a hospital emergency room entrance, crowded emergency rooms,

by Douglas J. Segan, MD, JD, FACEP

Most of us dread going to the emergency room when we are sick or injured. Even under ideal circumstances, it is a scary experience. The pain, the noise, the dread of the unknown diagnosis, the long waits to be seen and for test results to return, the loss of privacy–and fear of a huge bill. And while we don’t like to think about it, we know that there is always the risk of bad news and bad outcomes.

One in three Americans will visit the ER this year. ER visits in this country are increasing for a variety of economic and social reasons. While there are many aspects of emergency care that you can’t predict or control, there are some things that you can do to optimize the likelihood that the experience will be less miserable and more beneficial.

1. Prepare in Advance

Evaluate your choices for emergency care before the need arises. Ask your healthcare providers, friends, and relatives about their preferences for ER care in your area. Every hospital has its strengths and weaknesses, and you should learn about the ones near you.

Your insurance company may use financial incentives to encourage you to go to a particular ER or hospital. If you have a serious or unusual medical problem, find out now which ER is best able to take care of your problem.

EMS providers are trained to check your cell phone for your ICE (in case of emergency) numbers in the event that you are unable to communicate. If you have not entered an emergency contact number in your phone, do so now, and be sure to indicate that it is ICE.

2. Put your critical medical information in your wallet and cell phone

If you have serious medical conditions or allergies, wearing an identification bracelet that EMS and ER personnel will find easily could be lifesaving. There are a number of companies that offer such items, like the nonprofit MedicAlert Foundation (888-633-4298 or www.medicalert.org).

Even if you don’t have a serious condition, you should write down your key medical and contact information, make a few copies to give to loved ones, and store it in your wallet and cell phone. The stress of being in the ER can interfere with our ability to recall the names and dosages of our meds.

A sample model form can be found at the ACEP (American College of Emergency Physicians) website: www.acep.org (search for “permedfm”). We have also created a Medical History form for you to use. If you fill out your own form, it should include, at the minimum, your medications, dosages, and how you take them (with food, in the morning, etc.), including over-the-counter and herbal meds; your allergies; your medical and surgical history; your physicians’ names and contact information; and your emergency contacts. It should be updated regularly.

If you have not written down your current meds and you are about to go to the ER, ask someone to put your meds in a re-sealable bag and take them with you.

3. Bring an Advocate

If at all possible, bring a trusted friend or relative with you to the ER. Ideally, it will be someone who knows both your medical history and your recent symptoms. It would be a bonus if she were a careful listener, had a good sense of humor, and the patience of Job.

In many ERs, the staff is pulled in multiple directions at once, and an advocate can help reduce the chance that you will be overlooked in the chaos or that something untoward will happen.

You need an advocate to help you get urgent assistance if you need it, aid the staff in reducing your risk of falling, help you remember instructions about your care, and give you a hand with things like phone calls. Time will pass more quickly if you have the right advocate at your side.

4. Lower your expectations

ER staff saves many lives and alleviates suffering every day. But the great benefits of ER care also come with some risks.

If you have watched too many ER television shows or been bombarded by too many ads from hospital marketing departments, then you may be disappointed in your ER care. The vast majority of ER nurses and doctors are caring and very competent, but while many are superheroes, they are also human. The ER you go to may be understaffed, overwhelmed, or tied up with critically ill or injured patients. The staff may be hungry and sleep-deprived, and may have had just one too many tragic situations to deal with that day.

All the usual risks that apply to being in any healthcare setting (falls, medication errors, catching an infection from another patient or from a staff member, incorrect diagnoses, over- or under-treatment, etc.) can be magnified in the crowded and hectic environment of many ERs.

Many patients come to the ER with high expectations and are disappointed when they are not met. Previous medical records are sometimes tough to find, your primary doctor may not be available, and the specialist that you need may not be available. Try to be patient and understanding while also not being afraid to stick up for yourself if something just does not feel right. Your advocate should be able to help with that.

5. Anticipate waiting

America’s ERs are getting busier. Generally, you will be promptly seen by a triage nurse, but then you may have to wait for quite awhile to be placed in a room (or even a hallway in some ERs), and then you’ll have to wait some more to be seen by the doctor. Patients are seen based on the acuity of their conditions, not on how long they have been waiting. If your condition changes while you are in the waiting area, let the triage nurse know.

