What's your E.R. threshold?

[SweetErika]

My kidlet has been sick, so I was reading up on his symptoms and was shocked by how many people said they'd taken their kids to the Emergency Room for things that seemed pretty minor/non-emergent to me (like the kid vomiting normal vomit once per night for a few nights, but being energetic and well-hydrated during the day), and were advising other parents to do the same.

Anyway, it got me thinking about how people decide to go to the E.R. Do you have to believe you're in imminent danger of dying or permanently disabled? For pain? Do you go for primary care treatment when nothing else is open?

 

[Loverskitten]

This is a good and scary question, especially for Moms. And I don't really have an answer. My son is older so I can ask the degree of pain and other questions. I usually will call the Dr. Before I rush to the ER if it's not something obvious.
HOWEVER, I very recently lost a friend in her 30's who had gotten up with a "stomach ache"

 

[SweetErika]

This is a good and scary question, especially for Moms. And I don't really have an answer. My son is older so I can ask the degree of pain and other questions. I usually will call the Dr. Before I rush to the ER if it's not something obvious.
HOWEVER, I very recently lost a friend in her 30's who had gotten up with a "stomach ache"

Yeah, ours is only 20 months, so even though he has extraordinary verbal skills, it's hard to pinpoint what's wrong sometimes. But he has the same symptoms of all of these other kids who were taken to the E.R. (sometimes multiple times!), and I just put him in our bed so we could keep an eye on him and then called his doctor the next day. Last night, his tummy was all distended, but it was clear he wasn't in imminent danger, so we took him to bed with us again and hoped it was gas.

We DID take him in last January when he was severely dehydrated, and I had to insist they give him an IV for it (they wanted to send him home to see if it got better or worse, and I just KNEW he was going downhill quickly). It was a terrible night, but I'm glad we went. Still, I felt he was in imminent danger if he didn't get treatment that night, and only took him after a lot of deciding and the consulting nurse from his insurance company advised us to take him in for treatment.

So I guess imminent danger or intractable pain are my personal thresholds. I've been for multi-day migraines that were so bad I seriously wanted to die. Obviously, I'd go if I thought I had an injury after a car accident or something, or like a broken limb or complex stitches, too. For anything else, I'll pretty much wait and see, call for advice, or go to Urgent Care (we have a 24 hour Urgent Care within 30 minutes of our house, fortunately) to save costs, even though it doesn't cost us a thing personally to take the munchkin to the E.R.

 

[infinity706]

I've been to the ER for myself, twice in my life. One led to an MRI and a CAT scan since I passed out in the floor. (Seriously, going 24 hours without eating is bad for your sugar) The other time, it led to a dozen stitches, since I sliced my head open, falling out of bed.

Some people go to the ER, though, because they don't have insurance and the hospital can't refuse to treat them.

 

[Eilan]

We've never taken the girls to the ER. They've been pretty healthy other than the occasional ear infection/strep/pinkeye, a bout with pneumonia that we caught super-early, and a plastic toy up the nose. We've been able to get away with getting them treated at an Urgent Care/Quick Care facility. We tend to err on the side of wait and see and undermedicate, but we'd take the girls to the ER if they were injured or seriously ill after hours, obviously.

I've been to the ER twice. The first time I was about 10 and my parents took me in for severe stomach pain in the middle of the night. They were concerned about appendicitis, but the doc figured it was stress-related because we'd very recently had a death in the family. The second time was when I got a kidney infection about a month before my oldest was born. That pain was way worse than any labor contraction I ever experienced.

 

[SweetErika]

Some people go to the ER, though, because they don't have insurance and the hospital can't refuse to treat them.

I didn't get that impression from these particular parents. It was more like one bout of vomiting multiple nights in a row induced panic and they felt the ER would give their kids the tests the parents wanted just in case the unexplained vomiting was a symptom of a serious problem (a bunch were concerned about cancer, epilepsy, bowel obstructions, etc.). I guess what surprised me most was the fact that they'd had multiple ER visits in a very short period, and advised other parents to do the same if their pediatricians didn't know what was going on, said it was a virus or they just "felt" something was wrong with their kids.

I'd be willing to bet most of those kids had insurance, especially free insurance through the state. Otherwise, multiple visits to the ER with expensive tests could lead to huge bills and even bankruptcy.

Oh, and I think here at least, if you don't have insurance, the ER is only required to STABILIZE a patient, not treat them. For non-emergency treatment, they refer people to their PCPs/community heath clinics the next day or whatever.

