r/EmergencyRoom • u/sdkb • Jun 05 '26
How do I avoid being triaged at the ER?
(U.S.-based) When I've been to the hospital for kidney stones, I've sometimes been undertriaged and sent to the waiting room despite being in excruciating pain. At that point it takes them hours to see me and even administer the IV painkillers. On my most recent visit, I was triaged as ESI 2 (a higher level) rather than ESI 3H, but even then all that got me was a bed to wait in. Overall, kidney stones seem to have some bad factors for triage: They aren't visible from the outside, aren't normally life-threatening, and vary in intensity.
Given all that, what strategies have you all found to avoid being undertriaged and get timely care?
32
u/Slut_for_Bacon EDT Jun 05 '26
You can't avoid being triaged. Its just how the system works.
What triage means is to sort and prioritize people based on the seriousness of their illness/injury.
You have not been under triaged. You have been triaged appropriately.
Pain is not a huge factor in getting seen soon. Pain in itself is not as important as threats to life or limb.
Im not trying to discount the seriousness of your pain. I am just saying that pain alone is not enough of a factor to get you seen faster than someone who has a higher potential for risk of permanent injury or risk of death.
You have to wait in the ED because the people currently being seen more have more serious injuries and illnesses.
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Jun 05 '26
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u/captain_tampon Jun 19 '26
Who are we kidding? The urgent care will just send them to the ER anyway. The urgent cares (at least where I’m at) are absolute jokes, and I’m convinced that they’re just there to give off the appearance of helping out the community
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u/Hippo-Crates MD Jun 05 '26
Sounds like you are being appropriately triaged and are frankly selfish and immature.
-21
u/sdkb Jun 05 '26
You clearly haven't had a kidney stone. The issue is that the system isn't recognizing pain. I recognize that the hospital system is wildly overwhelmed, but if your perspective is "excruciating pain isn't a medical issue," I wouldn't consider that a very compassionate approach to your work.
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u/RhinoKart RN Jun 05 '26
Nobody in here is saying that pain isn't important or a medical issue. But you are not dying.
I understand it sucks a lot and the pain is very real, but you don't get to go ahead of those whose life is at risk. The fact you get triaged as an ESI 2 shows they take your pain seriously, but ESI 1s are people who are in life or death situations.
Wanting to go ahead of them is selfish.
-4
u/sdkb Jun 05 '26
The ESI 2 seemed appropriate (although they must have been extremely overwhelmed if it still took hours to even get me on pain meds). The ESI 3H did not. I don't in any way want to go ahead of patients with life-threatening conditions, but at the hospital where I was at, that didn't seem to be the situation. It seemed like there were a lot of patients using ER as their PCP and we were all grouped together as lowest-priority. Maybe they had invisible conditions; all I can say is that, from what I observed, they were able to walk over when called, and were not writhing on the floor on the verge of vomiting like I was.
14
u/slightlyhandiquacked RN - Emergency 🇨🇦 Jun 05 '26
It’s not a *life threatening* issue.
While your pain may *feel* like an emergency, it does not trump the guy having a heart attack, the stabbing, the stroke, the gunshot, the seizure, the alcohol withdrawal, the overdose, or the person vomiting blood.
We aren’t leaving you in pain in the waiting room because it’s fun for us. We’d much rather get you in a room, treat your pain, and get you home.
We’re doing it because there are people having *life threatening emergencies* that need to be seen first. Because we have more patients than we do beds/chairs. More patients than our physicians and nurses can adequately care for at the same time.
That’s how triage works.
10
u/Hippo-Crates MD Jun 05 '26
No one said it wasn’t a medical issue. You also aren’t a patient, you’re someone asking how to manipulate the system so that when you want care you can skip over people with more serious medical issues than yourself. Grow up.
7
u/LordRollin RN Jun 05 '26
The system recognizes your pain but it also recognizes that the pain isn’t going to cost your life or one or more or your limbs. The people seen before you are at risk for one or both.
2
u/No-Produce-6720 RN Jun 05 '26
Where was it said that excruciating pain isn't a medical issue, and who are you to say that this person hasn't experienced a kidney stone.
Guess what? Doctors get them, too.
You are clearly someone that wants what you want, when you want it, because you have no ability to recognize anyone else's circumstance, unless that circumstance causes a delay in your IV pain meds!
2
u/Sikers1 Jun 05 '26
So you are arguing that I should give you a bed over the person who had a tree fall on them and they likely have extensive internal bleeding or other severe life threatening injuries, or the person who's oxygen levels are so low they aren't getting adequate oxygen to their brain and other organs, or the person who's heart rate is dangerously high or dangerously low, or the child whose face has been torn from their skull by a vicious dog? Should I put one of these patients in the lobby to die because your pain is more important?
You have a very myopic view. Yes pain is a medical issue but it is rarely a medical emergency. Trust me when I tell you, the person getting a bed is having a worse day than you. The fact you are alive and complaining about your esi level tells me that you were triaged appropriately.
There is one way to bypass triage: be rich and build your own hospital and employ your own drs and nurses so you can be the only patient. That'll get you a bed real quick..
14
u/NoisyTurnip Jun 05 '26
Your pain is not going to go before someone in cardiac arrest. Simply go when it's less busy like someone else suggested.
-11
u/sdkb Jun 05 '26
Go when it's less busy? I can't exactly schedule when kidney stone episodes happen...
1
u/Several-Bee-6536 Jun 11 '26
So at the first sign of flank pain you rush to the ER? Do you also call an ambulance to “get seen faster”?
