How to Patient - emergency department edition

When I went to the emergency department (ED) for the first time, I had absolutely no clue what to expect. I got frustrated with certain things, didn't have the right things with me to make my stay comfortable and just didn't know a lot about the process.

In this edition of How to Patient I will share my learnings of the New Zealand health system.

Getting admitted

The experience in ED may be slightly different depending on whether you come in on your own or via ambulance.

If you come in via ambulance you will go straight into a triage area. In my experience you will then go into a bed in the ED. Typically with heart issues you need to get hooked up to an ECG for monitoring which means you get a room. I have also once been stable enough where they had me move from the room to a bed in the hall as a more urgent case had come in.

If you come in on your own to the emergency department, you will typically wait in the waiting room with everyone else. Then when your name gets called you will go to triage. From here you will typically go back into the waiting room until a bed frees up for you. How long that is depends on how serious you are assessed to be by the triage nurse.

The nurses

The first person you will meet at the emergency department is the triage nurse. They will ask you some questions or what happened to assess how serious your condition is. The first time I went to hospital I thought that this person was the one I needed to give my most detailed explanation too. In retrospect, I think I gave them too much information compared to the doctor, who you only see later.

Then, once you are admitted to ED you are assigned a nurse who will take your vitals, hook you up to any machines, hook you up to an IV if needed, take any blood tests and generally keep an eye on you. This nurse may change if your visit falls over a shift change. You will not typically tell this nurse much about how you landed in hospital (unless you really want to).

The doctors

Once you are settled into ED and your tests come back, a doctor will come see you. In my experience this is typically a resident doctor. A resident doctor will make calls on your condition up to a point, but may need to speak to a specialist if your condition is more complex like sarcoidosis.

You will only see this doctor twice. The first time they will come in and ask you to tell them why you are there. This is the important conversation, and is your main chance to tell the doctor everything about your condition and what lead to you being in the ED. Sometimes this can be harder than it sounds. If someone asks you how you are feeling - you might focus only on the right now and not the whole lead up to that moment. Share all your concerns at this point. Not just what is asked.

Typically after this conversation the doctor will go away and decide what tests you need. Once all the tests come back, the doctor will return to tell you if you will be discharged or admitted, and any recommended follow up actions.

Clothes

The right outfit will make your stay a lot more comfortable. Pajamas are an excellent choice for clothes in both the ED and the hospital. Pajamas are light weight, warm and can be easily moved around by nurses to check your blood pressure and other vitals. Bear in mind whatever you wear going into ED you will need to wear leaving ED. In my experience, arriving happens after hours and leaving happens in broad daylight. You may want a bit more coverage for your PJs when leaving the hospital.

Shoes

A few times now I have ended up in ED without shoes or socks. This is a bit grim, especially if you need to use the restroom while in hospital. And leaving hospital barefoot is also not ideal.

Flip flops are useful - easy to throw on or kick off. Or slippers.

Socks are great to keep your feet warm in the cold ED.

Communication

Having a charged phone on hand is super important for letting you communicate with your loved ones and anyone else who may need to know that you are at the hospital.

Entertainment

This may sound like a weird thing for an emergency department, but you will end up being there for quite a while. Take a book to read or a device to watch a movie. The ED I go to has free Wifi which is really useful.

Chargers

This brings me to my next point: bring your phone and other device chargers with.

A visit to ED is normally a few hours in my experience. And if all you are doing in that time involves your phone, you are likely to run out of juice.

Drinks

Keeping hydrated while in ED will mean you have to ask the nurse assigned to you for some water, tea or coffee. I do not recommend hospital coffee. If you want something warm, in my opinion tea is the best option. Just use your call bell.

Food

If you are in ED for a few hours, you may be skipping a meal. You can ask the nurse for something to eat. There are normally sandwiches and fruit available in the ED where I have gone to here in New Zealand. They don't tend to let you know it's available, so if you don't ask you might not know.