 

[fire_breeze]

I've only been to the ER twice. Once when I was 15 with a visibly dislocated knee, and second time this past summer. Both were on the advice of doctors.

I do know that some people don't have regular docs or access to one will go to ERs (at least over here). However, I also know that in some cases, people just expect to get treated earlier and quicker. It's no wonder that so many are so full if the ER is filled with minor scrapes, and illness that can healed with lots of rest and fluids.

I wonder, though, if there is a Health Line in the States? Up here, I'll call a number, talk to a nurse who will then advise me whether it can wait, to see a doctor or if it's a medical emergency. This has helped to cut down ER visits tremendously and to save time and money for everyone.

 

[Ellafun]

Erika, I think the internet is partially responsible for the increase in ER visits. People go on WebMD and even the slightest symptom could be listed in life-threatening illnesses. Sheesh!

Basic rule of thumb for us was a bleeding injury that was an inch or longer and/or too deep to quell the bleeding (requiring stitches) and any eye injury. My kids always had a knack for getting injured during holiday weekends when I would have to wait until Tuesday to get to the doctor; on one Labor Day weekend, I did end up taking my then 2-year-old son to the ER because he had a splinter the size of a toothpick wedged in his foot. (on a Saturday morning -- newborn in the house, also, husband away for weekend...no way I was waiting until Tuesday!!!)

For any other respiratory type illnesses, we had an emergency number for the pediatrician. They could call in a prescription to a 24 hour pharmacy if necessary based on the telephone diagnosis. And now that the kids are older, we have several drug store chains that offer in-store care centers. No insurance necessary if you have the cash.

I would use the ER as a last resort if I couldn't safely wait for a call back or an appointment. I think it's abused by a lot of people, unfortunately.

 

[Saucyminx]

I've only ever taken each of mine once, the boy child for stitches in his forehead, the girl child for a sliver of metal in her eye (scratches on the eye only thank goodness.) I always called the docs office and asked their advice. I went to the E.R once as a kid, after getting hit in the head with an ice skate. If we weren't bleeding heavily or on fire--we were told to go get a bandaid and suck it up.

I work for one of the free state insurance companies, and the population that we serve does spend a great deal of time in the ER for things like ear aches, headaches, the flu, and tooth pain. It is one of the measures that we keep track of and do mass mailings, nurse visits, nurse line, and a host of other things to try and educate people that the Emergency room is for emergencies, hence the name.

 

[infinity706]

I didn't get that impression from these particular parents. It was more like one bout of vomiting multiple nights in a row induced panic and they felt the ER would give their kids the tests the parents wanted just in case the unexplained vomiting was a symptom of a serious problem (a bunch were concerned about cancer, epilepsy, bowel obstructions, etc.). I guess what surprised me most was the fact that they'd had multiple ER visits in a very short period, and advised other parents to do the same if their pediatricians didn't know what was going on, said it was a virus or they just "felt" something was wrong with their kids.

I'd be willing to bet most of those kids had insurance, especially free insurance through the state. Otherwise, multiple visits to the ER with expensive tests could lead to huge bills and even bankruptcy.

Oh, and I think here at least, if you don't have insurance, the ER is only required to STABILIZE a patient, not treat them. For non-emergency treatment, they refer people to their PCPs/community heath clinics the next day or whatever.

That's, also, a part of why healthcare isn't affordable. We only have a limited number of healthcare professionals and people waste their time with stupid shit. (especially people that don't have the money to afford care and don't care since they don't make enough for a court to really make them pay up on anything) Then, the costs of all this care, as well as the slashing of Medicare/Medicaid payments gets shifted to the people with insurance.

It's not the only problem, but it is a major one and the same reason we have to have co-pays.

Stabilizing still costs money, though. I think one state even had something like 5 homeless people that had run up millions on the state tab, with the main complaint being that they had chest pains or some other heart attack symptom.

 

[TheLM]

Pediatric urgent care clinics with P.A.s or Nurse Practitioners/Doctors of Nursing Practice are the way to go. They will send you to the E.R. if your kid needs rapid infusion or something crazy, but 90% of stuff can be handled there.

And it's cheaper and the wait will be less.

 

[myorangelily]

We have only taken our child once when we thought she had gotten into my meds (she didn't). Luckily she has never been so sick that I felt an ER trip was needed. I think as a mother who is with her child much more than the doctor you know when the situation calls for more help than you can provide at home.

