Urgent Care Or Emergency Room? That Is The Question.
Medical problems can happen without warning. Sometimes you’re able to get into your regular doctor. But many times you’re stuck with the position of deciding whether to go to an emergency room (ER) or an urgent care.
Being a physician who works in both ERs and urgent cares, I see countless patients in the ER who could have gone to an urgent care for a minor issue, saving money, not to mention time. According to Health Affairs, 27% of all emergency department visits could have taken place in an urgent care.
On the other hand, I also see patients who come into the urgent care who need to be transferred to an ER because they need more testing that cannot be done at the urgent care. In some urgent cares, this number is as high as 10% of all visits. For busy urgent cares, this can be over 1000 visits per year that need an ER level of care.
This is not the fault of the patient, but the system itself. Many patients do not understand what urgent cares can offer and vice-versa with emergency departments. They are also not aware of how significant the cost difference can actually be, even though it is generally understood that urgent cares are cheaper than ERs.
Plus, the terms emergency and urgency, to any non-medical person, can both give the impression of being able to handle serious complaints that need immediate attention. And the truth is, ERs and urgent cares can handle both. But there are some big differences between the two.
Differences between ERs and Urgent Cares
#1 Resources
One difference is that an urgent care will be more limited in regards to the tests that they can perform. While x-ray is fairly standard in urgent cares, blood work and other radiology tests such as CAT scan and ultrasound are not generally available in urgent cares.
As an emergency physician, my job is to evaluate a patient for the worst-case scenario. For instance, if a patient comes in with chest pain, I need to make sure the patient is not having a heart attack or another dangerous condition. This frequently requires a number of tests that are generally not available in urgent cares. Abdominal pain is another example, where blood work and a CAT scan or ultrasound are often needed. These are largely unavailable in urgent cares.
But for the general laceration, rash, UTI symptoms, or injured knee, an urgent care has plenty of resources to diagnose and treat your condition.
#2 Cost
Though emergency rooms have a plethora of tests, visits will generally be considerably more expensive for similar care than urgent cares when it comes to minor complaints. In one survey, the average urgent care visit was $150 while an average emergency room visit was around $1300. With health insurance costs skyrocketing and high deductible plans becoming the norm, this can be a hefty sum of money spent out of pocket.
Perhaps the questions we should all be asking are: Why don’t ERs provide urgent care pricing for minor complaints? And why don’t urgent cares provide more resources to diagnose other conditions? This is a long and complicated answer, though in my patient-centered brain I believe it would be best for our society. Let’s just say “money talks.” Until the government, hospitals, and insurance companies focus on the patient and not their margin, this fragmentation is likely to continue.
#3 The Physician’s Specialty
Emergency medicine trained physicians generally staff ERs. There are also a number of family practice and internal medicine doctors who staff ERs, but they usually have extensive experience in emergency care and work in community and rural sites.
On the other hand, urgent cares are staffed by mostly family practice and internal medicine physicians. These physicians are very skilled in minor emergencies such as sprains, broken bones, or lacerations. But they do not have training in emergency care such as chest pain, severe shortness or breath, or major abdominal pain. It’s important to go to the correct facility to get the best care possible for your issue.
Both urgent cares and ERs remain important access points for unscheduled care needs in our country. Being more informed can help a majority of patients choose the right care at the right time. This article will take you through symptom by symptom to help you understand where you should go when you need immediate care.
Symptoms that require an ER
Difficulty breathing
The list of conditions that can cause difficulty breathing is quite long. From the heart to the lungs, to a major infection, many patients require a number of tests to determine the cause of their shortness of breath. Unless you have an asthma history and only have a mild or moderate exacerbation, you should likely go to the ER where tests can be done to determine the cause of your symptoms.
Chest pain
Chest pain is not appropriate for an urgent care. If you go to an urgent care, you are likely going to be transferred to an ER, and very appropriately. Chest pain requires a number of tests in a higher resource environment. For more on chest pain risk, see this article.
Abdominal pain
Many causes of abdominal pain are benign, but it can be hard to tell the cause without blood tests, and sometimes radiology studies such as a CAT scan or an ultrasound. Appendicitis and gallbladder infections can be serious. These require testing that is unavailable in urgent cares. The best place to obtain these tests quickly is in the ER.
