What are the most important questions to ask in the emergency department to ensure optimal patient care?

Essential Questions to Ask in the Emergency Department for Optimal Patient Care

The most critical questions to ask in the emergency department focus on identifying life-threatening conditions, establishing accurate diagnoses, and ensuring appropriate disposition and follow-up care.

Recognition of Emergencies

• Ask about warning signs that may signal an emergency, including extremely labored breathing, blue or pale color (cyanosis), noisy breathing (wheezing or stridor), altered mental status, seizures, agitation, vomiting after head injury, and uncontrolled bleeding 1
• Inquire about the onset of symptoms, as timing can help differentiate between critical conditions: sudden onset (pulmonary embolus, pneumothorax), hours/days (pneumonia, heart failure), weeks (malignancy, sarcoidosis), or years (COPD, obesity) 1
• Assess for sentinel events that may indicate deterioration, such as cancer progression, decline in functional status, increased healthcare utilization, or poor tolerance of previous treatments 1

Medical Assessment Questions

• Determine if psychiatric symptoms could be caused by an underlying medical condition by asking about medical history, medication use, and substance use 1
• For patients with trauma, ask about mechanism of injury, timing, and associated symptoms to determine appropriate imaging needs 1
• Inquire about medication history, including over-the-counter medications, to identify potential drug interactions or adverse effects 2
• Ask about allergies, particularly cross-reactivity between aspirin and NSAIDs, which can cause bronchospasm in sensitive patients 2

Patient-Centered Communication

• Ask open-ended questions about how a patient's culture, religion, or spiritual belief system affects their care preferences 1
• Explore patient goals and values, recognizing these may change over time in response to disease progression and treatment 1
• Inquire about the patient's understanding of their condition and treatment plan to identify knowledge gaps 1
• Ask patients about their specific concerns or fears regarding their condition or treatment 1

Medication-Related Questions

• For patients receiving medications, ask about current medications, allergies, and previous adverse reactions 2
• When prescribing NSAIDs like ibuprofen, inquire about cardiovascular risk factors, GI bleeding history, renal function, and concurrent use of medications like aspirin, ACE inhibitors, or diuretics 2
• Ask about pregnancy status before prescribing certain medications, particularly NSAIDs which should be avoided after 30 weeks gestation 2

Discharge Planning Questions

• Ask patients to repeat back discharge instructions to verify comprehension 1
• Inquire about the patient's ability to obtain prescribed medications and follow recommended care at home 1
• Ask about social support and resources available to the patient after discharge 1
• Determine if patients know when and how to seek follow-up care or return to the ED if symptoms worsen 1

Emergency Preparedness Questions

• For healthcare providers, ask about the emergency readiness of staff, including training in first aid, CPR, BLS, ALS, and PALS 1
• Inquire about written protocols for office emergencies and whether they cover times of low staffing 1
• Ask if all staff members know how to access the EMS system and provide necessary information 1
• Determine if the practice has a system to check emergency equipment and medications regularly 1

Documentation and Communication

• Ask about critical information that needs to be documented during patient handoffs and changes of shift 3
• Inquire about the patient's understanding of discharge and follow-up instructions to ensure effective communication 3
• For research purposes, emergency physicians commonly ask questions about drug dosing, medication selection, disease manifestations, and appropriate laboratory tests 4, 5

Pitfalls to Avoid

• Avoid assumptions about a patient's care preferences based on stereotypes related to race, ethnicity, culture, religion, or spirituality 1
• Don't neglect to ask about medication costs, administrative questions, or community services, which are often overlooked in emergency settings 4
• Be aware that time constraints, distractions, and interruptions are common barriers to pursuing clinical questions in the ED 5
• Remember that the ED environment is often noisy and fast-paced, which can make effective communication challenging 6, 7