BEYOND THE LOCAL: Tips for managing an emergency department visit

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Research shows nearly half of all patients leave hospital with a misunderstanding of their ER visit

This article by Jasmine Mah, Dalhousie University and Melissa K. Andrew, Dalhousie University originally appeared on Conversation and is posted here with permission.

The emergency department (ED) can be a stressful and confusing place for people who are ill or injured. During the pandemic, with many hospitals not allowing friends or family to accompany patients to the ER, being alone can exacerbate the uncertainty, fear and anxiety patients may feel about things such as wait times, tests or medical prognoses.

Research shows that nearly half of all patients leave the hospital with a misunderstanding of their ER visit. As doctors who see the consequences of miscommunication, let us break down what happens in the ER and give you the knowledge and tools to help you have a smoother experience.

Emergencies explained

In the emergency room, some patients arrive alone (or are dropped off by family), some disembark from an ambulance, and some are transferred from other hospitals. To decide the order of patient care, clinicians use a decision support tool called the Canadian Emergency Department Triage and Acuity Scale (CTAS). CTAS is used instead of a first-come, first-served system.

The CTAS triages patients based on the severity of the illness or injury. A score of 1 suggests imminent risk of death or severe disability within minutes without treatment (eg, serious car accident or stroke). A score of 5 suggests that the outcome of the medical problem will not change whether treatment is given now or in a few hours.

The movement of a patient around the ER, from the waiting area to the treatment room to the investigation area, is based on the presenting disease and CTAS. Patients expect the room with the best resources for their condition. For example, a cast room is the best place to do a cast for a broken ankle, but doesn’t have the heart monitoring equipment to diagnose or treat a heart attack.

These factors help explain why some patients seem to leave the waiting room more quickly than others.

People at ED

People working in the emergency room include clinicians such as doctors, nurses, and social workers, as well as non-clinical staff such as clerks, porters, and cleaners. The number and types of staff will depend on the size of the hospital. Each team member has a defined role and scope of practice, resulting in a roughly predictable sequence in which patients will see each staff member.

A patient entering the emergency department first has their information gathered by a clerk, followed by a preliminary assessment by the paramedic or triage nurse. They may then be seen by another professional for a test or procedure such as an X-ray. They can be monitored and treated by a nurse for much of this time, and seen by a doctor. Before leaving the ER, a social worker or patient escort may also be seen.

Sometimes clinicians come and go over time, depending on whether they are waiting for test results or responses to treatment, so visits can vary in length. Recognizing the different roles of each employee and the different timelines can help patients understand the diagnosis and treatment process.

Why it’s important to understand your ER visit

To minimize feelings of being overwhelmed and improve the overall quality of care, patients need to understand what is happening in the emergency department. Patients may understand their diagnosis, but often have less understanding of the follow-up plan. For example, approximately 5-10% of patients do not take their emergency department medications as prescribed and many do not keep to recommended doctor’s appointments.

This is partly due to a lack of understanding of their ER visit, and results in more ER returns and a higher likelihood of hospitalization, especially for older people.

Certain factors put patients at a higher risk of leaving the emergency room without sufficient knowledge. These include hearing or visual problems, cognitive impairment or impaired cognition (for example, due to intoxication or serious illness), speaking a main language different from the one spoken at home. emergency, as well as difficulties in reading or a lack of knowledge about the health-care system or health problems.

what you can do

While the healthcare system must do its part to improve the ED experience and communicate clearly, there are evidence-based strategies that can empower patients in their own care.

  • Have a list of your medications, allergies and medical conditions at your fingertips, saved on a phone or in a wallet. It pays to be as prepared as possible. Think about the questions you want to ask: What is the purpose of the visit? Who will help you follow the recommendations? Preparing in advance can speed up the process and provide information to the healthcare team.
  • For the elderly, those with mobility or sensory issues, and those who are very ill, a family member of the caregiver can call the hospital and ask to speak to a nurse or doctor to transmit or receive this information if their loved one is unable to do so. .
  • Upon discharge, the patient should request clear written instructions. Short, concise, plain language medical summaries are preferable to long medical summaries. Written instructions are generally better than verbal instructions.
  • Repeat discharge and follow-up instructions with the nurse or doctor to verify accuracy. If the information and next steps are overwhelming, ask to speak with a discharge planning nurse or care navigator who can help ease the transition from emergency to home.
  • If the patient and/or loved ones see barriers to completing a suggested plan of care (such as the inability to pay for medications, go to a pharmacy, or swallow pills), these barriers should be addressed. to the attention of the SU team. It is better to deal with them proactively than to leave a condition untreated.
  • If you don’t feel better or your condition worsens, return to the emergency department. Learn about return precautions: symptoms to look out for that should prompt a return to the emergency department. Going back may give ER staff a chance to see your symptoms at a different stage, which may result in a different course of action.

When it comes to what to ask, research has shown that it is helpful for patients to record a few important points:

  • Date of ER visit and primary diagnosis
  • Medication details (dose, purpose and duration of intake)
  • All doctors to follow, when and how to contact
  • Symptoms that should lead to an immediate return to the emergency room

Being well-informed and prepared to defend yourself can not only make the next ER visit easier and less stressful for you or your loved one, but can also help you leave with the information you need.

Jasmine Mah, MD (Internal Medicine Resident) and PhD Candidate (Geriatrics Focus), Dalhousie University and Melissa K. Andrew, Professor of Geriatric Medicine, Dalhousie University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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