Emergency room blues: what you need to know before you visit the hospital.

EACH YEAR, MILLIONS OF AMERICANS UNDERGO THE sometimes frightening and traumatic experience of visiting the emergency room of a hospital.

However, unnecessary ER visits can delay care for people with true emergencies and cost patients billions of dollars. According to the Medical Expenditure Panel Survey, conducted by the Agency for Healthcare Research and Quality in 2003, the average expense for an emergency room visit was $560 compared to $121 for a trip to the doctor's office.

"People use the emergency department as their primary physician a lot of times," says LaKenya Linton, a former emergency room nurse for Children's Hospital in Philadelphia. "The reason there is such a wait is because the ER has a lot of nonemergency issues to deal with," she says, such as the common cold, earaches, and sprains. "People don't realize that there are different levels of illness, so if people who come in after you are sicker than you, then we have to see them first."

Read on to find out how to help reduce anxiety and ensure a smoother process should you or a loved one require emergency services.

Here are 10 things you need to know when you visit the ER:

1. Know when to call 911. When you are facing a life threatening situation such as loss of consciousness, breathing trouble, or excessive bleeding, calling 911 may be your best option. Be aware that you lose the opportunity to choose the ER because paramedics are required to take you to the closest hospital.

2. Don't go to the emergency room alone. Bring someone to keep you company, provide information, and take treatment instructions. "if you do not speak English, bring a translator, or ask for one when you arrive," says Linton. "The ER has a translation line or an interpreter."

3. Keep important medical information on you. The American College of Emergency Physicians recommends keeping an "emergency file" containing your insurance cards, a list of medications, chronic conditions, and operations you have had. It is also important to know the time that you last took your medications and the dosage.

4. Be prepared to wait. On average, patients spend a little more than three hours in the emergency room, according to the Centers for Disease Control. The longer wait is because people tend to migrate to the ER on weekends.

5. Always ask questions, When you receive any treatments, ask what is being done and why. Once the results come, you need to understand what they mean. If you don't understand something, ask questions.

6. Know your insurance coverage. While emergency departments are federally mandated to care for patients regardless of their ability to pay, be sure to ask about outof-pocket expenses.

7. Be honest about your injury or situation. "if you did something embarrassing, don't be ashamed to tell the staff," says Dr. Everett A. Cantrell, the ER physician for Warm Springs Medical Center, located in Georgia. A concocted story could delay the appropriate treatment.

8. Ask for privacy if you need it. If you need privacy, ask the staff and they will make sure you have it. Whether you're pregnant or taking Viagra, if you don't want your partner or relative to know, ask for privacy.

9. Get all your discharge instructions in writing, lake sure you know how to care for yourself and what to do if your symptoms should worsen Also, read the instructions carefully,

10. Don't keep returning to the ER. "Don't use the ER as your primary physician," explains Linton. "if the symptoms have worsened, return to the ER. However, if you are the same or better, then follow up with your primary care physician."