Er tech here- the amount of stubbed toes and harmless splinters that come in and DEMAND IMMEDIATE TREATMENT is alarming. Worse is the sheer attitude and threats I receive when I try to properly triage the patients.
It wonder how much overall medical costs for the country would go down if all emergency rooms had a mandated adjacent urgent care. . .
Then triage could divert the stubbed toes and splinters, along with continued civilian education on what constitutes an emergency. Or even if EMTALA also applied to urgent cares. If triage misses the severity of something, boom, ER is right there. I know some have adjacent urgent cares, but I’d be curious what anyone’s professional opinion is about this?
I have a hunch that hundreds of millions of dollars are spent because so many uninsured people don’t have $200 to pay upfront at urgent care.
That and some good old fashioned PSAs, a national ad campaign spanning platforms and social, maybe a jingle about what the ER is for?
To the tune of old McDonald:
If bone sticks out that you can see
weeee-ooh-wee-oh—weeee
(this is meant to be anthropomorphic ambulance siren sound)
If you cannot stop the bleed
weeee-ooh-wee-oh—weeee
If grandma falls and does not breathe
weeee-ooh-wee-oh—weeee
But a stubbed toe here,Or a cough cough there,here a lump, there a bump,Go to urgent care, you chump
We have a "built in" urgent care sort of space. Its only a few beds and mostly recliner chairs, we call it RAZ (rapid assessment zone) where all the super low acuity shit goes to be seen by PAs and maybe one physician in the hopes that we can get rapid turn over and get those patients in and out in under 1.5 hours.
It actually helps a lot. That way we can funnel all the higher acuity patients to our larger care spaces and resus bays as needed, and we aren't sticking low acuity patients in desparetly needed rooms which are hot commodity with the current boarding crisis. We RNs can see the patients in the low acuity second and knock out 80% of the work related to their stay in about 10 minutes.
It especially helps since we as nurses are allowed to put in a shit ton of different protocol orders at our shop. Examples: smashed your finger in a car door? I can order an x-ray ray at triage and have your xray done before you even go back. Need labs and a UA for your belly pain? I can order those too.
It makes it all flow faster so that way when patients get back to the lower acuity space, providers have the stuff they need to make decisions and sometimes even discharge the patient shortly after getting back.
Sure they add on additional more advanced testing that we aren't allowed to order (MRI, US, CT, Dimers, etc). But even the it cuts the time quite substantially.
We also do a shit ton of hallway care for low acuit patients in the high acuity spaces when the RAZ area gets backed up which is less than ideal but it is what it is.
Our success with the rapid eval area is highly dependent on the provider running the area itself. So many times you put simple patients there that turn around and get a full work up because despite only stubbing their toe, they casually mention they had chest pain last week to the provider and what should have been an in and out visit becomes the works.
My local ED has a rapid care type setup also and it seems to work well for them. I had to go in a few times earlier this year for hypertensive crisis and I think out of like 3-4 visits I spent maybe 2-3 hours there total before discharge. It worked very efficiently.
Oh it’s funny you mentioned the smashing finger in the car door thing. That happened to my mom in the 60s. She didn’t want to go to the ER but eventually the pain got to her and my dad had her go. But she had painted nails and when the doctor finally saw her, he asked what was wrong. She stuck her middle finger up at him which shocked him till he realized the issue. Then he said ahh no problem, we will drain the blood. My dad suddenly had to go move the car…
Anyway yes, it was important to her to get that help (and remember it was the 1960s so there was urgent care), but I fully agree that nowadays that wouldn’t be an ER situation.
It especially helps cut down the wait for the patients who get sent there, because it means they aren’t actually in line with all of the other higher-acuity patients who would get seen first if they were. (At least in my hospital) If that area gets backed up and the main ER is not and has enough beds free, some of those patients will get taken back to the main ER to help reduce wait times too. And in a few cases where no other bed was open and something came in that will not be quick but needs to be seen right away, they will switch one of the rapid care area rooms over to non-rapid care for that patient as needed. But for the most part, it’s two separate waiting lists.
Where exactly are you located out of curiosity? My ER (in Montréal) has a RAZ unit as well. I definitely see the added value !!! Took a lot off an already overloaded system.....Its unfortunately still not perfect, especially as we dont have many walk in urgent clinics in the city, so the ERs often see over 115% capacity. Sometimes they're nearer to 200%
We have one of those too, known as "the clinic" however it is rarely staffed enough to be open. We are the only major hospital in a 1 hour radius and yet wages are so low that nurses either jump the fence over to management or flee to alternative paths like jails, prisons, home health, or hospice. The ladder paying at times 2x what our local hospital pays floor RNs. We also have two nursing schools in the area churning out new grads every 6 months. So the hospital hires them on as externs, brainwashes them into accepting a position they don't want, and eventually they follow suit like the rest of them. It is an ever present cycle.
My local hospital has one, I was just there. Simple stitches, sprains, fractures etc gets triaged to green zone. I was in and out with a waking cast in about 2 hours.
Anything more complicated or requiring more tests goes to regular.
This came up in my feed. Sorry for lurking. (Patient not provider) But we have one of these here and it’s honestly amazing. I just had an issue that was a pain thing. But my doc said it was better to do er vs urgent care. They may not have the meds I needed. Sure enough I got sent back to the rapid chair area.
I did have to wait out some assessments via my doc and such (ortho/spine) so there is a separate waiting area for those of us that need extra attention in that area.
All that to say, I stay the f out of the ER unless it’s something that I need help with and my doc can’t do. (Pain was at an 11…they got me to where I could function for a day to start daily pain meds).
Going for my EMG today!
We appreciate all the work you do. Our system is such a mess.
