Urgent care clinics and emergency departments provide similar services like extended hours, treatment for all ages, diagnostic testing, and coordination of care. However, they differ in important ways. Urgent care clinics are best for non-emergent care and offer low-cost, high-efficiency treatment, while emergency departments are intended for true medical emergencies and acute issues that could threaten life or limb. It is important for patients to educate themselves on when to use urgent care versus an emergency room in order to receive the right treatment in the right setting. Conditions that generally require emergency care include chest pain, difficulty breathing, severe abdominal pain, injuries, and other issues listed. With guidance and knowledge of options, patients can make

1. Urgent Care Clinic vs Emergency
Department – Which is Better?
Why? When?
Sal A. D’Allura, DO, FAAFP
Board Certified Family Medicine and Urgent Care
Medicine
Past Osteopathic Family Medicine Program Director –
Duke/VCOM SR-AHEC Program
January 21, 2014

2. How To Know Where To Go For Your Medical Care?
When an emergency strikes, you
know you need medical care fast.
But what if you’re not sure if it’s a
true emergency? How can you
tell if what you or a loved one is
experiencing should have you
rushing to the ER? While the
answer is not always simple,
knowing the difference between
urgent care and emergency care
and where to seek treatment
could save your life in an
emergency.

3. Preliminary Thoughts
• New Healthcare Realities Are On The Horizon
Related To The Affordable Care Act
• More Insured People!! = More Utilization!!
• Patients Need To Become Consumers Of Healthcare
• Patients Will Need To Learn How To Navigate In The
“Rough Waters” In This Difficult Healthcare Arena

4. Preliminary Thoughts……
• Patients Need To Know Where To Obtain Top
Quality Medical Care For Unplanned Problems &
Unscheduled Illness Or Injury
• Dwindling Healthcare Resources = Facility Closures;
Yet We Still Need To Care For The Community’s
Illnesses

5. Community Outreach Forums
• Recognize The Importance Of Forums Like This!
• People Need To Gather Information, To Navigate
Confidently In This Difficult Healthcare Arena
• People Need To Gather Information To Make The
Right Decisions For Their Own Healthcare Needs

6. Learning Objectives
• Settle Confusion, Myths & Misconceptions
• Acquaint You With The Important Similarities &
Differences
• Empower You To Recognize & Choose The Proper
Venue
• Right Care, Right Place, Right Time

7. UCM vs EM – Which is Best?
• Leave You At The End With A “Bucket Full Of
Knowledge”
• UCC & ED – What They Are and What They Are Not
• How Do I Choose Where To Go
• Take Home Points

8. What Is Urgent Care Medicine?
• 3 Governing Bodies:
I. AAUCM {American Academy of Urgent Care
Medicine}
II. UCAOA {Urgent Care Association Of America}
III. UCCOP {Urgent Care College Of Physicians}

9. Urgent Care Medicine Defined
• Provision Of Acute Ambulatory, Unscheduled
Healthcare Services
• Immediate Care
• Outpatient Healthcare With Extended Care Access
• Medically Necessary Care That Is Not Life or Limb
Threatening
• Injuries That Will Not Result In Further Disability,
ED Care or Hospitalization

10. Urgent Care Medicine Defined….
• Ability To Treat Acutely Arising Conditions In All
Age Groups That Are Not Considered Life or Limb
Threatening
• Does Not Replace Primary Care Services!!

11. Urgent Care Medicine Industry
Snapshot
• 30+ Years Of Service
• 9,000+ Facilities {50% In Existence >10 Years}
• 300 To 600+ Facilities Opening Annually
• 20,000+ US Physicians Practice Urgent Care
Medicine {>90% Are Board Certified}
• Fueled By The Public’s Desire To Have Access To
Immediate Care

12. Urgent Care Medicine Industry
Snapshot……
• There Is An International Presence:
I. Australia
II. Canada
III. Israel
IV. New Zealand
• Urgent Care Medicine Is Firmly Entrenched In The
Healthcare Community

13. Urgent Care Medicine Important
Why?
• 160 Million Visits In 2012 {Extremely Busy
Places}
• Studies Reveal That >40% Of ED Visits Are For
Non-Emergent Care
• UCC Are The Most Attractive Alternative To ED
• UCC Can More Readily Respond To The Realities
Of The Affordable Care Act, Positioned Perfectly
To Handle The Influx Of Patients

14. Urgent Care Medicine Important
Why?......
• UCM Services Provided >$13 Billion In Healthcare
Revenue
• PCPs Spend Time On PCMH And Delivery Of
Healthcare Maintenance For Their Patients……
• Then PCPs Cannot Handle Acute Healthcare
Problems That Need To Be Addressed
• UCM Compliments Primary Care

15. Characteristics of Urgent Care
• Outpatient Delivery Of Healthcare
• Focused Healthcare
• Treatment Of New Onset, Episodic, Acute, Non-Life
Threatening Illness
• Crosses Over All Medical Disciplines
• Lower Acuity Injuries & Illness

