Emergency Room Vs. Urgent Care: Knowing Which Is Needed

If you’re sick or have been injured, you might wonder whether a hospital emergency department or urgent care clinic is the right place to be treated.

The American College of Emergency Physicians (ACEP) offers some general advice, to help take the “guesswork” out of deciding where to go when prompt medical attention is needed.

The Emergency Department

Go to the nearest emergency department if a medical emergency is suspected.

“The emergency department is the best option for concerning symptoms, severe illness or injury, and we’re open 24/7, 365,” said ACEP President Dr. Christopher Kang. “Emergency physicians are ready to help anyone who needs them — we are trained to treat every kind of medical emergency.”

“Knowing when and where to go in a health emergency can save a life,” Kang said. “If you need care for a severe illness or injury, or if you’re unsure about what’s wrong and your regular physician is not available, an emergency physician will always be there for you.”

Emergency departments have the advantages of having advanced medical equipment and rapid access to hospitals’ operating rooms and intensive care units, if such care is needed. Emergency departments are staffed to handle more complex care for severe health issues, the ACEP said in a news release.

Some of the most common reasons to seek emergency care include trouble breathing, chest pain, uncontrolled bleeding, seizures, severe abdominal pain, head injuries, sudden severe headache or dizziness, and sudden weakness, confusion or disorientation.

Dr. Gary Gaddis is an experienced emergency department physician, served as Professor of Emergency Medicine at the Washington University School of Medicine, and is currently a Teaching Professor of Biomedical and Health Informatics at the University of Missouri-Kansas City School of Medicine. He points out, “Many people are unaware that emergency medicine has been an officially recognized medical specialty since 1979. All emergency physicians board-certified by the American Board of Emergency Medicine have completed an emergency medicine residency which has specifically trained them how to evaluate and manage a very broad range of mystery injuries or ailments.”

Dr. Gaddis adds, “Emergency departments are required by a law known as ’EMTALA’ to evaluate all patients who arrive for a medical evaluation, to determine whether an ’emergency medical condition’ exists in those persons, and then to treat or attempt to stabilize the condition of anyone who manifests evidence of a possible medical or surgical emergency, regardless of their ability to pay or their insurance status.

“This guarantee does not require emergency departments to provide medical care at no cost to the patient. Uninsured patients will eventually receive a bill for services rendered. However, the guarantee does assure that a patient’s medical well-being takes precedence over the financial issues that can be worked out later. For patients of limited financial means, hospitals and emergency physicians will often agree to a discounted payment plan, adjusted to a patient’s income level, as documented by recent year tax returns.”

Urgent Care

Urgent care is a vital part of the health care system, the ACEP president noted, and is a good option for minor medical issues, especially after-hours or on weekends when you can’t see your primary care doctor. However, most urgent care centers are not equipped to substitute for emergency care.

Urgent care tends to be the right choice for symptoms such as a modest cough, runny nose, sore throat, rashes, minor cuts, an upset stomach, pink eye and other seemingly mild symptoms, as well as for minor injuries such as suspected joint sprains and lacerations. Dr. Gaddis notes, “Some bony fractures can be handled by urgent care centers, but many cannot. It is difficult to expect most lay people to know at the time of an injury whether fracture care beyond simple splinting will be necessary, so it is difficult to give airtight advice regarding how to address such an injury.”

Urgent care centers often require proof of health insurance or the presentation of a charge card before initiating an evaluation of a patient. Importantly, urgent care centers often decline to accept Medicaid as a form of payment, because Medicaid, a federally funded and state-operated form of payment for health care goods and services, technically is not a form of health insurance.

The understandable belief that Medicaid is health insurance is pervasive among those covered by the Medicaid program. However, Medicaid is a federal entitlement program that reimburses physicians and hospitals at rates markedly lower than is paid by Medicare or health insurers. In any case, urgent care centers require payment when services are delivered, and many can accurately estimate a patient’s insurance “deductible”, and thus expect payment for the patient’s share of expenses as part of the discharge process.

When to call 911

In an emergency that requires on the spot attention, dial 911 from your phone immediately. This includes any situation that requires immediate assistance from an ambulance and/or paramedics.

When you call 911, be prepared to answer the call-taker’s questions, which may include: n The location of the emergency, including the street address. (Some patients may know that many municipalities adopted “Enhanced 911” (E911) in earlier decades, but this form of 911 activation requires the presence of a land line phone to function effectively. “E911” cannot be expected to accurately accommodate for the location of a caller using a mobile phone.) n The phone number you are calling from n The nature of the emergency n Details about the emergency, such as a physical description of injuries or symptoms being experienced by a person having a medical emergency.

Remember, the call-taker’s questions are important to enable dispatch of the right kind of help to you quickly. Be prepared to follow any instructions the call-taker gives you. Many 911 centers can tell you exactly what to do until help arrives, such as providing step-by-step instructions to aid someone who is choking or needs first aid or CPR. Do not hang up until the call-taker instructs you to do so.

What This Means for You

Consider the severity of symptoms when deciding whether to visit urgent care or the emergency room and when to call 911. Dr. Gaddis adds, “When in doubt, err on the side of caution and access care in an emergency department. Symptoms such as severe bleeding, trouble breathing, chest pain and seizures require emergency care, but so do many other symptoms. It is difficult for most lay persons to predict how serious their condition is with 100% accuracy. Heavens, even doctors or nurses can’t do that! It is only after they deploy their knowledge and training, obtain a patient history, perform a physical examination, and order lab tests and/or X-rays that such a determination can be accurately reached.”

SOURCES: American College of Emergency Physicians and 911.gov

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