Published: Oct. 17, 2006
Updated: June 14, 2010
A world of chaos and stress where doctors and nurses try to catch a few hours of sleep in between crises. That’s the way many people envision hospital emergency rooms, thanks to television series like "ER" and "Grey's Anatomy." NBC describes the premise of the former as “a Level One Trauma Center where heroic doctors and nurses are faced with life-and-death decisions on a daily basis.”
It's true that emergency departments are faced with life-altering decisions every day, and the shows do offer a realistic glimpse into the world of emergency medicine in many ways, says Michael Hocker, MD, chief of Emergency Medicine for Duke University Hospital's Emergency Department (ED).
But they miss the mark in some respects -- for one thing, emergency departments lack the starry-eyed theatrics that such shows thrive on. What's more, television dramas perpetuate some myths about emergency departments, especially the perception that life in the ED is total chaos.
"From the periphery, it may seem chaotic and unorganized,” says ED Clinical Operations Director Frank DeMarco. “But we actually operate according to established emergency department protocols and standards. The way ED staff members approach the various situations is actually well organized and carefully orchestrated to meet patients' needs.”
Duke's emergency team includes 25 physicians, more than 100 nurses, and 10 mid-level providers, as well as social workers, respiratory therapists, chaplains, and support staff such as nursing assistants, unite coordinators, clerks, and volunteers. While, in the heat of the moment, responsibilities may overlap, every staff member knows who is in charge, what role he or she is expected to play, and even where to stand in the treatment room during an emergency.
The impression of barely controlled chaos isn't the only misconception people have about emergency medicine. Here are some other popular myths about emergency departments, contrasted with the facts.
Myth: Patients are seen on a first-come, first-served basis.
Fact: Those with the greatest need are served first, and someone who does not need immediate medical attention may wait a while to be seen. However, DeMarco adds, even the method of prioritizing patients for treatment is based on a scientific set of criteria.
"The emergency department uses a five-level triage system called the Emergency Severity Index to determine patients' degree of illness and need for emergency treatment," DeMarco says. So, decisions that may appear to be random or subjective are actually made using evidence-based criteria.
In addition, information keyed into a computer tracks the particulars of each patient's care, from how long he or he has been waiting to what tests have been ordered and where the patient is to go next.
Myth: Emergency department care providers don't treat patients -- they simply stabilize them and send them to someone else for treatment.
Fact: Emergency medicine is a specialty that includes elements of many specialties, including pediatrics, obstetrics and gynecology, cardiology, and just about every other specialty. Duke University Medical Center offers an accredited residency program that is training the next generation of in emergency medicine physicians.
The difference between this specialty and many others, Hocker says, is that in emergency medicine, doctors must have a basic expertise in everything because of the variety of problems they see each day.
"There's a rule here: never say 'no' to a patient in need," says DeMarco. "Finding the resources and helping the patient through the immediate crisis is our goal."
With novel technology and new medications, more and more first-line critical care is being done in the ED. The better those emergency medicine physicians and front-line staff do their jobs, the better the patients fare. That’s particularly true in cases such as trauma, severe infections, strokes, and heart attacks, where fast action can mean the difference between life and death.
"The primary goal is to get the patient in front of a provider who can perform a medical screening evaluation and determine if an emergency medical condition exists, as well as provide the medical treatment needed" says DeMarco. "Our staff's readiness and knowledge fulfills an important commitment to our patients and the community at large."
Myth: The ED is overcrowded because many patients come in for care of minor ailments that could be treated at a doctor's office.
Fact: "Sore throats and sprained ankles are not our problem. We get them in and out," says Hocker. "It's increasing number of sicker patients -- and patients who are waiting on inpatient beds -- who make the ED crowded."
Most of the people who come to an ED for help need to be there. The proof: More than 40 percent of Duke University Hospital's admissions come through the ED.
The emergency department actually serves as one of the primary entry points into the health system, DeMarco adds. An average of 200 patients per day are seen. That number can rise to more than 250 people on any given day.
Myth: The ED can expand indefinitely to treat everyone who comes in.
Fact: The Duke University Hospital administration and the ED have developed strategies to overcome hospital and ED overcrowding. But even with those efforts, a full ED can occasionally happen.
“ED overcrowding is not only an ED problem, but a health system problem that the entire nation is experiencing,” says DeMarco. “So we’re always monitoring current conditions in the ED to move patients through safely and as rapidly as possible."
Duke's ED -- completed in April 2007 -- features a state-of-the-art design that makes it easier to treat large volumes of patients. The ED is now equipped to treat more than 90,000 patients a year.
A full-service pediatric emergency department includes critical are and isolation rooms for children with infectious diseases, three adult care areas are tailored to patients of varying needs, and patient rooms are equipped with computers so physicians can enter orders and look up medical histories while at the patient's bedside. In addition, a new 7,000-square-foot ambulance bay is outfitted for a wide variety of emergency situations.