Urgent Care? Hospital Emergency Room? Freestanding ED? What to know.

Urgent Care? Hospital Emergency Room? Freestanding ED? What to know.

By Michelle Crouch

With urgent cares, freestanding emergency rooms and special orthopedic and behavioral centers opening across the state, deciding where to go for a medical emergency is more complicated than it used to be, when the hospital ER was the only option.

Doctors said they often get calls from friends and family members asking for advice.

“The landscape is changing very quickly. It’s unfortunate that patients are put in a position to ‘make a diagnosis’ in order to decide where to go,” said Abhi Mehrotra, vice chair of operations for the UNC Department of Emergency Medicine. “It depends how acute their condition is, and that’s hard for a patient to determine – it’s why we (doctors) go through so much training.”

If someone needs guidance for a specific situation, their best bet in the moment is to call their physician’s office or 911, Mehrotra said.  

But it’s also a good idea to understand the different types of after-hours medical facilities before a crisis, he said.  The Charlotte Ledger/NC Health News asked Mehrotra and other physicians what people should know about each:

Hospital Emergency Room

What it is: Hospital ERs provide the highest level of care and offer the widest range of medical services, including access to specialists, operating rooms and surgeons and more maternity wards, advanced imaging and lab technology, and inpatient beds. They are open 24 hours a day and accept patients regardless of their ability to pay.

“A traditional emergency department has advanced equipment, more staff and more capabilities to care for severe illnesses,” said emergency medicine physician Tim Lietz, president and CEO of Mid-Atlantic Emergency Medical Associates in Charlotte,

What they’re intended for: Patients experiencing a time-sensitive, life-threatening emergency including but not limited to chest pain, difficulty breathing, loss of consciousness, severe trauma, slurred speech, a severe broken bone, weakness or numbness, sudden vision loss, severe abdominal pain and pregnancy-related medical conditions.

Considerations: They typically have the highest patient volumes, especially during peak times, so a person should prepare for a long wait and a crowded waiting room. (Many health systems list their current ER wait times on their websites.) Hospital ERs also charge the highest rates for care.

Freestanding Emergency Room

What it is: Although not physically connected to a hospital, they are open 24 hours a day and equipped to treat and stabilize patients experiencing many types of emergencies. 

Like hospital ERs, they also treat patients regardless of their ability to pay. Facilities typically have 6 to 12 rooms, imaging services (CT, ultrasound and x-ray but usually no MRI), as well as limited lab and pharmacy services. About 90 percent of patients are walk-ins, compared to about 40 percent at hospital ERs.

What they’re intended for: Patients who need emergency care for a time-sensitive, life-threatening condition, especially if the freestanding facility is the nearest option. “If you’re concerned about your safety, go to the facility that is closest to start the process of getting seen and stabilized,” Mehrotra said.

They are also a good choice if someone wants to be seen quickly, because they are typically less crowded and have significantly shorter wait times compared with a hospital ER.

Considerations: Patients pay the same higher rates for care as they would pay at a hospital ER. Unlike hospitals, freestanding ERs typically don’t have operating rooms, labor and delivery services, interventional cardiac catheterization capabilities, a blood bank or MRI imaging. If patients need any of those services, if they need immediate surgery or if they need to be hospitalized for any reason, they will need to be transferred to a hospital by ambulance, for an additional fee.

To avoid a transfer, Lietz said patients over age 70, those with complicated health conditions and those who think they may get admitted may want to “spend the extra 10 minutes in the car” to go to an ER connected to a hospital.

Urgent Care Center

What it is: They are designed to treat non-life-threatening injuries and illnesses that require prompt attention but are not emergencies. They are open evenings and weekends, but usually not 24 hours a day. Some centers offer online appointments to minimize the wait.

What they’re intended for: If people don’t want to wait for their doctor’s office to open, or they can’t get an appointment, these walk-in clinics can treat minor sprains and strains, minor broken bones (fingers, toes), minor allergic reactions, minor burns, eye irritation and pink eye, skin rashes, bug bites and stings, urinary infections as well as respiratory illnesses like strep throat and flu.

Considerations: They are significantly less expensive than an ER visit. The urgent care center may refer a patient to the ER if they are unable to make a definitive diagnosis or if the patient needs a higher level of care. 

Orthopedic Urgent Care

What it is: A specialized center that offers treatment for non-life-threatening injuries involving bones, joints, ligaments, tendons and muscles. They are typically open in the evenings and on weekends, but not 24 hours.

What they’re intended for: For tendon and ligament sprains and strains, falls/trips, sports-related injuries and most broken bones that don’t have bones protruding from the skin. An orthopedic urgent care has advanced imaging and orthopedic specialists on site, potentially allowing a patient to get a diagnosis and treatment in one visit.

Considerations: As many as 75 percent of people who go to the ER or urgent care with musculoskeletal injuries could have waited for an appointment, said OrthoCarolina CEO Leo Spector. He said OrthoCarolina’s “Hurt” mobile app offers patients live guidance from orthopedic professionals about whether they need to go to the ER, the urgent care or if they can wait to be seen.

Behavioral Urgent Care or ER

What it is: Specialized centers that offer diagnosis and treatment of behavioral health conditions such as depression, anxiety, mood disorders, eating disorders and substance use disorders.

What they’re intended for: If a mental health crisis becomes life-threatening or a patient needs to be restrained, an emergency room is the best option. (Atrium has a freestanding ER dedicated to psychiatric health in Charlotte.) Otherwise, a walk-in behavioral health urgent care typically offers assessment and screening, stabilization, crisis counseling, access to psychiatrists, medication and referrals to other providers and community resources.

Considerations: To avoid hospitalization, experts said people should seek out help sooner rather than later. Many hospital ERs are filled with behavioral health patients who are waiting for a bed in a residential psychiatric facility. With a shortage of resources in North Carolina, a wait may be inevitable. 

This article is part of a partnership between The Charlotte Ledger and North Carolina Health News to produce original health care reporting focused on the Charlotte area. Want more information? Read more here.

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Urgent Care? Hospital Emergency Room? Freestanding ED? What to know.

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