Should I go to the ER? Triage decisions!

November 14, 2013

Mark L. Friedman, MD, FACEP, FACP

Triage is a classic concept, the origin of which hearkens back to battlefield medicine.

In the modern civilian setting, triage is the term for sorting patients based on acuity and assigning them to the appropriate setting for care. This can make a big difference in the cost as well as the quality of care. While it is nearly impossible to render high-level care for acute complex problems such as a heart attack or stroke in a doctor's office or clinic setting, it is usually more expensive and less convenient to go to an emergency department for a cold, a rash, or other minor illness.

In the "good old days," I remember a nurse sitting at the front desk in the ER, performing this "triage" function. She would send acute cases in immediately, ask less acute patients to take a seat in the waiting area, and even schedule outpatient appointments with a doctor when appropriate.

Due to a variety of factors, including liability concerns and wanting to hold onto all available revenue, hospitals no longer do this. The result is that the triage decision is now being made by the least medically qualified party: the patient. If you call the hospital and try to get advice you will simply be told: "We are not allowed to give medical advice on the phone. Come to the ER. The doctor will see you."

The result is that the ER often becomes backlogged with patients who could have made an appointment or gone to a less intensive (i.e. expensive) facility.

At the same time, patients are presenting to urgent care centers with acute emergencies that should have gone straight to the ER (by ambulance). Just the other day I put the first two patients of the day at a walk-in clinic in an ambulance and sent them straight to the ER. Not, however, before they were registered (delayed) and examined (billed). Had they made the correct triage decision they would have saved both time and money.

So what can the average layperson do?

According to the American College of Emergency Physicians, warning signs of a medical emergency include: difficulty breathing, chest or abdominal pain, fainting, weakness, dizziness, changes in vision, confusion, difficulty speaking, severe pain, uncontrolled bleeding, severe vomiting or diarrhea, coughing or vomiting blood, or suicidal feelings.

Still unsure? Often the best option is to get expert advice when the decision is not clear-cut. According to the New York Times, a physician call can often help you make the decision as to whether to go to the ER or arrange for an alternative. In simple cases they can even phone in a prescription to your local pharmacy.

A telehealth service is by no means a replacement for a primary care physician you visit in person on a regular basis. But if you need an answer to a question fast, and don't want to use the emergency room as your fallback, establishing a relationship with a doctor by phone really will save you time and money. Perhaps most importantly, it can help you make decisions on the various treatment options when you don't know what to do.

Originally published Nov 14, 2013 4:59:00 PM.