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ER vs. Urgent Care vs. PCP: Know When to Go!

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Crystal Greenleaf

on 7 March 2013

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Transcript of ER vs. Urgent Care vs. PCP: Know When to Go!

Urgent
Care According to the American Academy of Urgent Care Medicine, the definition of urgent care is “the provision of immediate medical service offering outpatient care for the treatment of acute and chronic illness and injury” (“What is urgent,” 2013). The following are various signs and symptoms that may warrant a visit to your local urgent care center, according to the National Association for Ambulatory Care (NAFAC) (“Where do I,” 2012): Coughs, colds, sore throats Ear infections Non-life-threatening allergic reactions Fever or flu-like symptoms Minor burns or injuries Eye injuries Sprains and strains Rash or other skin irritations Mild asthma Minor animal bites Broken bones Cost/Insurance According to Anthem BlueCross BlueShield, the average Emergency Room co-pay can cost between $100 and $150 (with insurance). This cost would be much higher for someone with limited or no health insurance (“When to use,” 2011). According to Anthem BlueCross BlueShield, an average co-pay for an Urgent Care clinic visit costs between $10 and $40 (with insurance). Benefits over seeing your Primary Care Physician
(Weinick, Bristol & DesRoches, 2009): Urgent Care centers are usually open on weekends (Primary Care Physicians are typically only open Monday through Friday.) Urgent Care centers generally have extended weekday hours (Primary Care Physicians are typically open during regular business hours (8:00am – 5:00pm). Benefits over the ER: Lower cost - See average co-pay cost comparison between ER and Urgent Care clinics. Shorter waiting times with Urgent Care - Average wait time in the ER is 1 hour (Hing & Bhuiya, 2012). Emergency care vs. urgent care. (2013). Retrieved from http://www.fairhealthconsumer.org/reimbursementseries/urgentemergency.aspx Hing, E., & Bhuiya, F. Centers for Disease Control and Prevention, National Center for Health Statistics. (2012).
Nchs data brief: Wait time for treatment in hospital emergency departments (102). Retrieved from National Center for Health Statistics website: http://www.cdc.gov/nchs/data/databriefs/db102.htm
US Department of Health and Human Services, Healthy People. (2012). 2020 Topics and objectives. Retrieved from US Department of Health and Human Services website: http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=1 Weinick, R. M., Bristol, S. J., & DesRoches, C. M. (2009).
Urgent care centers in the u.s.: Findings from a national survey. BioMed Central Health Services Research, 9(79), doi: 10.1186/1472-6963-9-79
What is urgent care?. (2013). Retrieved from http://aaucm.org/About/UrgentCare/default.aspx
When to use the emergency room. (2011). Retrieved from http://www.anthem.com/wps/portal/ca/popcontent?content_path=shared/f0/s0/t0/pw_b156016.htm&label=When to use the Emergency Room
Where do I go? The emergency room? Or an urgent care center?. (2012). Retrieved from http://www.urgentcare.org/UrgentCareDefined/ERvsUrgentCare/tabid/253/Default.aspx
Edelman, C., & Mandle, C. (2010). Health Promotion Throughout the Life Span. St. Louis, Missouri: Mosby Elsevier.
Health and Human Services, U. D. (2009). Safe Kids USA, Poison Control. Retrieved March 05, 2013, from www.safekids.org
Health and Human Services, U. D. (2013). Healthy People . Retrieved March 05, 2013, from www.HealthyPeople.gov
Physicians, A. C. (n.d.). Medical Emergencies What You Need To Know: Is it an Emergency? Retrieved March 05, 2013, from Emergency Care For You: www.emergencycareforyou.org
Duke Medicine. (2013). Emergency Room, Urgent Care, or Primary Care? Retrieved from DukeHealth.org: http://www.dukehealth.org/health_library/health_articles/wheretogo
Office of Women's Health. (2012, March 6). Family Health: Regular Check Ups are Important. Retrieved from Center for Disease Control and Prevention: http://www.cdc.gov/family/checkup/
Poudre Valley Health System. (2013). Should I go to urgent care or the emergency room? Retrieved from UC Health News: http://pvhs.org/body.cfm?id=2152
Richardson, D. B. (2011). Association between waiting times and short term mortality and hospital admission after departure from emergency department: population based cohort study from Ontario, Canada. British Medical Journal, 342.
Scripps Health. (2013). Should you go to the Emergency Room or Urgent Care? Retrieved from www.scripps.org: http://www.scripps.org/news_items/4231-should-you-go-to-the-emergency-room-or-urgent-care
South Carolina Public Health Institute. (2011). A Report On Frequent Users of Hospital Emergency Departments in South Carolina. South Carolina: South Carolina Public Health Institute.
O'Malley, A. S. (2013, Jan). After-Hours Acces To Private Care Practices Linked With Lower Emergency Department Use And Less Unmet Medical Need. Health Affairs, 32(1), pp. 175-183. EmergencyRoom Primary Care ER vs. Urgent Care vs. PCP:
Know When to Go! The Emergency Room … Know when to go!! Hospital emergency rooms are the one place every single person can go for help from a doctor, no matter what time of day it is, no appointment is necessary, no insurance is required; the law states that no one can be denied access to emergency care. However, once all the hospital beds are full, even very sick patients must remain in the emergency department until beds are available. If the emergency department becomes full, the wait in the waiting room gets longer and longer. Right now, and for the next few years, there is growing concern that the emergency room wait times will be getting longer instead of shorter. In an attempt to help lessen the rate of emergency room overcrowding with non-emergent visits, emergency room physicians recommend going to the closest emergency room if the following symptoms are experienced: Always take these symptoms seriously! Chest pain - (or upper abdominal pain) that will not lessen if a person slows down or changes positions, lasting two or more minutes. Pain that radiates to the shoulder, back or down the arm. Be aware that women may have left jaw pain. Chest pain with sudden shortness of breath, dizziness, sweating, weakness, nausea. Stroke - sudden numbness, weakness in arms, legs, or face and mouth; sudden slurring of speech, mixing of words, speaking “non-sense” sentences, forgetting common words (like, arm, foot, leg, eye, etc.)Blindness or blurring of one or both eyes; dizziness, sudden