When a heavy metal door swung over her 14-year-old son’s foot, ripping the nail almost completely off his big toe, Tina Mobley didn’t want to take her chances in a crowded hospital emergency room or wait for an appointment at the pediatrician’s office the next day. Instead, she drove to an urgent-care clinic inside a Wal-Mart in Yulee, Fla., near her rural home. Within minutes, the doctor on duty numbed the pain with an injection, removed the nail, and cleaned and bandaged the injury.
Patients who need immediate care for injuries and illness, are increasingly turning to walk-in urgent-care clinics. These facilities aim to fill the gap between the growing shortage of primary-care doctors and a shrinking number of already-crowded hospital emergency departments, with no appointment necessary and extended evening and weekend hours.
Urgent-care clinics are staffed by physicians, offer wait times as little as a few minutes and charge $60 to $200 depending on the procedure — a fraction of the typical $1,000-plus emergency department visit. Some offer discounts and payment plans for the uninsured; for those with coverage, co-payments vary by insurance plan but may be less than half the amount of an ER visit, which can range from $50 to $200.
Urgent-care-center physicians and other medical staffers can put casts on broken bones, sew up lacerations, provide I.V. fluids for dehydrated patients and deploy advanced life-support equipment for both adults and children. They often have equipment not available in physicians’ offices, such as X-rays.
There are currently more than 8,000 urgent-care centers around the country, including about 1,200 affiliated with hospitals, and that number is expected to expand.
But as the number of urgent-care clinics has grown, so have concerns about their quality and safety, as well questions about the risks of patients substituting urgent-care centers for an ongoing relationship with a primary-care doctor who coordinates care and follows them over time. Recently, the Urgent Care Association of America, a trade group representing 3,141 urgent-care professionals, struck an agreement with the Joint Commission, the non-profit group that accredits hospitals and other health-care organizations, to take over accreditation and publish national quality standards by 2010.
“We’d look far more favorably at an urgent-care clinic that was accredited than one that wasn’t,” says Troy Brennan, chief medical officer at insurer Aetna.
While Aetna says patients shouldn’t seek treatment in an urgent-care facility if their condition requires emergency services, and encourages them to call their doctor first, “if it is a good high-quality urgent-care center that can keep someone out of the emergency department who doesn’t need to be there, that is a good thing.”
But Linda Lawrence, president of the American College of Emergency Physicians, says the majority of patients who show up in the ER belong there until their conditions can be evaluated. “A patient who says they are having indigestion and goes to an urgent-care clinic may really be having a heart attack,” she said.
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EMERGENCY (WAITING) ROOM
The average time that hospital emergency room patients wait to see a doctor has grown to almost an hour, according to new federal statistics released Wednesday.
The increase is due to supply and demand, said Dr. Stephen Pitts, the lead author of the report by the CDC.
“There are more people arriving at the ERs. And there are fewer ERs,” said Pitts, an associate professor of emergency medicine at Atlanta’s Emory University.
Another reason for crowding is patients who are admitted to the hospital end up waiting in the ER because of the limited number of hospital beds, Pitts added.
The difficulty many patients have in getting appointments to doctor’s offices — which causes some to turn to emergency departments — also contributes, experts said.
– Associated Press