When to visit Urgent Care vs. Emergency Room

I don't know about you, but our ER copay is $400. So, I'll pretty much do whatever it takes to avoid that place. Last summer, my 3 year old took a flying leap off of the jungle gym and bit a gaping hole through his tongue. As he sat crying and bleeding all over my husband, I made calls frantically trying to find somewhere to take our son, other than the hospital's Emergency Room. Unfortunately, our pediatrician, nearest urgent care, and nearest pediatric urgent care all told me "go to the ER" and that was that. An Uber ride, couple of hours, 2 stitches, and $400 later, my son was good as new.

When it comes to illness and injury, whether an adult or a child, it's not always crystal clear whether you should head to your primary care provider (PCP), urgent care, or straight to the ER. Making the decision can be overwhelming, especially in the moment when someone is really sick or hurt, so I was grateful to attend a very helpful presentation for parents and mommy bloggers at the new Northwell Health-GoHealth Urgent Care in Williamsburg last night and pass on what I learned to all of you!! 

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Why you shouldn't head straight to the ER for every illness & injury:

• It's a very scary place - children may see extremely traumatic injuries come in. They may see police officers and belligerent or dangerous patients. A Pediatric ER should be a bit less scary, but it can still be a frightening and stressful experience.
• It's not first come first served - they see the sickest patients first, which can mean a LONG wait.
• It's full of germs (kids under the age of 1 are especially susceptible).
• It's the most expensive place to go, with or without insurance.

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When is Urgent Care the best option?

• Your PCP is closed or can't fit you in at a time convenient for you (Note: urgent care is NOT a substitute for regular preventive care; they can however provide records from your visit to your PCP to help update your charts) 
• You have a non-life threatening illness or injury and don't want to deal with the long wait time at your PCP or the ER.

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What can they do for you at Urgent Care?
(The following are applicable specifically for Northwell Health-GoHealth Urgent Cares, but probably apply to most urgent cares)

• Get rapid flu, strep, mono, and urine tests.
• ​Have wounds cleaned, glued or stitched (​Note: Northwell Health-GoHealth Urgent Care can't sedate a child - they can strap them down papoose style for a couple of stitches but that's about the extent of it. A specialized pediatric urgent care may have more options here.)
• Receive an IV and rehydrating fluids.
• Get an x-ray (The Northwell Health-GoHealth MD/DO or PA/NP will send films to be read by the radiologist, but may send you home if they think it looks clear, and will call you if radiologist sees a problem).
• Get blood drawn and sent to lab.
• Receive oral medications, and some intramuscular shots.
• Get treatment for a mild allergic reaction limited to skin only (rash, hives)
• Get your child's summer camp physical done. Northwell Health-GoHealth Urgent Cares in Brooklyn and Manhattan are currently offering this service for only $50!
• At Northwell Health-GoHealth Urgent Cares (in NYC, Portland, Vancouver, San Francisco, & Hartford), you can view the wait time and check-in online, and if needed, they can give you a prompt referral to a Northwell affiliated hospital, Emergency Department, or specialist.
• Most commonly seen at urgent care include colds and flu, fever, ear pain, superficial injuries, sprains, and strains.

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But obviously, urgent care has limitations and is not the best option for severe and life threatening illnesses and injuries. If the situation is dire and the patient is really struggling, your best bet is to head directly to the ER or call 9-1-1 and start any necessary first aid treatments immediately! 

When to call an Ambulance (or head straight to the ER):

• difficulty breathing (for example, an older child can't count to 10 without needing a breath, a baby can't breathe well enough to nurse, lips are turning blue), this includes allergic reaction with swelling of the lips and face (urgent care has epi pens but cannot intubate).
• seizure
• fever in a baby under 3 months (they have zero immune system so are incredibly vulnerable to infection)
• change in mental status (behaving odd, lethargic, not eating or drinking)
• Meningitis Trifecta: stiff neck, fever, & rash (will likely need a spinal tap)
• large cut to head, neck, or abdomen that won't stop bleeding with pressure (as well as major injuries to the tongue or airway)
• electric shock (stuck something in the outlet or chewed a wire)
• burn on more than 5% of the body (the palm represents 5% of that person's body, adult or child)
• poisoning, ingestion of button battery or magnet
• head injury and odd behavior (a quick CAT scan at the ER wil yield the quickest answers)
• ​abdominal pain with fever and vomiting

And finally, some helpful tips and reminders for parents:

• I mentioned it in passing above, but let me emphasize about first aid... every care giver (that's parents, babysitters, teachers, grandparents - anyone who will be taking care of your child) needs to know the basics of First Aid and CPR including rescue breathing, the Heimlich, how to stop bleeding, etc. Go take a class, or gather your care givers and friends and host a class at your home!! And don't forget to practice at home and take refresher courses. (You can find a local Red Cross class here).
• Know your medical options at home and on vacation - know where the closest ER and urgent care are, and see if there are any specializing in pediatrics. Also, make sure your health insurance will cover your family when traveling abroad - you may need supplemental travel insurance.
• Make sure your children know how to dial 9-1-1 (they should also know your address and how to unlock the front door).
• Prepare a family disaster plan (here's a guide by NYCEM) - come up with a safe meeting place and rehearse your plan.

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Phew - that was a LOT of info, but so important!! I hope you found it useful!!! If you have anything to add on the subject, please please do leave a comment below!! Have you had a good or bad experience at the ER or urgent care? Know of a great local First Aid class? Sharing is caring!!

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Disclaimer: This post was sponsored by Northwell Health-GoHealth Urgent Care, but I'm no sell out, all thoughts and opinions are my own!!