Fainting
In medicine the term for fainting is syncope. Many times this condition is benign caused by anything from dehydration to a surge in nerves throughout the body known as a vasovagal episode. But there are some dangerous conditions that can cause fainting including an abnormal rhythm of the heart. You should go to the ER to be checked for this condition where the appropriate testing is available.
Sudden dizziness
Sudden spinning dizziness or a lightheaded feeling could be dangerous, including conditions such as stroke or heart disease. Though benign vertigo or other non-dangerous conditions are possible, it’s generally recommended to go to an ER where tests can be performed to rule out life-threatening illnesses.
Weakness or difficulty walking
Weakness is a very common complaint seen in the ER. It is especially common in the elderly. Generalized weakness occurs on both sides of the body (usually manifested as difficulty getting up or walking). Focal weakness means weakness on one side of the body, which can be concerning for stroke. Either way, both of these types of weakness require an ER where blood tests and radiology studies can be performed.
Change in vision
Getting scratched in the eye or getting something small in the eye is one thing, but vision changes such as double vision, blurred vision, or loss of vision, are concerning and need an immediate visit to the ER. There, a doctor can test for life-threatening and vision-threatening conditions such as stroke or retinal detachment.
Difficulty speaking
Any difficulty speaking, such as slurred speech, difficulty finding words to create a sentence, or words that do not make sense (we call this a word salad), is concerning for stroke and needs an immediate evaluation in the ER.
Confusion or unusual behavior
In medicine we refer to this as altered mental status. This condition is concerning for a number of dangerous conditions and should be evaluated in the ER. One caveat is patients who are having increasing difficulty with memory. As long as the person seems otherwise normal, this could be the beginning of dementia or part of older age, but can generally be evaluated by the primary doctor for outpatient testing.
Any sudden and severe pain
If you have severe pain, especially if it come on quickly, it’s generally better to go to an ER where any number of tests can be performed. Of course, if the pain is from twisting your ankle or there is concern for a broken bone, an urgent care can certainly take care of this. But unprovoked pain is more concerning and deserves an emergency room visit.
Dislocated Joint
If you think your joint looks out of place, such as a shoulder dislocation, or your ankle is turned the wrong way after an accident, then an ER is the place to go. If you need a sedation to replace your joint or other potential orthopedic care, this will be best accomplished in the ER.
Severe or persistent vomiting or diarrhea
Urgent cares can handle basic vomiting and diarrhea. But if it has gone on more than 2 days or there is any pain involved (chest or abdomen), an ER will be able to better handle your condition and make sure your vomiting or diarrhea is not dangerous.
Suicidal or homicidal thoughts
If you are depressed or having any number of psychiatric issues including suicidal or homicidal thoughts, an ER is the only acute care facility that will be able to help you. An urgent care is not appropriate and you will likely be transferred immediately.
Severe headache
A basic migraine can be handled at an urgent care, but anything new or more severe than normal (especially in the setting of a fever, trauma, or if there is any family history of brain aneurysm) should be seen in an ER immediately.
Major head injury
If you’ve had a major head injury like a fall from height, a car accident, or if you have persistent vomiting or confusion, you should be seen in an ER immediately.
You may need a CAT scan of your head to evaluate for a head bleed. Also, if you fall and hit your head while on a blood thinning medication, you need to go directly to the ER for a CAT scan. For more information regarding head injury risk in children, you can read this article.
Other major trauma
If you are in a major trauma like a car accident or fall off of the roof or a ladder, you should really be going to an ER. Though you might have only a minor injury that can be diagnosed in an urgent care, these bigger traumas can hide much bigger injuries. Emergency physicians are trained to evaluate for these dangerous conditions.
Unconsciousness
If someone is unconscious, please do not bring them to an urgent care. This will only delay their care while they are immediately transferred to an ER. To be honest, you should really be calling 911 and the paramedics will know what to do.
Palpitations
Palpitations include a multitude of different feelings ranging from a fast heart rate to an intermittent fluttering in the chest, or even an intermittent strong thumping heartbeat. These symptoms are generally benign but can also be related to an abnormal heart rhythm. An ER can place patients on a monitor and do blood work to make sure there is not a serious condition.