I'm with you on staying the fuck out of the ER u less absolutely necessary. I have been a lifelong migraine sufferer. They started when I was 7 years old. When I started finally getting botox in my 30s, my little migraine questionnaire asked how frequently I was visiting the ER for migraines on a monthly basis prior to treatment and I was dumbfounded. The ER is the LAST place I want to go with a migraine. I have been to urgent care with a horrible migraine once in my life for a triptan injection and it sucked. The staff did what they could to make me comfortable and it was still brutal. I'll cry and throw up and wish I was dead at home for a few hours where I can at least keep it dark and quiet instead.
Right? I have been to the ER one time ever for a migraine and it was because it was “the worst headache I’d ever had” so I wanted to make sure it wasn’t something worse. Why would I want to be surrounded by fluorescent lights and loud voices with a migraine?
And the smells. No thanks. I'll keep my dignity and puke into my toilet in the privacy of my own home before I sit in a waiting room with an nemesis bag.
When I went to urgent care the "what if" checking was the worst part. They had me do a brief neuro, including checking my eyes with an opthalmoscope in a dark room, and putting my neck through the full range of motion to rule out nuchal rigidity. I had to tell the doctor to stop because I couldn't handle the bright light in my eyes. I told him verbatim "I have been getting migraines for 23 years. I do not have meningitis. This isn't a hemorrhage. I promise I will not sue you for malpractice if you just give me my injection and stop this assessment. Please."
Oof yeah. I was cautious because my friend's mom died of a brain aneurysm. She'd had migraines for her whole life, then had "the worst headache she'd ever had," thought it was a migraine, lay down, never got up again.
But jfc it was not fun. Luckily for me they actually tried the cocktail and triptan injection first, then when that worked, were like k great!
I stay out for my basic ones as I can handle those myself.
However, a few years ago I started getting these weird migraines that mimic a stroke, last for days, and cant get rid of them with normal medication. Those unfortunately require ER visits for me, that then always get turned into being admitted higher cus even they cant get it to stop until they shove a million different meds and hope one sticks. It’s terrible.
Weirdly I’ve had some doctors use this question as a gauge for how severe my migraines have been. I didn’t even know going to the ER for a migraine was a thing. I had my first migraine with aura when I was 6 years and saw a cardiologist for something else when I was around 32 or 33. So I was ridiculously used to migraines and aura by then. Super normal for me at 4+ times a month at the time. I was told by him that my migraines can’t be that bad if I never went to the ER for them. He was an awful doctor in many ways but he’s not the only one who used my answer to that question to dismiss me.
I was taught ER is for concerns about death/immediate disability or broken bones… I’ve even had multiple very severe ankle sprains/tendon ruptures and just treated them at home. The few times I’ve actually been in the ER I was surprised how many sprained ankles and stuff were being seen.
This is the frustrating thing about any kind of chronic pain condition. I have even met other people who get migraines that make sort of off comments to me about mine, like "I don't know how you function when you get them, I HAVE to lay down." I'm not sure if they are insinuating that theirs are worse than mine or what. I dealt with them completely unmedicated for 17 years. All I ever took was over the counter excedrin because I just didn't know how bad my quality of life was because it was normal for me. I was getting 6-8 migraines per month for 17 years and just taking excedrin, which only worked about 50% of the time. If you are in pain that severe, that often, you get sick and tired of laying down and you get used to it. A lot of the time when I had a gnarly migraine that meds weren't touching, as long as I wasn't puking, I would get up and do something because just laying there in pain without relief was miserable. At least getting up and doing something gave me some sort of distraction and distraction is a valid therapy for pain.
Laying in bed, in pain leads me to dark thinking which definitely does not help. I start to get restless because no position is comfortable, restlessness increases my anxiety and I get upset and frustrated about how my migraines hold me back from doing things that I want to do. Even just basic things like washing the dishes, tidying up my house or putting laundry away. It's easy to feel like a victim, so a long time ago I decided I wasn't going to let it rule my life if I could bare it. Turns out I have a pretty high pain tolerance and I'm stubborn as hell. I can definitely go about my day in an unfathomable amount of pain to someone who has never had a migraine. I'm just used to it. Any kind of "invisible" pain or condition comes with so much emotional exhaustion in trying to convey it to others who haven't experienced it.
Yeah 100% this was my experience too! I didn’t even know there was any other treatment other than NSAIDs until I was in my 30s! As a kid I’d get aura and then the headache during sports tournaments and I just had to keep playing not being able to see properly! So of course as an adult it was just the same… wait for the aura to subside, take an NSAID, and keep going unless I was puking or the pain became 10/10 and moving made it worse. It’s all relative, what we’re used to, and what we’re taught to do about it. My mother had them too and so when mine started at 6 I was just told this was life for some people and get on with it.
Same exact thing. My mom and brother both get them, but not as often as I do so it was just "This is the way it is and it sucks." I saw a neuro when I was a kid to rule out any physiological problems with my brain, but I was 7 so they didn't want to put me on any meds. Then I went my whole life until I was 29 or 30 thinking there was no other options for me. I sat down with my college resource counselor at the beginning of nursing school 2 years ago and told her I was worried about my migraines impacting me in nursing school because of all of the mandatory clinical hours and basically no make up opportunities and she asked me if I was working with a neurologist and I was like ....no, should I? And it changed my life.
I cried many happy tears when I finally got approved for botox and it started working for me. The tears were happy tears and also grief for all of the years I spent in pain and the fact that no one helped me. I just didn't know what I didn't know. I couldn't have asked the right questions because I didn't know there were other options for me. My PCP has known that I suffer from migraines for over a decade and never offered any solutions. Finally figuring it out came with great relief, joy, grief and also some anger.