Even after you’ve been seen by the ER doctor, your test results will take time to obtain. Also, the first doctor who evaluated you may be in training, and may need to wait to present your case to a more senior physician. If you can, bring something with you to make the wait less agonizing. Some light reading or music with headphones may help the time go more quickly.

If you are experiencing a true emergency (heart attack, stroke, etc.), it is generally advisable to call 911 and be transported by EMS. Patients arriving by ambulance are almost always evaluated more quickly than walk-in patients.

6. Things not to do before visiting the ER

If you know you are about to visit the ER, it is wise not to eat or drink anything, especially if there is any chance that you will need surgery. (Some surgical procedures may be more difficult to perform if your stomach is full.)

Don’t bring valuable jewelry or loads of cash to the ER. They can be hard to keep track of in what is often a busy and overcrowded setting.

7. Help the ER staff take care of you

If you highlight your most significant new symptoms, it will increase the likelihood that the ER staff will do the same. It is worth mentioning your chronic medical problems when you are asked about your past medical history, but if those problems are stable and not the reason you are in the ER, don’t dwell on them, as it could lead your doctor to mistakenly think that is why you came to the ER.

Anticipating the questions that you will be asked may also be productive. For example: have you ever experienced these symptoms before? When did they start? Any other associated problems? Does anything make it better or worse?

If there is a particular disease or condition that you are worried about, discuss it with your doctor early on, not when you are being discharged.

Be especially vigilant and patient when there is a change of shift. If you are asked the same questions by your new nurse and doctor that you were asked earlier, try to consider that a blessing and not a nuisance.

If you feel well enough, having a sense of humor and developing a rapport with the ER staff is also a big help.

8. Ask Questions

Most ER staff members enjoy working with inquisitive patients and like explaining and teaching. Don’t be afraid to ask questions.

If you feel that things are not going well or something serious is being missed, speak up. It may not be feasible at all times and at all hospitals, but it may be worthwhile to ask for a second opinion, see a specialist, or be observed for a while. In some situations, it may be helpful to call your primary doctor. It’s in these difficult scenarios that an advocate is really helpful.

If a medication is about to be administered, remind the staff of your allergies. Ask what is being given and why. Ask about its side effects. If a test (such as a CT scan) is recommended, ask for an explanation of the risks and benefits. You are allowed to weigh your options.

If you notice that your caretakers are not washing their hands, cleaning their stethoscopes, or (if indicated) wearing gloves, gently remind them.

9. Understand your discharge instructions

It is imperative that you understand anything the medical team may have found and any follow-up treatment they recommend for you. Appreciate the uncertainty that is often part of emergency care. Medical conditions evolve over time, and some things are only clear in hindsight. Make sure you understand which symptoms to watch for, and what kinds of reactions would require a return visit to the ER. If you are prescribed any medications or administered any tests, be sure to write down what they have been prescribed for, the names and dosages, how to take them, and what side effects to watch out for. Ask if they will interfere with your other meds.

Read (or ask your advocate to read) your discharge instructions. If you don’t understand something, be sure to get clarification. If you don’t read the instructions until you’re home, it’s not too late: call the ER, and get a doctor or nurse to explain the instructions to you.

10. Obtain Close Follow-up

If the ER will give you copies of your tests on discharge, take them home with you and bring them to your follow-up appointment with your primary doctor. Review your ER visit with your primary doctor as soon as feasible. It’s especially important to review the final lab reports and the final radiology readings with your doctor.

If you prepare in advance for a possible ER visit, work with your ER providers and an advocate, and understand the things that you can do to help the staff care for you, you will increase the likelihood that you will have a good outcome.

By Douglas J. Segan, MD, JD, FACEP (Emergency Medicine Specialist)

If you would like other tips on surviving your hospital visit or a trip to your doctor’s office, you may find our new book, Top Screwups Doctors Make and How to Avoid Them, helpful.

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  1. Sweeney
    Scranton, Pa.

    I have two blood clots in my leg since a week before Thanksgiving. I have been on a blood thinner since but have had some problems with shortness of breath, just discomfort. The doctor treating me wanted a STAT chest CT SCAN… Well, I am allergic to the needed contrast dye, so the nurse practitioner said we’ll call you later. In the mean time I called my doctor for the prep meds because this has happened in the past. Well, I never got a call back from the ordering Dr. or his nurse practitioner.. When I go back a week later to fire them they say to go to the ER…. I am not afraid of anything…. I had 9 spine surgeries, 3 reconstructive hand operations, 2 separate surgeries on the leg with the clot before there was a clot. The leg surgeries resulting from an auto accident also left me many broken ribs and a severe traumatic brain injury. Approximately 2 weeks in ICU another 2 in a regular room followed by a month of inpatient rehab for my legs and brain swelling. Now? I have my regular manageable back pain and these 2 clots with the breathing issues. Again, not afraid… My brain just won’t let my body go into the hospital without a major panic attack.

