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Tuesday, February 14, 2017

Emergency room or urgent care? Knowing where to go, and when

Posted By on Tue, Feb 14, 2017 at 9:00 AM

click to enlarge emergency_sign.jpg

A trip to the emergency room is rarely a happy one.

As if an injury or illness isn’t harrowing enough, throw in notoriously long ER wait times and the fear that the coughing person in the next seat is contagious. It’s no wonder that people who experience an acute complaint end up going to urgent care or treating it at home instead.

Many factors affect the decision to go to the emergency room or urgent care, but there are medical reasons to keep in mind that dictate which option is best.

Dr. Matthew Bernard, director of Touro Infirmary’s emergency department, has heard all the usual gripes about ER management. He and the other practitioners in Touro’s emergency department see about 100 patients a day for reasons ranging from broken bones and dislocated joints to schizophrenia. Bernard even sees people with twisted and sprained ankles from stepping into potholes.

The idea that ERs peak at night and on weekends probably turns people away from the emergency department during a crisis. However, Bernard says, that is a popular misconception.

“It’s relatively constant across all ERs I’ve worked in (that) weekends are slow. Monday mornings are our busiest times. We don’t see as many people at night either. 10 a.m. to 10 p.m. are our busiest hours, and is when we have the most doctors and nurse practitioners on the clock,” he says.

A trip to the ER doesn’t necessarily mean a long layover in the waiting room, either.

“(Doctors) typically touch patients in about 7 minutes,” Bernard says. “It’s a customer service industry — we feel like we should treat people well in the emergency department. They are having their worst day when they see us.”

Touro’s Fast Track area helps keep wait times short by facilitating the admission and discharge of patients with less serious complaints. The unit also has more advanced monitoring equipment than traditionally would be found at urgent care facilities.

Still, urgent care is convenient, sometimes more so than the nearest emergency room, especially if the illness or injury doesn’t seem dire. It’s important to know what symptoms require what treatment, Bernard says, and it’s equally important to know where to go.

click to enlarge Both urgent care and emergency room facilities have basic diagnostic equipment, such as digital x-ray machines.
  • Both urgent care and emergency room facilities have basic diagnostic equipment, such as digital x-ray machines.

Urgent care and emergency care are similar because both possess diagnostic tools such as body fluid analysis and X-ray machines, and both are staffed by physicians, nurse practitioners, nurses and medical residents. An urgent care facility is fully equipped to handle ailments such as minor sprains or cuts, low-grade fevers and persistent sore throats or other cold symptoms.

When someone is experiencing more acute trauma — a possible fracture or broken bone, persistent weakness associated with a lingering illness or any severe pain — that person should check in to the nearest ER. This flu season has been particularly brutal, Bernard says, and even healthy young people have found themselves in the emergency room with fatigue and increasingly severe symptoms.

“Chest pain, stroke-like symptoms like tingling or numbness, severe abdominal pain … or any significant shortness of breath are indicators that you should go to the emergency room right away,” Bernard says. These complaints may be symptomatic of a serious problem, and the longer dangerous conditions persist without medical attention, the more damage is done.

“When people come in, it’s important for us to recognize symptoms and react with blazing speed,” he says. “Heart conditions need to be treated within 90 minutes (of arrival), and strokes within 20-30 minutes. Every minute matters. Time is tissue.”

Emergency departments are staffed with personnel trained and certified by the American Board of Emergency Medicine, and they can admit patients directly into the proper hospital ward if the patient needs more intensive treatment. ERs also have access to a broad range of specialists and tools to provide advanced care. Urgent care, as a stand-alone facility, usually does not have these resources.

Whether an ailment requires urgent care or the ER, patients should follow up with a primary care physician (PCP) immediately following the incident. Urgent care is thought of as a quicker alternative to waiting for an appointment with a PCP, but ideally, they work together, Bernard says.

If a patient hasn’t named a PCP, it should be a priority. ER and urgent care physicians are trained to find and remedy problems, but a PCP is trained to find underlying issues before they become problems.

“Urgent care and the ER are like having AAA (roadside assistance), but a PCP is where you go for a tune up and an oil change — the things that help you get more mileage,” Bernard says. “It’s preventive maintenance versus an acute incident.”

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