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Short of an emergency, urgent care offers immediacy

By David Maas, MD

From Minnesota Healthcare News

Illness and injury often happen at the most inconvenient times. You sprain your ankle moving that last piece of furniture into your new home at 10 p.m. Or you wake up with a very sore throat on a Saturday morning before a trip to the lake.

Not all that many years ago, a person with a severe sore throat had two choices: Wait a couple of days for an appointment with a primary care physician, or make an expensive— and, often, inappropriate—visit to a hospital emergency room to sit for hours while people with more serious conditions were treated first. Today, someone with a condition that needs immediate attention but is not a true emergency can visit an urgent care center and usually be seen within minutes.

An “overflow valve”

Urgent care centers emerged in the 1970s as a practical alternative for conditions that needed to be seen quickly but weren’t emergencies, such as sore throats, ear infections, and sprains. The Urgent Care Association of America refers to urgent care centers as “overflow valves” for primary care clinics, offering patients immediate attention when primary care physicians are not available. Most urgent care centers offer a broad selection of diagnostic and therapeutic services, including x-ray, laboratory testing, pharmacy, and procedure rooms for routine lacerations and fractures.

Urgent care centers deliver unscheduled, walk-in care at a much lower cost than hospital emergency departments. The Centers for Disease Control reports that approximately 40 percent of visits to hospital emergency departments are for non-emergencies or semiurgent problems, adding to an already overcrowded situation and average waits of 3.2 hours. According to the American Academy of Urgent Care Medicine, some emergency departments have started to assess a surcharge of $100 to patients who come to the emergency room with less-thanemergency conditions.

As the landscape of medicine has changed in the past few years, urgent care facilities are nearly everywhere. A reported 17,000 exist in the United States alone, treating 180 million visits every year, according to the Urgent Care Association of America. It’s no wonder, then, that many patients without established physician relationships use urgent care facilities for their primary care. (While supportive of urgent care for the function it serves within the health care spectrum, most physicians recommend that patients have an ongoing relationship with a physician, especially for preventive care.)

Most urgent care centers are open extended hours, making them viable options for care early in the morning, late at night, and on weekends. The Urgent Care center located within the Apple Valley Medical Center is believed by its staff to be unique in Minnesota in that it is open 24 hours a day year-round. There is always a physician on site, and patients have access to lab and x-ray at all times. This facility sees more than 40,000 patients every year, most of whom come in with typical cuts and bruises, sore throats, and ear infections.

When a higher level of care is needed

A patient with chest pain, severe bleeding, or serious injuries should call 911 or head directly to a hospital emergency department. If you’re unsure about which service you need, call the nearest urgent care or emergency department and ask. If someone arrives at an urgent care facility requiring a higher level of care, clinic personnel stabilize the individual and arrange for ambulance transportation to a hospital.

Typical conditions appropriate for an urgent care center:

  • Sprains or strains
  • Ear infections
  • Urinary tract infections
  • Upper respiratory infections
  • Coughs and congestion
  • Diarrhea
  • Sore throat
  • Insect bites
  • Rashes
  • Mild to moderate asthma attacks
  • Lacerations

For life-threatening situations, such as those listed below, call 911 or go to the nearest hospital emergency department.

  • Chest pains
  • Severe abdominal pain
  • Sudden, severe headache
  • Difficulty breathing
  • Seizures
  • Severe burns
  • Coughing up or vomiting blood
  • Deep cuts that won’t stop bleeding
  • Sudden blurred vision
  • Sudden numbness anywhere in the body
  • Sudden dizziness or loss of balance

Retail clinics

In the last few years, retail clinics have sprung up in grocery stores, shopping centers, and pharmacies. These facilities offer a convenient service for certain routine tests to identify such conditions as strep throat, sinus infections, bladder infections, and pregnancy. In many cases, patients know in advance what each test will cost. But patients need to be aware of some limitations. Retail clinics usually are staffed by nurse practitioners or physician assistants and thus may be limited in the scope of illnesses they are able to treat. Unlike urgent care centers, many retail clinics won’t treat patients with high fevers, for example, or won’t see young children and infants.

If a problem is beyond their ability to treat, retail clinics sometimes refer patients to urgent care centers. A patient with a sore throat, for example, may require more extensive evaluation and treatment; or someone with a bladder infection may, in fact, have a more serious kidney problem.

In general, treatment at retail clinics is less expensive than at an urgent care facility, because of staffing and technology differences. Visiting a retail clinic also may sometimes yield incomplete results unless the patient is all but certain he or she is experiencing a routine illness— a cold or flu, for example. The American Medical Association (AMA) at its meeting in Chicago in June called for stricter regulation of retail clinics, citing concerns for patient safety. Clinic operators in turn accused the AMA of protecting physicians’ interests, rather than putting patients first.

While urgent care facilities were never meant to provide ongoing patient care, they serve a key role in today’s complex health care environment. For patients with non-lifethreatening conditions, urgent care facilities are quick, economical, and convenient. Patients usually are seen by medical professionals sooner than if they had scheduled visits to their family physicians. Urgent care centers can be found in most communities. The co-payment at urgent care centers is less than at hospital emergency rooms, and normally insurance companies don’t require prior approval before patients are seen.

When the medical situation is urgent—but not life-threatening—an urgent care center is often the best place to go.

David Maas, MD, is medical director of the Apple Valley Medical Clinic Urgent Care, located at the Apple Valley Medical Center.