Table of Contents

I.
II.
III.
IV.

Introduction ...2
How it Works .3
What that Means ....11
Conclusion ..13

Introduction

There are many behind the scenes aspects and inner

workings of hospitals that most people dont know, well, this is your
guide to understanding and making the best decisions for you and
your loved ones. Now, every hospital is different and has things that
are unique to it, but this is just a general overview of some of the
most common aspects.

The Emergency Room tends to have a terrible reputation for

its long waits and bad service but the point of this guide is to try and
alleviate some of the undue pressure and stereotypes placed on
Emergency Rooms; and also help anyone and everyone understand
the best way to utilize it and the care it can provide. Dealing with
ones emotions while in an emergency can be hard, so this guide is
to help you be prepared for making the right, smart decisions about
care when under an enormous amount of stress.

How it Works

Procedures:

There are many procedures and systems in place that make the
Emergency Room run as smoothly as possible:

1. Some hospitals have just a Triage 1 nurse and some have a

Triage 1 and 2 nurse. Depending on the whether they have
both, the Triage 1 nurse is the first person you encounter
after you check in to the Emergency Room. When they have
both the primary function of the Triage 1 nurse is to get the
initial information and health complaints from the patient
and input that into the system so that the triage 2 nurse has
an idea of what they are getting and what to be looking for
when the patient comes in for further analysis. The Triage 2
nurse or Triage 1 nurse if there is only one, is the person
you go into the side room with and they take your weight,
blood pressure, temperature and better assess the acuity of
your ailment so they know how quickly you need care.
Triage nurses are very important because without them all of
the other procedures and systems in the Emergency Room would
fall apart.
2. In the Emergency Room one of the integral players is the
Charge Nurse. The Charge Nurse is the nurse for that shift
that makes all the assignments and is in charge of the other
nurses and team assignments. They try and make

everything run as smoothly as possible and organize the

entire shift.
3. One of the most integral things in the Emergency Room,
that most people dont know or seem to forget, is that the
procedure for deciding when patients get seen is based on
acuity. Acuity means the severity of the illness or ailment. If
the patient is going to die, lose a limb, or lose fertility they
have top priority in the Emergency Room. Those three
things are one of the first few any Triage nurse will look for
so that they can properly treat and help every patient.
There are many reasons people go to the Emergency Room,
not all of which are emergencies. If you dont get seen right
away it just means youre not going to die and that there
are people much worse off than you, who may.
4. In the Emergency Room there is something called the fast
track. The fast track is something the charge nurse will try
to enable if there is an influx of lower acuity patients that
could be in and out in no time. It takes a lot of resources
and a lot of things all going right to make this able to be
enabled.
Everything in the Emergency Room comes down to
resources. If there arent enough nurses that affects how many
patients they can see at once and how much they can handle when
the higher acuity patients start coming in. If there arent a lot of
doctors that shift it affects team assignments and how much they
can handle also.
Most Emergency Rooms use teams so allocate resources
most efficiently. They split up the doctors and nurses so that they
can see the ost patients. The Charge Nurse usually assigns the
teams and which patients are seen by each team. Charge Nurses

also have to worry about not overloading one team with harder
patients, they need to make sure the acuity levels are as evenly
distributed as possible according to the available resources and
team members that are working each shift. So, as you can see there
is a lot that goes into making the Emergency Room run smoothly
and they really do try their best to make sure that every patient gets
the best possible care.
5. Another thing that most commonly gets blamed on the
Emergency Room is the wait time once you get put into a
room. The nurses and doctors do the best they can to get
you in and out as fast as possible but a lot of diagnoses
require further lab testing. The lab works at the speed the
lab works, it is not the doctors fault how slowly they get the
results and they cant make it go any faster; so if correctly
placing the blame, it is the laboratory's fault not the
Emergency Room or its physicians.
6. Every Emergency Room at any hospital is obligated to see
and stabilize any patient no matter their insurance or ability
to pay.
7. Most hospitals dont take down insurance or payment
information when youre checking in. They wont ask and
you dont need to ask. They have people for that very thing.
Those individuals will come and chat with you about a
payment plan and will take down all pertinent information
once you are already in to see the doctor and the ball is
rolling on your diagnosis and treatment.
8. There are many different staff that work in the
Emergency Room not just nurses and doctors. There
are Nurse Practitioners, Physicians Assistants (PA),
Respiratory Therapists, Techs and many others. All

of these team members serve a different function

that make everything run smoothly.
Nurse Practitioners are very highly certified
nurses that are permitted to make diagnoses on
their own and come up with a treatment plan as
long as there is a physician present at the hospital
or on the team that can supervise decisions if
necessary. It is important to know that if a Nurse
Practitioner comes into your room and starts talking
to you like theyre your doctor thats because they
probably are serving as your main provider that day
and have every right and certification to do so. You
can question them if you like and demand to see a
real doctor but that doctor will probably just tell
you the exact same thing.
Physicians Assistants (PA) are the same kind
of care provider as Nurse Practitioners they just go
to PA school instead of nursing school. They are
certified health care providers that are permitted to
make diagnoses on their own and come up with a
treatment plan as long as there is a physician
present at the hospital or on the team that can
supervise decisions if necessary. Just like with a
Nurse Practitioner there is no reason to question
the authority of this care provider just because their
name tag doesnt say doctor, they are capable of
providing you with the same level of care as
someone with an MD.
Respiratory Therapists can be found in the
Emergency Room to help with cases specific to
breathing problems. Especially in a childrens ER

