A hum of machines; a crush of patients and medical providers; life and death. The ER sees it all, in express fashion.
That can be a good thing for those whose life depends on swift treatment. But the same rapid-fire approach to care can also put patients in danger since, as with any medical setting, there’s room for error.
So how can patients optimize care when they need it in short order, while reducing the likelihood of medical mishaps? Charted are some safety tips from health experts for patients and their advocates who find themselves in the emergency department:
Come prepared – even in an emergency. To start, keep basic, vital health information close at hand.
“Patients should come prepared when they’re going to their doctor’s or the emergency department,” says Dr. Roneet Lev, an emergency medicine physician and director of operations for the emergency department at Scripps Mercy Hospital in San Diego.
Lev, who chairs the San Diego County Medical Society’s emergency medicine oversight commission, which focuses on ways to improve local emergency care, recently blogged about what health providers can do to reduce errors in the ER.
Provide comprehensive medication information. “It’s amazing how many times patients come in and they don’t know their medicines and they don’t know their allergies,” she says. “It’s understandable that something happens, you’re in an accident, you don’t remember those kind of things.”
Still, Lev says it’s important that patients – or a loved one or another advocate, if a patient isn’t in a capacity to advocate for himself – know what medications they’re taking. “It’s really hard to help people if they have a medication reaction or I want to give them a medication if I have no idea as an emergency physician what they’re taking or what they’ve been on,” she says.
Patients can store the information electronically on a smart phone or simply keep a hard copy for such occasions.
“I think a typed or handwritten list of medications with doses and frequencies and all that is just fine,” says Dr. Tejal Gandi, president and CEO of the nonprofit National Patient Safety Foundation, which partners with patients, families and the health care community to improve safety for those receiving and delivering care. She suggests bringing in the actual medication bottles, if possible, to make it even simpler to communicate medication information.
In addition to prescriptions, patients should let health providers know about all the over-the-counter medications, supplements and vitamins they’re taking, since those can interact with medicines.
Have an allergy list. Provide a list of allergies as well, Gandhi says. Be prepared to share information about how you react, for example, to a particular drug.
“Because there’s a big difference between I was nauseous for an hour versus I had anaphylactic shock,” she says. “So knowing the difference, and what the severity of those allergies are is really important, too.”
Have your medical history handy. If you go to an emergency department within the same health network in which you receive all your care, it’s possible that providers will have access to your medical information. However, that’s not a given, and if you received care through various medical organizations, it’s unlikely the ER has all your medical information on hand.
“We’ll have folks that assume records talk between hospitals,” says Dr. Howard Mell, a spokesman for the American College of Emergency Physicians, which represents more than 32,000 emergency physicians, residents and medical students. “They very rarely do, and so even though a hospital may be geographically close to another hospital, if they’re not affiliated they don’t speak to each other.”
Make sure to let ER providers know where you’re receiving care, and the names of your other doctors.
At the very least, come bearing a “problem list,” Gandhi says.
This briefly summarizes medical issues you currently face, such as diabetes or high cholesterol. “I would encourage patients to try to get that information – that problem list from their primary care doctors – so that they can have that on hand … just like you keep a med list with you.”
Speak up – and repeat yourself. “The best thing a patient can do to help us help them is to communicate and to speak up when they don’t understand something,” says Mell, a practicing emergency physician and assistant professor of emergency medicine at Wake Forest School of Medicine in Winston-Salem, North Carolina.
Don’t hesitate to relay the same information to the different providers you’ll see.
“Don’t assume because you told the nurse something, the doctor got that information,” Lev says. “The system is designed to be repetitive.” Doctors ask about information already in your medical record to ensure it’s accurate and up-to-date and confirm information shared with other clinicians.
Resist the urge to brush off a flurry of questions by referring clinicians to your medical record, which, experts say, often provides an incomplete picture of your health. Instead, be thorough in answering all questions, including not holding back any sensitive or potentially embarrassing medical information, as it could be critical for diagnosis.
Make sure to also get all your questions about tests and treatments answered before making decisions about care.
Strong communication between health care providers and patients, or the patient’s advocate, help providers quickly assess whether you’re suffering a possible stroke, experiencing chest pain that may be a heart attack (not just heartburn) or you face a sensitive, but not life-threatening issue that needs attention now.
“There’s a saying in emergency medicine: Time is testicle,” Lev says, referring to the condition called testicular torsion, in which the spermatic cord that supplies the testicle becomes twisted. “If you catch it within six hours, you can save the blood supply there,” with emergency surgery; if not caught early, the testicle can become so damaged that it must be removed. “So that’s a time-sensitive diagnosis,” she adds.