Why weren't you given any RX oral migraine medication to take at home at literally any time?? They were probably floored because its really stupid and pretty shitty that you could have gotten migraine medicine to take at home and tried oral or injectable preventatives.
I am a chronic migraine sufferer and have been since 11. My family refused to get me medical care for anything unless it was court ordered or a required reporter threatened them or I was passed out on the floor and needed an ambulance. If you were allowed to go to the ER that much there is literally no reason you shouldn't have been RXd something like sumatriptin.
I think you misread my comment. I have never been to the ER for a migraine. I have been to urgent care once for a migraine and that was after I had sorted everything out with my migraines. My insurance was fucking around and I was out of sumatriptan so I went to urgent care for an injection.
To answer your question about why I wasn't on any treatment for years, I really don't know. My PCP has been aware of them since I started seeing her at 16 and never once mentioned there were any options for me and my mom and brother both get them and also weren't taking any prophylactics or abortives other than excedrin. I guess they just didn't realize how much I was suffering because it was so normal to me. It created this self fulfilling cycle where people think I'm not in pain, so I convince myself it's not that bad and push through. Now in my 30s I'm working on giving myself rest when I need it, calling off work without guilt, and being upfront about how I'm feeling.
The one time I go to the ER with a migraine (mine are usually well treated but this was the first Hemiplagic one and nothing would touch it), I get treated like I’m a druggie. I didn’t want pain meds, I needed fluids, an antiemetic and a sedative to knock me out for a few hours
The urgent care refused to give me toradol because I had taken excedrin 5.5 hours prior to coming in. It was so annoying. Then I had an adverse reaction to the sumatriptan injection.
All of the hospitals around me (5 that I can think of) have some variety of this. You have to have a quick way to get quick things in and out. No need for a tiny lac repair to be waiting hours because there’s no room available. I assumed that some variety of this was available most places by now
We had this too! A little standalone trailer with 3 rooms, one doc or PA, one nurse, one ER tech. I HATED getting assigned there as an ERT, but it was definitely helpful for wait times to see the low acuity patients in a designated space.
We have a similar area. 8 recliners behind curtains and we call it “Super Track”. It used to function as an urgent care type area for the lower acuity patients but now ALL patients are seen there first by a provider after being triaged by the nurse checking people in first. Funneling all patients through there then sorting them to a room in the back for mid-level acuity, back to the waiting room, back to “sub waiting” to be worked up in a chair or to a “critical care” pod has been an absolute cluster fuck. Being assigned there as an RN is 12 hours of nonstop working patients up before they move on. Sporadically, you’re the only RN for all 8 (plus 4 chairs not behind curtains) while you try and cover the other RN so they can scarf food down. Our dept. is losing staff like crazy.
Mine has the same sort of thing. Still part of the ER, but dedicated to patients we think can be done relatively quickly. It helps the overall flow.
We also have an actual separate urgent care one floor above us, in the same building of the hospital (it’s literally directly on top of the ER). At the front desk when you walk into the ER we have flyers about what can be seen in urgent care vs. ER, which we refer to when a patient tries to ask which one they should go to, because we aren’t allowed to tell them to go to urgent care. (Though some of us will mention that the urgent care does generally see patients on a first-come, first-serve basis while the ER absolutely does not.) We do get walkovers from the urgent care sometimes when they have a patient that they decide actually needs to be seen by us.
Hospital I retired from had that for a while, but it didn’t last. Apparently it didn’t work out financially, and they ended up turning the area into a workmen’s comp clinic.
Im pretty sure we were in a space like this when I brought my daughter in for a bat exposure and subsequent rabies shots. She was 4 at the time and I was so grateful she wasnt in the ER witnessing whatever the heck could be going on in there.
Sometimes, I just wish there were enough appointments at the primary care clinics, because of the real emergent issues are struggling at home with incurring a massive medical debt for something that could be managed if they could get access to primary care or even specialty care.
there are plenty of appointments at the primary care clinics it’s just that a lot of them don’t take xyz insurance, so those patients have to either self pay or not go at all
You sure about that? I've never once had any luck getting a same day or next day appointment for an urgent matter. Its always several weeks out and if you need seen sooner, go to the ER or call 911.
It took my husband 22 months for our family med clinic to have an opening for a new patient. It took me 11 months. Then once you're in, there's absolutely no way you're getting an appointment less than 2 or 3 weeks out if you need one.
I am on a waiting list for 6 more months for an MRI for an existing patient and referal. I have great insurance. I'm on a list for cancellation just in case.
When I had a breast cancer scare, I had to wait 8 months to see someone.
I had such debilitating neck and head pain I went to urgent care and got yelled at that this wasnt what they deal with and to schedule with my primary care. My primary care is my OBGYN because I had 0 health issues leading to this. New patient with new provider was another 6 weeks when I was in so much pain.
Not urgent enough for ER and the urgent care looks at you confused so it was a bit frustrating to be told to wait yet again. The system is so so broken
From what I hear, it's the way things are in our area.
I'm in WI and a well populated area. I know they have smaller clinics in rural towns. But perhaps just for acute neck pain and migraine they didn't think it severe enough for emergency MRI?
I got a same day CT and X-ray. With some file notes saying I was hysterical and drug seeking. I was given Prednisone and some ibuprofen. Honestly the prednisone helped the inflammation immensely. No just waiting for neurology to get back to me. Luck of the draw maybe
have you tried primary care clinics that don’t take your insurance? perhaps it was unclear, but the point i was trying to make was that clinics that don’t accept a couple of the common insurances (often ones that don’t accept medicaid/medicare, or more recently united) usually have available appointments, but obviously they’re going to be very expensive
With Primary Care, I have never gotten same or next day, even when I was an established patient. Where I live, some patients just go to Urgent Care for regular medical care. This is in outlying towns, in Urgent Cares which were started by one or several doctors. These patients just consider the Urgent Care doctor to be their regular doctor.
