Urgent care center vs. ER?

[shangrila]

What is the difference between urgent care centers and emergency rooms?

From what I understand: Urgent care centers usually see less life-threatening cases, are staffed by mostly primary care docs, have less waiting times, and functions as a middle ground between medical emergencies and walk-in primary care clinics. On the other hand, ERs see more serious emergencies, are staffed by mostly ER docs, can have long wait times for cases not deemed as emergencies, and are usually attached to a hospital.

What do urgent care centers usually consist of? Are they just like primary care centers with many patient rooms and slightly more advanced equipment like high-quality x-rays? Do they usually have a few ORs as well? Why do they have physical therapy?

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[WolfofSDN]

I've worked in both. Our urgent care is like a standard doctor's office. We refer patients to the radiology department, which is thankfully in the same building. We don't have any ORs; I believe those are usually exclusive to hospitals? We do not have a physical therapist on staff.

 

[shangrila]

What's the difference between urgent care center and primary care offices, ie. a clinic of family doctors?

 

[AMEHigh]

What's the difference between urgent care center and primary care offices, ie. a clinic of family doctors?

You don't have to make an appointment at urgent care centers. Like the title urgent implies you can go there in unexpected urgent situations when you need to see a doctor but it's not necessarily an emergency.

 

[shangrila]

Sorry what I meant was "What's the difference between urgent care center and WALK-IN primary care offices?" Because for those who do not have personal primary care doctors, they would go to walk-in clinics I presume.

 

[Siggy]

I've worked in both. Our urgent care is like a standard doctor's office. We refer patients to the radiology department, which is thankfully in the same building. We don't have any ORs; I believe those are usually exclusive to hospitals? We do not have a physical therapist on staff.

When was the last time you saw a physical therapist in an emergency department (mind you, free standing EDs are the same as an ED, just not attached to a hospital).

 

[PTPoeny]

Sorry what I meant was "What's the difference between urgent care center and WALK-IN primary care offices?" Because for those who do not have personal primary care doctors, they would go to walk-in clinics I presume.

There is more variation within each group than between them. In general a lot of urgent care centers have evening and weekend hours, but some pcps offices do too. Both groups vary greatly in their ability to do things like suture lacs, I&d abscesses, splint fractures and give iv fluids. Some of each will do them, some won't.

Pcps offices that do that stuff are going to be more comfortable with their own chronic patients with multiple/unusual disorders. A lot of urgent care centers also won't touch infants. My (biased) opinion is that if your PCP is open and does that stuff, just go to your pcp.

 

[SuckySurgeon7]

There's a very similar thread going on in the Family Med forums right now:

http://forums.studentdoctor.net/threads/family-med-vs-urgent-care-clinics.1062926/

 

[colbgw02]

We don't have any ORs; I believe those are usually exclusive to hospitals?

There are plenty of ambulatory surgical centers. They're usually collocated with hospitals, but that's just a matter of convenience. Also, it's not rare for cosmetic surgeons to have ORs in their clinic.

 

[operaman]

Most urgent care centers are money-printing machines. Years ago, they were able to convince CMMS to let them bill facility fees just like ERs do, but they would bill less and sold it as a way to save money over an ER visit (which is does). Most UCs can handle minor emergencies -- basically anything you could handle in the ED without sending them anywhere else. So, no OR, no PT, no hospital rooms. They also cover a lot of service you would ordinarily get at your pcp, but they are usually open longer hours and always take walk-ins. Of course, compared to a PCP they can also bill facility fees.

As for money printing, most UCs are very good at running up the tab. Having rads on site (not a radiologist, just the scanners) allows them to BILL for doing the scans which is a huge source of revenue. Most will also have some rudimentary lab equipment ($$). If anything needs to be done, they just transfer to the nearest hospital ED. I've been amazed at what I see come in our ED from them, especially the extensive and unnecessary workup many receive. My personal favorite was the simple fracture that they got an Xray for (normal), fracture was very visible on Xray, but also stuck the kids arm in a CT scanner for what reason I don't understand and nobody else could either.

