Overcrowded ERs Remain Problematic, But Here’s How To Tell If You Should Go

For years, we’ve been hearing about the problem of overcrowded emergency rooms. While it’s true that 44% to 65% of all ER episodes could have been treated in urgent care facilities instead, some experts say that an influx of patients with non-life-threatening conditions isn’t necessarily to blame for the ongoing issue. Still, going to an overcrowded ER could potentially compromise your quality of care. But when is it actually necessary to brave the crowds and seek emergency treatment?

Experts say one reason for ER overcrowding is that many patients don’t have a primary doctor to go to. And with this year’s particularly bad flu season, ERs are becoming even more congested (pun intended). Although urgent care centers are becoming more popular for this reason, it’s not a cure-all. A practice known as “boarding,” wherein admitted patients are forced to wait in the ER for hours or even days until a bed becomes available, also contributes to overcrowding. Every facility has different contributing factors, but the negative impact is fairly universal.

Now, a physician survey suggests that patients who receive care in especially crowded emergency departments — to the point where they have to be seen in the hallway rather than in a room — are much more likely to experience treatment delays or even be misdiagnosed.
A study involving 440 ER physicians from 2015 found that privacy has a big impact on diagnosis and treatment. Nine in 10 doctors surveyed said they shortened or changed how they asked about their patients’ medical histories when another individual was present, and more than half of doctors changed the way they performed physical examinations. In cases where patients were treated in hallways, more than 75% of doctors surveyed said they had performed abbreviated medical histories; nearly all doctors said they sometimes, often, or always changed how they conducted physical exams. Even when patients had a room but they had a friend or relative present, these doctors may have gathered medical histories or performed examinations differently. And in general, this happened the most with female patients.

While only 26% of doctors who said they took abbreviated medical histories had resulted in a failure to diagnose social issues (such as elder abuse or suicidal ideology), 54% of doctors said their altered physical exams did not keep them from zeroing in on such issues. Still, too many doctors missed the signs of domestic abuse, child abuse, or substance abuse.
With all that in mind, is there any reason you should actually go to the ER?

In a word, absolutely. Americans come down with approximately 1 billion colds every year, but the common cold doesn’t typically warrant a trip to the ER; however, influenza might. Life-threatening situations — even if you’re unsure whether your life is in danger — warrant a trip to the emergency room.

For example, chest pain with shortness of breath accompanied by sweating, nausea, and/or lightheadedness needs to be treated in the ER immediately. Extreme, sudden headaches and severe abdominal pain should also be considered emergencies, especially if they are trauma-induced or you are vomiting blood or have difficulty standing or keeping your balance. Deep cuts, high fevers, persistent vomiting, seizures, and other out-of-the-ordinary, intense symptoms should be assessed by an ER doctor to be on the safe side. Experts advise that if your insurance includes tele-health to place a call to one of those medical providers if you’re ever in doubt. That could save you an unnecessary ER visit or ensure you get immediate help if it’s serious enough.