Clark Howard's Tips

January 25, 2008

Recently there was a story that got huge media coverage about the long waits in hospital emergency rooms. Those in dire or critical condition endure waits that are up 40 percent over the last 7 years. The wait time for heart attack victims is up 300 percent! It's as if the emergency rooms have had a nervous breakdown because they're a catch-all for the uninsured, the urgent care patients and those who have been critically injured in accidents. Triage nurses have to see everyone, play traffic cop and hope they don't make a fatal error.

Clark recalls taking his wife to an emergency room once. The triage nurse seemed to hate her job and had no eye contact with Clark or his wife while she was taking vitals. Suddenly, she hit the code blue button and people swarmed in, put Clark's wife on a gurney and rushed her down the hall. That was a situation where triage actually worked. But it's not working in a lot of instances.

Nurse-in-a-box clinics can help alleviate the emergency room crunch. Clark's 2-year-old son was sick this past weekend. On Saturday, he took him to a nurse-in-a-box practice and for $59 he was seen, evaluated, treated and they were on their way. The nurse practitioner wanted to see him again the next day because it couldn't wait until Monday when Clark's regular pediatrician was in. The follow-up was free! Not every nurse-in-a-box has free follow-ups, but this one did to encourage continuity of care.

Clark's executive producer Christa originally turned him on to this specific nurse-in-a-box practice. She's been there about 8-10 times with her 2 children.

Doctors have been upset with Clark for advocating nurse-in-a-box practices. But so far medicine has failed to come up with an alternative to see people on an urgent, non-emergency basis. So this is what the marketplace has devised.

If doctors are upset, they need to find a way to encourage more of their ranks to go into primary care to alleviate the crunch. Primary care docs are the unsung heroes of medicine. They make far less than if they're specialists and have far higher patient loads.

Clark thinks we need a nurse-in-a-box in every hospital where triage can funnel people who are not truly emergencies.

Consumer advice courtesy of