Friday June 28, 2013

There are numerous factors contributing to the rising number of emergency room visits at hospitals across America, including in our community. Everything from an aging population managing chronic illnesses to issues of access to healthcare plays a role. But no matter whether patients are brought in by an ambulance or walk in the door, an immediate concern for their health is what brings them to us.

We see many patients in the Brattleboro Memorial Hospital Emergency Department who may not be having the textbook definition of a medical emergency, but it is certainly an urgent matter for the individual. Once the episode has passed, some people actually say they are sorry for taking up our time. It’s just that they were scared, and that’s okay. Part of our job here is to help people figure out whether or not they are having an emergency.

All emergency departments have a system by which they evaluate the urgency of a patient’s need for medical help. Someone who suffers a traumatic injury during a car accident is obviously a high-priority case. But what about a patient who comes in with chest pains? It could just be indigestion. It could also be a heart attack. It makes perfect sense to come to the ED, where we have the technology and expertise to make that determination.

More hospitals are now hiring nurse practitioners and physician assistants, known collectively as associate providers, to help manage this particular ED patient population. People have become accustomed to seeing associate providers in a primary care setting, where our broad education enables us to make diagnoses and recommend a course of treatment. The same skill set of listening to the patient, asking questions and ordering the appropriate tests to help determine the nature of a patient’s complaint also comes into play in the ED setting.

Having associate providers also adds a great deal of flexibility to Emergency Department staffs during busy periods. If a patient’s symptoms lead us to discovering an illness or injury is more serious than initially thought, we have the ability to get things started until the patient’s condition stabilizes and a physician becomes available.

When the BMH Emergency Department renovation and expansion project is completed, there will be separate entrances for ambulance and walk-in patients. This arrangement won’t automatically determine which patients need care more urgently than others, but it will help us manage patient flow more efficiently. After you’re admitted and examined, whether it’s by a physician or an associate provider, you can rest assured you’ll be receiving the most appropriate care as quickly as possible.

Linda Rice, APRN, is a board-certified nurse practitioner working in the Emergency Department at Brattleboro Memorial Hospital.