5 Tips for an Emergency Room Visit

I hope you never need to use the emergency room -- either for yourself or a loved one. But the truth is that there are more than 115 million ER visits each year in this country, so a trip to the ER at some time is bound to befall you or someone you know.

The ER has been lifesaving for many members of my family over the years -- my mother with a sudden heart attack, my father with dangerous heart palpitations and my son with a fracture and dislocation of his knee. My patients, including elderly nuns, end up in the ER for emergency care and attention, too. These personal and patient experiences have taught me a lot about how to get the best ER care.

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The steps I will share with you may sound familiar. I have spent the past few weeks writing about the importance of taking charge of your own health, including collecting your medical records, getting the best hospital care and taking a health buddy with you.

So I couldn't help but respond to a recent research article that caught my attention in the July 2008 issue of the Annals of Emergency Medicine titled, "Patient Comprehension of Emergency Department Care and Instructions: Are Patients Aware of What They Do Not Understand?"

Researchers at the University of Michigan interviewed 140 patients or their caregivers about their recent ER visit. They questioned them about their diagnosis, treatment plan and instructions on leaving the ER. They then reviewed the medical charts. They found that there was a major mismatch between what the patients described about the visit and what was recorded in the medical record.

According to the study, more often than not, patients left the emergency room unaware of their diagnosis and instructions. Worse yet, patients didn't know that they didn't understand what was wrong or what their follow-up plan was.

If patients don't even realize they are uninformed, how can they ask good questions and take the best action when they get home?

It should be no surprise that not understanding your diagnosis and discharge instructions can lead to serious and potentially life-threatening and costly problems. An earlier study showed that up to one in five elderly Medicare patients are readmitted to the hospital within one month of discharge because they, too, didn't understand their instructions when they went home. The riskiest time to be a patient, it appears, is during the transitions of care -- such as on admission to and discharge from the hospital, emergency room or rehab setting.

Special Problems for the Elderly

I fear more for the elderly who come to the ER than for any other group. They often come alone, have multiple medical problems and a number of different doctors, and are often hesitant to speak up and ask questions. They often don't bring their medications with them or any other information other than their insurance card.

Let me share with you something that happened to one of my patients a few months ago. Patient A. was an elderly nun on many different medications, including digitalis, a common heart and blood pressure medication referred to as an ACE inhibitor, and a diuretic (to mention only a few). On the day of her ER visit, she suddenly became weak and had trouble getting up from her chair. The staff at her residence thought she may have had some diarrhea recently, as well, but was drinking lots of liquids (mostly water).

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