 

[SweetErika]

I wonder, though, if there is a Health Line in the States? Up here, I'll call a number, talk to a nurse who will then advise me whether it can wait, to see a doctor or if it's a medical emergency. This has helped to cut down ER visits tremendously and to save time and money for everyone.

We don't have a national one, but many insurance companies and hospitals provide "consulting nurse" hotlines. Unfortunately, because we are such a litigious country, much of the time the nurse will tell you to go in to the ER if you feel it's a real problem, just to cover their own asses. Like we called about my son's dehydration last year, and the nurse told us to take him in right away, whereas the ER staff didn't feel it was such a big issue. I was kind of on the fence until I talked to the consulting nurse and watched him go downhill for another 20 minutes.

Erika, I think the internet is partially responsible for the increase in ER visits. People go on WebMD and even the slightest symptom could be listed in life-threatening illnesses. Sheesh!

Basic rule of thumb for us was a bleeding injury that was an inch or longer and/or too deep to quell the bleeding (requiring stitches) and any eye injury. My kids always had a knack for getting injured during holiday weekends when I would have to wait until Tuesday to get to the doctor; on one Labor Day weekend, I did end up taking my then 2-year-old son to the ER because he had a splinter the size of a toothpick wedged in his foot. (on a Saturday morning -- newborn in the house, also, husband away for weekend...no way I was waiting until Tuesday!!!)

For any other respiratory type illnesses, we had an emergency number for the pediatrician. They could call in a prescription to a 24 hour pharmacy if necessary based on the telephone diagnosis. And now that the kids are older, we have several drug store chains that offer in-store care centers. No insurance necessary if you have the cash.

I would use the ER as a last resort if I couldn't safely wait for a call back or an appointment. I think it's abused by a lot of people, unfortunately.

Agreed. With the vomiting thing, apparently a bunch of the parents had watched "Medical Mysteries" TV shows and were convinced their kids had the same rare conditions that were presented on those.

I definitely use the Internet to research, but more often than not, it reassures me it's nothing serious than scares me about the possibilities.

Like you, we have found the ER is necessary for serious cuts. One time I took my husband to Urgent Care for suturing, but they wouldn't do anything because he might have needed a hand specialist. So that just ended up costing us an extra $30 copay, and the last time he had a major cut, we skipped the Urgent Care (the ER we typically go to has like no wait, ever, because it's a small, more remote hospital).

I work for one of the free state insurance companies, and the population that we serve does spend a great deal of time in the ER for things like ear aches, headaches, the flu, and tooth pain. It is one of the measures that we keep track of and do mass mailings, nurse visits, nurse line, and a host of other things to try and educate people that the Emergency room is for emergencies, hence the name.

That pisses me off as a responsible user of resources.

When I was little, I had lots of severe ear infections and my parents DID take me to the ER a bunch, but in those days there was no urgent care and you were screwed if you couldn't get into the doctor between 9 and 6 on weekdays. I'm sure I would have survived without the ER visits, but I understand how awful it is to have a kid who's in terrible pain in the middle of the night.

 

[bailadora]

Anyway, it got me thinking about how people decide to go to the E.R.

It's got to be something pretty major for me (or someone else in my immediate family) to go to the ER. Personally, I've only been twice: once for my appendix and the first time I miscarried. The latter time, I really didn't need to be there because there was nothing the docs could do for me anyway. But....I was hoping against hope I wasn't actually losing the baby and that there was some way to stop the bleeding.

Things like dislocations, major cuts, or severe pain that won't abate with otc pain meds are automatic trips to urgent care and then to the ER only if recommended by on site staff.

 

[tkinsc]

For me personally it has to be life threatening, severe bleeding, or major pain.

For the boys, It has to be something severe, cut with lots of bleeding, croup or some other respiratory distress, a big bump on the head that could cause a concussion, lots of throwing-up, or extreme pain. Each time we have taken one of our boys, we have call our Peds office first to talk to the Dr. on call. A few times we have managed to meet them instead of taking a trip to the ER.

 

[CutieMouse]

#1 (now age 17)

- once as a 5 month old when I dropped him on his head.
- once as a 15 year old for pneumonia (after hitting an urgent care, first, on the advice of that doctor)

#2 (now age 15)

- once at 6 for an allergic reaction to a wasp sting (her hand doubled in size in 10 minutes)
- once at 8, for a broken arm (skateboarding accident)
- once at 12 for what presented as pertussis (it was a nasty nasty nasty case of bronchitis)

# 3 (now age 12)

- once at 3 for a dislocated elbow [nursemaid's elbow], and only then because our chiropractor friend had moved out of state

#4 (now age 9)

- never

#5 (now age 7)

- never

I consider the ER to be an option of last resort - broken bones, stitches, severe allergic reactions/breathing problems sorts of things.

