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Urgent Care or ER? Don’t Make The Wrong Choice

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WASHINGTON — With the holiday season here — along with increases in decorating injuries, falls from ladders and illnesses related to rich food — emergency physicians are concerned that people are confused about when to seek medical care in emergency departments. Nearly three-quarters (71 percent) of emergency physicians responding to a poll said they treat patients every day who ended up in the ER after first seeking help in urgent care centers that were not equipped to care for them.

Ninety percent of emergency physicians said one of the top reasons patients are redirected to emergency departments is because the patients’ medical conditions were more serious than could be treated in an urgent care setting, according to the on-line poll conducted by the American College of Emergency Physicians (ACEP).

“Many people may feel they are saving time or money by going first to urgent care, but in instances of serious illness, that loss of time can be dangerous, said Dr. Jay Kaplan, president of ACEP. “Urgent care centers are great options for common medical problems, but they are not substitutes for emergency care.”

More than half (54 percent) of emergency physicians say that urgent care centers are marketing themselves as alternatives to the emergency department, sending a dangerous public health message.

“Urgent care centers don’t have the same equipment and staffing as an emergency department,” said Dr. Kaplan. “They treat minor illnesses and injuries, such as sprains and minor cuts requiring stiches. They don’t have the capabilities that emergency departments do for complex diagnoses and treatments.”

Sixty-five percent said that limited equipment and staffing at an urgent care center was another top reason for patients being redirected. A study in Chicago at BroMenn Medical Center confirmed the concerns by documenting several cases of patients with chest pain who needed transportation to the emergency department for additional medical care.

In addition, the most recent data from the Centers for Disease Control and Prevention shows that an overwhelming 96 percent of patients who were triaged needed medical treatment within 2 hours, an increase from 92 percent in 2010. The percentage of patients triaged as non-urgent (needing care in 2 to 24 hours) dropped in half from the previous year’s report (from 8 percent to 4 percent).

This poll suggest that the growth of urgent care centers may be increasing health care costs.  Forty percent of emergency physicians said it’s increasing the use of health care resources, such as physician visits, medical testing and procedures. Despite the proliferation of urgent care centers, more than half said emergency visits have increased (16 percent of respondents) or there were no changes in the number of visits (39 percent of respondents).

“Emergency departments are prepared for every kind of medical emergency, including heart attacks, stroke, motor vehicle crashes, psychiatric emergencies and other life-threatening conditions,” said Dr. Kaplan. “They are open 24 hours a day, every day of the year and have special equipment and highly qualified physicians, assistants and nurses to respond to every kind of adult and childhood emergency. If you think you’re having the symptoms of a medical emergency, get to the nearest emergency department. If there’s any doubt in your mind, go to the emergency department and let us make the call.”

Only 9 percent of emergency physicians responding to the poll were confident that urgent care centers in their areas have access to on-call specialists. Almost 90 percent of emergency physicians said they have at least one urgent care center within 10 miles of their emergency department. Only 40 percent said that all of the urgent care centers in their area are staffed by physicians on site.

Most urgent care centers accept health insurance, but require payment at the time of service.  Urgent care centers also do not have a federal mandate to treat patients, regardless of their ability to pay, unlike emergency departments which fall under the Emergency Medicine Treatment and Labor Act (EMTALA). When asked, nearly half of emergency physicians think urgent care centers should be subject to EMTALA regulations as well and almost three-quarters believe that states should also have specific staffing or equipment criteria for urgent care centers.

Emergency Care or Urgent Care?

Seek urgent care for minor medical conditions or for a medical condition that could be treated in your family physician’s office, but the office is closed.

Seek emergency care if you think you may be having a medical emergency. The following are examples of warning signs of a medical emergency:

·         Difficulty breathing, shortness of breath

·         Chest pain or upper abdominal pain or pressure lasting two minutes or more

·         Fainting, sudden dizziness, weakness

·         Change in vision

·         Difficulty speaking

·         Confusion or changes in mental status, unusual behavior, difficulty walking,

·         Any sudden and severe pain

·         Severe or persistent vomiting or diarrhea

·         Coughing or vomiting blood

·         Suicidal or homicidal thoughts

·         Unusual abdominal pain

·         Severe headache or vomiting after a head injury, unconsciousness, uncontrolled bleeding

Methodology:

Marketing General Incorporated conducted the poll on behalf of ACEP. This survey was conducted online within the United States by Marketing General Incorporated on behalf of the American College of Emergency Physicians between September 1-8, 2014, among 2,853 emergency physicians age 18 or older, providing a response rate of approximately 11 percent and a margin of error of 1.8 percent. To see the complete poll results, please click here or contact Mike Baldyga at mbaldyga@acep.org or 202-370-9288

ACEP is the national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.

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