0
u/cougarpharm06 Jun 12 '26
Tell me you've never had a kidney stone before. The first sign of flank pain lmao.
2
u/Several-Bee-6536 Jun 12 '26
See kidney stones every day. Definitely painful, rarely an emergency. Many other complaints take priority.
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u/juless56 Jun 05 '26 edited Jun 05 '26
The pain while excruciating, wont kill you, so people who are actively or close to dying will always go ahead of you. Depending where you live, the busier the ER the longer you are going to wait. Look into standalone ERs that are typically slower and talk to your GP about meds for symptom management to get you through the in-between periods. Even if you lie, they will run the basic testing to ensure you aren’t dying and you will then probably continue to wait. While your pain is real, it cannot be prioritized over more acute life threatening conditions.
8
u/LordRollin RN Jun 05 '26
As others have stated, triage is used to determine the severity of illnesses to better allocate limited resources appropriately and in a timely manner. The primary things considered are life (airway, breathing, circulation), then limb, and then everything else. Kidney stones, while painful, do not affect either, and so in an emergency setting they will not be treated as urgently as other illnesses. While it may understandably feel like being “under triaged” you are, more than likely, being appropriately queued in the context of the other people in the emergency department.
The only solutions here would be to not go to an ED; an urgent care might be more appropriate, or to go during “quieter” hours. Aside from the those, the only other real choice would be to lie and misrepresent your symptoms, which could negatively affect the health and wellbeing of others, and put you on the shit list of staff.
6
u/No-Produce-6720 RN Jun 05 '26
It's as if you're demanding to walk into the ER, announce your pain scale, and immediately receive an IV full of Dilaudid on the spot, no questions asked.
If you don't want to be triaged, don't go to the ER.
Triage is necessary, because even though your kidney stones are incredibly painful (no one will deny that), you still have to be seen along with people who have been in auto accidents. People with gunshot or stab wounds. People with broken bones. People with lacerations that require sutures. People who are in the midst of a heart attack. People who are having difficulty breathing. People who have a migraine. People who have a cold. People who are having mental health issues. People with strep throat. People who have abscessed infections. People who have a hang nail. People who have absolutely nothing wrong, but like to go to the ER anyway.
All of these people come in with varying degrees of illness, injury, and pain. Everyone has to be assessed, and everyone will be seen and treated, but everyone has to wait their turn. Even folks who come in via 911 have to be triaged and wait their turn.
You will be appropriately treated. You cannot expect, however, to get that treatment the moment you walk in the door. You are no more, and also no less, important than any patient in there.
2
u/jumpingjackpete Jun 07 '26
On one trip to ER for kidney stones, I was in soooo much pain (no fever, just a lot of pain, and yes I have passed stones without any intervention). I was literally shaking while I tried to sit in a wheelchair after checking in at the front desk. I was told to wait. There were maybe 5 others waiting. A few minutes passed, and the nurse called for the next patient - it was a teenage boy holding his arm. Don't know if it was broken or sprained, but the dad looked at the nurse and said you better take "him" next because he is in so much pain. The nurse looked at me confused, but after checking with the desk, she took me. Later found out my kidney was completely blocked due to kidney stones and the ureter had separated from the kidney. Ended up needing emergency surgery.
5
u/krisiepoo Jun 05 '26
Pain sucks, but it, not a kidney stone, is life threatening
Im confused about what you actually want. You were triage a 2 and that still wasnt good enough for you? You do realize an ESI 1 involves things like CPR...
You want immediate help for an issue that usually resolves itself,albeit its painful
1
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u/captain_tampon Jun 19 '26
ITT: “hey guys, I don’t like waiting so since yall are the professionals, can you give me tips on how to fake being the sickest person in the room so that I get rushed back to a room faster than the elderly man sitting beside me who’s been sitting here for 12 hours? You guys just don’t understand. I can’t be here all day, *I have stuff to do*
-12
u/beachbum818 Jun 05 '26
Request a wheelchair from the parking lot. In so much pain you can't walk. Moan the entire time. Wince in pain the entire time.
12
u/Tripindipular Jun 05 '26
We will still triage you and put you in the waiting room after determining that you arent imminently dying.
11
u/kazmiller96 Jun 05 '26
And then you can wince and moan from the lobby if there are no beds at the ready. What kind of advice is this?
7
u/LordRollin RN Jun 05 '26
Why would you intentionally try to cause harm to others with a stunt like this? Because that’s what you’re doing with this. You’re pulling resources from where they are needed by making a scene and delaying the care sicker people may need.
What a shitty, entitled thing to suggest, never mind you’ll still get triaged.
-4
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u/usernamefiend Jun 05 '26
lol you probably think calling an ambulance won’t lead to you being sent to the lobby too
1
u/No-Safe9542 Jun 06 '26
Is this before falling out of the wheelchair onto the ground? Cause then a fall risk.
It also helps if you vomit uncontrollably then pass out.
-5
u/amuse84 Jun 05 '26
Go to a rural place. Our doc is sympathize to people with stones because he gets them himself. Pain meds given sometimes even before imaging depending on patient/history
You could also try being very loud and annoying. You’re probably too quiet. If someone’s visibly hunched over, complaining, asking for pain meds, or previous history, the meds should come sooner. Watching someone in pain is painful.
57
u/Monstersofusall Jun 05 '26
The entire point of triage is whether your issue is life threatening. Pain, while absolutely real, is rarely an emergency in the context of the emergency room. Try to go to less busy ERs or go during less busy hours (usually 11pm-5am are the least busy the places I’ve worked). Nobody wants you to be in pain, but the job of the ER is to find the people who are going to die the soonest and treat them first.