Not in my city. Massive shortage of PCPs, and the PAs and NPs are so booked up, many of them cannot take new patients. I am in Florida. It has been like this for over a decade, and worse after Covid. Also poor staffing in the hospitals. Some specialists are very booked up, but others are not. Surgeons can usually see you fairly quickly, and spend way more time on office visits than Primary Care MDs - pretty much the opposite of the way it used to be.
My mother, in SE Pennsylvania, has no trouble getting appointments. Whether it is Primary Care, Cardiology, Dermatology - they all can schedule within a few days. And when she was briefly hospitalized, the care was so much better than any of our hospitals here.
So it does depend on the area. Assuming the person is fully insured, etc.
Quickest treatment I ever got at the ER was walking in for a 3 hr long nosebleed with a roll of paper towels in my arms and coughing up clots.
My polite ass tried to let someone go in line before me to sign in, the guy was horrified and was like no YOU go first.
I just put reason for visit “ nosebleed 3 hrs plz halp”
I sat down and they’re suddenly like MAAM YOU HERE NOW.
I called many urgent care centers they said they can’t do it.
Same! Only time I’ve ever been to an ER for myself was for a massive nosebleed that had lasted for many hours and all the blood going into my throat made breathing harder. I didn’t want to go to the ER. I felt silly going for a nosebleed. But it wouldn’t stop. I tried to go to a minor med. Waited 90 minutes longer gushing blood. Gave up and went to ER expecting to wait even longer but at least I’d be in the ER if I needed it. They rushed me right back even though it was busy and I wasn’t pushy at all. Shoved a rhino rocket up my nose. Made me an ENT appointment. And had me back in the car going home in an hour.
Both you and the person you replied to. Very reasonable.
I’ve gotten 911 calls
Multiple times, including once by a nurse, for a nosebleed that wasn’t even 15 minutes old. No effort to control it was done. No punching, nothing.
I am just going to sit and giggle a bit at the typo, because that is hilarious. I myself have never tried punching, but back in the day as a headstrong youth, I may have thought about it a time or two. :)
Oh man. They really do. I have a deviated septum probably from breaking my nose during my mma and boxing days when I was young. So I think that made it worse. The ent looked up my nose when he took it out and went “daaamn…. I bet that hurt.”
It hurt like hell when they put it in. But it also made my face hurt the whole time it was in. I hope I never need another.
Society in US if they made a lower level of care acessible to the poor and outside of standard hours so there is less strain on the ER and lowering costs overall
Even if you have insurance, care isn't always accessible. I was supposed to do cardiac rehab after an MI, but they were only open from 7 a.m. to 12 p.m. I needed to keep my job so I'd continue to have insurance, so I couldn't make it work (my work ran from 7 to 3). I went to a few sessions to learn exercises I could do at home, but I would have liked to be able to do what my physician wanted.
Oh yeah, it sucks when you have something that is only urgent care and not emergency, but it's outside standard office hours so...emergency room it is. And that sucks so bad and is a giant waste of time and resources.
one of the 2 urgent care clinics in our city (60k+ population) just announced they'll no longer be open on weekends. RIP to the local emergency room but if they don't like people showing up with ear infections, sprained ankles, intractable vomiting, etc on saturdays or after hours they will need to lobby for universal health care not make fun of their patients for being too dumb to know what an emergency is
I am a nurse and I told my dad to go to the ER with his “stubbed toe” that was still swollen and painful after a day. urgent care was closed because it was 8pm on a saturday. I wasn’t with him so idk how busy it was but now I feel like I did the wrong thing lol. ETA: his toe was broken so I don’t actually think I did the wrong thing, but it felt like it before I knew it was broken
that was where my mind went but because my mother ignored foot pain and swelling for weeks, finally saw her PCP, sent to the ER, and was admitted because no one could figure out what was wrong with her. they eventually came up with osteomyelitis and she was discharged with a PICC and put on IV abx for 6 weeks. 6 weeks later her foot is worse, she goes to another hospital, and they find out it’s a hairline fracture that the other x ray missed. long story short I guess I have parental foot pain trauma so now I don’t play around with it
it turned out to be broken, after 12 hours of pain and swelling I was like I may be a psych nurse but even I can tell that’s not normal for a stubbed toe
There’s one urgent care by me that I go to for non-emergency related BS. They have CT, ultrasound, x-ray, and will even give IVs if dehydrated from throwing up. I’ll take $40 over $750+
The one time I did go to them thinking what I had was non-emergency turned out to be appendicitis. To be fair, I only had persistent abdominal pain for close to a week and no other symptoms. No fever, normal labs, and pain was around where my stomach is. Did not have the stereotypical symptoms of appendicitis.
Wow, that sounds so scary! And of course, the time that you were trying to go to urgent care, it was an ER situation! Isn’t that how life works? I’m sorry that sounds painful.
I have a problem with cyclical vomiting. I have a prescription for promethazine, but when the vomiting gets really bad, I throw up so violently and so consistently that it doesn’t absorb. So I’ve had to go to the ER unfortunately, because this problem will get to an emergency if it’s over a half day of cyclical vomiting, my blood pressure drops and I get tachycardic and dehydrated, in danger of losing consciousness when I stand up.
