests with a test strip for sugar for some patients? Women under the care of midwives routinely take their own weight and test their own urine as they are waiting to be seen.

        Many might think these ideas are way out of bounds. It seems to me providers want to control everything in hospitals. Most patients are actually quite capable. At Mt. Sinai, a study was done that involved allowing parents of preemies (not on vents) to assume most of the care for their newborn. The outcome was a win-win all around. Decreased staff ratios, less stressed parents, decreased LOS, and babies gained weight faster! http://www.biomedcentral.com/1471-2393/13/S1/S12

        1. Another great comment, Barb!

          I agree with everything you said. As providers, we often make patients do things our way on our time, when patients could do it themselves more efficiently. Even hemo-dialysis patients are being given the chance to do their own kidney dialysis after getting proper training! Self dialysis patients get access cards to swipe in to dialysis units after hours so they can hold down regular jobs. I expect this will explode once it catches on.

          The more we discuss these things, the more likely the system will change. Our present approach is 100s of years old: provider does everything, book appointments and wait, book tests and wait, patients served when it’s convenient for me. We have to change.

          Thanks again!

          Cheers

          Shawn

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