How to be an advocate for a loved one in the ER
In the emergency room, the health-care system’s shortcomings are laid bare. Not enough nursing staff, too little communication, confusing interactions.
I have seen that effective advocacy, whether from a family member, friend, or professional patient advocate, can have a positive impact on emergency room outcomes. Caregivers, who are usually familiar with their loved one’s care and medical conditions, have the ability to act as advocates and perhaps make up for some of the shortcomings we find in ERs.
The tips I will outline aren’t easy, and they sometimes run counter to the natural fear or even panic that accompanies a trip to the ER. But you will be doing your loved one and yourself a favor if you can remember them.
Evaluate whether going to the ER is necessary.
Patients present themselves at the emergency room with issues that could and should be handled by a primary care doctor or urgent care center. The result, of course, is an even more overburdened emergency room.
Go to the ER when there’s:
• Chest pain or pressure (possible heart attack)
• Difficulty breathing (asthma attack, pulmonary embolism)
• Sudden numbness or weakness (stroke symptoms)
• Severe bleeding (uncontrolled, deep wounds)
• Head injuries with confusion/vomiting (possible concussion)
• Severe burn or fracture (bone protruding, major burns)
• Poisoning or overdose
• Seizure lasting more than 5 minutes
Bring a list of the patient’s current medications and allergies.
Electronic health records (EHR) have done a lot to improve coordination of care, but the various systems sometimes don’t “talk” to each other. Not only that, the medications and dosages listed in an EHR aren’t always up to date.
Keep a list of current medications, including how many milligrams are prescribed and the frequency, printed out and kept in a “go bag” that you can grab on the way out the door. This can save precious moments in the ER.
Understand the triage process.
People who need immediate life-saving care, or who appear to be having heart attack or stroke, are considered Level 1 and Level 2 patients and will be seen almost immediately.
Your loved one will be evaluated and, if it’s determined they’re not in imminent danger, you likely will have to wait. If the wait feels too long, calmly and courteously ask at the desk how much longer it may be.
Be able to summarize the patient’s conditions and what brought them to the ER.
The patient may be able to do this themselves, but I find they usually downplay certain things or even omit them. If your loved one has heart disease, diabetes, chronic kidney disease, allergies and previous surgeries, the clinicians need to know as soon as possible.
Have the patient’s ID and insurance card with you.
One of the first people through the door (faster probably than any doctor) will be from admissions, and they will need information to register your loved one as a patient: photo ID and types of insurance.
Also, if you’re not the spouse or the patient is your child over the age of 18, you will need their permission to receive medical information from the clinicians. The patient can give permission verbally, but having a signed HIPAA form or durable medical power of attorney is better.
Be familiar with the patient’s preferences for care.
Some people don’t want blood transfusions. Some don’t want to be resuscitated if their heart stops beating or intubated if they stop breathing. The best way to provide this information is with a living will or advanced care directive. Bring copies with you.
Make sure your loved one is comfortable.
If they need more pillows or a heated blanket, ask for them. If it’s OK for them to drink water (they may not if the docs feel there may be a surgery), get them some. Talk to your patient about what’s going on, what’s being said to you and what they can expect.
When you hear, “We’re admitting you,” understand what that means.
Is your patient being admitted for observation, which may have an impact on insurance coverage? Is an in-patient room available, or will they have to remain in the ER? What unit will they be admitted to, for example intensive care?
Listen carefully to the discharge instructions, ask questions and take them seriously.
The most common reason people return to the ER is not following discharge instructions. This may include what activities to avoid or new medications to take. The most important instruction is often “follow up with your primary care doctor within 72 hours.” Don’t brush them off.
It’s easy to feel lost in the ER. The staff is there to help you, so speak up as an advocate and remember to say “thank you.”
• Teri (Dreher) Frykenberg, R.N., a registered nurse and board-certified patient advocate, is the founder of www.NurseAdvocateEntrepreneur.com, which trains medical professionals to become successful private patient advocates. She is the author of “How to Be a Healthcare Advocate for Yourself & Your Loved Ones” and her new book, “Advocating Well: Strategies for Finding Strength and Understanding in Health Care,” available at Amazon.com. Contact her at Teri@NurseAdvocateEntrepreneur.com to set up a free phone consultation.