you will almost always see a Respiratory Therapist

on standby to help monitor and take care of
patients who come in with breathing problems. This
care provider has specialized in this field and is fully
capable of being of service to patients who need
them.
In the ER, Techs serve to help nurses do the
little things that are more technical that they may
not want or have time to do. Techs can help with
putting casts on, taking vitals, setting up the
machines in the room, they are like nurses only
different and play a key role in the Emergency
Room.
These are just some of the team members that play key
roles in the Emergency Room, there are countless others that all
have their own niches and specialties that try and help in any way
they can for a quick and speedy recovery of every patient.
9. Another thing that may be good to know about is
the Quality of Care Department. This is not a
universally used term but most hospitals have a
department or committee that is in charge of
looking into all mistakes made when handling
patients and patient complaints made after theyve
left the hospital. Usually this department consists of
physicians and hospital administration that are
advocates for making patient care as safe as
possible. Nurses are only human, even doctors are
only human and humans make mistakes. Whether
that mistake negatively impacted the patient or not
doesnt matter, every mistake is looked into and

when possible affirmative action is taken to try and

ensure it never happens again. Also, your
complaints dont fall on deaf ears. This department,
tries to address every issue and be as fair as
possible when deciding what to do about a
complaint or a report of mistreatment.
The bottom line is that the Emergency Room and hospital
administration is not out to get you and wants to help you in the
best possible way it can. There are a lot of moving pieces involved in
making the Emergency Room run as smoothly as possible and now
you have a better understanding of just a few of them.

What it Means

There are many reasons people go to the Emergency Room,

not all of which are emergencies. If you dont get seen right away it
just means youre not going to die and that there are people much
worse off than you, who may.
As stated, the Emergency Room is required to see and
stabilize every patient no matter their insurance or ability to pay.
This means that anyone can come in to the Emergency Room and
be seen. Many people when they first arrive to the Emergency
Room are really worried about if the hospital takes their insurance
or how they are going to pay and the number one thing to
remember is that there are people whose job it is to talk through
that with you, later, when everything/everyone is settled. That
being said the Emergency Room has a large number of patients who
come in seeking service and have no insurance and cannot pay so
the Emergency Room is the only place they can go. For those of you
out there that fall under this category, the ER is the place to go if
you truly need assistance, however if you do have insurance this
may not hold true for you. The Emergency Room is aptly named for
the fact that they handle Emergencies, life threatening ailments,
and referrals from Primary Care providers who cannot properly
handle or diagnose a patient. If you are sent to the ER due to a
referral from your Primary Care provider then yes, you should be in
the Emergency Room, but no you may not be seen first because you
still may just be there for further testing and the acuity of your
illness or ailment is low in comparison to others.
Now, I know, when in a perceived emergency it is hard to
step back and think about your options and be somewhat rational
about things, but thats what this guide is for. For those of you I

mentioned earlier that have insurance, you have options. The

Emergency Room is for emergencies, so if you or your child has a
cold, a sprain, maybe even the flu those are things that can easily be
handled by your Primary Care provider. The bad reputation and
pressures placed on the Emergency Room could be significantly
reduced if those that could would seek care where best
appropriate. The less life threatening the more you will have to wait
and though it may be very inconvenient in the moment it makes the
most sense. Someone with a headache has no business getting a
room in the Emergency Room when there is also someone coming
in whos had a heart attack.
What it all comes down to is who you are, what is going on,
and what you can afford to do about it.

Conclusion

The interworkings of the Emergency Room is almost like

that of the human body. There are tons of pieces that all do very
different things and serve different purposes but they all serve one
larger goal, just like the body. The human body works and does
everything it does to keep the human alive. In the ER every piece
works together to do just that, to try and keep every patient alive
and well and to do it as safely and in as timely a manner as is
possible.
Everyone has an off day and just because someone is in a
service industry doesnt mean they can always be perfect.
Healthcare is a service industry. To be a doctor or nurse and any
kind of health provider you have to have so much patience and love
for people to deal with anything and everything that is thrown at
you on a daily basis. The job is hard and in the Emergency Room it
can be especially trying. Somedays you lose people. Other days you
have to deal with crazy and frantic friends and family. The people
you see that are working in and ER it is because they truly have a
passion for medicine and for people and all they want to do is help
you. They arent trying to steal your money or make you wait a long
time on purpose, they want nothing more than for there to be no
one that comes in that day because that means they dont have to
worry about having another persons life in their hands. In the
Emergency Room a slow day is a good day.
So now that you know a little bit more about everything
that goes into making this very well-tuned machine run, maybe you
can cut the ER a little slack and allow some of that bad reputation,
that seems to follow it everywhere, to start to dissipate a little bit.