When to Go to the ER vs. Urgent Care vs. a Walk-in Clinic (podcast)

Dr. Evans: Urgent care is for when you have a disease or an illness where you’re not going to have a life or limb-threatening problems within a week.

It might be an after-hours problem, or anything where someone doesn’t feel imperiled, where they know they’re going to live more than 24 hours.

Dr. Evans: The emergency department is traditionally reserved for people who feel they won’t have 24 hours to live or they have a limb-threatening event. It is somebody who has had a sudden accident, a sudden severe headache perhaps,something they can’t see. Ultimately it turns to fever, neck stiffness, or they’re unable to swallow, have chest pain or pain radiating to their back, sudden abdominal pain, vaginal bleeding with abdominal pain in pregnancy. All these represent emergencies as there can be life or limb-threatening injury or illness within 24 hours.

Dr. Geary: Unlike urgent care and emergency rooms, our walk-in clinics are really for low-acuity problems, things that you do want to be seen for the same day, that you don’t want to wait for. For example a cough, strep throat, urinary tract infections. You can have abdominal pain, rash, minor sprains, minor trauma, things that are not serious enough to warrant a trip to the urgent care or the emergency room, but your doctor may not have an appointment for you that day. That’s exactly what I would use the walk-in clinics for.

Dr. Evans: I think 911 should be reserved for people who typically can’t mobilize themselves. They can’t get up and walk on their own. It’s for someone who’s dizzy or has chest pain, someone who’s blood pressure may be disturbed, somebody who has been injured and can’t get up. That’s what traditionally 911 is reserved for. It’s for situations where they shouldn’t drive themselves, but if they have somebody, a neighbor or a family member who can get them to the hospital within 10 to 15 minutes, typically they’re going to do fine.

Dr. Geary: I would also add that 911 is for when there are conditions that should not wait to be treated. So we think of heart attacks. We think of strokes. We think of severe rapid bleeding. In those cases, time really is critical and if you call 911. The ambulance can take you to the emergency room that much more quickly. You don’t have to deal with traffic. You have to reserve it for those conditions.

Dr. Evans:

• Slurred speech
• Serious burns
• Chest pain
• Concussion
• Broken bones
• Head or eye injury

Scripps emergency departments are located in Encinitas, La Jolla, Hillcrest in San Diego and Chula Vista.

Dr. Evans:

• Fever without a rash
• Ankle sprain
• Dehydration
• Vomit, diarrhea

For vomit, diarrhea and dehydration, I would say urgent care, for the vast majority of people. However, if they have illnesses that take away their immune system, if they’re on chemotherapy, if they’re in advanced age, or if they suffer from an other illness and have some complex medical background, the emergency department is probably the destination of choice, given the likelihood of them needing hospitalization.

Scripps has urgent care centers in Torrey Pines, Vista and Rancho Bernardo. All have advanced imaging.

Dr. Geary: Our Scripps HealthExpress clinics are ideal for low-acuity problem, such as:

• Eye pain, eye redness,
•  Allergies,
•  Ear pain, ear infections,
•  Strep throat,
•  Bladder infections,
•  Skin rashes.

We have 12 locations throughout San Diego. Our Scripps HealthExpress clinics are open seven days a week, Monday through Friday, 7 am to 9 pm, and Saturday and Sunday, 8 to 5 pm. If your doctor is not available or you can’t go during work hours, you can just pick up the phone and call us at 858-779-0680. You can do a walk in. It’s very easy. No appointment is necessary but you can call or go on www.scripps.org and reserve a place in line.

You don’t have to be a Scripps patient.

We accept all patients with all different insurances, and also on a cash basis. Anybody in San Diego can use our services.

We have pediatric specific providers at two of our locations. Currently that’s at Rancho Bernardo and Carmel Valley for children three months to 17 years old. The pediatric HealthExpress clinics are available 5 pm through 9 pm, Monday through Friday, and 8 am to 5 pm, Saturday and Sunday.

Dr. Geary: No, and they weren’t meant to do so. Scripps HealthExpress was really to supplement our offerings for our patients and for all San Diego.

We recommend that you see a primary care doctor for your health physicals, for chronic disease and for anything that requires more than one visit. A primary care doctor can see you when you have a cough, a cold and bladder infections. Sometimes, they’re closed when you actually need to see them, or sometimes they may not have an opening until two days from now. This is an additional resource that we offer to our patients.

Dr. Geary: We have a nurse phone line that you can call for Scripps HealthExpress. If you’re not sure, you can always call and our nurse will ask you questions, and based on your symptoms and your medical history, give you advice on where to go. If you’re not sure, and it’s something you think is serious, I recommend you call 911. Better safe than sorry.

But if you go to any of our clinics, if you go to a HealthExpress clinic, and they evaluate you, and you need to be sent to an emergency room or sent to an urgent care, they will let you know at that clinic, at that time.

Dr. Evans: It can be very hard to acknowledge that you need help. This goes for all of us. Nobody wants lights, and sirens and firemen and folks in big, heavy yellow gear walking up to the house and knocking on the door and to be surrendered to get help.

When a patient arrives in the emergency department, that’s probably one of the most sensitive things we see. Folks come in and this is the first time in their life they’ve really needed help, that they’ve felt imperiled. So, 911 is an absolutely wonderful and fundamental element of our society.

When to call is important. I would say that if somebody feels they’re going to lose consciousness, if they can't mobilize themselves, if they don't have access to transportation, if they have any of the big three — if their head, their vision, their breathing or their chest or their abdomen feels imperiled or severely injured — they need to get to the emergency department. And it's 911 every time.

Strokes and chest pain are the two most popular source of complaints where people will use 911 appropriately. So, if somebody's dizzy, or has slurred speech, or trouble with their vision, or difficulty mobilizing themselves or chest pain of any sort, that really is 911, so that those access providers can get you there in traffic and you're with somebody who can responsibly take care of you when you're on your way.

Dr. Geary: Know that the person taking care of you, whether it’s the nurse or the doctor, or anybody else, they want to know your medical history in order to treat you appropriately and then give you the best care possible.

They will need to know what allergies you have, what medications are you currently taking, (including supplements) what medical problems have you had, or currently have? Have you had any prior surgeries? All this makes a difference when the provider who’s assessing you wants to quickly and accurately diagnose you and treat your condition, whatever it is.

Dr. Evans: I would agree and as accurate as our health care record system is, there is always a little disparity because of recent events where somebody might be on a different medication or they are traveling.

Please keep a list of your medications. Include your allergies. There’s one more thing. Provide a phone number of somebody we can reach out to who can give reasonable information in the event that you become unconscious, or alternatively, somebody who knows you and can help you to make decisions, if things are dire.