Here's an example:
You have a kid with n/v/abdominal pain, slightly elevated temp. It's 10am so you call your family doc. He will:
History and Physical
BGL
Assuming nothing concerning, rx supportive care and follow up.
Bill:
Level IV office visit $203
Lab(s) $23
+/- fluids if needed. ($111)
Total: either copay, or your share of $226 - 400ish per your insurance

Now, same story but at 8pm so you go to UC:
H&P
As many labs as they can get
Abdominal US, closely followed by...
CT abdomen
IV fluids
Followup with PCP

Bill:
Level IV office visit ($203)
FACILITY FEE (easily hundreds of $)
Abdominal US ($263)
IV fluilds ($111)
CT Abdomen ($741)
Follow up ($100)
Total: ~$1400 + facility fee (likely anywhere from 200-600)

In either case, if anything is serious, you'll get referred to the ED anyhow where much of the workup will need to be repeated.

 

[Pose]

The UC I work in now is staffed by ED docs who rotate through from our affiliated hospital system, and we use the same full lab and radiology services that the ED uses. We're considered a "tier 2" or specialist service. We've taken over all of the same-day visits for affiliated primary care offices, provide their holiday coverage, and weekends. We can almost always get same-day referrals to ortho, ENT, and GS, and we can direct admit to our affiliated hospitals. We ship out anything that needs monitoring, and pretty much anything else scary that walks in. Not really sure about how the billing works though...

 

[styphon]

The urgent cares I work at have Xray, basic labs, splints.. A doctor works alone, or with a PA - the doctor is a family medicine or ER doctor (We are an adults+pediatrics Urgent care). Its walk ins only. Some people come in who should go to ER's - I have had a few hand/finger amputations, STEMIs, CVA's, unstable SVT...

The family med clinic I work at has Xray, U.S., dentists, and opticians.. Where I have also had STEMI's, a developing CVA, sepsis...

 

[KnuxNole]

Urgent care, from what I hear is the same as ER with less wait time + what people use for pcp visits(chronic med refills, well child checks, pelvic exams). Although the stereotype is more benign things, since people treat it similar to ed, there would be sepsis, DKA, heart attacks galore as well. I know people prefer the urgent care instead of the ed due to less wait time, so I doubt anyone who wants to do UC should only expect colds/flu, since there would be highly sick patients left and right :O

 

[Rendar5]

No there will not be heart attacks and sepsis galore unless you count strep throat which usually does meet sepsis criteria. It's basically colds coughs basic injuries. You just have to be able to pick out the rare MI that comes in or the head injury that requires an emergent ct. They do happen and I get them referred to me but they are rare.

 

[Siggy]

Urgent care, from what I hear is the same as ER with less wait time + what people use for pcp visits(chronic med refills, well child checks, pelvic exams). Although the stereotype is more benign things, since people treat it similar to ed, there would be sepsis, DKA, heart attacks galore as well. I know people prefer the urgent care instead of the ed due to less wait time, so I doubt anyone who wants to do UC should only expect colds/flu, since there would be highly sick patients left and right :O

There aren't often highly sick patients left and right in many/most emergency departments, and the only ambulance service that delivers to urgent cares is the home boy ambulance service. Home boy deliveries would get a reflexive referral to 911 at an urgent care.

 

[KnuxNole]

Really? That's what I've been told, and why I thought it was scary for a resident like me to moonlight. Since, there will be no attendings to check cases too, and worried that 90% will be sick ed visits and Pap smears D:

If it is colds and cough, that is manageable and easy to learn w asking people for help here and there. I'm just worried for the hard cases, since that I would have no clue what to do. And the ED might be pissed if I sent hard lacs and I+Ds to them. But, like others have told me, it's not generally a safe idea for a 2nd year to work urgent care with no attendings...

 

[Rendar5]

You should also be able to splint in addition to sewing and cutting