  2. B.D.

    I have inoperable cancer of the small intestine, carcinoid, which is moving very slowly over ten years; because of the surgery removing the tumor in the large intestine, scar tissue partly obstructs the exit from the stomach, and sometimes I have a traffic jam. Everything goes into spasm; I try to make it without more than OTC pain medication, but all too often it will be all night with vomiting, spasms, pain, and finally I realize the only thing that works is blessed morphine. It is miraculous for me. It stops the pain and allows the gastric passages to relax. I go in demanding “morphine!” I get my shot and a warm blanket and I am so grateful.
    They contact my doctor by phone and I know the drill: upstairs for overnight and discharge the morning after a normal stool. Only one time, when my doctor was out of town did I get a doctor who insisted I would be having gastric surgery the next day. He insisted on putting in a shunt and line so I would be prepped for surgery!! I was fine the next morning (normal function restored) and asked to go home; The CA surgeon saw me and said I looked fine. This doctor refused to discharge me for THREE DAYS.
    The skin around the needle in my arm began to redden, sign of infection, and I told the nurses I was going to check myself out AMA (against medical advice). That is when I learned something very important!! If you check yourself out of a hospital AMA, your insurance will not pay your bill!!!!!!!!!!!! You can imagine how much the e.r. treatment and three days hospitalization would come to?!! I had the nurses call and warn him that the arm was becoming infected, the surgeon had told me I was fine, and he allowed me to check out. I had the wrong doctor, for sure, one that wouldn’t listen and didn’t know me.
    As for having a hard time being seen, I am usually in so much pain I go in through the ambulance entrance. Once I was dropped off by a granddaughter on her way to work late at night at the front entrance and I found myself in a long line and in a lot of pain, and not even a chair. When you are in a lot of pain, you have no shame. I simply lay down on the floor–in line–and dealt with the pain as best I could.
    That did produce a gurney and some rapid movement, but I also point out that I had a record with this hospital that was quickly accessible. So my personal experience with emergency room has been generally relieving and welcoming. I’m usually exhausted from trying to get through the night without resorting to the ER, and so grateful for any help, like that warm blanket over my shaking body, that my memories are affectionate and thankful.

  3. Brison

    Our regional hospital only offers `triage` care to patients arriving by ambulance.
    All ER walk-in patients are treated on a “numbered, FIRST-COME BASIS”. The typical wait for emergency treatment for walk-in patients is 5 to 8 hours.
    Our local ER encourages all emergency room patients to return for a routine (walk-in) follow-up exam. These non-emergency, `well` patients returning for their follow-up exam fill up the waiting room along with the distressed emergency patients, ALL OF WHICH ARE TREATED ON A FIRST-COME BASIS……
    We wish that our local hospital would solve this extreme wait problem by separately handling Triage Medical Services and `Well Care` Non-Emergency Follow-Up visits.
    Tip to the patients who are encouraged by the hospital to return to the ER for a follow-up check-up:
    It is far less expensive and time-consuming to seek medical follow-up treatment at a clinic or with a personal physician. Unlike with the ER, your follow-up check-up can be set up at the clinic or with your own doctor as an appointment, avoiding hours of needless waiting and expense.
    (1.) CALL AN AMUBLANCE if you are in extreme pain or in a life-threatening medical condition. Yes, you may have to wait for the ambulance to arrive, but you receive immediate medical attention upon arrival at the hospital.
    (1.) EXPECT TO WAIT – About 5 to 8 hours for medical attention.
    (2.) HAVE PATIENCE + BE NICE to the staff – You are just one of hundreds of distressed patients per day waiting to see a doctor.
    (3.) TAKE A PILLOW – the waiting room chairs are not designed for comfort.
    (4.) TAKE A BOOK or iPOD + HEADPHONES for the inevitable 5 – 8 hour wait. It will help to calm the patient and caregiver to be occupied or entertained.
    (5.) TAKE A WATER BOTTLE – You really don’t want to drink out of the water fountain in the ER.
    (6.) MOBILE PHONES MAY NOT WORK, or have reception at a hospital.
    (7.) DON’T EXPECT TVs or magazines in the waiting room to help your pass the time. Some hospitals do not offer either.

