I don't like this patient: instinct and experience that save lives in the ER

In the heart of Ljubljana’s General Emergency Medical Care (SNMP) facility, nestled within the premises of the Health Center Ljubljana's Urgency Center, the morning air was unusually calm despite the usual bustle. The atmosphere, typically charged with urgency, had momentarily settled into a rare stillness. However, this quietude was fleeting, by evening, the emergency room would once again be overwhelmed with patients seeking care, each bringing their own unique set of health concerns, anxieties, and expectations. March last year marked the introduction of a groundbreaking organizational innovation at the urgent care units: the so-called “consultation during triage.” This initiative, implemented due to the consistently high volume of visits and the extreme workload faced by emergency staff, has proven to be both necessary and effective. It allows specially trained triage nurses to provide detailed professional advice to patients whose conditions are not immediately life-threatening. These consultations occur after the initial triage process and are intended solely for individuals who do not require urgent medical attention but are willing to accept such guidance. Approximately five percent of all patients conclude their visit at this stage. Sometimes, the conversation alone can ease a patient’s worries. Among those visiting the SNMP are individuals dealing with minor ailments, such as sore throats, earaches, or insect bites, and others who feel more comfortable receiving immediate assistance rather than waiting days for an appointment. Nastja Tomažič, an experienced and dedicated triage nurse employed at the Health Center Ljubljana for sixteen years, explains the process. She emphasizes that empathetic and professionally informed dialogue often suffices to calm patients and restore their sense of security. Some patients come to the SNMP because they have no personal physician, are dissatisfied with their current care, or simply prefer not to wait for an appointment. For them, the emergency setting offers an accessible alternative, a nearby point of contact for comprehensive care. Despite the fast-paced environment, Nastja’s workday begins with coffee, though it’s usually consumed during breaks and in between shifts. Her team regularly holds briefings to coordinate tasks and anticipate the day’s flow. The rhythm of work in the emergency department is unpredictable, as patients arrive unexpectedly, and the influx is constant, requiring no prior scheduling. “Sometimes we start the day with ten patients waiting, sometimes there are none,” she describes, highlighting how even the most tranquil days have become increasingly rare. The calmness of the working day depends not only on the number of patients waiting in the clinic but also on the number and complexity of interventions required on-site and the overall staffing levels. When the team of doctors and nurses is fully available, even amid the chaotic pace, operations run smoothly and organized; however, if three doctors must urgently respond to field calls and only one or two remain in the clinic, the pressure and waiting times quickly increase. The role of triage requires exceptional composure, high professionalism, and a subtle detective-like intuition. Every patient arriving at the SNMP is carefully assessed using the Manchester Triage System, considered the gold standard in emergency medicine and representing a strictly defined, standardized protocol for categorizing patients based on the severity of their condition. Nastja Tomažič explains that this algorithm forms the foundation of their work and must be followed meticulously. Upon arrival, a patient outlines their primary concern. If the issue involves chest pain, a detailed inquiry follows, focusing on specific symptoms and potential underlying causes.