When is the Emergency Department the Right Choice for Care?

Dr. Corey Slovis, Chairman of the Department of Emergency Medicine at Vanderbilt University Medical Center and Medical Director of the Metro Nashville Fire Department and the Nashville International Airport, speaks with Occupational Health about appropriate use of the Emergency Department.

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Stephanie Townsend:  Welcome to this edition of the Vanderbilt Health and Wellness Wellcast.  I am Stephanie Townsend with Vanderbilt Occupational Health.  We’re here discussing who should really be seen at the emergency room, with Dr. Corey Slovis, Chairman of Emergency Medicine, Professor of Emergency Medicine and Medicine, Medical Director of the Metro Nashville Fire Department and Nashville International Airport. Thank you so much for taking the time, Dr. Slovis, to be able to discuss who should use the emergency department and when should they use the emergency department for services or medical needs. How would it benefit a person to use alternative health care options like a walk-in clinic or their primary care provider instead of going to the emergency department?

Dr. Corey Slovis:  When I started in emergency medicine, it was called the E.R., and now that emergency medicine has grown into a specialty and about 50,000 people are involved in the care of patients around the country as emergency physicians, it is called an emergency department.  Either one works for me.  I think the single most important concept to get across is it is called either an emergency room or emergency department because it is for emergencies.  If you have a chronic problem that has gotten somewhat worse, where you think you need to see a specialist, or you would like to have something checked out, that is not the purpose of the emergency department, and because so many people use it as a more chronic care kind of facility or a place to get "checked out," waits in many emergency departments, including our own, have grown to be way too long.  They have grown to be in hours rather than minutes.  The emergency department is for acute severe problems, complaints or traumas.

Stephanie Townsend:  What situations would warrant ... outside of just saying "acute" … what situations, specifically, would warrant actually going to the emergency room versus going to your primary care doctor or to an urgent care facility?

Dr. Corey Slovis:  Before I do the specifics, let me say - the words that we like to think about are acute, sudden, severe.  If something isn't acute or sudden or severe, unless it is a high-risk kind of complaint, it is best seen in a walk-in clinic, in an urgent care center, or calling your physician.  Things that mandate coming to the emergency department, whether they are severe or not, is concern over having a stroke, having a myocardial infarction, having appendicitis, having shortness of breath that is new, which might represent pneumonia or a pulmonary embolus, when a problem might be life or limb-threatening, uncontrolled bleeding, new severe bleeding, trauma that is moderate to severe, a broken bone.  Those are the times that the emergency room is the perfect place to go, but an injury to your arm three or four days ago that just seems not to be getting better is no longer an emergency and can be seen in places better than the E.D.  Someone who has had chronic bleeding, perhaps, from their GI tract, that has been going on for weeks, months or years - that is not the thing to come to the emergency department with ... acute problems, sudden problems, severe problems.  A low-grade fever, where you "might have the flu" - unless you have a lot of underlying diseases, you don't need to come to the E.D.  Sudden acute fever, where you are having trouble thinking, or you can't hold fluids down - that is when to come to the E.D.

Stephanie Townsend:  What are the options that we have for being seen if it doesn't fit the criteria of what should truly be seen in the emergency room?

Dr. Corey Slovis:  Well, if you are here at Vanderbilt, and you have a primary care provider or specialist, you should call he or she.  If you would prefer, there are walk-in clinics.  There are urgent care centers.  We now have nurse practitioners scattered around the city, and soon the region, at Walgreens.  There are many opportunities to use those clinics or some other healthcare facility other than the emergency department.  When I look at Vanderbilt and 100 Oaks, when I look at Williamson Medical Center, we have so many outpatient options that it is hard to justify why so many people feel they have no option other than to come to the E.D.  Certainly, here at Vanderbilt, if you are an employee, there is Occupational Health.

Stephanie Townsend:  Can you tell me, what are some of the reasons, or why alternative, going to a walk-in clinic or going to your primary care doctor, would be more beneficial than going to the emergency department?

Dr. Corey Slovis:  If you don't have something that needs all of the resources of the emergency department, all of the doctors, nurses, sub-specialists, CT scan, immediate blood analysis availability, then by going to the E.D., you are going to generate a huge charge that you will be partially responsible for, and with some insurance companies, if it is truly not an emergency, you may be responsible for most or all of the charge, which can be very substantial.  The beauty of walk-in clinics, the beauty of primary care providers, the beauty of non-emergency care, provision of care, is how economic it is.  The economics of going to a walk-in clinic are in a few dollars, $25, $50, or $100, whereas that very same visit might exceed $1,000 in an E.D.  Those of us that work in the hospital forget how much any of us, including me, can be charged.

Stephanie Townsend:  Thank you so much.

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