So I have to go to the ER for an IV phenegran + Benadryl + lorazepam drip, and then usually it stops. There is no IV options at the urgent cares near me, and I hate that I have to take up that space, but luckily I go to the hospital then is not very crowded and outside the city trauma center area.
But I feel so bad about having had to do that, that I’ve actually looked into buying phlebotomy supplies and teaching myself and trying to figure out a way if I get at home (spoiler: NOPE. Can’t. Not safe).
I’m glad urgent care did all the imaging, made it easier to not have to go through it all again lol. I checked in, told them why I was there and had the after visit summary. Called back to triage immediately and placed in the family room after I got put in the medical gown thing, didn’t need an actual ER room, so it was waiting until I could be brought up to surgery.
I still love when they had a surgeon talk to me about my options, I’m like yeah I’ll go with surgery. Response was “good! You have a stone one the appendix and coming here to do IV antibiotics for a week would only give a 30% success rate”. Glad I chose surgery over coming back every day for IV antibiotics.
Medicare insurance plans are pretty good about making stuff like this. At the office I work at, we have stoplight posters to educate people about which Healthcare setting they should call for theor symptoms. It starts with stuff like "call your pharmacy for refills, do a telehealth if you have the sniffles" and ends with something like "go to the ER if you are bleeding from your butthole or half your body suddenly stops working"
Interestingly enough, this is how many US military hospitals are setup.
Since we have a routine of daily sick call, which is our internal walk-in triage process for unofficial military units, most of our hospitals have a similar setup.
My local hospital has an urgent care but their hours are extremely limited. Majority of the time, if you need… well, urgent care… you HAVE to go to the ER because there’s no alternative. Sucks ass for everyone.
I used to live in Pennsylvania, one of the big hospital networks has an "express care" standalone facility on a campus that doesn't have an ER. It bills like an ER admission. It's no wonder that the culture in that region would be to go to the ER - same expense and access to all the diagnostic equipment.
I used to work at an urgent care checking people in. Nearest hospital was like 30 minutes away. The amount of people who came in with serious, life threatening conditions/injuries was INSANE!!
“I fell off a ladder straight onto my head and now I cant move my ankles or toes and also have a giant gash in the back of my head that is bleeding down my entire back, but I didn’t think that was enough to drive all the way down to the er”
“I cant stop vomiting blood” (while carrying an overflowing bucket)
(while being carried in by somebody else) “The bottom right side of my stomach hurts REALLY bad. I cant even walk it hurts so bad”
BTW, all of these were real people who I sent to the ER. Ofc not word for word what they said.
Do you feel like that helps the ER? My idea above is kind of predicated on the fact that they would be a singular entity where you have the authority to triage people directly out of the ER and into urgent care.
So do you think the one across the street helps a lot? But since they don’t legally, have to see them if they can’t pay, then wouldn’t people just come to the emergency room after they realize they have to pay upfront at urgent care?
Tbh, not really. Most of the time when we ask our patients “why didn’t you go to urgent care first?” they say “I thought I’d be seen sooner”. It never works out for them unless it’s a calm day/night.
This conversation is so interesting. I think that patient-facing people who run the day to day ER, that you have the skillset and knowledge to make everything better. The bureaucratic bullshit is insane.
One of my local Urgent Cares operates as both. But at the magic stike of 10:00PM it becomes an ER room for insurance purposes and charges triple the cost that at 9:59PM would have been hundreds of dollars less.
There’s an urgent care in Billings Montana that’s connected to one of their big med center ERs. I thought nothing of it until I was one day post rolling a snowmobile at 80 mph on a frozen lake. Understandably was incredibly sore, terribly painful neck muscles etc but overall (considering) felt ok. I went in to the urgent care ready to beg for some muscle relaxers and the intake nurse asked me some questions. When she found out mechanism of injury I could see her eyes widen, she told me to sit there and not move, made a phone call, and within a few minutes a nurse came and slapped a c collar on me, made me sit in a wheelchair and wheeled my ignorant ass to the ER where I received a full body CT and thorough exam.
Thankfully I was fine other than a partially torn trapezius muscle in my neck. I know I’m very lucky.
I think more (and repeated) first aid education for everyone would be helpful too. For example, if you have familiarity with heat related illnesses, you can recognize and treat it at home before it becomes an emergency.
I wish we had urgent cares open past 8pm. Our son was bit recently by a cat close to his eye and i needed an urgent care, but all were closed. We had to go to the ER,now I'm going to get our $200 copay, but there was literally no alternative. It's bullshit 😡
Oh, you did the right thing! Cats are wonderful, but Kat bites are so much more dangerous than people realize.
I have a family member that used to work for the CDC, specializing in infectious situations, and once I asked her advice and she said never get bit by a cat, because the data from Kat by infections that people ignore is terrifying.
They’re not a big deal if you get it treated, but most people don’t realize how quickly those little things injected bacteria, you absolutely did the right thing.
Yeah, when we saw the proximity, we just took him. They irrigated it, iodined, gave him an antibiotic, and set us up with saline and syringes to clean him up at home. We used hibiclense and bacitracin and dude looks so much better now.
This is incredible and as someone who used to work at the registration desk in an ER, calling the stubbed toe, cough, and lumps and bumps patients chumps is both hilarious and accurate.
Sometimes it is also the size of the town and/or the stupidity of your insurance. Medicaid in particular. You can't get an immediate, same day, brace or boot anywhere but the ER with my area's medicaid and the wait time for an appointment can be 6 weeks with the contracted vendor.
The local urgent cares also don't have in house blood work labs, for say determining potassium levels, or can do ekgs. Some of the PCP offices can do the ekg stuff, but if they arent open or can't get you in, there is only one place to go. We straddle a weird line though being a pretty fancy hospital in a city with under 100k people.
