ER or urgent care, what’s the best choice?

February 21, 2012

Doing research in advance can assist decision making when a crisis occurs

By Christy Schulte, For Healthy Connections

Whether a broken bone, difficulty breathing or a cut that needs stitches, chances are, at some point you will be faced with an unexpected medical situation and will need to decide the best place to seek treatment. The emergency room used to be the only option, but with the explosion of urgent care centers and retail clinics, patients now have more choices than ever before. Even with so many alternatives, emergency rooms visits have been on the rise, whether out of convenience or lack of knowledge.

“Emergency rooms should be used if you have a serious enough problem that you need to be admitted to the hospital, like a heart issue, head injury, major burn or severe shortness of breath,” said Dr. Gail Croall, senior medical director for CareSource. “The primary purpose of an urgent care center is to treat injuries and illnesses that are less serious, but still require immediate attention.”

More than 66 percent of emergency room visits by Medicaid patients are considered potentially avoidable, with commercial insurance patients close to 60 percent, according to Croall. “Going to the ER for non-urgent care fragments our health care system. Sometimes people perceive they’re getting better care in the ER, but there is no continuity of care.”

Most major insurance companies offer their members a free 24-hour nurse line to help make medical decisions when the primary care physician is unavailable. “These lines have standard protocols that are certified for triage. They can give you things to do on your own at home to treat the problem or help you determine the best place to receive treatment,” Croall said. Anthem, United Health Care and CareSource are just a few companies that have these service lines available for their members.

By moving non-emergency treatments to urgent care centers, the wait time in emergency rooms can be reduced.

“The average wait time at our urgent care center is less than one quarter the wait time for the ER,” said Brian Barberic, director of marketing for Hometown Urgent Care.

Reduced wait times aren’t the only benefit. Choosing the appropriate level of care can save hundreds or thousands of dollars.

“The average minor injury cost at the ER is $1,200 and usually $200 or less at an urgent care center,” Barberic said. “The average co-pay can be $75 to $100 at the ER and is generally $20 to $50 at an urgent care facility. Each visit will save, on average, over $1,000 in healthcare costs.”

Emergency rooms

Conditions that should be treated at an emergency room include chest pains, difficulty breathing, loss of consciousness, traumatic injuries that could include excessive bleeding, a head injury or severe pain. Major broken bones like a leg or arm fracture would most likely need to be treated at the emergency room. In a severe emergency, 911 should be called because the immediate medical treatment provided by the ambulance personnel on the way to the ER can be life-saving.

Emergency rooms connected to a federally funded hospital are required to be open 24 hours, seven days a week.

Urgent care centers

Urgent care centers can usually treat most minor injuries and illnesses like sprains and strains, coughs, colds and sore throats, ear infections, fever or flulike symptoms, rash or other skin irritations and animal bites. They can also take care of minor broken bones like fingers, toes and collar bones. When in doubt, call and ask if they can treat a certain condition.

One of the difficulties in seeking treatment at an urgent care center is that staffing, equipment and hours of operation vary from center to center.

“Hometown Urgent Care employs physicians, physician assistants, medical assistants with X-ray capabilities and registered technicians,” Barberic said. Hometown is open seven days a week and has the capability to handle X-rays, lacerations, EKGs, blood work and prescriptions. While most of these are standard at urgent care facilities, it’s best to call ahead.

Since decisions need to be made quickly during an emergency, it’s good to be prepared by finding information on treatment options before an emergency. Ask a doctor about local centers or search for urgent care centers in your zip code. Make a list of four or five nearby urgent care centers. Keep all information in a folder, including maps, directions, hours and which insurance plans they accept. Hours of business often differ between centers. Call ahead before you go, in case information has changed.

Retail clinics

Many pharmacies, supermarkets or other retail stores now offer some type of urgent care that is usually staffed by a nurse practitioner. These are good places for getting a flu shot, having your blood pressure checked or having a rapid strep test. Routine physicals, treatments for minor illnesses such as allergies, rashes, pink eye, insect bites and ear infections can also be treated. However, they usually do not have diagnostic equipment and cannot run lab tests or take X-rays.

Retail clinics accept most major insurance policies and have a pharmacy on-site for filling prescriptions. In addition, most have convenient hours, including evenings and weekends.

Treating kids in an emergency

People tend to go to the emergency room if they’re worried, especially with a child.

“This is where a nurse line can help you determine if there is a clinical difference between a 101 and 104 degree fever that your child has,” Croall said.

The age of the patient should also be taken into consideration. “Urgent care centers usually have general practitioners who may not be comfortable treating a six-week old infant with a fever. Usually they can handle lacerations though.”

Dayton Children’s has its own urgent care center.

“We encourage families to choose a children’s urgent care because our pediatric experts know how to best take care of kids, said Jessica Saunders, community relations manager. “We have the right sized equipment, know proper medicine dosing and see kids all day so we have the most experience working with children.”

Physicians at Hometown Urgent Care are also trained in the treatment of children.

“We provide specialized training to make sure our physicians are comfortable treating children of all ages,” Barberic said.

With all of the options available, conducting research ahead of time can help you be ready to choose when a crisis occurs.

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