Nov 3, 2015

Interview Transcript

Dr. Miller: It's the weekend and your primary care doctor is not available. What is best for you, emergency care or urgent care? We're going to talk about that next on Scope Radio.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. "The Specialists with Dr. Tom Miller" is on The Scope.

Dr. Miller: Hi, I'm here with Dr. Robert Stephen and he is an emergency room physician here at the University of Utah, also a member of the Department of Surgery. Robert, what do you think about that? Is there a difference between the care one gets at urgent care and emergency care rooms?

Dr. Stephen: There's not a difference in the approach to the care per se. What's different is the capabilities of each one. The emergency room is by definition capable of dealing with all manner of emergencies, be they mild and merely painful to life-threatening, whereas an urgent care is much more structured to deal with what we call lower-acuity or more minor complaints which nonetheless need to be addressed, such as sore throats, lacerations, maybe sprains, simple fractures, things like that.

Dr. Miller: So would you say if someone has a lower-urgency problem, as the examples you just mentioned, it might be better served at an urgent care center?

Dr. Stephen: I don't know if they're better served, but they may be able to be seen and treated and evaluated appropriately and discharged more quickly than a large ER that is quite busy dealing with other critically ill patients.

Dr. Miller: Now, urgent cares are not going to see very severe types of illness. Is that correct?

Dr. Stephen: Generally, no, but of course, patients don't know sometimes how sick they are, and so urgent cares certainly do get patients being brought in by family members who tend to be quite ill, and if that's the case they evaluate them and then transfer them to a higher level of care, which would be an emergency room.

Dr. Miller: Let's say you're at home, and you're watching TV and all of a sudden you have crushing chest pain. Should you go to an urgent care center or should you go to an emergency care center, or should you just call and ambulance and let them decide?

Dr. Stephen: I think if you're having truly crushing chest pain you should probably call an ambulance and go to an emergency room. Chest pain is not a complaint to be trivialized by any stretch of the imagination, and probably the better part of valor is to go to an emergency room if you're having significant chest pain.

Dr. Miller: Now very likely if you're in an auto accident and have significant trauma, they're going to take you to an emergency room, not an urgent care center.

Dr. Stephen: Correct.

Dr. Miller: But what other types of illness might you think you should call an ambulance for, and then they can decide where you need to go, or maybe ambulances just take people to the emergency room?

Dr. Stephen: Ambulances generally take people to emergency rooms, but what you call an ambulance for is honestly based on the patient's perception of their illness. If you're having something that is severely painful, or if someone is, you notice, severely confused, if they appear to be ill, if they've obviously broken something in a fall, then you should call an ambulance to have them help assist you and determine how ill you are, and then they will take you to the appropriate level of care.

Dr. Miller: Now urgent care centers, do they do the same sort of triage that emergency rooms do to decide how severe your problem is before they take you back?

Dr. Stephen: They do an initial screening questionnaire to see if you're appropriate to be cared for there, and you're usually seen by the doctor or the treating physician or the treating physician extender, depending on who's manning it, and they will make the decision on whether you're appropriate to be treated there or sent to a higher level.

Dr. Miller: Dr. Stephen, one final thing, I'd like to talk about the expense of either the urgent care center or the emergency department. Is one cheaper than the other? Is that a consideration?

Dr. Stephen: It is. Urgent cares generally tend to be cheaper than emergency departments, so that is something that some people may need to take into consideration although, again, an emergency department will see anyone at any time without regard to their ability to pay.

Dr. Miller: And urgent care centers, they tend to be free-standing, that is, not associated with a hospital, many times?

Dr. Stephen: Many times, yes. There are models where there are some associated with a hospital or they preferentially refer people to places, but generally free-standing.

Dr. Miller: Now, it's interesting, we were talking before this show about our emergency room, and it sounds to me like you've developed an urgent care center within the emergency room here. Could you talk to us about that a little bit?

Dr. Stephen: Yes, recently we established an urgent care that is actually inside the hospital itself, and is open from roughly, I think, 8:00 a.m. or 9:00 a.m. to the evening, sometime about 8:00 p.m., and again it's supposed to see more of the lower-acuity complaints, and people can request to be seen in the urgent care when they present to the emergency department.

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