To understand how the emergency room or waiting room of a hospital works, you must understand one of the underlying factors that go into patient care, which is Risk Stratification in healthcare. It isn’t hard to tell when waiting in the Emergency Department at any hospital why some patients are given priority over others. It may be frustrating at moments, and not always is it evident why or how some people are chosen before others.

Even if you haven’t watched any medical dramas on TV, it isn’t hard to understand why someone who is bleeding severely or is struggling to breathe would be quickly ushered into a room for assessment and treatment. But, what about all the people in the emergency waiting room expecting to be seen, and someone is pulled out even though you may have been waiting longer? This might be directly tied to where a person falls on a risk stratification model scale. The scale, depending upon the healthcare organization, is usually divided into 3 to 5 different categories of severity. The simplest of the models are divided into High-risk, Moderate-risk and Low-risk groupings.

High-risk Patients

There are a number of factors that would put a patient in the High-risk category, but it is the combination of age, ailments, and ongoing conditions that make it fairly straightforward. Most organizations state that a person with 10 or more clinically diagnosed symptoms/conditions, such as:

  • COPD
  • Congestive heart failure
  • Kidney disease or failure
  • HIV/AIDS
  • Hypertension
  • Depression or Bipolar
  • Obesity
  • Drug dependency

When a patient goes to a hospital or clinic, especially when he or she has a long-established history at the location, and presents with multiple symptoms, along with the already recorded medical history, they may receive what appears to be preferential treatment, but it may tie directly into the possibility of having a negative outcome if they aren’t treated quickly. There is a lot that happens behind the scenes that most people aren’t able to see and understand, but it is for the benefit of the patient.

Moderate-risk Patients

Though not as severe, nor as urgent in nature, a patient listed as moderately at risk is stated to have anywhere from 3 to 9 different chronic issues. A majority of the population in the United States actually fall into this category simply because it is so broad and because most of us are dealing with a few health problems that are typically managed by medications. For example, if you showed up to the emergency room because of a possible broken arm, that chance of a break would be considered one health issue, add to that slightly high blood pressure and being slightly overweight, and you fit into this grouping.

Obviously, depending upon the severity of the situation, medical professionals will make judgment calls as to urgency in the matter, but you might be waiting with everyone else that is there for a harsh cold or sprained ankle.

Low-risk Patients

Those that are young, in good health, probably don’t have to visit the doctor all that often, and may or may not be on any prescriptive drugs will fall into this category. It does go without saying that most of these patients aren’t the ones bogging down the healthcare system, repeatedly visiting hospitals or clinics, or require much if any personalized care.

At some point or another, we all end up in the care of a doctor, and it can be difficult when you are in pain and have to wait for an appointment or to be seen. We all know that there are some patients that require more medical attention over their lifetime, and in a 2009 study, it was estimated that 5% of the population expanded 50% of the spending on healthcare costs. In a day and age where healthcare costs are constantly on the rise and there isn’t always much more to show for it, this can be frustrating. This is exactly why risk stratification in healthcare was developed: to help control costs and to provide better care, with more positive outcomes.

If a healthcare organization was able to better assess the needs of the patient, not only in the moment that care is being sought but also after they left in the form of personalized care, maybe there wouldn’t be so many instances of hospital readmissions, emergency visits or chronic doctor visits. Those patients deemed as High-risk could greatly benefit from having an advocate to help them on an as-needed basis to answer questions, remind them of visits, help to schedule appointments, and to explain changes that might come with added health issues. Instead of always turning to a healthcare visit, if the patient was able to make a call, or email someone regarding the ongoing circumstances, this would free up physicians to see other patients.

Though this solution may not fit for all High-risk patients, even eliminating a small percentage of the number of patients a doctor must see in a day can help the healthcare system to run more efficiently. And, if High-risk patients received help in the form of personalized care, the number of medical visits may be reduced, and long-term health of many patients could improve because they are not left out on their own or without help to navigate the changes to their life.