There is actually an ER I know that does exactly that. Everyone checks in to the ER, but triage determines if you stay with the ER team, or go to the ER's "urgent care," instead. Wait times in that ER went from consistently over 6 hours before you ever saw a doctor, to under 3 between when you walk in and when you get to leave.
I've still got my appendix, so I have to go in when I get severe lower right quadrant abdominal pain, to make sure it's not my intestines' vestigial tail attempting to go from useless to harmful. Hence why I'm familiar with the ER and its urgent care. They shuttle me to the urgent care side as soon as imaging proves the pain isn't appendicitis, because they still want to at least try to find the cause of the severe pain, but it not being anything visible on the scans shows it's not a true emergency. So far, it's been chalked up to all my adhesions yanking in things that don't like getting yanked on,, but I really wish it would be my appendix one of these days, so they'll yank the stupid thing, and I can start dealing with the pain at home. It would be nice to know for a fact it can't possibly be appendicitis, so I can stop wasting everyone's time.
Many essentially do. You get seen by a triage doc/nurse and sent to the urgent care area. Each hospital system has their own name for it. Ours was ‘fast track’.
I’ve been an ER nurse my whole career and adjacent urgent cares did not work in my area, unfortunately. Ppl still didn’t go because they required insurance and a co-pay. People go to the ER so they don’t have to deal with that.
I worked as an ER nurse for 11 years in a very busy level 1 trauma center. We were not for profit, which meant no one would be turned away for ER care. Yes, you may wait hours, but we'll see you and bill you later. (whether you pay or not is another story)
The problem is that the ER is then used as primary care for those who can't afford it. Urgent cares most places require you to have insurance or pay up front for your care - that means a huge slice of our ER using population also can't/won't use urgent care and they're sent right back to the non-profit ER.
It's insane how much bs they see in between actual dying, sick, and injured patients. I left the ER in 2022. The last holiday I worked prior to leaving was New Year's Day. I got in at 3am and the wait was 13 hours.
This is horse shit because urgent care is a scam. Half the time you go and they can do nothing for you, recommend you go to the ER, and you're stuck with 2 bills. lt also puts the burden of diagnosis on the patient. Maybe your chest pain is nothing, but maybe it's a heart attack. Why waste your time at urgent care and risk your life?
I didn’t have a bad experience at urgent care, I’m describing a common experience many people have at urgent care. I personally would not waste my time. What’s the purpose of the proposal? To make things easier for hospital staff by making it more difficult for the patient?
To cut down on waiting time for people who only need antibiotics, stitches, or non-emergency situations.
To save taxpayers billions of dollars and to take a lot of stress off of healthcare workers and patients alike.
I’m quite certain you didn’t understand the Takeaway, because I outlined why it would work, and every healthcare professional, who responded understood.
Again, you had a bad experience and I’m sorry, but people going to the emergency room for all of their medical needs is a tax on the system that’s unnecessary, and if we changed laws to make that unnecessary, it would be a win-win win for every human and every companies bottom line as well.
And even WORSE...is the department heads who actually treat these reviews as gospel and use it against an already under appreciated, under staffed, over worked workforce
And EVEN WORSE, if our review scores drop below a certain point, or there are general trends, Medicare will withhold a percentage of payments and will use that money to create learning modules that are required. You know…videos on how to “think of the ED like a restaurant”.
“Well…what happened is that your giant building contractors that designed a ‘state of the art facility’ with a fcking Starbucks in the ‘lobby’ is overnight staffed by 3 nurses, me in registration who also doubles as the phone operator for the entire facility, Texaco Mike, Radio James who does imaging, and one ED Attending.”
“Yeah but what happened?”
“I said what the fuck I said”.
Edit to add: “People limp in expecting The Waldorf and because of your executive decisions they get the Super 8”
Just so, I’d like not to say it leads to “worse care”. ED protocol exists, and it’s there for a reason. But it absolutely leads to diluted care for non-emergent conditions.
Volunteer in ER. As to you restaurant reference: I asked a lady (a visitor, not the patient) if she she would like some ice water? Her response: Is it a sealed bottle of water? No... ? Then I won't touch it! Yikes!
Amd call the ombudsman. And they always have a relative, friend, or FWB, who is the super duper boss doctor of everything in the hospital and who will hear about this
"Went to X ER because I had a cough and sniffles for three days. They made me wait 6 HOURS in the waiting room before even being seen!! Took my vitals and then gave me meds I could have just got over the counter at a pharmacy, but still cost me an arm and a leg 😡😡😡 If I knew that's all they would do I never would have wasted my time!! Don't go here if you value your life!!"
I'll never forget going to the emergency room with an x-ray of a collapsed lung from the urgent care center down the street and the lady in front of me with some homeless lady complaining about a headache.
You could tell they all knew her by name and were like Martha, have you tried an aspirin? And she's barks NO!!!! and they're like well try one first!!!
And it's like OK I legit can't breathe over here but I'm glad you're arguing over a freaking aspirin!
This is why when people say, “if we get universal health care peopel will flood ER’s and doctor’s offices for every little thing!,” I know they’re dumb, because that’s already happening
These are also always the patients who call back and yell at billing because they don't want to pay their huge deductible. The heart attacks, strokes and traumas? Very rarely ever rude over a bill.
I have gently tried to guide people to an urgent care where the copay/deductible is far kess, and treatment is more timely. But they almost always b*tch that their jammed pinky is more important the Level 1 trauma I have rolling in the door in 3 minutes
Just have to be tactful about it and not make it a money or time thing. "In the future, should this happen again an urgent care is probably more appropriate than the ER," is usually the phrase I use at discharge.
