Emergency Room vs Urgent Care: Do You Know Which to Choose?

You can use urgent care for certain acute issues related to a chronic condition like brain injury, but it’s not the best setting for continuous care of the condition itself. Urgent care focuses on sudden, non–life-threatening issues. They’re not equipped for ongoing care of chronic and complex conditions like brain injury. However, they can step in when old injuries change for the worse, that is to say, acute symptoms that need attention right away.

Let’s start with history.

Care for the very ill and injured patients goes back thousands of years, but organized emergency medical care came to be in the late 20th century. Emergency medicine (EM) became a specialty in response to several factors, most among them being the appearance of patients with increased mobility who required unscheduled care that the current system could not afford financial support for these visits.

A group of innovators founded the Emergency College of American Physicians in 1968 in response to the need for physicians skilled in managing emergency patients. In 1970, Cincinnati opened the first EM residency. Emergency Medicine was approved as the 23rd specialty in 1979.

The field of EM adapted to medical and technological advances, resulting in diverse areas of focus that developed from the bottom-up into ABEM subspecialities: 1990s, Pediatric Emergency Medicine, Sports Medicine and Medical Toxicology; 2000s, Undersea and Hyperbaric Medicine, and Hospice and Palliative Care Medicine; 2010s, Anesthesiology Critical Care Medicine, Emergency Medical Services (EMS), Internal Medicine-Critical Care Medicine, Pain Medicine, and the targeted practice in Advanced EM Ultrasonography. 

Then along came urgent care

In her comprehensive review, Community-Based Urgent Care in Israel and Worldwide, Dr. Deena Zimmerman explores the health care delivery trends behind the rapid explosion of urgent care centers globally and the impact such trends have had on her native Israel.

Dr. Zimmerman provides a substantial review of the state of urgent care in the United States, where there has been rapid growth for about 20 years now, reaching over 10,000 urgent care centers nationwide.

“Despite the size of the industry, there has been little research to date, and there are many gaps in our understanding of the current and potential impact of this hybrid model of emergency care and primary care. It accurately identifies the different influences moving the early growth of urgent care in the United States versus Israel, with entrepreneurial physicians leading the former and insurers behind the latter.

“It is here, at the convergence of these two unique paths, where I find the most fascinating and transformative aspects of the evolution of this discipline,” says Dr. Zimmerman.

The Israeli model is “managed care” and its emphasis on finding solutions that reduce cost and improve efficiency while reducing unnecessary ways, quickly discovering the convenience of urgent care and patients consistently rated their experiences higher than at other health system, including their own personal physicians.

The convergence of managed care and consumer-driven care has led to a rapid progress of urgent care centers in Israel. Many other countries, with similar health care delivery models, have followed suit.

For the last 15 years or so, urgent care have flourished under these economic and professional conditions. Urgent care in America was born from a revolutionary vision of health care and led by physician innovators who recognized gaps in health care delivery.

Urgent cares were, for the most part, welcomed graciously by the communities they served and the insurance companies were eager to contract with them in an effort to support an emergency department variation strategy. 

An urgent care center is a medical facility that usually offers evening and weekend hours. Many patients visit an urgent care clinic for convenience, and appointments are not necessary. Some may stop in at an urgent care clinic if their regular family doctor is not available. Urgent care is an excellent option for patients who need non-emergency medical attention outside of their regular physician’s office hours.

At an urgent care center, services are provided under the direction of an allopathic or osteopathic physician. Both allopathic and osteopathic physicians are fully trained in diagnosing and treating illnesses and disorders.

Both can also prescribe medication, perform surgery, and practice specialties. However, osteopathic doctors receive specialized training in areas such as osteopathic manipulative treatment (OMT), and they may emphasize preventive care.

• X-rays
• Simple lab tests
• Stitching for minor cuts
• Treatments for infections
• Casting
• Physicals
• Employment drug-testing
• Pain management medication
• Vaccinations

• Medication side effects or minor injuries
• Light infections or wounds secondary to mobility or cognitive challenges
• New or worsening symptoms that need immediate attention but aren’t life-threatening
• Infections or illnesses that develop alongside your condition
• When your regular specialist isn’t available and you need prompt care
• A minor fall or bump to the head in someone with pre-existing brain injury
• Flu, cold or allergy symptoms
• A sore throat
• Vomiting
• Diarrhea
• Nausea
• Asthma
• Minor back pain
• Urinary tract infections

Examples when to go to the ER instead:

• Stroke-like signs: facial drooping, arm weakness, slurred speech
• Intense headache, vomiting, or sudden vision changes
• Any major head trauma or rapid neurological decline
• Needing a referral or quick imaging (CT scan, for example) when you can’t reach your neurologist
• Severe confusion, loss of consciousness, or seizures
• Sudden worsening of neurological symptoms
• Signs of increased intracranial pressure (severe headache, vomiting, vision changes)

Here’s another way to look at urgent care vs emergency room:

You woke up in the morning with an earache. Not being able to take time off of work, you forced yourself to make it through the day. Your symptoms got worse after work, and you developed a fever and run-down feeling. Since your primary doctor’s office was already closed, you thought if you should go to an urgent care center or stay at home. Urgent care to the rescue!

Very often, it can be hard to tell if your condition requires a trip to the emergency room. Or you may not live close to an ER or have the funds to cover the cost of hospital medical bills. 

A lot of Americans visit the emergency room every year, often unnecessarily. In 2014, 141.4 million Americans went to the emergency room, almost  million were admitted to critical care and 7.9 percent of the visits resulted in hospital admission, according to the CDC (Centers for Disease Control and Prevention). Over 30 percent of emergency department visits in the U.S. are non-urgent.

In general, if your injury or illness is not life-threatening, you can save time and money by visiting an urgent care center. However, if you’re experiencing symptoms of a life-threatening condition like a stroke or heart attack, you do not want to waste any time. Call 911 or go straight to the nearest emergency room. 

Brain injury typically requires specialized, coordinated care from neurologists, physiatrists (rehabilitation medicine doctors), neuropsychologists, and other specialists. Urgent care providers may not have the specialized knowledge to manage complex neurological conditions or access to your complete medical history.

In summary:

• Establish care with appropriate specialists for regular management
• Use urgent care for acute, non-emergency issues
• Have a clear plan from your medical team about when to seek urgent vs. emergency care
• Keep a summary of your condition and medications with you