If you are unconscious or come to an emergency department by ambulance, you will be assessed and treated right away. If you walk in to the emergency department or someone else drives you, you will first come into the waiting room where you will be assessed by a triage staff member, usually a nurse.
The triage nurse will assess your symptoms to determine whether you need to be treated right away, based on the severity of your condition. Your vital signs -- such as temperature, heart rate, blood pressure, and breathing - will be checked, and medical chart information will be gathered, including details on allergies, any medications you are taking, and your medical history. It's a good idea to bring a medical history form or wallet card, so you can quickly provide this information.
If you need to be treated right away, you will be assigned a bed in the treatment area. If you don't need to be treated right away, and the emergency department is busy, you may be directed to a registration area where you will be asked for basic information, such as your name, age, address, and the name of your health insurance company. By law, you cannot be denied emergency medical care regardless of your ability to pay or lack of insurance coverage.
The Waiting Room
If your condition is not life- or limb-threatening, you may be directed to sit in the waiting room, because the most critically ill and injured patients are treated first in an emergency department. (It's not first come, first served, and having health insurance does not mean you will be seen quicker.) If you are in the waiting room, it's important to let the triage nurse know right away if your pain or condition gets worse while you are waiting.
Why Am I Waiting So Long?
Emergency physicians are committed to providing high-quality emergency care as quickly as possible to all patients, but if you've been to a hospital emergency department lately, you most likely know that many of America's ERs are overcrowded.
There are two kinds of waiting - in the waiting room and for a hospital inpatient bed. While the average time people spent in emergency departments (door to discharge) was 3.3 hours, according to the Centers for Disease Control and Prevention (2005), many patients who have been admitted to the hospital lie in gurneys along the halls, waiting hours - sometimes days - to be moved to inpatient beds, a practice known as "boarding."
Boarding means emergency staff can't care for additional patients from the waiting room or from an ambulance, which also leads to ambulance diversion. Boarding is the primary cause of gridlock in our nation's emergency departments - not the myth that too many people are coming with non-urgent medical conditions. Boarding and emergency department crowding are dangerous because they can jeopardize a patient's ability to receive high-quality, lifesaving medical care in a timely manner and interfere with the ability of emergency departments to respond to a potential pandemic illness or terrorist attack.
Many hospitals have stopped "boarding" patients in emergency departments and instead, once they are admitted to the hospital, move them directly to the floors to which they are admitted. This spreads the burden of overcrowding throughout the hospital and often results in beds becoming more quickly available. ACEP advocates on behalf of emergency patients and has developed effective solutions to overcrowding. In addition, ACEP is working at the state and national levels, in urging decision makers and policymakers to implement these solutions to help emergency patients and to improve our health care system as a whole.
Once you are in an examination area, an emergency physician will examine you, monitor your vital signs and possibly order tests (e.g., x-ray, blood, electrocardiogram). For certain tests, you may need to avoid eating or drinking. Nurses and other medical professionals also will assist you during your visit. Family members may or may not be able to stay with you, depending on the hospital's policy, your condition and the level of crowding in the emergency department.
During your visit, be proactive and ask questions about anything you don't understand. If you have concerns, ask to speak again with the emergency physician. If your concerns still are not addressed, most hospitals have patient advocates available to help you.
If you are critically ill or require constant intravenous medications or fluids, you may be admitted to the hospital. Otherwise, an emergency physician will discuss your diagnosis and treatment plan with you before you are discharged. You also may receive written instructions regarding medications, medical restrictions or symptoms to watch out for that could require a return visit. In addition, you may be instructed to follow up with your family doctor.