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Knowing when to use the emergency room, urgent care and doctor's office
August 18, 2010

Ear infections and ankle sprains don’t often happen at convenient times, but knowing where to go for your medical care can save headaches later.

 

According to a recent study by Press Ganey, the average length of stay in an American emergency room (ER) increased last year to more than four hours. Multiply that by the 123 million who use the ER each year, and it adds up to nearly 5 million hours spent waiting for care.

 

A big reason for the wait – up to 70 percent of ER visits are not for actual emergencies1.

 

Paul Karazija, M.D., Wellmark Blue Cross and Blue Shield chief medical officer, notes that using the ER for non-emergencies impacts the entire health care system. Patients waste time waiting in crowded hospitals, and money in the form of higher copays and deductibles. Insurers pay larger bills, which impacts future insurance premiums.  And inappropriate use places a burden on already stretched doctors and hospitals, and may result in delays for patients who truly need emergency care.

 

The first step in seeking care in the appropriate setting is to understand the care continuum, which begins with a phone call to your health care provider, and ends with the hospital ER:

 

Phone access

Many hospitals and health systems offer 24/7 access to nurses and other health professionals who can assess common conditions and direct patients to appropriate care. Keep these numbers nearby (i.e., on the refrigerator and in the wallet) so you can access the service when you need it.

 

Doctor’s office

The doctor’s office is still the best place to go for situations that do not require immediate attention. Your doctor has your records, knows your health history, and can help determine which type of care is best for you. Use the doctor’s office for issues that can wait until the next day, or after the weekend.

 

Urgent care center

Urgent care centers can offer prompt evaluation and treatment for a variety of conditions that do not require a hospital or emergency room. Most are open seven days a week, including holidays, and are staffed by physicians. And compared to the average four-hour wait in a hospital ER, urgent care visits are usually an hour or less. Conditions appropriate for urgent care centers include:

  • Sprains, strains, and cuts.
  • Minor infections, rashes and sore throats.
  • Minor broken bones (fingers, for example).
  • Diagnostic services, including X-rays and laboratory tests.

Urgent care centers in Iowa and South Dakota.

 

Emergency room

The ER, as the name implies, is for significant health issues that require immediate treatment. Reasons to use the ER include:

  • Chest pain, shortness of breath, and other symptoms of heart attack or stroke.
  • Major broken bones.
  • Significant, uncontrolled bleeding.

Karazija says Wellmark members use the ER in communities that have urgent care centers and physician offices available, and primarily during the day (8 a.m. to 8 p.m.). Karazija urges Iowans to take time and find the nearest urgent care facility before they need to visit.

 

ER misuse has a significant impact on health care costs. Treatment in a doctor’s office or urgent care clinic can be received for a fraction of the cost of a trip to the ER. And much of the savings goes right back to the patient in the form of lower copays and coinsurance.

 

“It’s important to be smart about the type of care we receive,” Karazija says. “The answering machine at the doctor’s office may direct us to go to the ER after hours, but we still have a responsibility to seek out the most appropriate care.

 

“However, don’t be afraid to use the ER if the condition is serious. After all, your health is still what’s most important.”

 

For more information on health and health insurance including help deciding between emergency and urgent care, call the Wellmark Blue Cross and Blue Shield Personal Health Assistant 24/7 at 1-800-724-9122.

 

1 "Urgent Care Saves Time, Money Plus Eases Overcrowding in ERs", www.bizjournals.com, viewed 1/09.

 

Contact Wellmark Media Relations

Traci McBee
Phone: 515-376-4338
mcbeet@wellmark.com

 

Teresa Roof
Phone: 515-376-5869
rooft@wellmark.com

 

1331 Grand Avenue
Des Moines, IA 50309-2901

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