Before we go too far into this topic, I want to make one thing very clear. You know your medical history and the way your body feels better than anyone else. With that said, if you feel like you need to go to a higher level of acuity setting than recommended, we are not discouraging you from that. This post is simply to help you understand what constitutes a complaint that an emergency department (ED) will be most concerned about and will try to address first.
As depicted in our first image, the NHS does an excellent job educating its population about what levels of care people should seek. For those in the United States, you will notice some differences compared to our broken system. Also remember that the Queen's English is used in this image and spelling will differ from that in the United States. We will approach this in a step-wise manner.
Self-care is exactly what it sounds like: take care of yourself at home. A simple cough or sore throat can usually wait. Times that it may need to see a higher level of care is when it becomes complicated or not taken care of well. One that is not listed but very well should be is pregnancy testing. Many places have pregnancy tests available for a dollar. Why go to the ER and pay a $500 (approximate and may vary) bill for a pregnancy test? We are basically doing the same urine test that you are doing at home. We care more if there are risks of complications and it is immediately impacting your health.
NHS 111 does not have a USA equivalent in its exact form. However, most insurance companies do have nursing lines and can be somewhat helpful. They will often direct you to a higher level of care than maybe needed though depending on how well you give the nurse information. If you are not sure what level of care is needed and you do not feel like there is immediate danger to life, limb, or sight this can be a safe way to manage care.
Pharmacists (chemists) are very beneficial in many cases. Have uncomplicated heartburn, headache, or diarrhea? Talk to them and see what over the counter medications are used. Keep in mind all these symptoms can have more severe and life-threatening implications and some common sense is required to help differentiate what level of care is needed. For example, is this headache extremely severe and you do not usually get headaches but it hit its peak in less than an hour? Any loss of sensation and/or strength to a part of the body? These are potentially concerning and need to be evaluated in the ED.
GP (Doctor) is referring to primary care. Chronic complaints are best seen in these settings. Yes, your back has been hurting for a week after you decided to be a weekend warrior and move all the furniture in your house without help but waiting one more day for the appointment with primary care is the best choice. They know you best and can take care of you in a better manner than we can in the ED. Usually they can do it much more quickly than waiting half a day (give or take) to get an ED bed for relief.
Walk-in clinics and urgent cares are two very different services. In many cases, walk-in clinics can be used for short-term complaints that you would otherwise see primary care for, but either do not have time for or unable to reach primary care. Urgent cares are meant to take care of issues that cannot wait for the next day but are NOT immediately threatening to life, limb, or sight. Examples of these including lacerations (cuts) that need sutures (stitches) or possible broken bones but that do not appear to be dislocated or displaced (not in normal alignment).
Finally, there is the ED. Choking, severe and uncontrolled bleeding, eye injury with loss of vision, chest pains, loss of consciousness (blacking out), or new onset stroke symptoms are some of the most common examples of life, limb, and sight threatening issues that require immediate evaluation and treatment. Reserving the use of an ED for such situations helps free up these professionals to take care of the most critically ill and injured.
Keep in mind that coming to the ED for a low acuity issue often leads to over-testing. Our main concern is to figure out if you have something that is immediately threatening to life, limb, or sight. If none of those apply and it is unlikely to lead to complications, it is usually most efficient to see another type of care depending on the situation.
Another example of this layout is seen above from the Mayo Clinic Health System. As you may notice, they include the need to call 911 when there are immediate life, limb, or eye threatening issues. There is a more expanded list with this image and may even seem more conservative compared to the less litigious NHS system. Either way, the choice is up to you.
Remember, emergency medicine is all about risk stratification. In the grand scheme of things when it comes to the ill and injured, we in the ED are more concerned about diagnosing and treating a new onset major heart attack than the uncomplicated strep throat you have had for three days that has not changed.
Ultimately, it is up to you the patient to help with ED overcrowding. Every person who inappropriately uses the ED is risking the lives of those that are needing care. ED overcrowding has become a public health crisis. Patients die from this problem and it can be easily prevented when patients use resources correctly.
Thank you for reading this post. There are sure to be questions and as mentioned multiple times, this is not a perfect list. Patients do need to understand that overcrowding is a serious issue but we recognize that serious issues can be hidden in simple complaints. Just remember to please use the ED appropriately and do not rely on it to fill other roles such as primary care.