Reasons to Go to the ER: Part 2

Do you visit the ER for primary care needs, like mild coughs, prescription refills and general health checkups?

If you are one of the millions of Americans using the ER because you have no other option, please read this article.

A spotlight on the tremendous cost of ER overutilization and misuse:

The Huge Cost of Misuse of the ER: “Misuse of EDs accounts for $4.4 billion in waste annually and contributes to the high cost of American health care.” Georgia Health News
ER Over-utilization & repeat usage: Of 53 Million ER visits between 2006 and 2010, about 8 percent of patients returned within three days, and 1 in 5 made a repeat visit over the next month; a third of revisits occurred within three days, and 28 percent over a month, occurred at a different ER. Press Herald
Post-Obamacare ER usage: “Doctors say emergency room visits have increased since the advent of Obamacare”. Washington Times
ER Prescription requests & abuse: “More than two million people went to the emergency department in 2010 because of misuse or abuse of drugs – that is well over 6,000 ER visits a day.” Drug Abuse Warning Network’s (DAWN) 2010 report
Emergency Room Staff: Their Job and The Cost of Misuse
The ER is where true medical emergencies are presented to be treated by a skillful emergency medical team of doctors, nurses and medical assistants, specially prepared to treat life or death health emergencies.

Ideally, people who truly need emergency care would go to the ER – but today’s Emergency Departments are frequently misused for relatively tame conditions, such as coughs and moderate fevers.

Sometimes people go to the ER for second opinions, a place to stay, prescription refills and — very inappropriately — for nothing at all!

It shouldn’t surprise the reader to hear that this type of misuse of the ED is a tremendous waste of state and local resources, and a burden on this much-needed emergency resource.

According to Georgia Health News, “Misuse of EDs accounts for $4.4 billion in waste annually and contributes to the high cost of American health care. Patients with insurance are often unaware of the actual costs of the medical care they receive at an ED, because they pay little or nothing out of pocket. ”

The following reasons are appropriate uses of the ER. After this list we will give you three options for health care that you should consider as good ways to get the non urgent care you need.

Examples of Appropriate Use of the ER
Although these are examples, they will serve to clearly separate in your mind what a life or death health care need is, versus a low urgency health care need.

Conditions that qualify as an emergency and are appropriate use of the ER:

In children:

If your child is turning blue or pale, has slow or labored breathing, is lethargic or hard to wake.

Why: Turning blue or pale is an abnormal state for a child, indicating suffocation and/or organ dysfunction. This child SHOULD go to the ER.

A fever of 101 or higher for babies under 3 months.

Why: In this early stage, babies can be vulnerable to all kinds of health conditions that may require medical attention immediately. This child SHOULD go to the ER.

Severe abdominal pain or possible appendicitis *
Why: Appendicitis can be deadly. Severe and sudden pain in the abdominal area can be/can become a very serious condition.

Ingested toxic chemical or medications – poisoning and drug overdose
Why: The faster a chemical or poison can be cleared out, the better. Organs may begin shutting down if an accidental overdose has occurred.

Head trauma with loss of consciousness
Why: A loss of consciousness is an uncertain condition which requires further study; and head trauma can result in further harm to you that may manifest much later.

Severe difficulty breathing or asthma attack
Why: shortness of breath, work of breathing and asthma attack are a dysfunction of the body which may lead to suffocation and death.

Broken bones
Why: broken bones along with bleeding or loss of consciousness and severe pain should be treated at an ER where the staff is specially prepared to treat this type of injury.

Pressure or tightness in the chest
Why: Pressure or tightness in the chest may indicate a more serious condition.

Bleeding
Why: Bleeding that doesn’t stop may lead to loss of consciousness and needs immediate attention for evaluation of severity and treatment.

Severe Burns
Why: Severe burns are significant injuries that require immediate attention, much like prolonged bleeding.

Severe falls, even without injuries
Why: A fall, whether very severe or minor, may not show symptomatically immediately after the fall. It is good to get checked out, even if it has been a day or two after the fall. Like car wreck injuries that aren’t visible on the patient, fall injuries can manifest a little bit after the accidental fall and may be severe.

Car or motorcycle wreck / bicycle accident / work accident
Why: Some injuries are internal and may go undetected by hospital staff during the initial evaluation immediately after a collision or workplace injury. Sometimes a patient will come in days after complaining of severe pain, though at their initial presentation in the ER they were able to leave ‘without injury’.

Assault / Domestic Abuse / Rape / Suspected Child Abuse
Why: If you have been assaulted, the police department or the emergency room are the proper places to go. Any assault warrants a visit to the ER and local police should be called on to investigate. Suspected child abuse should be reported to police for investigation.

Stroke
Why: A stroke can be deadly and manifests in different ways. Some of the ways to identify a stroke is by looking for one of the below conditions or all three:
– Drooping on one side
– Weakness on one side
– Slurred or strange speech
Call 911 if you see any of these signs.

Three options for medical care that is effective and can be faster than the ER:

1. Go to Urgent Care!
Call a local urgent care, find out if they’re open, and ask them if they take your insurance.

Ask them if the symptoms you or your child/friend has are worth going to the ER for.

Then go and get your condition treated.

Urgent cares have varying operating hours so calling the office you are considering is best before heading out. If you regularly have moderate conditions that need care, you could jot down your favorite local urgent cares that you can go to. Since some insurers will cover urgent care visits (please call your insurer to confirm), it will be less expensive for you and less expensive for the state, alleviating the burden on the local ER(s).

2. Call your insurer to locate your PCP and schedule an appointment.
Doctors shouldn’t be hard to reach, but if you have trouble getting an appointment, face lots of delays in your care – then it’s time to speak to your health insurer and ask them to give you another PCP (primary care physician). Not all doctors do a good job of spending an appropriate amount of time with each patient – some are hurried, some don’t express the attention and care needed to treat a person and send them home with assurance and hope. It’s good to find one that listens to you, provides you more than 10 minutes of their time to answer your pressing needs, and will be happy to speak to you over the phone. A doctor shouldn’t avoid his patients, nor should he hold them in suspicion.

3. Learn to treat common illnesses such as coughs, colds and fevers at home. Some conditions simply require that you wait them out, like a cold. A child with a fever can seem like a disaster to parents that have never been instructed by grandparents or parents to treat it; it’s important that you be educated, so spend some time in the library, or on webMD studying how to treat common illnesses that don’t require a PCP or an ER visit. Some parents go to the ER today simply because no one taught them how babies behave in their first 12 months. This lack of education leads to worried, frightened parents; if you are a grandparent or an older generation of parent, instruct your children in the treatment of common health problems.

Image credits: Lee Cannon, CC

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