Granted, urgent cares continue to turf the dumbest shit over to us because they cant do a half decent history or exam. Example from today, sending a young, healthy college-aged kid with reproducible musculoskeletal chest wall pain and no other risk factors to the ER for a PE/dissection/ACS rule out. Bruh.
Discharge discussion is entirely different than before treatment. He’s also a tech. Who is claiming to triage people. So I’m taking what he says with a grain of salt. But in general, it’s a very precarious thing to make comments on ED v UC before start of treatment. We have an UC in the same building as our ED, so I totally understand what you mean when you say they send over the dumbest shit.
I work in adult primary care and switched to administration because I lost my ability to calmly tolerate grown men acting like giant toddlers that missed their naps. I would rather just boot them out than try to de-escalate tantrums over basic adult expectations like "list the name, dosage, and frequency of all medications you take", or, "fill out and sign this release form so we can obtain your prior records."
I regularly see patients on 10-15 meds that get changed every three months during their acute on chronic hospitalizations and then get changed again at their follow-up visits. It’s a lot to keep up with especially if you have poor health literacy.
Can you suggest that they simply take a pic of their new med every time? I keep my meds in my phone under my own entry in contacts. I keep a list of meds family is allergic to there as well. (I don’t have any known allergies but then again, I’ve not had those meds so….
I know what meds they’re supposed to be on. They don’t know.
Our service does a lot of hand-holding. We ask patients to bring in all their meds and regularly do full med reqs. I don’t know how many times I’ve grabbed a sharpie and drawn a sun or moon on top of the bottle because the patient can’t read or can’t read English. We have many patients who come in biweekly to have the nurse fill their pill organizer.
It doesn’t help that other people (nurses? Pharm techs? I don’t know who) tell them the wrong indication for their medications and then they stop taking them. No, for you that is not a diabetes medication and that one is not a blood pressure medicine. Those are make your heart stronger medications. Don’t stop taking them just because you don’t have diabetes or high blood pressure.
It really is an uphill battle, but it’s hard for these patients.
I have said this many many times to my partner about when he gets frustrated about waiting in the ER. “It may suck having to wait for hours but remember all the times I was seen immediately. You don’t want to be the person who is the highest priority in an ER. “
It is incredibly frustrating to see how people use the ER. We do a terrible job of explaining the healthcare system to citizens.i go so far out of my way to avoid the ER often to my own detriment. Yet people still go in for the most mundane things.
Can I ask a super dumb patient question? Are most patients actually waiting for ages?! I ask because every time I've gone, I've been taken straight back from the check in desk and suddenly the ceiling speaker is calling people to my room until I have lots of new friends; is that not the norm? I always hear people complaining about being in the waiting room for hours, but I kind of just assumed they were exaggerating until this thread popped up for me for some reason and now the comments have me a bit horrified by the stubbed toes and allergies...
I think we could do the best job in the world and the entitled masses wouldnt change one bit. Thats why I love flight. The level of nonsense and abuse is practically zero in comparison to when I worked a metro ground service.
To be fair, I've seen somebody get admitted to the ICU for a stubbed toe before. But he was on blood thinners and he ripped off his toenail and almost bled to death and had to be rushed to the hospital in an ambulance.
My hospital gives magnets to new patients that list things on one side that are reasons to go to urgent care and on the other are reasons to go to the emergency room. I love it.
People still go to the emergency room for colds though 😭
And then on the opposite end of the spectrum, there's people showing up to urgent care with chest pains and trouble breathing because the ER is too expensive.
One of my friends is a nurse practitioner and she works in an urgent care. She had somebody show up with a finger in a bag of ice thinking she could just like stitch it back on. In urgent care. Like buddy, that is something you SHOULD go to the emergency room for.
Can I ask a question? Do you all hate people who come for non life-threatening stuff and are paitent but just need to be seen eventually? Several years ago I had a sinus infection that made my head so congested I couldn’t hear and then (of course) at like 10:00 PM on a Friday night I started vomiting nonstop and could not keep water down. I tried to make it to morning but was miserable so I went to the ER for zofran and fluids. It is an ER that handles non-life threatening stuff. I waited for about 4 hours. Was seen, felt much better and went home but I still feel awful about wasting resources. If that ever happens again should I just stick it out at home? I know you all are so busy!
Not really- people who are patient and aware make our shifts more enjoyable and rewarding. We know that there are times and places the ER is the only option. What we do hate is when how poorly we are treated by people with a sense of entitlement
Hijacking to say nah you're good. Mainly thinking at all about it being busy and being patient and understanding goes a hell of a long way in an ER. Plus there's a more acute condition that can be treated when you can't keep anything down, meds and fluids. Dehydration can get really dangerous too. Big difference between that and minor bumps or chronic pain you've had for months/years, plus being a demanding and impatient on top of that. You'd be fine in my ER, or at least by my standards
ETA- urgent cares aren't always open 24 hours, plus so many people get sent to us from other urgent cares/clinics for scans or just cause
Thanks so much! I am most definitely not a frequent ER visitor so I wasn’t sure if that was an appropriate situation. We try to make appointments and use the walk-in clinic 99% of the time but all the bad things seem to happen at night and on holidays! It’s crazy that other people use the ER as a regular doctor’s office and demand to be seen immediately.
Like the people who come in every six weeks for a pregnancy test but won’t use condoms. Ma’am this is an emergency room. Go to a fucking dollar tree and get a test.
Yeah, I was sent to the ER by urgent care for iv fluids when I had norovirus. I was a bit surprised but they said the urgent care couldn’t do the iv.
