Welcome to the Jungle.
I come to you from my standardized-faux-wood, beige on beige on beige, confetti-foam-ceiling-tiled, not really "my" office office. The patients are filing in. The aroma of CaviWipes is in the air. <one of my favorite smells>. Kills everything. Including livers.
And damn the bad luck for us healthcare workers 'cuz our livers are already living on the edge. It's fine.
This episode of the blog is brought to you by me. But it was actually a reader request!!
How cool is that?
I had considered doing this topic but brushed it off as maybe being something only me and my fellow urgency and emergency workers care about... But, as it turns out, 1 other person cares about it as as well. Let's gooooo!
We live in an era of fast. Fast food. Fast response times. Fast technology. Fast cars. Fast internet. Fast relationships. Impatience. General self-neglect. Woops. Walked right onto a soap box - who put that there?
It's no wonder that Urgent Care clinics have popped up on damn near every corner in medium to large cities. We also live in an era where insurance is barely affordable and there are a whole lot of people "in the middle" who make too much for government-funded health care, and too little to buy insurance on their own. Or, there are those people in the middle that choose to have insurance over other things. And then there's that deductible that you have no money left over to meet because the PREMIUM TOOK ALL YOUR MONEY. So you still avoid the doctor.
Geezus Mary and Joseph it's a clusterf**k ain't it? So, where do all of you end up because primary care doctors have a 6 month wait and then their schedules are completely booked for 2 weeks and then they are closed half a day on Friday and then their visit charge is $125 and it's March and you can't even holler at your deductible cuz it's so far from met?
Urgent Care dingdingdingdingding!!
I just so happen to work at an Urgent Care as an NP, and might I say we do a darn good job. We are nice people and we are pretty quick. "Nice". Ew Ugh. I hate when people use "nice" as the main descriptor of their healthcare provider. "Nice" is not in my top 5 of what I care about when seeking a doctor or NP/PA for a medical problem. In my day, I've seen a lot of bad nursing and bad medicine hide behind "nice". #ReverseSoapBox #SteppingDown
In a former life, I also worked in an Emergency Department. It's not a "Room" anymore. It's a
lot of rooms. It's a whole department, or jungle as I lovingly referred to it. So, I do feel I can
speak to the topic, of what is and is not appropriate for an Emergency Room versus an Urgent Care Clinic.
This discussion could go on and on and on and on and it's the song that never ends my friends, but there are some things that are a always or often a no-go in an Urgent Care and some other things that the ER is not the place for.......
This one might be short. Might be a novel. Idk.
SO, allow me to clarify!
Urgent Care clinics are meant for things that can't wait a week, maybe at times can't wait 'til the next day to be addressed. Urgent Care is meant for things that are simple to take care of. The Urgent Care I work in is unique, because it is part of a hospital system that focuses it's care on people who have Medicaid, no insurance or are indigent (definition: suffering from extreme poverty). (1) We do a lot of referrals within our system to primary care providers, specialists, and we do a lot of medication refills, and seeing patients who cannot get appointments with their established providers. All good.
Here's a list of many of the most common reasons patients can and will go to an urgent care:
Bladder Infections/Urinary Tract Infections
Upper Respiratory Infections - ALL flavors
Sexually Transmitted Disease exams
Chronic Back Pain/Other musculoskeletal pain (knees, shoulders, necks, foots)
Gastroenteritis ("stomach virus") and/or dehydration from that
Abscesses ("Boils" or "Cysts" they want drained)
Pregnancy Testing (yes, you read that right)
School or Work or Sports Physicals
Immunizations or Immunization Titers (checking to see if you need boosters by drawing blood)
Problems after surgery
Tooth Pain/Cavities/Mouth Infections
and much, much more!
Now, most of these things can be handled in the Urgent Care, and if you see your problem on the list, it's not your job to know if you are having a little "extra" going on and need to be seen in the ED or by your specific doctor. That's our job to decide.
The Emergency Room is meant for just that - EMERGENCIES!
The ER is meant to treat and stabilize medical conditions that can't wait 5 minutes, or 1 hour, or 12 hours. If you will deteriorate or die within the next minute to few hours - you belong in the ED.
Emergency Departments all across America have adapted, because people use the ED for things they shouldn't, by the dozens or hundreds, every day. Because we're adaptable, roll with the punches types of people. There are "fast-tracks" or "quick-care" beds within EDs for minor/urgent-care-appropriate patients. HOWEVER - the charges are always $$$, especially if you go during the night. Even seeing a nurse practitioner or a physician assistant in the ER will be more expensive than your regular doctor or an urgent care... because they get paid more... because they work in a place meant for "higher acuity" = sicker and sickest patients.