16. Characteristics of Urgent Care……
• Serves All Patients Of All Ages On A First-Come
First-Serve Basis
• Provides Office Based Lab & X-Ray Services
• Low Acuity IVF Management & Medications
• Staffing For Optimal Delivery Of Healthcare
{Physicians, PA/NP, Ancillary Support Staff}
• Transport Of Acutely Ill Patients

17. What Urgent Care Is NOT:
• NOT A Replacement For Continuity Of Care
• NOT A Mini-Emergency Department
• NOT A Venue For Advanced Critical Care
• NOT A Venue For True Medical Emergencies,
Obstetric Care/Emergencies or Acute Psychiatric
Emergencies

18. What Is Emergency Medicine?
• Defined & Divided Into 2 Parts:
I. Pre-institutional Care: EMS And First Responders
At Scene Of Emergency
II. Institutional Care: The Main Hospital Emergency
Department

19. EM History & Industry Snapshot
• Specialty Since 1979
• 40,000+ Residency Trained, Board Certified
Physicians
• 3,900 USA Hospital Emergency Departments
{Beware!!!! The Industry Is Being Challenged & EDs
Are Closing}

20. EM History & Industry Snapshot……
• 20+ Million EMS Transfers Annually
• 136+ Million ED Visits Annually
• Origins Of Emergency Medicine Were Derived From
The Pontiac, Michigan Plan and The Alexandria,
Virginia Plan {The Birth Places Of Emergency
Medicine As We Know It}

21. EM History & Industry Snapshot……
• 45% Of All Hospital Admissions Originate From The
ED {Primarily The Elderly}
• 2/3 Of All USA EDs Are Classified As “Safety-Nets”
Operating At, Or Over Capacity, With Visit Times
Exceeding 4+ Hours
• ED Is A Gateway For All Hospital Admissions, Open
24/7/365

22. EM History & Industry Snapshot……
• High Cost, Low Efficient Facilities For Non-Emergent
Care
• Offer Access To State-Of-The-Art Technology
• Offer Access To A Full Range Of Specialty Physicians
& Healthcare Options

23. What The Emergency Department Is
NOT:
• NOT A Replacement For Continuity Of Primary Care
• NOT The Venue For Non-Emergent Care
• NOT The Venue For Short Wait Times {Patients Are
Prioritized Based Upon Acuity Of Care Needs And
Not Time Of Arrival}

24. UCC & ED Similarities
• Extended Hours
• Evaluation & Treatment Of Patients Of All Ages
• Extensively Trained Providers & Ancillary Staff
• Care For Unscheduled, Episodic, Acute Illness Or
Injury
• Availability Of A Wide Range Of Diagnostic Testing
& Medical Therapies
• Allow For Coordination Of Healthcare Delivery In
Real-Time

25. Choosing Between UCC & ED – While
Similar; They Are Very Different……
• Showing Up At The Wrong Place, At The Wrong
Time, With The Wrong Diagnosis, Will Guarantee
You A Delay In Definitive Healthcare & May Even
Put Your Life At Risk!!
• GET ADVICE!!

26. How To Get Guidance:
• 24 Hour Help Lines
• Nurse Advice Lines
• Insurance Plan Documents
• Call The ED or UCC And Ask For Guidance…..Not
Medical Care Questions
• Educate Yourself…..Under The ACA, Decision
Making Will Fall To The Patient; Studies Have
Shown That Average Patients Can Figure Out What
Is and What Is Not An Emergency.

27. Self-Education Requires An Action
Plan
• Understand Your Options & Ask The Correct
Questions
• Consider The Severity Of The Condition……Is It
Urgent Or Emergent? Certain Conditions Should
Only Be Treated In The Emergency Department
{More To Come Later……}
• Understand “The Prudent Layperson Standard”
Which Is Now Law By Way Of The Affordable Care
Act

28. The Prudent Layperson Standard
Definition:
The prudent layperson definition of an emergency medical condition commonly in practice
is any medical or behavioral condition of recent onset and severity, including but not limited
to severe pain, that would lead a prudent layperson, possessing an average knowledge of
medicine and health, to believe that his or her condition, sickness, or injury is of such a
nature that failure to obtain immediate medical care could result in placing the patient’s
health in serious jeopardy, cause serious impairment to bodily functions, serious dysfunction
of any bodily organ or part, or in the case of a behavioral condition placing the health of
such person or others in serious jeopardy. This prudent layperson definition of emergency
medical condition focuses on the patient’s presenting symptoms rather than the final
diagnosis when determining whether to pay emergency medical claims.
Note: Under the prudent layperson standard payment for emergency care is made for the
initial evaluation and examination based upon the nature of the patient’s presenting
complaint. Payment may be made for additional medical services until the condition is no
longer clinically determined to be emergent in nature and the patient is stable for transfer or
discharge.

29. Prudent Layperson & Medical Necessity:
Any medical condition of recent onset manifesting itself by acute severity of
symptoms, including severe pain is considered medical necessity.
A determination of a medical emergency focuses on the patient’s presenting
symptoms rather than the final diagnosis. However, certain conditions are the leading
cause to seek emergency treatment. These conditions include, but are not limited to:
loss of consciousness, seizure, no recognition of one side of the body, paralysis, chest
pain, shock, gangrene, coughing blood, trouble breathing, and choking.
Cases that fall into categories that may be chronic or blatantly non-emergent
generally do not fall into qualifying for immediate treatment under the prudent
layperson standard. Normal follow-up of a medical condition, removal of stitches, or
medication refills would generally be considered as non-emergent conditions under
the prudent layperson standard.