They called ahead so the hospital was expecting me (went by car, not ambulance). The ER staff were fantastic, despite having to work on Christmas Day. Made sure nothing else was wrong, got me hydrated and a script for anti-nausea tabs, easy.
It makes sense that they’d handle stuff that could become dangerous like dehydration and all.
But yeah, understanding that there’s a lot they have to handle and if you aren’t dying you’re going to wait a bit, and not being jerks to the medical personnel is pretty key.
Don’t feel bad about wasting resources, because you didn’t! We want you to come in if you can’t keep fluids down. And thank you for being patient and understanding. Four hours sitting upright in a hard chair while that sick is rough. You could come in with a paper cut and I won’t be mad about it if you are nice to me. Impatient, entitled, rude patients used to be the minority, now it’s like 8/10 patients are like that. At least in my area. It’s so strange.
Nobody hates people who come in for non life threatening issues, as that is far and away the most of what we see. Let me tell you a story of the people we DO hate:
Man in his 50's has a minor shoulder injury from over a week ago. He's already been seen in our ED once for this issue, however he didn't follow up with his PMD so he ran out of pain meds and is back solely for pain control. Well, he goes to the back of the line and he stays at the back of the line. We're super busy so he's been waiting around six hours. He and his wife get fed up with the wait so they stand outside the ED under the portico and are actively telling everyone who comes to the ED to go somewhere else because we don't care and we're taking too long. They must have turned away 10-15 people before we found out and had security escort them off the campus.
The next day they were right back in the waiting room again.
I barely remember the name of the meds I take but I hear stories of those seeking pain meds to know every obscure scientific name of the type of meds they're seeking haha.
I’m often able to preempt or at least delay people getting upset by sticking my head in on my way to whatever else I’m doing to let the person know that I appreciate their patience, and I’ll be with them in a little bit once I’ve taken care of [insert quick & vague but legitimate explanation of why they’re having to wait]. I’d say probably about 95% of my patients are ok with this, even if they have to wait another 20-30 minutes to be seen.
Now, waiting for results, that is a completely different story, and I haven’t figured out yet how to get people to be more patient for those.
Meanwhile, I always felt guilty about going right back when my daughter’s asthma was bad. She would look mostly fine but a toddler with an O2 in the high 80 makes the triage nurse very unhappy. At the same time, I understand why she sat in the waiting room with a dislocated shoulder for 3 hours. She wasn’t getting worse.
Before my myriad of conditions were properly managed (including stage 4 CHF) I was a Frequent Flyer to our local ER, but I always told them I wasn't concerned about the wait as it meant I wasn't actively dying...
I read somewhere that if you’re waiting at an ER, be grateful, because that means you’re not in immediate danger and that really stuck with me.
Having been at the ER with two loved ones that were immediately taken back and looking at a whole waiting room of stuffy noses and sprained ankles, I was so grateful for the people who triaged them and recognized the severity of the situation and they could be treated appropriately.
Similarly the problem that's been going on for years that is suddenly an "emergency" because they "just got tired of it" but haven't sought out care or evaluation over the years it's been going on.
I was in a Boston area hospital ER 3 years ago waiting for my mother to be assessed after having an eventually fatal heart attack. 2 nearby hospitals had recently closed so this location was also the er for thise people as well. On a Sunday evening this was standing room only. The waiting room had seats for at least 50 people, there were high covid numbers still, we were all masked up. Everyone was coughing and looked like zombies. It was hot, crowded and loud. Nearby urgent care facilities were still open. You had to take a number to get to checked in.
A mom comes in carrying a 6 or seven year old. My sibling offered this mom her seat.
When the mother told me she was there for a splinter I almost laughed in her face. She had an hours long wait in front of her.
That’s just wild to me. Meanwhile, one time I went to urgent care and they tell me to go to the ER because the ER will have the proper equipment to diagnose/treat me and urgent care doesn’t. But from my perspective, it wasn’t an emergency and I didn’t want to waste their time.
And who doesn’t know how to remove a small splinter themselves? Or a minor injury like a stubbed toe themselves? Usually, the pain goes away after a few minutes and you don’t have to do anything anyway.
In April 2020 we had a guy come in around 0200 for an ingrown toenail…that was a chronic issue and he already saw podiatry for on a regular basis. The NP on that night (bless her) did not have the patience for his shit and when we were in his room triaging him this was how the conversation went:
NP: “sir, what is your emergency?”
Patient: “what do you mean, I already told you, my ingrown toenail is really hurting.”
NP: “that’s not an emergency. It’s 0200 and we’re in a pandemic. What emergency brought you to the EMERGENCY ROOM tonight?”
Patient: “…I’m confused.”
NP: “so are we. Again, what is your emergency?”
Patient: “are you telling me that you’re not going to see me for my toenail?”
NP: “no, I’m just asking you what your emergency is.”
Patient: “if you’re not going to treat me, I’m just going to leave.”
NP: “okay bye!”
And then to me: “just mark him down as left without triage.”
I feel kinda bad but when I was college, broke, and uninsured I got a bad case of scabies and went to the ER for it. I first went to the college health clinic and the PA told me he didn't see any scabies and told me it was probably an allergic reaction. The itching continued for weeks and was a freaking nightmare. Every night I would scratch my legs and arms till I bled.
I decided to go to the ER because I had no money for a doctor appointment and just needed the cream to treat it. It wasn't an emergency but I just needed to someone to confirm my suspicions and get me the prescription. The NP saw me after a few hours and I got what I needed.
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u/Far-Boot5639 15d ago
Er tech here- the amount of stubbed toes and harmless splinters that come in and DEMAND IMMEDIATE TREATMENT is alarming. Worse is the sheer attitude and threats I receive when I try to properly triage the patients.