Quote:
Originally Posted by blueash
While it would be medically better if only patients with real "emergencies" went to the ER it would not necessarily save money for the health care system unless many ER's closed. The ER needs to have on site the equipment and medications needed for real emergencies. The facility must be constructed to allow patient and staff flow to optimize care. The base cost of all the requirements to be an ER are huge. This cost is then spread over the charges applied to the users of the ER. Fewer patients, higher per user cost. So the runny nose that really doesn't belong in the ER gets socked with a high bill which represents that person's contribution to the cost of having a facility equipped to handle emergencies.
Fewer patients in the ER and the ER can't survive economically. So like it or not, the ER's financial viability depends on having people in the beds, and the waiting room.
A couple random thoughts. The training to become a board certified ER specialist is college, 4 years of medical school, and then 4 years of residency/fellowship training. That is 7-8 years post college in a very intense program. And no PA or NP does anything even approximating that kind of training. So when I see that the PA is providing care I know that the ER is having staff available for the very low level of medical urgency that a PA or NP is qualified to handle. Saving money on staff costs.
As to the insistence that the ER is not required to care for you if you do not have an emergency that is both true and wrong. The ER cannot send you away until after they have determined that you do not have a condition requiring emergency care. So they must evaluate you first. As the evaluation usually is more complex than the management there is little reason for a general policy of declining care when the triage secretary may think it is not an emergency. And they are not really qualified to make that decision. A runny nose may be just a mild URI or allergy. Or it can be a fractured cribriform plate which if ignored will rapidly lead to bacterial meningitis.
Making that differentiation requires a good history and if appropriate a urine glucose dipstick. So even runny nose can be, extremely rarely, a true emergency. That's what the ER doctor spent all those years learning. Sometimes it is a zebra.
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Thanks, couldn't have said it better
I suggest that the people who insist that an ER can turn you away read the COBRA of 1987