Fever in newborn
If your newborn is less than 3 months old and has a rectal temperature of 100.4 degrees F or higher, you need to go to the closest ER. An urgent care cannot perform the testing needed. Once the child is over 3 months old, the risk decreases greatly and an urgent care can certainly be appropriate.
Testicular pain
Generally speaking, all testicular pain requires an ultrasound. Not all urgent cares have an ultrasound. My general advise is to go to an ER where this test can be performed to make sure there is no danger to the testicle such as a twisted testicle, which requires immediate urologic surgery.
Vaginal bleeding or pain during pregnancy
These symptoms during pregnancy often require an ultrasound and blood work. An ER is the correct place for these tests.
Serious burns
Serious burns require IVs, pain medications, and perhaps even an actual burn center. If there is any involvement of the face, patients can have trouble breathing and could require ventilator support. Any serious burn should go immediately to the ER.
Seizures
Even though many patients who experience a seizure ultimately go home, certain testing such as blood work and perhaps a CAT scan of the head may be required. Urgent cares are not generally equipped to handle this so you should seek care in an ER.
Symptoms that are appropriate for an Urgent Care
Minor Accidents and falls
If it’s not a major car accident or fall off of the roof, chances are you are most concerned about having broken a bone. Assuming your injury does not look significantly misshapen, an urgent care should be perfect for your needs. Whether you need the immediate x-ray or not is a different story for a different article.
Minor cuts
If you sliced your finger with a knife or have a number of other minor type cuts, an urgent care can easily stitch you up. And for a great deal less money than the ER.
Breathing difficulties (such as mild to moderate asthma)
As stated above, if you have asthma and need a breathing treatment or steroids for a minor or moderate exacerbation, an urgent care can definitely take care of you. For other breathing difficulties, going to an ER is generally advised for further testing.
Eye irritation and redness
Urgent cares are well equipped to handle pink eye or even minor injuries to the eye. This includes something small like metal or wood getting in the eye. For vision changes such as double or blurry vision, you should go to an ER immediately.
Back problems
If you have had a recent back injury or back pain, urgent cares can generally treat these without issue. The only caveat to this is if you cannot walk, have severe weakness, numbness, or any urination problems. Any of these symptoms require an ER for additional testing.
Sore throat, flu-like symptoms, or other upper respiratory symptoms
This is bread and butter for an urgent care. Rapid strep tests are usually available in urgent cares. And even if you end up having pneumonia, an urgent care can diagnose this and provide an antibiotic. Sinus infections are also commonplace in urgent cares. If you’re interested in getting rid of your sinus infection without antibiotics, you can read this article. If you want to learn more about whether Tamiflu is right for you, you can read this article.
Minor strains/sprains and broken bones
This is also bread and butter for urgent cares who almost always have x-rays. Once again, whether you need the immediate x-ray or not is a different story, but urgent cares are your place for these injuries.
Skin rashes and infections
These are generally easily treated in urgent cares with creams, ointments, oral medications, or perhaps no treatment is necessary. An urgent care physician can help you decide what is best for your condition.
Urinary tract infections
Easy to diagnose by symptoms and/or a urine dip, urgent cares see this all of the time and can easily treat these infections.
Vomiting, diarrhea, or dehydration
If you believe you got food poisoning or a virus, urgent cares can generally assess patients for more serious conditions and also treat patients with medications to prevent nausea. Some can provide IV hydration if necessary.
Conclusion
This is a fairly extensive list of symptoms but there are certainly some conditions I may have missed. My hope is that the above lists will help guide you when you need immediate care.
At the end of the day, some issues that seem minor can end up being more serious and some that seem serious can be minor. Urgent care physicians are able to evaluate any condition and decide whether a higher level of care is needed in the ER.
If you are unsure after reading this article and want to attempt a lower price facility, there’s no harm going to the urgent care first. If you need to be transferred, then it is only a small delay in care. However, if you have symptoms such chest pain or difficulty speaking, or any of the other conditions listed under the ER symptoms above, time matters and it’s best to go immediately to the ER in case you have a more dangerous condition.
Are there any other conditions you can think of that should be routed to the ER or an urgent care? Have you had any experiences in ERs or urgent cares that are relevant to this article? Please comment below.