 

[BertrandRussell]

What's my threshhold? Sixty bucks. At least until my conscience kicks in.

My insurer - Blue Cross/Blue Shield - has made what I consider to be a rather imprudent decision. A co-pay to my primary care physician is 15. The co-pay to an emergency room is 75. And that 60 dollars is the only difference. So the incentive that they have given me is this: is it worth 60 dollars of my inconvenience/uncertainty/pain to wait until my primary's office is open?

They have placed absolutely no burden on me to determine if it is indeed an emergency. I can go for something that I know is not an emergency, and there is no penalty beyond that 60 dollars: no fines, no cancellation of contract, not even a decent scolding - even though doing it is clearly a violation of the terms of the contract. I can do it repeatedly, and as long as I pay that 60 bucks, nothing changes, nobody cares.

It is a perverse incentive, and, of course, it leads to perverse results. Emergency rooms get jammed with non-emergency cases, and sometimes real emergencies don't get treated fast enough and people die.

( FWIW, I personally haven't used it for non-emergency visits, but only because my conscience says don't be a hog. )

 

[SweetErika]

What's my threshhold? Sixty bucks. At least until my conscience kicks in.

My insurer - Blue Cross/Blue Shield - has made what I consider to be a rather imprudent decision. A co-pay to my primary care physician is 15. The co-pay to an emergency room is 75. And that 60 dollars is the only difference. So the incentive that they have given me is this: is it worth 60 dollars of my inconvenience/uncertainty/pain to wait until my primary's office is open?

They have placed absolutely no burden on me to determine if it is indeed an emergency. I can go for something that I know is not an emergency, and there is no penalty beyond that 60 dollars: no fines, no cancellation of contract, not even a decent scolding - even though doing it is clearly a violation of the terms of the contract. I can do it repeatedly, and as long as I pay that 60 bucks, nothing changes, nobody cares.

It is a perverse incentive, and, of course, it leads to perverse results. Emergency rooms get jammed with non-emergency cases, and sometimes real emergencies don't get treated fast enough and people die.

( FWIW, I personally haven't used it for non-emergency visits, but only because my conscience says don't be a hog. )

You are very fortunate to have such good insurance, but I'm sure you know that.

My office visit/urgent care copay is $30 and the ER is $100 (unless I'm admitted to the hospital), so I certainly don't want to spend the extra $70 copay if I don't have to. However, I also have 20% coinsurance on most tests, procedures and treatments, and the ERs around here charge even more than the hospitals for those things (plus, they're happy to run up bills for insured patients), so there's an extra financial incentive to get treated elsewhere if possible.

The last time I went was in 2005 for migraine pain and some vomiting that even the maximum doses of multiple prescription meds weren't touching. Fortunately, IM injections of pain meds are cheap, so I think I escaped with spending just over the $100 copay, which was well worth it considering I was ready to decapitate myself upon arrival. Even that's a pretty shitty reason to go, IMO, but the urgent care facilities around here will not give the type/amount of meds I need for that kind of pain, thanks to the asshole drug seekers abusing the system.

When we took my son last year, we were shocked to find there was only ONE doctor in the ER in the middle of a Saturday night. It wasn't busy, but that doctor was caring for a guy in heart failure and several other patients. Plus, the hospital lab took 6 hours to return results on simple tests. And this is a huge ER in a large hospital, not the small one that we prefer to go to if we can make the 40-minute drive. I still think about what would have happened if our infant was dying, and now I'm even more hesitant to go there for anything serious knowing they're so understaffed.

 

[glynndah]

i've been a few times. once for spilling boiling water down my legs; once for a dislocated knee and tuesday for a broken hand. Severe pain and injuries i know i can't handle are the criteria.

 

[SweetErika]

i've been a few times. once for spilling boiling water down my legs; once for a dislocated knee and tuesday for a broken hand. Severe pain and injuries i know i can't handle are the criteria.

I hope your hand heals quickly, Glynndah!

We had to take the munchkin yesterday after he ate 50-75 gummy vitamins and his doctor said he might need his stomach pumped. Fortunately, he escaped with a dose of Zofran for nausea and oral Benadryl for the allergic reaction he started having when we were just about ready to leave. Hopefully that was our one trip for the year, and now we know childproof caps aren't all that childproof!