The Emergency Room (ER) is a dangerous place to be, and the less time a patient spends in one, the better their chances of an optimal outcome.
This is a simple unpleasant fact, and one reason is a simple truism – people who really need to be in the ER tend to be very ill and if you are one of them, your odds are already sub-optimal. Other than the rare hypochondriac with Munchausen’s syndrome, most patients in the ER are not in a good way – otherwise they would have fixed it themselves or gone to their general practitioner.
The other reason is both more sinister and complex: ERs tend to get crowded, chaotic, and triaged. The chaos is a result of a combination of crowding, acuity, variation, and stressed processes. Many ER patients really should be treated by a primary care physician, but go to the ER instead because they lack health insurance, don’t know how to gauge their condition, or their primary care provider is not open after hours or on weekends. The ER increasingly supports primary care by performing complex diagnostic workups not provided by primary care facilities, handling primary care overflow, and after hours care.
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