#2: What’s the Difference?

 When deciding where to go for medical care, a big question is “What’s the difference?” between facilities?  Between a Free-Standing Emergency Room and Urgent Care?  Between Urgent Care and a Retail Clinic?  In this post, we describe the differences, including a table for easy viewing.

Depending on the illness or injury, your first choice should generally be your primary care physician (your medical home).  They know you, they have your records, and you’ve already established the fact that they accept your insurance. But, what if you cannot get a same-day appointment for a sudden medical condition that requires immediate treatment?  What then?

Table 1: Spectrum of Care

Physician Office Routine care, chronic care, and health maintenance
Retail Clinic / Cash Clinic Minor illness care (sore throat, upper respiratory infection, urinary tract infections, and rashes), immunizations, and minor injuries (sprains, strains, and simple lacerations)
Moderate Urgent Care More extensive laboratory and radiology diagnostic capabilities
Advanced Urgent Care Advanced injuries including fracture care, intravenous fluids therapy, repetitive dose aerosol breathing treatment, advanced diagnostics including computed tomography (CT) scans for evaluation of head injury, kidney stones, and abdominal complaints
Freestanding ER Care for all levels of injury – minor to advanced, typically exclude major trauma, may treat and stabilize all levels of medical care, typically include advanced imaging (CT, plain film radiography, ultrasound),

full-service lab

Acute Care Hospital Care for all levels of illness and injury, including major trauma, with full inpatient care continuum available onsite.

(Table adapted from Boyle and Kirkpatrick, see Endnote #13 below.)

Retail Clinics

Retail clinics are typically found in drug stores, grocery stores, and retail areas such as The Little Clinics found in King Soopers.  We will answer questions in later blog posts about Colorado’s requirements for staffing and care at different facilities.  Retail clinics are appropriate for sudden minor illnesses like flu, urinary tract infections, pink eye, insect bites, poison ivy, and minor injuries that you are uncertain how to treat at home. 

Urgent Care Clinics 

Urgent care clinics[1] (also called urgent care centers, walk-in care, immediate care, medical clinics, convenient care, and community clinics), provide walk-in outpatient care and treat most medical conditions requiring same day attention.[2],[3],[4] Urgent care clinics are distinct from typical primary and medical care centers in that there is no appointment necessary, although it may be possible to call ahead and make an appointment, and they usually operate into the evenings and on weekends. Most are able to handle a wide variety of conditions from pneumonia to lacerations and fractures.[5],[6]  Many are equipped with X-ray capacity on site.  Urgent care clinics cannot call or categorize themselves as emergency centers. 

Although urgent care clinics tend to be available when primary care physicians are not, they are not always open 24/7.

Locations vary. According to the Urgent Care Association of America’s Benchmarking Survey Headlines Summary (2015),[7] 34.1% of urgent care clinics are located in a shopping center or strip mall, 33.2% in a free-standing building, 19.1% within a medical office, and 13.6% in a mixed-use building. 

Urgent care clinic services range from basic-level urgent care to advanced-level care. The type of treatment available will differ from place to place. Urgent care clinics are able to serve everyone from children to adults. Urgent care clinics are best equipped to handle injuries and illnesses that need immediate attention but are not considered to be life threatening.   Remember that “deep gash” in the fleshy part of your daughter’s leg we mentioned in Blog Post #1?  An urgent care center may be the ideal choice since the injury heeds immediate medical treatment but is not life-or-limb threatening.

Free-Standing Emergency Rooms 

Free-standing emergency rooms (FSERs) (also called emergency centers, stand-alone emergency rooms [ERs], and free-standing emergency departments [FSEDs],) offer walk-in emergency services but are structurally separate from hospital emergency rooms.[8],[9] These facilities may be located on medical campuses but can also be stationed in high traffic areas such as strip malls or other retail locations.

FSERs offer a spectrum of care from minor first aid to advanced life-saving services but are not as fully equipped as hospital ERs for major or multiple trauma cases. Like hospital ERs, FSERs operate 24/7/365 and are required to do so as a part of their licensing standards.[10],[11] Theoretically, FSERs help expand access to care while maintaining the same standard quality as a hospital-based ER. 

Free-standing emergency rooms are an excellent place to go for significant injuries or life-or-limb-threatening emergencies; however, be aware that if your situation is significant, life-or-limb threatening, FSERs are not able to admit patients (since they are not physically connected to a hospital with inpatient beds).  Some may offer extended observation for some cases, and all will assist in arranging transportation to a hospital for patients in need of further inpatient services.[12]

What Level of Care Do You Need?

There is a fine line in distinguishing what level of care you need.  That’s why you need this information in advance – so you can be prepared to make the right choice in a potentially frightening or confusing scenario.

Remember, if the condition is non-urgent, you can generally wait to have it treated by appointment at your primary care office.

For medical conditions that require immediate medical attention, but are not life-or-limb threatening, retail or urgent care centers may be most appropriate.

Go straight to an emergency room for life-or-limb threatening trauma.

Conclusion

We hope these distinctions help you “Know Where to Go.”  In the next blog post, we’ll discuss the differences in cost.

[1] The use of the term “urgent care” is unregulated in Colorado.

[2] Urgent Care Association of America (UCAOA). (n.d.). Urgent care FAQ. Retrieved from http://www.ucaoa.org/page/faq Accessed January 29, 2016.

[3] Colorado Department of Public Health and Environment. (2009). Standards for hospitals and health facilities. Chapter IX: Community clinics and community clinics and emergency centers. 1-8. Retrieved from http://www.sos.state.co.us/CCR/GenerateRulePdf.do?ruleVersionId=2949 Accessed January 29, 2016.

[4] Mayo Clinic Health System. (2012-2015). Retrieved from http://mayoclinichealthsystem.org/locations/austin/medical-services/urgent-care Accessed February 5, 2016.

[5] Urgent Care Association of America (UCAOA). (n.d.). Urgent care FAQ. Retrieved from http://www.ucaoa.org/page/faq Accessed January 29, 2016.

[6] American Academy of Urgent Care Medicine (AAUCM). (2016). Patient FAQs. Retrieved from http://aaucm.org/faq/patients/default.aspx#qid396 Accessed January 30, 2016.

[7] Urgent Care Association of America (UCAOA). Benchmarking survey headlines summary. (2015). Retrieved from

[8] Denver Post, 2014.

[9] Ayers, A.A. (2013). Dissecting the cost of a freestanding emergency department visit. Urgent Care Association of America. Retrieved from https://c.ymcdn.com/sites/ucaoa.site-ym.com/resource/resmgr/Alan_Ayers_Blog/UCAOA_Ayers_Blog_FSED_Pricin.pdf

[10] Ayers, A.A. (2013). Dissecting the cost of a freestanding emergency department visit. Urgent Care Association of America. Retrieved from https://c.ymcdn.com/sites/ucaoa.site-ym.com/resource/resmgr/Alan_Ayers_Blog/UCAOA_Ayers_Blog_FSED_Pricin.pdf

[11] Colorado Department of Public Health and Environment. (2009). Standards for hospitals and health facilities. Chapter IX: Community clinics and community clinics and emergency centers. 1-8. Retrieved from http://www.sos.state.co.us/CCR/GenerateRulePdf.do?ruleVersionId=2949 Accessed January 29, 2016.

[12] Boyle, M.F., & Kirkpatrick, D.G. (2012). The Healthcare executive’s guide to urgent care centers and freestanding EDs. Health Leaders Media, 1-35. Retrieved from http://healthleadersmedia.com/supplemental/10444_browse.pdf Accessed January 25, 2016.