My doctor’s office referred me to the Emergency Department (ED)

My doctor’s office referred me to the Emergency Department (ED)

My doctor’s office referred me to the Emergency Department (ED):

The first and most important thing to know is exactly why you are referred to the ED. Was it because you spoke to the front desk person to try to schedule an appointment and they suggested you go to the ED instead? Did you speak to the nurse and based on your symptoms, he or she recommended that you go to the ED? Did the office simply not have any appointments available and stated that if you felt you need to be seen sooner to go to the ED? Did you have a recent appointment and the doctor told you specific symptoms to go to the ED for and those have now occurred? Did you have a recent appointment in which labs or x-rays were ordered and have resulted abnormally and you are being referred to the ED?

Each of the scenarios above occur on a daily basis in our healthcare system. However, not all of these scenarios represent true emergencies. Additionally, our healthcare system is terribly fragmented and communication between primary care and the ED is often delayed or lacking completely. This is not because your doctor or the ED doctors do not care about you or do not want to do the best possible job of helping you. This is because our system is broken and hard to navigate.

So what is a patient to do? How do you know you are being given the best advice possible?

The best possible thing you can do for yourself and for those for whom you are responsible for healthcare decision making is to keep a written, detailed health history including all medications and prescribers and recent testing and results. There are a number of downloadable forms online to help with this, but even keeping a word document with your healthcare timeline can save you lots of time and healthcare dollars, particularly if you have multiple health problems or see several specialists. Even in this era where most practices are required to use an electronic health record (EHR), often these do not communicate with the ED or hospital and other specialists’ offices. Thus, if you carry a form with you, you can be assured that all of those involved in your care are up to date and aware of what the other doctors treating you are prescribing. If you are technology savvy and can keep a jump drive with this information continuously updated that is even more to your advantage. I am happy to assist you with this process as well.

The first question to ask your doctor (and yourself) when referred to the ED is what shall I expect the ED doctor to do about this problem? For example, if you are experiencing chest pain and are concerned you could be having a heart attack, you should expect the ED staff to perform an EKG and take your medical history and vital signs to determine if you are, indeed, having an acute heart attack that needs to be rushed to a cardiac cath lab. This can be done within 10 minutes in most ED’s. If you are not having a heart attack, we will still care for you, but there may be times when you have to wait a bit longer than the person next to you who is having an acute life-threatening event.

Now, if you are sent for an abnormal lab result, a good question for the sending provider is, what result was abnormal and why is it an emergency? The answers to these questions can help you understand what to expect from the ED visit. It is also important to know from your doctor if they spoke to the ED and if so, who should you ask for when you get there. We in the ED are often not called by doctors sending patients in. This sets the patient up for disappointment when we ask questions about their medical history, etc, to determine exactly what we need to do for them in the ED. But, if a doctor calls me to tell me that they are sending a patient to the ED because they are worried about XYZ, I can inform my charge nurse to be expecting the patient and to initiate care for XYZ when they arrive. Or, for example, if a patient checks in to the ED stating they were sent there by their doctor for an abnormal test result, we still have to research what tests were done and what was abnormal that we need to address. This can be very challenging especially if the abnormal test results are in a different medical record system and we can’t access them, etc. Versus a patient who checks in saying that their doctor’s office told them their potassium level was 7 and they needed to be evaluated to see if that was an error or if they are in danger of side effects of high potassium such as abnormal heart rhythms. So, the more knowledge the patient has on their side, the better job the ED can do in caring for them quickly and efficiently.

If your doctor feels you need to be admitted to the hospital and refers you to the ED, ask them if there is a process for direct admissions. Unless you are having an immediate life-threatening emergency like a heart attack or stroke that requires timely diagnosis and treatment, perhaps you do not need to go through the ED to get admitted to the hospital. For example, if you have pneumonia that your doctor diagnosed with an outpatient x-ray and feels you should be treated with IV antibiotics in the hospital, they should be able to arrange for you to be admitted without being seen in the ED. But, if your doctor finds you to have very low oxygen levels or very low blood pressure or other concerning vital signs or symptoms, they may send you to the ED to initiate treatment more quickly prior to hospital admission. Many times this will require an ambulance to take you to the hospital so that the paramedics can begin treatment on the way.

Author: Dr. Julie Johns Emergency Medicine