Issue link: http://viewer.e-digitaledition.com/i/872903
PATIENTS KNOW THAT the ED is a place where care is always available, but they may be unaware that treatment in their primary care doctor's office may be faster, more cost-effective and—depending on their illness or injury—better suited to their medical needs. "Up to a quarter of patients who come to the ED could receive the treatment they need at a doctor's office," says Lawrence Melniker, M.D., an emergency medicine physician and vice chair for quality management at NewYork-Presbyterian Brooklyn Methodist Hospital. "We often see people with colds and relatively minor injuries who don't require an intervention or medication other than what they could obtain over the counter." Experts recommend that people ask themselves this question when deciding where to go for medical care: Is the condition life-threatening, potentially disabling or extremely painful? If the response is yes, the ED is the right destination. The answer, however, may not always be clear, particularly if there are existing conditions or confusing symptoms. Consider the following scenarios: EMERGENCY? SCENARIO ONE: A TWIST OF FATE Izzy is an avid runner. The 27-year-old middle school teacher goes for a three-mile jog most days after work and enjoys longer runs on the weekends. On a recent Friday evening, Izzy was preoccupied with thoughts of the next week's lesson plan and missed the transition from sidewalk to street. Her left ankle buckled and felt sprained. She limped home and followed the strategy that had helped her overcome sprains in the past: She took ibuprofen, rested her ankle by staying off of her feet, applied ice to the ankle in 20-minute intervals, wrapped the ankle in a compression bandage, and elevated her foot by propping it up on a pillow. By Sunday morning Izzy's ankle had improved, but it was visibly bruised and still uncomfortable when she tried to put weight on it. She worried that she might have torn a ligament. Her doctor's office was closed, so she went to the ED. Did Izzy make the right call? "If a patient wants to ensure that there is no severe ligament damage, an orthopedic surgeon or primary care doctor can assess the injury," says Nicholas Vaccari, M.D., medical director of the department of emergency medicine at NYP Brooklyn Methodist. "Suspected broken bones and compound fractures—where broken bones puncture the skin—merit a trip to the ED." SCENARIO TWO: TEMPERATURE CHECK Hector has lived with type 2 diabetes for more than a decade. Last winter, the then 58-year-old restaurant manager took a day off from work because he was feeling extremely fatigued, and his entire body was achy—symptoms consistent with the flu. The influenza virus is especially dangerous for people with diabetes, whose immune systems may be less able to fight infections. The virus can also cause blood sugar levels to spike or plunge. " Patients should trust their instincts when deciding whether their condition requires emergent care or not. If someone who is typically healthy begins to experience severe chest or abdominal pain, symptoms of heart attack or stroke, have difficulty breathing or suspect a broken bone, that person should seek care at the ED. " NICHOLAS VACCARI, M.D. W H Y W A I T ? Emergency department (ED) wait times are a product of triage—a system to ensure that the most seriously ill or injured people are seen first (see "Taking the Mystery Out of Triage"). Eighty percent of patients who visit the ED at NYP Brooklyn Methodist see a doctor within two hours, and they often see a physician assistant or nurse practitioner—who can order diagnostic tests—sooner. P H Y S I C I A N RE F E R R A L / / 718 . 49 9. C A RE 17