THE Accident and Emergency Department (A&E) or the Emergency Room (ER) is usually the first stop when patients arrive at the hospital.

Across the world, there are patients sitting in emergency rooms waiting to be seen. Some may be waiting more than four hours, and I’m sure most of these patients are complaining about their long wait time.

I believe that most people don’t understand why there is such a long wait time in the ER. It is my hope that we can achieve better patient satisfaction if more persons understand how patients are triaged.

Triage is the process of classifying patients for treatment by priority. When you arrive at A&E, you are assessed by the triage nurse and doctor who, based on a quick history and examination, assign a priority level.

We see patients based on how urgent their condition is. The more urgent your condition is, the faster you will be seen. The less urgent patients, therefore, will have a longer wait time.

There are five priority levels:

Level 1/Emergent

We need to save this person’s life immediately.

Level 2/Urgent

This patient is critical, and will get worse quickly if we don’t intervene.

Levels 3-4/ Less Urgent

Stable, this patient’s life is not in danger.

Level 5/ Non-Urgent

Stable, this patient needs minimal medical intervention.

Here are some examples of these five triage levels:

1. Emergent — Unconscious with gunshot wound to the abdomen

2. Urgent — Heart attack, seizure, severe breathing problems, sickle cell patients in pain

3. Less urgent, but requires more than one intervention (like X-rays plus blood tests) — Broken limb, abdominal pain

4. Less urgent, and requires one intervention (like only an X-ray) — Sprained ankle, a cut that needs stitches

5. Non-urgent (only requires a prescription) — Toothache, throat infection

So, if you come to A&E complaining of, for example, a leg injury, and your doctor orders an X-Ray (and some pain medication, of course), you will be assigned priority level 4. This means patients with a priority level of 1-3 WILL be seen before you, even if those patients arrive AFTER you, therefore you may (and probably will) have a longer wait time.

If you see someone being rushed into A&E and immediately taken to a cubicle, that typically means we need to save their life. The doctor HAS to see that child having a seizure with a temperature of 103 degrees Fahrenheit before the person with a cough and cold who is breathing without assistance and waiting for two hours. We cannot have a first-come-first-serve approach in the ER.

Now, priority levels can change. So if while you are waiting, there are new or worsening symptoms (eg your breathing has worsened, level of consciousness has changed, fever skyrocketed) PLEASE bring it to our attention.

In addition, not everyone needs to be treated in A&E. If your medical condition requires nothing more than a prescription, chances are you don’t need to be treated in the ER. In those instances, patients with non-urgent ailments will be advised to seek treatment at their nearest clinic, or given a referral to return on another day to attend a specialised clinic.

I understand that you may have had to take time off from work, spent money for transportation JUST to come to the hospital only to be told to go somewhere else, and we are sorry for this inconvenience. However, the health system is set up in such a way so non-urgent and less urgent health concerns are managed at health centres/clinics versus at the hospital.

If you believe your illness is mild or not urgent, I encourage you to seek medical attention at your nearest health centre. If they are unable to properly care for you, the staff will refer you to A&E. If you believe your condition is urgent, head straight to A&E.

Dr Tal’s Tidbit

Your wait time in the Accident & Emergency Department is based on how life-threatening your condition is. The less urgent your case is, the longer your wait time may be. Be patient with us as we take care of all our patients.

Dr Taleya Girvan has over a decade experience treating children at the Bustamante Hospital for Children working in the Accident and Emergency Department and Paediatric Cardiology Department. Her goal is to use the knowledge she has gained to improve the lives of patients by increasing knowledge about the Health Care system in Jamaica. Dr Tal’s Tidbits is a series where she speaks to patients and caregivers providing practical advice that will improve health care for the general population. Email: dr.talstidbits@gmail.com IG @dr.tals_tidbits