  4. ljh

    Don’t forget the availability of Urgent Care/Immediate Care facilities. Can anyone comment on experience with these?

  5. cpmt

    I think if it is a serious problem take an ambulance, don’t wait to ‘almost die’ in the ER… or until not other serious health problems have been resolved. I don’t know how they do it in Atlanta hospitals, but when I went there with an asthma attack/ problem I waited less than 15 min.
    Other people were helped with in 10-15 min. It is crazy to have to wait 12 hrs. Non-serious problems SHOULD NOT taking care in the ER… THE HOSPITAL IS RESPONSIBLE TO HAVE A CLINIC OR A SECTION TO SEPARATE THESE CASES immigrants or not.

  6. JLL

    During the show on ER’s, the Graedons’ mentioned a 3 minute test that would tell if a person was having a stroke. Do any of you know where to find information on this test? The last time I went to an ER because I had badly hurt my side, the ER doctor ran to the door of the room where I was waiting for results, yelled in that I was okay, and literally ran away. When I was leaving, without any more information than that, I saw him in the doctor area flirting with a woman. Believe me, they were not talking hospital business. I continued to have trouble with that side for three years.

  7. Elouise

    At age 64, I suffered every few months (for a 2+ year period) what seemed to be flu symptoms for a few days and then it went away. A friend finally forced me to see the doc. I immediately went in and was told to go to the ER after blood work
    From 3pm to midnight, I sat in waiting room. Put in room where at 4am they did an ultra sound. One ovary was hiding so couldn’t diagnose problem. I had an abscess but what caused it? They drained it and after 3 days I went home. Next was colonoscopy to check that area. Nothing was found to have caused the abscess. Finally they scheduled me for appendectomy.
    After the ruptured appendix removal, the surgeon left the rest to staff (interns? residents?) I had an event on the table where I couldn’t breathe. They checked for obstruction – none was found. They should have ordered the drug to determine within 2 hours of the event on the op table whether this was shock or allergic reaction to anesthesia since I have an extensive list of drug allergies. Now, I wear a tag with the question about anesthesia and drug allergies.
    Three days later after going home, I was back with an upper bowel obstruction. Concerning the ruptured appendix, they said I had probably been walking around for a couple of years with it and it had fortunately walled itself off or I wouldn’t be here writing this. I did go to see an allergist but cause of event couldn’t be determined because they failed to test within the 2 hour period.

  8. PP

    The best comment was to take an ambulance, because they are in contact with the ER and will get seen soonest!

  9. CAR

    This past summer we were instructed to take my husband to the ER because he was having plumbing problems, infection in the skin around a knee joint replacement, & his heart was out of rhythm. We got there to find no parking place inside or out.
    They didn’t take my husband back & finally I went out & used my cell phone & called the Dr. & within 20 min. he was up in a room admitted to the hospital. The next time his blood pressure was sky high & the Drs. office said go ER immediately & they will take care of you right away. HA HA! He was there 4hrs. before they checked anything & at ! AM they released him to come home; so we were not impressed with going to the ER when there were obvious symptoms that needed to be addressed.
    We aren’t ones to go there unless it is a dire emergency. I guess some people take advantage of going to the ER, but we sure aren’t some of them & wouldn’t recommend doing it.

  10. Pat

    I need some additional advice. I recently had to go to the ER. I had trouble breathing due to CHF. They gave me O2 and Lasix and I began to feel better. Then I had a severe episode of Restless legs with jerking and pain in my legs. I told the staff what was going on and asked for Sinemet.
    They knew I took it because they had my previous records, but they refused to give it to me. I had no choice but to get out of bed and walk around holding onto the bed because I have severe arthritis. It was torture. I was admitted and got the med 3hours later. Is there anything I could do if this should happen again?

  11. Carol


  12. Barbara W.

    Some years ago I had a patient (I’m a Marriage and Family Therapist) who went to a California ER and waited 12 hours to be seen. She finally was in great distress so that they took care of her BUT she very nearly died.
    They were overwhelmed with immigrants who use the ER as their primary doctors.

  13. Dorothy

    While you can’t always dictate when to go to the ER, the best time is between 5 and 7 A.M. All the late night accidents have been taken care of and the morning rush has not yet begun.

  14. paulbyr

    A very helpful & well written article – thank you!

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