11/4/2018
Courtesy of Tribdem.com. Original article can be read here.
Everyone has been there.
You slipped on the ice and now your wrist is swelling and it hurts. That pain in your belly you’ve been trying to ignore gets worse, doubling you over. Your toddler starts throwing up, or Grandma is having trouble speaking.
In these situations, there may be uncertainty about where to go for care.
Experts admit there are no clear guidelines, but knowing the differences between urgent care centers, emergency departments and walk-in clinics can save time and money, or even be lifesaving.
“It is really important to go to the right level of care,” Dr. Dave Burwell, chief medical information officer, said from UPMC Altoona. “Medical costs and insurance costs are skyrocketing; some of those costs are associated with going to the wrong level of care.
“In the same vein, we don’t want to discourage people from seeking life-saving treatment in the emergency room or trauma center.”
All of the region’s hospitals have emergency departments, which are required by law to treat all patients. But coming to the hospital for something that could be treated at a lower-level facility may mean longer waits and higher out-of-pocket costs, Burwell said.
The emergency departments triage cases, taking the most acute illnesses and injuries first, said Dr. Dheeraj Taranath, MedExpress regional medical director.
“If you go to the ER, you could wait several hours before even being seen,” he said “If you have insurance, the emergency room co-pay can be $100 to $200. At the urgent care center it might be $35 or $50.”
Without insurance, emergency room bills can soar into the thousands, while MedExpress bills usually top out around $200 or $300, he said.
“What people should go to the emergency room for is life-threatening illness and trauma,” Burwell said, listing symptoms of heart attack and stroke, severe unrelenting pain and “bodily functions no longer working.”
Injuries from traumatic events such as traffic accidents and falls should be evaluated in the emergency department, even if they may not seem so bad, he added.
“Urgent care is for episodic illness and injury on the day-to-day basis that doesn’t rise to the level of being life threatening,” Taranath said.
“Any of the common illnesses that one might incur, urgent care center is a great alternative for that.”
Lacerations that might need stitches, sprains and other minor injuries can be seen at the urgent care centers, too, Taranath added.
MedExpress operates urgent care centers at 1221 Scalp Ave. in Johnstown, 1490 N. Center Ave. in Somerset, 300 E. Plank Road in Altoona and 2128 Oakland Ave. in Indiana.
Other urgent care centers include iCare Medical centers at 167 Zeman Drive, off Route 22 in Ebensburg, and 100 Susan Drive, off Menoher Boulevard in Westmont; and Conemaugh’s MedWELL urgent care centers at 1450 Scalp Ave., and at 236 Jamesway Road, off Route 22 in Ebensburg.
Simple Rules
Dr. David Csikos, vice president for medical affairs at Chan Soon-Shiong Medical Center at Windber, said he used a few simple rules for helping his private practice patients decide if they should go to the emergency department.
“What I used to send to the ER would be what I called the ABCs: airways, breathing and circulation,” he said, adding that acute pain and serious injuries are also emergency medical issues.
“It’s for those cases where time is of the essence. You have those diagnostic studies right at your fingertips.”
Specifically, Csikos lists acute onset of weakness, paralysis on one side, slurred speech, and difficulty talking as signs of a stroke that can best be treated with blood-clot busters in the hospital emergency department. Severe chest pain and difficulty breathing are symptoms of a heart attack that can be treated in the hospital catheterization lab, after emergency room treatment.
“These people need urgent diagnostic studies and intervention,” Csikos said.
No Substitute
Neither the emergency room nor an urgent care center is a substitute for the primary care doctor, said Dr. James Stewart, Windber’s medical director of the emergency department.
“Ideally, care is best managed by the primary care doctor – especially ongoing medical problems,” Stewart said.
Treatment of high blood pressure, diabetes, cholesterol management and other chronic conditions should be included in a plan developed with a primary care provider, Burwell agreed.
“The PCP has your clinical plan,” Burwell said. “You want to continue on the plan, so it’s a longitudinal approach, as opposed to an episodic approach.”
When possible, there are advantages to have even minor injuries and illnesses treated by the primary care provider.
“When I was in private practice, I saw patients who walked in or called in with specific symptoms,” Csikos said. “I made every effort to do that. I knew their history better than anyone.”
Walk-in clinics offer another access point to health care.
The clinics are growing in popularity in urban centers, but have not made an appearance in Cambria or Somerset county. UPMC Altoona operates a walk-in center at its Station Medical Center, 1516 Ninth Ave.
“Walk-in clinics could be utilized for any of the service that you would would use your PCP, except for things like acute illnesses and sprained extremities,” Burwell said. “In the walk-in clinic you are usually see by a mid-level provider. They are usually not your primary care provider.”
Mid-level providers are also called physician extenders and include nurse practitioners and physician assistants.
In Case of Emergency
When in doubt, the experts say, it’s best to get the the emergency room.
“When a patient is experiencing a true medical emergency, they should go to the Emergency Department or call 911,” said Dr. Jennifer Savino, medical director of emergency medicine at Conemaugh Memorial Medical Center. “This includes chest pain, shortness of breath, dizziness, confusion, blood loss, abdominal pain, or thoughts of harming oneself or others.
“If it’s something that can’t wait – get to the emergency department.”
The state has defined emergency care that must be treated by hospital emergency rooms for any patient:
“Services provided after the sudden onset of medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the prudent layperson would believe that the absence of immediate medical attention could reasonably be expected to result in placing the patient’s health in serious jeopardy, serious impairment to bodily functions or serious dysfunction of any bodily organ or part. This includes active labor.”
The Health Department urges anyone with serious injuries or symptoms to call 911 for help.
“It is important that people realize that if they are questioning or unsure if their condition needs medical attention, then they should call 911,” department spokesman Nate Wardle said. “The dispatchers within the state utilize emergency medical dispatch and other protocols to ensure the right resources are sent to address the needs of the patient.”
