Need an ER, or Can it Wait: Doctor Offers Guidance for Making the Call

With many medical treatment options available, you might find yourself debating whether your condition requires a trip to the emergency room or an urgent care center, or if you can wait until your doctor’s office opens.

“The true role of the ER is to evaluate and stabilize the seriously ill,” said Dr. Andrew Miller, medical director of the Lehigh Valley Health Network-Cedar Crest emergency department and chief of pediatric emergency medicine. “While our mantra is anyone, anything, at any time, we are equipped and staffed for more complex and critical medical issues.”

An ER visit is in order for any condition that threatens your life and requires immediate attention, he said. He listed examples including heart attack, stroke, bad car accidents, chest pain, shortness of breath, blue extremities, head and spinal injuries, serious allergic reactions, and dislocated, broken bones.

When the risk of immediate death or life-limiting outcome is high—such as with a stroke or heart attack— Dr. Miller said calling 911 is the safest option for accessing care quickly.

If you go to the ER without a life-threatening illness or injury, he said, “That is where your ER visit might not be as satisfying.”

“We want to get everyone in as quick as possible, but it depends on the severity of your illness, how complex your injury is, and the overall need for critical stabilization,” said Dr. Miller, who serves as acting vice chair of Lehigh Valley Health Network-Hazleton. “Triage is a complex, confusing topic.”

The hospital uses a five-level triage Emergency Severity Index to calculate patients’ physical needs from most to least urgent. The chances of being seen quickly also depend on a hospital’s available resources. For instance, Dr. Miller’s Cedar Crest location operates a pediatric ER, as well as a fast-track space for lower-level injuries, and patients who fit those categories might end up being treated before a patient in the regular ER.

Dr. Miller noted that in some geographic areas, especially rural ones, overall use of the emergency room is up. But he said more than 90 percent of patients visiting represent true medical emergencies and their visits are appropriate.

In all but true medical emergencies, Dr. Miller recommended first calling your primary care doctor, even after hours. With the advent of telemedicine, you might be able to be treated virtually, or the doctor could make the call on whether immediate treatment is needed.

If you go to the emergency room, Dr. Miller suggested bringing a list of the medications you take or the medications themselves, a list of your known allergies, and copies of any medical tests such as EKGs or X-rays related to your symptoms.

“Many hospitals are connected electronically, but it helps to have records on what’s going on,” he said. “We can treat patients faster if it’s at our fingertips.”

After all considerations, it’s your call.

“You have to trust your gut,” Dr. Miller said. “You will never be wrong by going to the ER, as we can offer more advanced testing and access to specialists. But if you know from experience you have an ear infection or urinary tract infection, it’s OK to try urgent care.”

“It’s our obligation to evaluate and stabilize any patient that comes in, regardless of ability to pay, which is different than a primary care practice and urgent care,” he added. “The care comes whether you end up being hospitalized or not.”