A few things everyone should know about the Emergency Room

I have never worked in the ER, but as a pediatric nurse a large percentage of our patients come from there. So we periodically look at the ER census board for patients under the age of 18 whose condition warrants an admit. Between that and just life and general it seems that there are many people who could learn a few things about the ER (or ED as it is sometimes called.)

The Emergency Room is the most expensive way to receive care. On the unit I work on, when there aren't patients to care for, the staff get sent home, and we don't have a doctor on the unit. That is not the case in the ER. They have to pay their nurses and doctors to be there at all times, because you never know what or when something is going to walk through the door. This is the case even when there aren't any patients, because the situation can quickly change. ER charges high rates because you are paying for availability.

There are many "emergencies" that can be taken care of at an Instacare.   The Instacare is usually a little more expensive than a traditional office visit, but vastly less expensive than an ER visit. The Instacare will generally be open much later than a traditional office. A few months ago my son put a hole in his forehead with my fireplace. I managed to get him to the Instacare twenty minutes before they closed. They stitched him up and we were out within 30 minutes. It cost me $40. If I had gone to the ER, I would have had to pay a $150 co-pay, plus a percentage of the costs of whatever tests or procedures you have done. And it has been my experience that the ER would have taken me a lot longer than 30 minutes. When my patients come up from the ER, it is pretty common for them to wait for hours before anything is actually done. Once I was in a car accident and taken to the ER. I was the only patient there and I still waited for an hour before anyone saw me.
 A few of the things that can often be taken care of at the Instacare: Large cuts, simple bone fractures, sprains, food poisoning, vomiting, diarrhea, dehydration, fevers, bladder problems, headaches and blood pressure issues.

Poison Control is a great resource. If your child has eaten or drunk anything they shouldn't, call poison control. That number is 1-800-222-1222. That's the number wherever you live in the United States. Even doctors sometimes call Poison Control for advice. I'm not sure how it works other places, but I know that in Utah, the Poison Control center is staffed by pharmacy students. It's part of their training. Calling Poison Control is free and the staff can often tell you if your situation is really emergent. 72% of Poison Control callers are treated safely at home. I've called them before, they're very nice and very helpful.

The ER is not your primary care provider. Do not go to the ER for hangnails. (Yes, I have seen that as a diagnosis on the ER board.) If you are going to the ER on a regular basis, (I had a patient once, who averaged five ER visits a month.) you need to find a regular doctor. Someone who knows your story before hand, can look at the whole picture and help you with your problems.
 I realize that there are many people who go to the ER because they don't have insurance and can't afford to visit a traditional doctor and the ER won't (can't) turn them away. I think that many people don't realize that there are programs out there to help. Ask your local doctors office or your local health department. If you have a legitimate need there are resources to help. It is more cost effective for the government to assist you with your medication payments than to pay for weekly ER bills. When people go to the ER and it is not an emergency, they are increasing the cost of healthcare for everyone. Besides that, they are delaying treatment for those who really need it. Injuries and even death have been caused by excessive wait times in the ER.

Call your doctor's office. Often they can tell you over the phone is something they can treat or if it is something that must be taken care of in the Emergency Department. And they're even cheaper than the Instacare.

 Reasons you should go to the ER 

• Vomiting blood
• Symptoms of a stroke
• Chest pain that is not relieved by anatacids (suspected heart attack)
• Abdominal pain
• Trauma
• Overdose
• New onset seizures
• Respiratory distress
• Significant loss of blood
• Any health problem that is actually an emergency

Go where you can be treated. One more thing that I don't think that most people realize is that you need to go to a facility that has the capability to treat you (if you possibly can). For example there was a community hospital that I worked at occasionally in their Mother/Baby unit. Most serious cases coming to their ER are transported to another facility, because they have no ICU, no Pediatric unit and limited surgical options. I've seen many patients who go there and then are surprised and upset that they have to pay for an ambulance ride to a bigger hospital (which is where I would see them, as I worked there too). (I don't say this to disparage this hospital. It is a great hospital with awesome staff. They take very good care of their L&D patients, and took great care of my mom when she had her minor surgery there. But I wouldn't take my child there in an emergency. It's only 10 minutes to a hospital that has everything you need.)

Use your common sense. Oh, and if your instinct (not your panic mode, but your instinct) tells you that the situation warrants an ER visit, go with it. Many lives have been saved by following "instinct", when other signs did not indicate an emergency.