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A Look Inside the Emergency Department

Knowing What to Expect Can Help Alleviate Stress

Recently, we sat down with Cleaveland and Dr. Stephanie Dabulis, MD, FACEP, medical director of the emergency department (ED), to learn more about how the emergency department works and how the ED staff work diligently to ensure a good patient experience.

Our Life-Saving Role

The purpose of the emergency department, Dr. Dabulis explained, is to rule out and/or treat any life-threatening issues.

“The emergency department is truly here to assess and treat your current emergency problem. It can be frustrating for patients who are looking for us to diagnose or help manage chronic medical conditions, but that is simply not our role,” Dabulis added.

For example, if a patient comes to the emergency department with a generalized complaint about falling down, tests will be done to rule out a heart attack, stroke or other emergent symptoms right away. “Every patient encounter gets looked at through a life-saving lens. We are going to immediately rule out those life-threatening issues and focus on what may have caused the fall in the first place,” said Dabulis. Discharge instructions will not always provide a diagnosis, but instead, are the gateway to the next step in the process – receiving followup care.

The goal of the ED is to treat the most critical or severe patients first, in order to save their lives. It’s important to understand behind every moment in the waiting room, there could be someone else receiving critical life-saving care on the other side of the door.

Reasons Behind The Wait

The needs in the emergency department can literally change in seconds. According to Dr. Dabulis, the ED is staffed for a predictable number of people and inevitably, that number will become unpredictable. An ambulance could come in requiring a large amount of emergency department resources, putting the patients in the waiting room on hold.

“When I come to work my hope for my patients that day is that none of them have to wait. I want them to have clear communication and a good experience,” said Dr. Dabulis. Because of patient privacy and safety, emergency department staff aren’t able to tell the full waiting room there is a combative patient or perhaps there was an accident and multiple patients are being transported to the ED by ambulance for life-saving care. All of these situations can require additional resources and do equate to longer wait times for those patients who are not experiencing life-threatening illness or injury.

Even the more routine cases can take up a lot of time, Cleveland said. Results for routine tests such as blood work and X-rays can take up to 90 minutes. And based on the results of those tests, a provider may make recommendations for further testing or medication. A typical visit to the emergency department is four to six hours long.

Being Informed Is Key

Whenever possible, patients should seek the right care, at the right time, at the right place. For concerns that are not of a severe nature, a visit to your primary care provider or an urgent care center may be a better alternative. Dr. Dabulis noted that seeking nonemergent care through a primary care provider or urgent care center is not always feasible after hours or on the weekends. She added, “We also understand that ‘the right place’ can be subjective. And that’s what we are here for..”

It’s also crucial to keep up with preventative care visits to detect health issues before they become emergent problems. Cleveland said that in recent months, the emergency department has seen increased cases of severe issues that are likely linked to patients delaying preventative care during COVID-19.

Another critical step to expediting care at the emergency department is ensuring that medical records are accurate and accessible. Dr. Dabulis said, “It’s important to bring pertinent records, know your medications, allergies and surgical history. Every patient who comes to this emergency department deserves to have me look at their records, and that takes time,” Dr. Dabulis continued.

“We may ask the same question several times,” said Cleveland. “This is because what may trigger a triage nurse to action is different than what a doctor may respond to. Their jobs are different, and they may be looking for slightly different things.” For example, if a patient complains of abdominal pain and vomiting, a nurse may work to get the patient started with labs, an IV and nausea medication. The doctor may ask what the pain feels like in order to diagnose and fix.

“If you have a true emergency, it doesn’t matter what the wait time is – you will be seen immediately. Although our primary role is to treat life- or limb-threatening illness or injury, we are committed to serving every single patient who comes through our doors,” Dr. Dabulis said.
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