most painful (ever) headache. Head injury - being hit on the head when accompanied by loss of consciousness, seizure, vomiting, even if those symptoms are experienced a few hours after the head trauma. Loss of consciousness - any time one loses consciousness, passes-out, even if you think you are aware of why, it may be nothing, but could be a circulation problem, a stroke or something else of an emergent nature. Joint or bone deformity - if a bone or joint looks like it is the wrong shape or out of place, swelling, bruising, and accompanied by inability to move or bear weight (like on an injured leg or foot). Bleeding - that cannot be stopped by applying pressure for ten or twenty minutes; any animal bite or puncture wound; any wound that bleeds worse during normal use like bending your knee, or walking; a deep cut where muscle or structures beneath the skin layers can be seen. Burns - that are bigger than two or three inches long, more than one half inch wide, goes all the way around a limb (like the wrist or ankle), blisters or penetrates the top layer of skin, or causes numbness. Pain - that causes profuse sweating, dizziness; pain in the abdomen could be an ectopic pregnancy, appendicitis, ovarian cyst, gallstones, just to name a few. Pain down about the middle of the back could be from a kidney stone, a bladder infection, or a spine injury. High fever - that does not respond to the normal dose of acetaminophen or ibuprofen. Skin abscess, bump, boil or insect bite - that is bigger than a pea; has a red, swollen, and raised area, may be an infection requiring antibiotics. Guidance for parents… Since children may not be able to tell you when they are sick, take your child to the emergency room if they experience any of the symptoms listed above OR any of the following: Difficulty breathing - if they seem to be working hard to get air, have blue lips (or gray lips for darker skinned children); any noisy breathing like wheezing, whistling, or moaning when they inhale or exhale; if they stop breathing AT ANY TIME; call 911! Delirium, confusion, unconsciousness, vomiting, or abnormal behavior any time, be especially watchful after the child has had a fall or head injury. Unresponsiveness - are hard to wake up, do not respond appropriately, or seem “out of it” or excessively sleepy when they are normally awake. Any problems walking or speaking that are out of the ordinary. Fever that does not respond to normal doses of fever reducer (Tylenol, acetaminophen, Motrin) and is accompanied by severe headache, vomiting, neck stiffness, rash, or unexplained bruising. If your child has eaten ANY amount of vitamins, Tylenol, acetaminophen, any other medications, cleaners, soaps, alcohols or products not supposed to be eaten/drank, call POISON CONTROL AT: 1(800)222-1222. They can tell you if you need to go to the emergency room and what information to take with you. The poison control website can be found at www.safekids.org and has much more important information to help parents protect their children from accidental poisoning. Parents can plan ahead… Parents who are prepared can make the trip to the emergency room a much less painful experience for themselves and their child. The following is a list of things you can do to be more prepared if you must take your child to the emergency room: Remain calm and communicate your emergency to the ER staff or ambulance dispatcher. Clear communication will be easier if you can remain calm. Make a list of the child’s/loved one’s allergies and daily medications and take it with you. Take immunization records and contact information for primary doctors. Explain to your child what is happening and be sensitive to their fear. Let the child know that you will be with them even when the doctor is examining them. If you have time, gather items that your child may need if they are admitted to the hospital for the night. Those items may include things like; a change of clothes, stuffed animals, pajamas, toothbrush, a story book, a blanket. Overcrowded emergency rooms threaten access to emergency care for everyone. Know when to go!! The following Healthy People 2020 objectives are relevant to this subject matter.
AHS-8
(Developmental) Increase the proportion of persons who have access to rapidly responding pre-hospital emergency medical services.
AHS-9
(Developmental) Reduce the proportion of hospital emergency department visits in which the wait time to see an emergency department clinician exceeds the recommended timeframe. Again, this cost would be higher for someone with limited or no health insurance, but it would still cost less than a visit to the ER (“When to use,” 2011). Urgent Care Clinics accept walk-ins, and you can often call ahead to put your name on the waiting list. Also, if you go to the Emergency Room with a non-emergent medical incident, your insurance plan may not cover your visit and you may face high out-of-pocket costs (“Emergency care vs.,” 2013). For those who do not have an emergency situation, an Urgent Care clinic would cost less for those both with and without health insurance. Primary Care General Health Issues Symptoms that come on gradually Minor injuries, aches, pains
•Sprains, Strains or possible broken bones
•Headache
•Sore throats
•Coughs
•Ear Infections
•Fever
•Minor burns
•Small lacerations Unexplained weight loss/gain Routine maintenance of chronic conditions
•Updated prescriptions
•Medication changes Preventive Health & Wellness Routine Check Ups
•Well-Baby check ups
•Well-Woman check ups
•Well-Man check ups
•Annual Wellness Visits
•Immunizations Disease Screening
•Breast and Cervical Cancer Early Detection (women)
•Cholesterol
•Diabetes
•High Blood Pressure
•Oral Health for Adults
•Prostate Cancer Screening (men)
•Skin Cancer
•HIV/AIDS
•Viral Hepatitis
•Sexually Transmitted Illnesses Though we cannot provide medical advice, the goal of this tool is to provide first-time parents with information that may help to make a decision on which type of health care facility to visit based on the severity of presenting signs and symptoms. As new parents, anxiety and concerns often arise, especially when it comes to providing health care for their children. Objectives By the end of this presentation, the reader will be able to:
Verbalize three signs and symptoms that may warrant a visit to each of the three types of health care facilities.
State two reasons for using the Emergency Room for emergency situations only. References This topic is relevant to the overall health and wellness for this age group as well as for society in general.

