How Emergency Rooms Decide Who Gets Seen First

If you’re waiting in an emergency room, sick or injured, it can be more than frustrating when someone else is moved ahead in line to see a doctor more immediately.

But the very nature of emergency medicine makes it all but impossible to simply see every patient in the exact order they arrive. The people who walk – or are carried– through the emergency department doors often have vastly different health needs. A patient having a heart attack is going to need quicker care than another patient with a broken finger.

Triage: Determining Need

Upon your arrival, The ER team’s first task is to assess your condition through a process called triage. Your vital signs will be measured, and you will be asked to describe why you are there. After this initial assessment, you’ll be assigned a score or rating that will help the team decide which patients need a higher level of priority and more immediate resources.

Emergency departments use a five-level triage scale known as the Emergency Severity Index (ESI):

• Level 1: These are deemed to be life-threatening conditions, including heart attack, stroke and drug overdose. These patients will be seen immediately.
• Level 2: Patients in this category are in severe pain or have conditions that could become life-threatening if not treated soon. This could include injuries with considerable blood loss, severe asthma attacks or head injuries (with loss of consciousness).
• Level 3: These patients are in moderate pain or are showing signs of infection or mild respiratory distress that could get worse if not treated soon.
• Level 4: Patients with this score are experiencing less urgent conditions. Examples include minor head injuries (without loss of consciousness), sprained ankles, mild to moderate pain and mild bleeding.
• Level 5: These patients are experiencing minimal pain, small cuts, or cold and flu symptoms. Others may need something as simple as a medication refill.

Reading the Room

After you have had your initial assessment, don’t expect to be given your score. The emergency care team is eager to get to you as soon as possible, but your ESI rating is kept in the computer system to help your care team manage and coordinate patient flow.

If you have to wait to be seen, just keep in mind that for many people, a trip to the emergency room is one of the most stressful events in their lives. With a few exceptions – those people looking for prescription refills, for example – everyone who checks into the ER is in the midst of a crisis. No one wants to wait. The goal is to get every patient seen, evaluated and treated as safely and efficiently as possible.

Emergency care teams are very good at assessing the health and immediate medical needs of their patients. If you find yourself waiting, that’s because someone else is in a more dire – and possibly life-threatening – situation. It may not always feel like it, but behind the scenes, the team is doing everything it can to free up space and make room for you and everyone else in the ER waiting room.

ER vs. Urgent Care

One way to avoid a potential wait is to take some time to consider your symptoms and ask yourself whether the emergency room is your best option. Emergency departments across the country are often used by patients whose needs could potentially also be met by an urgent care center. Self-screening could help you avoid a wait in an ER line if your condition appears to be less serious.

Consider where your symptoms might best be treated:

Urgent Care

• Fever
• Minor burns
• Minor allergic reactions
• Mild abdominal pain
• Sore throat
• Ear infection
• Rashes or skin infections
• Nose bleeds

Emergency Room

• Chest pain
• Breathing problems
• Severe cuts or burns
• Head injury (particularly with loss of consciousness)
• Stroke symptoms
• Severe dizziness
• Seizure
• Moderate to severe headache
• Moderate to severe abdominal pain

If you do go to urgent care with symptoms that are worse than you realize, you will promptly be rerouted to the emergency room if you need a higher level of care. The ER teams work diligently to provide the best possible care to you and every other patient in our emergency departments.