My kids know they have to be half-dead before I’ll take them to the emergency room.
Thanks to training and experience from my 25-year career as an emergency department and intensive care nurse, when one of my children tells me they’re sick I immediately go through a series of questions to assess how serious the situation is: What’s your temperature? Are you drinking enough fluids? What color is your urine?
These are the subtle signs that don’t necessarily require a test to figure out how bad a case is, and I will exhaust all of my at-home options and triage ability before going into the emergency room.
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Even a pandemic like COVID-19 doesn’t change my thinking, but unfortunately, that isn’t true for many.
A recent survey of 100,000 Americans by Evidation Health found 37% said they would seek care in the ER or an urgent care clinic if they believe they have symptoms of coronavirus, even as experts warn widespread anxiety about COVID-19 is causing the volume of unnecessary emergency room visits to balloon to the point of straining hospital resources.
To ensure healthcare professionals are able to effectively slow the spread of coronavirus, everyone—including hospitals—must think like a nurse: always have a plan, and always be ready to improvise when the plan goes south.
As a nurse, I learned to triage symptoms by building a mental checklist to determine the severity of any situation and to think industriously about using resources before a doctor is needed.
For too many Americans, COVID-19 triage looks like doomsday prepping: buying frozen and canned foods or, worse, hoarding toilet paper and hand sanitizer. Those things may provide the illusion of safety, but what happens if you actually start to feel ill? At that point, you need to take your temperature and have over-the-counter painkillers on hand.
Beyond that, you need to familiarize yourself with the signs of coronavirus. After all, just because you’re tired doesn’t mean you’re sick. And finally, be sure to call your healthcare provider before rushing to a clinic.
Individuals who don’t take even those basic self-triage steps are much more likely to pay a visit to an emergency facility, which would ultimately increase their risk of exposure to disease in addition to straining the system.
Hospitals need to be analytical and nimble, too, since normal patient management isn’t working right now. On a recent visit to the hospital where I used to work as a nurse, some of my former colleagues told me boxes of gloves and masks that wouldn’t normally get a second look in waiting areas are being stolen within minutes. How many hospitals have a policy in place for that sort of situation?
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Hospitals also have to rethink something as basic as what “sick” looks like and what should trigger isolation protocols. After all, a patient could walk into a facility and look healthy but have a fever.
Allowing a sick individual to sign in and then sit in the waiting room for any length of time could offer them the opportunity to accidentally infect many others since we’re dealing with a highly contagious disease. While a visual diagnosis isn’t going to solve this problem, hospitals need to find ways to create new access points like drive-through screening areas that keep patients isolated during triage.
Most individuals and health systems have never experienced a pandemic on the scale of coronavirus, so they’re either outside what their preparedness checklist covers or they’re being forced to improvise as they navigate completely new territory. Nurses know that once a horse is out of the barn, it’s too late to lock the gate.
But if you have a plan and it’s not working, that doesn’t mean a bad situation can’t be improved by being organized, exhausting non-emergency options and adjusting to variables—just like a nurse would do.
Inge Garrison, R.N., a former ED and ICU nurse, is the chief clinical officer of Verge Health.