30. What Does All This Mean?
• Health Insurance Plans Need To Define What Is An
Emergency Condition In Order To Reimburse For It
• Patients Need To Educate Themselves As To What Is
An Emergency & Coordinate Their Healthcare
Accordingly As Well……The Burden Is Not Only
Upon The Insurance Company Any Longer
• Unnecessary Use Of Services Is Going To Fall Upon
The Patient For Reimbursement To The Facility If The
Facility Was Utilized Improperly.

31. Benefits Of Making The Right Choice
• Tailored Quality Medical Care For The Presenting
Condition
• Time & Money Savings {Can My Problem Wait? Is It
After Regular PCP Office Hours?}
• Best Use Of Healthcare/Insurance Dollars IF THE
PATIENT CHOOSES WISELY
• Care Expectations Relative To Wait Times – You Will
Wait Longer If You Are In The Wrong Place, At The
Wrong Time With The Wrong Condition!!!!

32. Medical Conditions That Require
Emergency Department Evaluation:
• Persistent chest pain, especially if it radiates to your arm or jaw or is
accompanied by sweating, vomiting or shortness of breath
• Persistent shortness of breath or wheezing
• Severe pain, particularly in the abdomen or starting halfway down the
back
• Loss of balance or fainting
• Difficulty speaking, altered mental status or confusion
• Weakness or paralysis
• Severe heart palpitations
• Sudden, severe headache
• Sudden testicular pain and swelling
• Newborn baby with a fever

33. • Intestinal bleeding
• Falls with injury or while taking blood thinning medications
• Loss of vision
• Head and eye injuries
• Broken bones or dislocated joints
• Deep cuts that require stitches – especially on the face
• Head or eye injuries
• Severe flu or cold symptoms
• High fevers or fevers with rash
• Bleeding that won’t stop or a large open wound
• Vaginal bleeding with pregnancy
• Repeated vomiting
• Serious burns
• Seizures without a previous diagnosis of epilepsy
• You may also be sent to the ER by your doctor, if you have an underlying
condition, such as hypertension or diabetes, which could complicate your
diagnosis and require extra medical care.

34. Medical Conditions That Are Suitable
For Urgent Care Clinic Evaluation:
• Fever without rash
• Minor trauma such as a common sprain
• Painful urination
• Persistent diarrhea
• Severe sore throat
• Vomiting
• If your symptoms come on gradually or you already know the diagnosis,
such as a urinary tract infection, or Upper Respiratory Infection, you may
want to try to get a same day appointment with your primary care
provider

35. Common Problems Are Not
Always What They Appear
To Be……
Note That There Are Many
Illnesses That Can Be Cared
For In Any Venue; HOWEVER,
THERE IS A GROUP OF
ILLNESSES THAT SHOULD
ONLY BE EVALUATED IN THE
EMERGENCY DEPARTMENT
While urgent care clinics are
always available, your
primary care physician will
have a better picture of your
overall health for a more
accurate diagnosis.

36. When Should I Take My Child To The
Emergency Department?
• Major trauma/injuries
• Injuries following a motor vehicle crash, being struck by a motor vehicle
or a fall from a height
• Serious head injury (with loss of consciousness, changes in normal
behavior, multiple episodes of vomiting)
• Burns with blisters or white areas, or large burns
• Obvious broken bone in the leg or arm
• Severe difficulty breathing/respiratory distress
• Fever in infants twelve weeks of age or less
• Severe pain
• Seizures

37. When Should I Take My Child To An
Urgent Care Center?
• You should always call your child’s pediatrician or family doctor first.
Urgent Care Centers offer treatment for illnesses and injuries that need
immediate attention, but do not need to be handled by the emergency
department
• Minor cuts and lacerations
• Minor/small burns
• Possible broken bones/simple fractures
• Sprains and strains
• Vomiting and diarrhea
• Asthma (mild wheezing)
• Rashes
• Mild allergic reactions
• Fever

38. Summary – The Take Home Points!
• Hospital Emergency Departments Are:
I. High Cost
II. Low Efficiency For Non-Emergent Care
III. Location Of Choice For True Medical Emergencies,
Acute Obstetric Problems & Acute Psychiatric Care

39. Summary – The Take Home Points!
• Urgent Care Facilities Are:
I. Low Cost
II. High Efficiency For Non-Emergent Care
III. Not Suitable For The Care Of True Medical
Emergencies, Any Obstetrical Emergencies or Acute
Psychiatric Emergencies

40. You Are Empowered To Choose &
Must Educate Yourselves To……
1. Know Your Care Options
2. Know What Is A True Emergency
3. Be Prepared In Advance
4. Consider The Severity Of The Illness
5. Consider The Time To Obtain Definitive Care
6. Research The Impact Of Your Choices
7. Keep Attending HPRHS Lecture Series For
Information

41. Thank You For Your Time……
Questions?