What Every Family Should Know Before Entering the ER

Every year, millions of people become ill and find themselves headed for a hospital. Many of us live in towns where there are no “Urgent Care” facilities and the lack of affordable health insurance for some precludes them from walking into a doctor’s office. Depending on the city you live in, walking into the ER can be a very frightening experience. Some cities have extremely busy emergency rooms in which patients wait for hours in agony and the staff is simply overwhelmed. Other cites have free standing Urgent Care businesses on every corner, which absorb a great deal of emergent patients, allowing their hospital emergency rooms to run rather quickly and efficiently. Whatever the case may be, being prepared ahead of time and knowledgeable about certain things can save you and your family a great deal of frustration and even a life.

The first thing that every head of household should do, is start an emergency plan of action in the event of an illness, while everyone is still in good health. This is especially true if you have children and elderly members living in the home. Start by always having an overnight duffle bag pre-packed for each member of your household in the case of an emergency admission. Each member’s bag should always accompany him or her if an ER visit becomes necessary. Make sure to first include in these bags required information, i.e., copies of insurance cards (back and front), a list of all your chronic illnesses, list of all current medications and doses, list of all physicians and their phone numbers and your family medical history (parents, siblings and grandparents). Second, include basic comfort items for a possible overnight stay, i.e., comfortable pajamas, a robe, rubber ‘flip flops,’ a wash cloth, pair of sox, toothbrush, toothpaste, deodorant, comb or brush, contact lens products or glasses(if used), chap stick, about $5.00 in cash, a small notebook and pen (very important), and any important phone numbers you’ll need. All adults should have and include a Living Will drawn up, signed and notarized. A Living Will designates who you would like to represent you medically in the event that you are unable to do so for yourself. A hospital social worker can also assist in this upon request. Third, if there are children in the home, placing copies of immunization records in their bags is very important. All these items play an important role towards preparedness because in the event of an accident or emergency illness, vital information can be easily forgotten. Also, if a patient does become admitted, they can be left without basic personal care supplies for hours, depending on the time of their admission.

All caretakers and babysitters must be made aware of these bags and have access to them at all times just in case. Keep signed letters in your children’s packed bags simply stating that you “(the parent) consent for hospital treatment of (said child) in the event of an emergency.” Also, make sure that the consent is signed and dated. If a sitter is charged with the responsibility of transporting an ill child to the ER, treatment cannot be attempted without a parent’s expressed consent. Therefore, this letter will save vital time if a parent cannot be reached by phone. Most importantly, make sure that all caretakers are familiar with the contents of the bags. Unnecessary anxiety can be avoided when everyone is prepared in an emergency.

The first thing that everyone will have to do upon arrival to the ER is to register themselves or their family member. Have all insurance information out of the bag and ready to be presented. Answer all geographic and financial questions carefully and accurately. Mailing addresses and phone numbers to your insurance company are usually on the back of the card. In the event of an admission to the hospital, it is the responsibility of the patient or patient representative, not the hospital, to notify the insurance company by phone within 48 hours. The payment of claims could be severely affected or denied if this procedure is not adhered to. Also, it is important to receive a copy of the “Patient Bill of Rights.” This is crucial reading, don’t just stash it away. Patients should know their rights and what to expect from their caregivers. With all the necessary information readily at hand, registration should flow smoothly.

The next step will be meeting with a nurse for a written physical assessment, so be prepared to answer certain questions. Some of the answers will already be in the bag such as the meds/dosages being taken, all chronic illnesses, a Living Will if available, and family medical history. Having it all on hand allows for accurate recall of important information. All women of childbearing age will be expected to recall the beginning date of their last menstrual cycle, all pregnancies and all terminated pregnancies (including miscarriages). The health care staff requires this information in the event that x-rays are needed or if medication has to be administered in the hospital. If pain is present, be prepared to show where it is and to describe it, i.e., sharp or dull, constant or intermittent and how the intensity rates on a scale of 1-10. Also, be prepared to describe all other symptoms in detail. In the event of stomach pain & discomfort, the color, frequency and consistency of recent stools will have to be noted. When describing any symptoms, be as detailed as possible regarding anything unusual that has been seen or felt. The more information the nurse has about a patient’s overall health, will allow for a more accurate diagnosis by the physician after the physical exam.

During the next stage of assessments, which is the physician’s exam, patients will have to undress (usually completely) and don a hospital gown that opens in the back. Here is where a packed robe and flip flops come in handy until the doctor arrives in the room for the examination. After the physical exam, blood tests are usually ordered and a urine sample sometimes collected. Children and some adults may have to be distracted while their blood is drawn, due to a fear of needles. Further testing such as x-rays, sonograms, CAT scans and/or MRI’s may also be required. These are all expensive but sometimes necessary diagnostic tests, none of which cause any discomfort or pain. They are totally non-invasive to the body. Any testing that is invasive (equipment being introduced into the body, except for lab work), will require a patient or parental consent form signed by the patient and physician. These more involved diagnostic tests may require an actual hospital admission. How these invasive procedures feel and are conducted, depend on the actual test. Some invasive procedures may require sedation, which may allow for no discomfort at all. Only the physician can determine what is required in order to complete a patient’s diagnosis.

It is during the period in which a patient is being assessed and diagnosed by the doctor(s), that the notebook and pen are to be put to good use. Make sure that every physician and specialist that has contact with the patient at this point, provides their name and title. This could be of great importance if an admission is required. The professional staff will be more apt to do the right things and be on their “P’s & Q’s” when they realize that their names are being recorded, therefore holding them accountable. If for any reason patients are not comfortable with the care being received from any staff member, it is their patient right to request the care of someone else with equal qualifications. Too often patients are treated unprofessionally or inappropriately and believe that they are stuck with the doctor or nurse who initiated their treatment. This is not the case at all. Spend some of the waiting time reading the “Patient Bill of Rights.” They are standard policy and very enforceable, so keep notes on whatever you feel is relevant and list all questions that you need answered by the nurses or physicians.

If a decision is made by the ER physician to proceed with an inpatient admission, continue to document names and titles of caretakers on the unit of admission. Also, request the name and extensions for the Patient Care Coordinator (PCC) of that unit, the extension of the front desk, the names and numbers for the hospital Director of Nursing (DON) as well as the Medical Director. In the event that a patient’s rights are ever violated while a in a hospital or the staff is inappropriate in any way, the patient should report it directly to the PCC. Do not stop there if it is not handled satisfactorily and immediately. Anyone who ever becomes admitted to a hospital facility in the USA, will be billed more per night than any 4 star luxury resort anywhere in the world. Healthcare is a business like any other and a competitive one at that. A patient can even be transferred to another facility at their own request, provided that they are stable enough physically to be transported. Patients should expect nothing but the best when it comes to hospital care and should never settle. Only the best should do for anyone’s physical well being. Also, never be fooled into believing that one hospital is more capable than another. Most of them are fully capable to give patients the best possible care. In the event that a hospital is not capable of completely treating a patient, it is their legal responsibility to stabilize that patient and transport them to a facility that can. Patients should always remain aware, make sure that all treatment is understood and document the staff and their treatment well.