What’s the Deal With Being Unprepared? Patient’s Should Know...

Submitted by Elaine S. Puricelli RN, BSN

Tags: cardiac emergency emergency department emergency room ER experiences

What’s the Deal With Being Unprepared?  Patient’s Should Know...

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I’m feeling compelled to write about an experience I have had within this week. This has been An eye-opening, untoward (in my opinion), experience and an experience that can become a learning moment for many, as my skilled eye in emergency room settings can cause “jading” of an experience, but the perception should carry forward.

My husband has had 2 chest pain events within a week. As a nurse working primarily in cardiac nursing most of my career, I knew that any family member entering the arena of chest pain treatment would bear the wrath of my watchful eye.

At our first emergency room visit, we were promptly greeted and our insurance information and demographics were expediently recorded and placed in the computer at the facility. Then the experience hit a fatal flaw: My husband and I were pointed toward the waiting area! This reads like an experience from some pre-historical time in hospitals when “chest pain” as a presenting complaint, was not often addressed with some sense of urgency. After a few moments, I returned to the lecturn where the “greeter” was stationed. Obviously a clerical person, I asked her if chest pain was taken seriously at that facility. I was inside a free-standing emergency center. To be truthful, I asked why my husband wasn’t being taken to the treatment area right away. I expressed my disdain at being sent to a waiting area only to be further insulted by a t.v. show that was airing over a television. Personal note: I am not a fan of a t.v. set in the emergency room treatment area, this is a personal preference. I find the t.v. distracting and noisy. While working in the hospital setting, I always lowered the volume on a patient’s t.v. whenever a physician entered to speak with a patient. I think it’s rude to have the t.v. on at any volume during a time when a healthcare profession is speaking directly to the patient even if it’s being viewed by family. The conclusion of the first E.R. visit was lackluster and unappealing. I WILL be expressing my disappointment regarding the facility’s policy of placing an active chest pain patient in a room wherein a t.v. is loudly raging. The “room” being a space not within the treatment area behind the heavy doors. My husband was not admitted as an inpatient.

More recently, a few days later, another emergency room visit occurred for the same presenting complaint. THIS facility (hospital) has a chest pain protocol in place. I was impressed by the quick movement of my husband to the treatment area and seeing the chest pain protocol proceed in a professional and expertly cadenced concert. Kudos will be given, all around on the evaluation that will certainly arrive in the mail soon. This second facility, had the urgency I sought.

Now to the point of this essay: There is a lot of gathering of data throughout an emergency room visit’s time lapse. There’s an unwritten protocol where the provider orders tests after the initial exam and the work-up ensues. Results are given at the end of the stay, in the form of a re-cap. At this point, paperwork is handed to the patient in the form of a bundle of plethoric verbiage.

In the case of my husband’s chest pain visit (#’s 1 and 2) to the emergency room, a quick mention of, “I’d like a copy of the EKG taken earlier, I’d like to hand-carry the document home,” was met with the mild admonishment, “You can access all the information from this visit on the patient portal, I’ll give you a brochure about the portal.” Perhaps the emergency room nurse isn’t aware of the disdain of introducing patient portal access via brochured instruction, in this setting, but I’m hoping there will be an emergency room nurse reading this essay. Documents from an emergency room visit should leave with the patient with the exception of the radiology report(s) that can be accessed remotely by most specialists. As we were asked to follow-up with cardiology within a few days, my strategy involved making my husband’s appointment immediately after leaving the facility. Why wait? Even the undesirable missing of a lunchtime meal by the patient can easily be the second stop en route to home. I felt it was expedient and efficient to visit the follow-up physician’s office after leaving the emergency room visits so that the bundled, written evidence of the visit, in perfectly printed written form, was still in access. Laboratory results were amongst the bounty, as well as the specific document instructing the patient to visit the specialist’s office post-emergency room visit. The patient’s EKG was within my hand from its tracing of a couple of hours prior. I can hand the doctor’s office staff my copy of the EKG, at this end point.

Secondly, a day or two later, (not three or four days), I sought out an old 12-lead EKG tracing that had been obtained within 5 years of this current time. I wanted the cardiologist to have a comparison copy. In addition, any medical records should be forwarded from the primary care provider’s office in advance of the specialist visit if the medical records are relevant. I requested record from my husband’s latest physical exam as well as recent lab results in hopes these documents will precede my husband’s follow-up visit.

I think there needs to be this concerted approach to following an emergency room visit, or perhaps an inpatient hospital stay as well, (those inpatient documents will take longer to convey), with cogent medical records, lab results, office notes and other relevant documents such as a 12-lead EKG tracing for comparison. I think caution should be taken not to let too much time elapse before requesting medical records from providers who recently saw the patient. I have found that the process by which medical records are sent to specialist providers varies, so I encourage readers of this essay to move quickly with medical records requests so as to offset the delay in obtaining the records. All of this to say that a pro-active approach post-emergency department visit should be initiated in a timely manner: Medical records can forward to specialists at varying times depending on office protocols for the handling of medical records.

In the interest of having an excellent follow-up visit from an emergency department visit, at the specialist’s office, the patient or patient’s advocate or caregiver (if authorized) should adopt a sense of urgency and efficiency to the follow-up documentation process. The wheels of the medical records world can move slowly. Obtain meaningful medical records that are also as recent as can be obtained from the patient’s primary care provider or even urgent care if that visit is applicable to the presenting complaint. The patient’s follow-up appointment can be scheduled the same day as the emergency room visit if business hours (and daylight) allow. Prior to the day of the follow-up visit, all pertinent and meaningful documents should be in place for the specialist visit. Some documents can be requested by remote access to the hospital’s radiology department for example, by the specialist engaged. Of course procedural documents from the emergency department will need to forward as well and may be in the initial bundle of papers from the emergency department visit. Let’s be organized and on task as soon as possible after the emergency department visit. Timely follow-up visits result from timely actions early on. Lunch or dinner on the way home from the emergency department can wait long enough for an initial contact with the specialist’s office first.

As an aside, my husband is doing very well, and is aware I have included his visit information in my essay. No intervention needed at this time.