Posted by Brigham and Women's Hospital March 22, 2016
Your daughter just twisted her ankle while playing outside, and her foot and ankle have become quite swollen. Are you unsure about whether to bring her to an emergency department (ED) or to an urgent care center? Either option is appropriate, but you might be surprised to learn that most urgent care centers can handle many of the bumps, bruises, and minor illnesses that previously were only seen in the ED.
Dr. Calvin A. Brown III, Medical Director of the Urgent Care Center at Brigham and Women’s/Mass General Health Care Center in Foxborough, says that the recent advent of urgent care centers has created a valuable health care resource. They help patients who desire – and probably need – immediate, same-day care, but who aren’t able to get an appointment with their primary care physician and wish to avoid a trip to the ED. The wide variety of medical issues that urgent care center clinicians can treat include sprains, simple fractures, small lacerations, abscesses, bronchitis, asthma attacks, allergies, urinary tract infections, ear infections, low-grade pneumonia, concussions, and many other conditions.
“There are certain issues, like a sprained ankle, that we can handle very effectively and efficiently at an urgent care center, with outcomes similar to what you would get at an emergency room,” says Dr. Brown. “But there are a lot of cases where it’s probably not appropriate to go to an urgent care center.”
Dr. Brown says that patients with severe abdominal pain, a wound infection, difficulty breathing, or chest pain – which might indicate a heart attack – should go to an emergency room. An ED has more resources for dealing with these complex and severe medical conditions, such as greater access to specialists and advanced diagnostic and treatment technologies.
First-Come, First-Serve vs. Triage
Dr. Brown, who is specialty trained in emergency medicine, has treated many patients in both an emergency department setting and an urgent care center. That combined experience gives him a keen sense of when a patient waiting in an ED could have saved a lot of time by going to an urgent care center.
No appointment is required at either an ED or an urgent care center, but how they respectively prioritize care upon a patient’s arrival is quite different. Patients are generally seen on a first-come, first-serve basis at an urgent care center. EDs, on the other hand, use triage, a system that prioritizes patient treatment according to the severity of a patient’s condition. This means that a patient who chooses to seek care at an ED for a sprain or other lower-priority condition may have to wait awhile before receiving treatment.
“In general, the wait time at an urgent care center is much less than what you would expect at an emergency department,” says Dr. Brown. “Our wait time is on the order of minutes, while some emergency departments, at their busiest times, can be an hour or more.”
Dr. Brown also notes that ED visits for minor conditions can be a public health issue. While many consumers may not incur large out-of-pocket costs for ED visits, the compounded effect of those visits on overall health care costs is significant. The total bill for treating a specific condition at an ED can be many times higher than what it would cost to treat the same condition at an urgent care center. Such differences, in turn, contribute to higher health care costs.
Dr. Brown, however, suggests that a safe choice is a wise choice when a patient has a serious condition and is unsure about what to do.
“I think it makes sense to err on the side of caution and go to the hospital if you suspect a serious illness or a serious injury,” says Dr. Brown. “We can always do an initial evaluation at the urgent care center, but there’s a good chance that we’ll end up transferring you to a hospital for further evaluation and treatment.”
– Chris P.