JACKSONVILLE, Fla. – If you’ve ever had the misfortune to end up in an emergency room, the order in which patients were seen might have seemed confusing.
We’re used to following a first-come, first-served system in most scenarios, but hospitals, particularly ERs, function very differently -- and for good reason.
Injuries and sicknesses vary when people show up to an ER for medical care, so doctors must decide, depending on the severity, which cases take priority in determining how soon patients can be treated in a room and the order in which they are seen.
This is called triage.
Dr. Steven Goodfriend, an emergency medicine physician at HCA Florida Memorial Hospital, says the hospital uses a five-tier system, with 1 being the most serious cases, in figuring out the order in which patients are sent back to a room.
Goodfriend put News4JAX anchor and reporter Aaron Farrar to a triage test to see what decision he would make if he needed to. With the following four scenarios, Goodfriend wanted to know which order Farrar would see the patients in:
- A 55-year-old with chest pain who is clutching his chest
- A 10-year-old with a runny nose and fever
- An 85-year-old slip and fall who takes a blood thinner
- A 25-year-old with their stomach hurting a little bit
“I’m gonna go with the chest pain patient first,” Farrar said.
Correct. Patients with chest pain are typically prioritized in ERs.
“I would say definitely that’s the first one because you want to get an EKG on that patient,” Goodfriend said. “You want to see if they are having a heart attack or not.”
Farrar went with the older slip-and-fall patient next.
“Yes,” Goodfriend said. “Slip and fall, hit their head [while having to take] a blood thinner. They are coming back [to be seen by a doctor in a room next] because that is a high-risk patient. If it is a 25-year-old slip and fall who hurt their head a little bit, they will probably have to wait a little bit longer. But [the older] patient has a high risk of bleeding into the brain, a cranial injury.”
Farrar guessed the child with the flu, headache or fever would go next.
“It is a trick question because it is based on what their vital signs are,” Goodfriend said. “If they had a low oxygen level, if their fever was really high, if they did not really look that good [are all things to consider]. If they started to develop a rash, then they would go back faster.”
Goodfriend said a lot of factors in this scenario determine who is seen more quickly.
“If a younger female or patient with abdominal pain [who possibly was pregnant, if they just had a little bit of a stomach ache, but their vital signs were stable, then the kid would still go back faster,” he said.
Goodfriend says it can be frustrating at times for patients who may need to wait a little longer than others, but he says medical attention starts as soon as you set foot in a hospital.
He says that includes getting X-rays and doctors putting in orders for medication while in the waiting area.
HCA Florida Memorial Hospital does not want people to become so frustarted that they leave without getting the care they need.
“What our focus has been the last six months is when we see them, get them back to a room,” Goodfriend said. “If your child comes in with a fever and you think it is nothing, ‘I’ve been waiting for two hours. It is probably nothing. I’m tired of waiting, and I’ll go home.’ That can be meningitis. It could be a severe, life-threatening illness.”