First, with the knowledge of the differences between the Emergency Room, Urgent Care, and Primary Care Physician (PCP), first-time parents and the general population can make educated decisions on where to go based on presenting signs and symptoms. If their situation is not critical, going to an Urgent Care center or visiting their PCP could save them both time and money and get them on the road to recovery more quickly.

On the other hand, in an effort to save money and time, people may go to their PCP or to an Urgent Care center when they have a situation that is actually an emergency. However, Urgent Care centers and PCPs are not equipped to provide the care that emergent situations require. Therefore, they will likely send the patient on to the Emergency Room. Again, having the knowledge of the differences between these three types of health care facilities will eliminate confusion, save time, and create a more positive health care experience for both first-time parents and society in general. Relevance to Health and Wellness The following Healthy People 2020 objectives are relevant to this topic:
AHS-5
“Increase the proportion of persons who have a specific source of ongoing care” (“2020 Topics and objectives,” 2012).
AHS-9
“(Developmental) Reduce the proportion of hospital emergency department visits in which the wait time to see an emergency department clinician exceeds the recommended timeframe” (“2020 Topics and objectives,” 2012).
AHS-5
“Increase the proportion of persons who have a specific source of ongoing care” (“2020 Topics and objectives,” 2012). Healthy People Objectives: Facts
•Primary Care Providers are better able to maintain an individual’s health as they have more in-depth knowledge of health over time (Scripps Health, 2013).
•Individuals lack primary care providers due to high costs and so use emergency rooms (South Carolina Public Health Institute, 2011).
•Individuals seek care in emergency rooms because their providers are difficult to reach (O'Malley, 2013).

Risks
•Crowded ERs making death more likely (Richardson, 2011).

Actions
•Establish a primary care provider.
•Call your primary care provider to determine if concerns can wait for an appointment. (The cost of calling is cheaper than ER costs.)

Recommendations
•Research the effects of educating new parents on signs and symptoms requiring emergency, urgent, or primary care.
•Educate public on affordable to free primary healthcare options.
•Develop 24 hour primary care facilities. Some Overall Key Points... Immediate threat to life, limb, or eyesight Regular health and wellness maintenance and concerns that can wait Concerns that can't wait, but are NOT life threatening If you or your child/loved one has any of the signs and symptoms mentioned, consider visiting an Urgent Care center! Source: today24news.com
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