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Vital Signs

Summer 2011

Urgent or Primary Care Often a Better Solution than Emergency Care


VS-Summer11-Urgent CareA recent study suggests that up to 30 percent of all emergency department (ED) visits in the U.S. could be managed in physician offices, clinics and urgent care centers, at an estimated savings of $4.4 billion annually. In addition to facing higher total and out-of-pocket costs, using the emergency department for nonemergency reasons puts patients at greater risk for adverse events and duplicative or unnecessary tests resulting from fragmented or absent care coordination.

“That’s the biggest problem,” says Bernard J. Katz, M.D., of UCLA Health-Santa Monica Bay Physicians. “It’s important for patients to establish a relationship with a primary care physician so that they can go to their physician for emergency or urgent medical problems, as well as for preventive care that may be able to head off some of these acute problems.”

It is recommended that patients who do not have a primary care physician utilize urgent care centers when possible and reserve the ED for truly severe or life-threatening problems, Dr. Katz says. Among the conditions that can be routinely treated in urgent care centers are ankle sprains and simple fractures that can be treated with splint or cast, bladder or upper-respiratory infections, abdominal discomfort, nausea, vomiting, diarrhea or other cold or flu symptoms.

“Typically we think of urgent care as conditions that would be handled in a primary care office that are being done in a non-primary care setting, either because the problems arise after hours or there is no appointment available during regular business hours,” Dr. Katz explains.

For patients who utilize the ED for nonemergency reasons, wait times can be substantial. According to the National Center for Health Statistics, most EDs use an acuity scale with three levels or more to evaluate the severity of each patient’s illness or condition. Patients are considered emergent if they have a problem that poses an immediate threat to life or limb. Patients are considered urgent when they require prompt care, but treatment can wait several hours if necessary. Nonurgent patients have conditions that need attention, but time is not a critical factor.

Still, Dr. Katz emphasizes that the most important gauge of whether or not to seek emergency medical care, rather than urgent care or primary care, is the patient’s own sense of the seriousness of his or her medical problem.

“If there’s any question, then go to the emergency department,” Dr. Katz says. “If you’re uncertain, it’s always better to seek immediate medical care than to wait because problems can become progressively worse, even life-threatening, when treatment is delayed.” Dr. Katz recommends that patients educate themselves about when and where to seek medical care for recurring illnesses and conditions by asking their physicians.

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