"Approximately 13.7 to 27.1 percent of all emergency room visits could have been treated at an urgent care center, resulting in a savings of $4.4 billion each year." (2) Remember those insurance premiums? It's not just their fault, or the government's fault - it's our collective fault too.
A collection of things that belong in the emergency department, this list could never ever be all-inclusive, because you humans are innovative and creative and y'all come up with new stuff all the time:
You are dead - Someone is doing chest compressions on you and hopefully calling an ambulance.
You are almost dead - you are drifting in and out, feeling like you will pass out, you are too weak to sit up or walk.
You find yourself missing a limb, whether that be a hand, arm, foot, or leg from a car accident, machine accident, saw accident, family quarrel, etc.
You have been shot or stabbed. Or perhaps run over by a vehicle.
You are having a stroke: You may not be able to speak, or you may not understand what people are saying to you, you can't move one side of your face, or even one whole side of your body.
You are so short of breath, that you cannot speak a whole sentence, or walk from room to room in your home.
You are having any degree of chest pain that perhaps radiates (goes to other places like your neck, upper back or left arm), feels like a squeezing or heaviness, is making you dizzy and/or nauseated, you are age 40 or older. Or younger if you have a history of heart surgeries/problems or you have 1st degree relatives that do (mom, dad, sibs).
You are having an asthma attack, and the medications you have on hand aren't working. You are becoming more and more short of breath despite taking inhalers.
You are having a severe allergic reaction and your face, lips, tongue, or throat are swelling. Your voice isn't coming out or it is very high pitched, you feel anxious and can't breathe.
You are having severe abdominal pain, difficulty standing or walking because of it, with or without fevers, with or without vomiting/pooping blood.
Your blood pressure is extremely high (example: 190+/110+) and you are also having headache, chest pain, numbness of body parts, trouble speaking or understanding.
Your blood sugar is very low or very high (less than 60 or higher than 350) and you feel bad, faint, confused, vomiting, abdominal pain, feverish.
You have been assaulted, sexually or physically.
You are pregnant, further than about 16 (or 20 weeks) weeks, and you are having severe abdominal pain with or without vaginal bleeding.
You are 2 months old or less, and you have fever with or without any other symptoms.
You have a large cut anywhere on your body that you can't get to stop bleeding.
You have any body part that won't stop bleeding.
You were in a major, serious car accident. You are in severe pain, you perhaps hit your head and lost consciousness, you have broken bones.
You have overdosed on something.
You have been electrocuted or severely burned.
Parts of your body are paralyzed. You can't move them no matter how hard you try.
You have a head injury with other symptoms - like nausea, vomiting, blurred vision.
You or your child had a seizure.
You have foreign objects stuck inside of you - on purpose or on accident.
Are we getting the gist? Again, I
There's a whooooole lot of grey area, but generally, if you fall on list #2, we will turn you away from Urgent Care and direct you or bring you to the ED ourselves. Sometimes, we can see you in urgent care, to check if you have a minor problem (like a UTI causing your abdominal pain) that can explain your symptoms, but other times, if what we can check comes back all clear - we're bumping you over to the hospital.
MOST urgent cares have X-Ray machines. Few have Ultrasound machines. None have labs in my area. Not a real lab. We can do rapid testing for things like Flu, Strep, Covid, UTI, pregnancy, Mono, some places can do a blood count or blood chemistry.
We cannot do continuous vital sign monitoring, we cannot treat your heart attack or stroke or keep you long enough to figure out if you are having one or not. X-Rays provide a lot of answers but often not the ones you need. We do not do MRIs, and most of us can't or won't order them because they require working with your insurance for a week, and we don't work M-F and we aren't your PCP. My urgent care does not administer narcotic medications. We do not give insulin to correct high blood sugars or sugar in an IV to correct a very low one.
Most of the time, if you're with a seasoned/tenured provider or doctor, they will be able to just look at you once over and know whether or not you need the ER. Sometimes, after just a few questions, if you say just the right (or wrong depending how you look at it) thing, we know whether we can keep or send you.
I think I've made my point right? Y'all get it. Y'all some smarties.
It's PERFECTLY okay to call an urgent care and ask if your problem is appropriate for them, or ask what they advise you to do! The providers working should be happy to advise the receptionist, nurses, or even speak to you themselves.
Extra credit reading and sources: