Behind-the-Scenes: What to Expect During an ER Visit

You’ve watched the scene unfold on TV: ambulance rushing in, paramedics running a stretcher inside, doctors and nurses flocking to the patient to try to save a life. While the majority of cases seen in an emergency department aren't always so dramatic, when you’re the patient, it’s intense, and you might not feel as in control as you’d like to be. Sometimes, just knowing what to expect can help.

Let's look at a typical case to see a simplified breakdown of the flow through an ER. The scenario: It’s the middle of the night, and you wake up with excruciating pain in your stomach. Something is definitely not right, so you decide to head to the ER in your own vehicle.

Stop 1: Triage

When you arrive, the first stop is triage. Here, each patient’s condition is prioritized, typically by a nurse, into three general categories: immediately life-threatening, urgent but not immediately life-threatening, and less urgent. At the same time, a registration clerk will get the basics -- name and date of birth – as the first step in creating your medical record.

The triage nurse records vital signs -- temperature, pulse, respiratory rate and blood pressure – and gets a brief rundown of your current issue and your medical history, including medications and allergies. Here you find out that your temperature is ­­­­100.4.

Stop 2: Physician Exam

If your condition is not immediately life-threatening, you’ll be brought to the triage physician who will perform a basic exam, and enter diagnostic orders (blood work, urinalysis, x-ray, CT, EKG etc.) and medicine orders to expedite your treatment.

Full registration happens at some point during your visit after the physician sees you. Documenting your vital statistics and insurance information is not exciting, but it’s an important step in creating a medical record. That way, your medical history and any tests like labs or X-rays will all be in one spot. Your bill will also be generated from the information in your medical record.

If you had arrived by ambulance, when you are registered could fluctuate and would depend on your condition.

<Important PSA>

Let’s stop the ER flow to talk about driving to the ER versus calling 911. Take heart attacks as an example. If you have symptoms like chest pain, shortness of breath, nausea or dizziness, sweating, or discomfort in your arms, neck or jaw, you could be having a heart attack. And when it comes to surviving a heart attack, every second counts. Patients who call 911 receive treatment an average of 20 minutes faster than those who drive themselves to the hospital because paramedics will begin treating you immediately, relaying your condition to the heart team at the hospital.

Stop 3: Examination Room

Next you are brought to the exam room. There, you vomit blood on the floor which could be a sign of a GI bleed. An ER nurse will perform an assessment, getting more details from you as well as any blood or urine samples that weren’t already collected. The nurse will also administer any ordered medications and get you a gown in preparation for the exam.

While in the exam room, you’ll see an emergency medicine physician, who will get even further into the details of your issue and history, and perform a general assessment of all your body systems, focusing even more on the area of you chief complaint. After taking into account your symptoms, a physical exam and test results, the physician may make a diagnosis or order some tests to help determine a diagnosis.

Stop 4: Diagnostic Tests

Some common diagnostic tests performed in the ER are blood tests like CBC (complete blood count), urine analysis, EKG, X-rays and CT scans. In our example, the physician ordered blood tests, urinalysis and a CT scan.

Stop 5: Diagnosis and Treatment

When the physician has all the information at hand, he or she can determine the most likely diagnosis, or decide that they don’t have enough information to make a decision and may require even more tests. At this point, the physician speaks to a gastroenterologist, the appropriate specialist in this case. The gastroenterologist comes to see you and performs a thorough history, physical exam and review of your lab data. He or she examines your symptoms, and these all point to a GI bleed. The treatment for a GI bleed is an EGD/colonoscopy. The gastroenterologist explains the procedure, including the risks and benefits. If necessary, you then sign a consent form to document this and permit her to operate on you.

Stop 6: End Game

Depending on your condition, the physician will either admit you to the hospital, discharge you, or transfer you to a more appropriate facility. (For example, a transplant patient would need to be in the care of transplant surgeons)

If you are discharged, you will receive instructions that explain your medications and other treatments. If medications are prescribed, you may receive a beginning dose. You will also be referred for follow-up care should your condition continue or worsen.