"The ED is full of people who shouldn't be there. That's why the wait is so long." I've heard many iterations of that sentiment from patients, visitors, the general public, politicians, and even healthcare professionals more times than I care to count in my 30-plus years in emergency services.
In my early days as an emergency nurse, I witnessed coworkers show obvious disdain when patients came to the ED with chief complaints that didn't fit their definition of an emergency. Unchecked, those attitudes were contagious and toxic. Fast-forward many years, and I gained a new perspective as an emergency nurse leader with elderly parents and in-laws. Frequent ED visits became a reality. My family members' fragile health conditions rapidly worsened if their infections and other concerning symptoms weren't evaluated and managed quickly and aggressively. They simply couldn't wait for an office appointment.
I'd like to set the record straight: Our ED population represents people in need. The definition of emergency is personal, especially for those who are scared, in pain, or lack healthcare knowledge. When you have a garden-variety UTI and can't access timely care because of personal circumstances, you seek relief ASAP. Urgent care centers and medical aid units can be good options, but many aren't open 24/7, have limited capabilities, and expect payment up front, which all pose barriers.
What about "drug seekers" and challenging patients with behavioral health issues? Granted, the ED may not be the best place for them-but with the right systems in place, we can try to connect them to the services that they need.
ED crowding is a complex problem with roots in the availability of health services in a particular community, care management systems, financial resources, public expectations for instant access, and many other factors. We need to stop blaming patients and focus on tangible, systemwide improvements. Many view ED care as expensive, but preventable harm from lack of timely access to that care carries a much higher price.
The ED is a safety net. No, it can't be all things to all people, but like the Statue of Liberty, it stands ready to help those in need: "Give me your tired, your poor, your huddled masses, yearning to breathe free...".*
Until next time,
Linda Laskowski-Jones, MS, APRN, ACNS-BC, CEN, FAWM, FAAN
Editor-in-Chief, Nursing2016 Vice President: Emergency & Trauma Services Christiana Care Health System, Wilmington, Del.
* Emma Lazarus, "The New Colossus." [Context Link]