August 11, 2006
One day last month, Judy Bradley was walking up some wooden stairs. She tripped on a “weird overhang” and cut her leg on one of the steps.
“It was gushing blood,” says Bradley, 68, of Wildwood, Mo.
She knew the cut needed stitches, but it was a Saturday evening. Her primary care physician’s office was closed, and she didn’t want the long wait of an emergency room.
She put pressure on the wound and told her husband to take her to the St. Luke’s Urgent Care center in Ellisville, Mo., that she had visited a few years ago.
“I knew it closed at 8, and we got there 10 minutes before 8,” she says. “They saw me hobbling out of the car, greeted me at the door … and within 45 minutes I was done.”
Her cut required nine stitches.
“They took care of it immediately, did a professional job and were friendly and nice,” she says.
Elizabeth Sparks, mother of four, likes urgent care for a similar reason: convenience.
“It’s just easier to go there,” she says. “And I know (my kids) are going to get good care.”
Sparks, 39, says she’s taken her kids there for everything from strep throat to a broken toe. “I take them to their regular doctor for checkups, but I take them to urgent care for just about everything else. It’s right down the street, and we usually get in and get out really quickly.”
Urgent care centers are facilities dedicated to treating conditions that require prompt medical attention but do not pose an immediate health threat. You need no appointment, and the centers are open nearly year-round for extended hours.
“That’s the main focus of this practice model,” says Dr. Larry Murrow, medical director of urgent care at St. Anthony’s Medical Center. “Our goal is to provide convenience for the consumer. I think in the future we are going to see more and more of this type of medicine. It’s a matter of the patient’s time needs being so great. Everyone is so intensely scheduled, it’s difficult to get in to see a primary care physician.”
St. Anthony’s operates three urgent care centers. This year, estimates call for 60,000 visits among the three centers.
St. Luke’s Hospital operates four urgent care centers. For the fiscal year that ended in June, they reported 88,000 visits, says Linda Hayden, nursing director for urgent care at St. Luke’s. That’s about a 10 percent increase over last year.
These days you can find urgent care centers, both private and hospital-run, in most communities in the area. Hayden says the popularity has grown exponentially in the past five years.
“I think the public is more aware of what we do here,” she says. “But I also think the wait times in ERs have contributed to it. And so have busy lifestyles. If someone is ill at work, they want to be seen on their way home. If someone wakes up with a sore throat on Saturday morning, they want to get in and get treated so they can be better by Monday.”
The urge for convenience is not only spawning more urgent care centers, but also health clinics planned to open at some Walgreens, Medicine Shoppe and Schnucks stores, which will be staffed by nurse practitioners and overseen by off-site doctors. The clinics will serve patients with common ailments such as a cold, flu and sore throat, and some will offer flu shots. None has opened yet.
What to go there for:
Urgent care centers, which are staffed by board-certified physicians and nurses, are equipped to deal with minor emergencies, such as a cut to the eye or a sprained ankle, and especially minor illnesses, such as a sinus infection.
“People would prefer to be seen immediately,” says Murrow. “That’s why we offer the hours we do.”
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At many centers, patients need no appointment; they just walk in the door and tell the receptionist why they’d like to see a doctor. The receptionist takes down all relevant information, and usually within minutes the patient is in to see the doctor.
The centers are equipped with X-ray facilities and some limited lab capabilities. If a doctor needs more work done, he or she will send the patient to the hospital. At some centers, the goal is to get the patient out the door within 60 minutes. At others, the goal is to get the patient seen within 15 to 30 minutes.
The centers are not intended for someone experiencing any kind of life-threatening situation, including chest pain, loss of consciousness or a head injury, says Murrow.
ERs and primary care doctors:
In recent years there has been a drop in the number of doctors entering primary care practice.
Because of that, there are fewer appointments to be had with those doctors.
“Sometimes you can’t get in for several days, and when you can, it’s often at an inconvenient time for those who work,” says Murrow.
In addition, the increasing number of uninsured patients is sending more people to the emergency room. In a report last year by the U.S. Centers for Disease Control and Prevention, emergency department visits increased from 90.3 million to 113.9 million annually from 1993 to 2003. Of people actually treated at the emergency room, 40 percent of the cases were deemed nonurgent or semi-urgent, the report said. Most of those would have been more appropriately treated in an urgent care center. In addition, the report stated that the average emergency room visit in the U.S. took 3.2 hours.
In many hospitals across the region, there is an emphasis on taking some of the load off of emergency rooms. That’s where urgent care centers come in.
At St. Luke’s, emergency room staffers will refer a patient who calls to an urgent care center if the symptoms warrant it.
“That’s a large part of the reason there’s an emphasis on growing urgent care,” says Murrow. “As the volume (in emergency rooms) decreases, it’s good for everyone. Wait time decreases. We have increased efficiency, and that’s good for the doctors and the patients.”
Drawbacks:
One of the drawbacks to urgent care is cost. Most insurance companies categorize it as an emergency room visit, so your co-pay could be five to 10 times higher than it is for a regular doctor appointment.
But Hayden says convenience outweighs the cost for many of their patients. “Sometimes it’s worth it to pay that,” she says.
In addition, even the people who run the centers say urgent care is not meant to replace primary care physicians.
At the St. Luke’s centers, they work closely with the primary care physicians, even sending your file to them once you have been in.
“We value primary care physicians,” says Hayden. “We strive to work hand in hand with them. They are important to our business, and we are important to theirs. Many times, when an office is closed, they will leave our address and phone number on the recorder.”
Murrow agrees.
“There are a lot of things we can do and a lot of things we can’t do,” says Murrow. “Your primary care doctor knows you, knows your history, and you should still try to see that doctor.”
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