When faced with a sudden illness or injury for yourself or loved one, trying to decide where to seek treatment can be a harrowing decision. Does the illness or injury warrant a trip to a hospital's emergency room, or should you seek care at an urgent care center? When should you seek treatment from your primary care physician?

1. Urgent or Emergent –
How Do You Decide?
Anthony V. Carrozza, MD, FACEP
Livingston Public Library
September 23, 2019

2. 2019
A Big Year for Summit Medical Group
• Celebrating our 100th Anniversary
• 6 major medical campuses in northern New Jersey
• Recently announced our merger with CityMD, the leading urgent care
provider in the New York metro area.
“A new organization which provides patients an exceptional,
seamless experience across a full spectrum of high-quality primary,
specialty, and urgent care with more than 1,400 providers, over
6,400 employees and nearly 200 locations in New Jersey and New
York.”

3. Close Follow-up for Patients
• If you visit a SMG Urgent Care Center or
a CityMD site, and need a follow-up with
a specialist, we have 900+ specialists in
northern NJ that we can refer you to.
• We can easily share your records from
the urgent care center to the specialist.

4. Fair Lawn 150 Park
Ave,
Florham
Park
Berkeley Heights*
Livingston*
140 Park Ave,
Florham Park*
Clifton
Westfield*
*Urgent Care locations

5. Bio
• Trained in Emergency Medicine at St. Luke’s-Roosevelt
Hospital, now part of Mount Sinai Health System in New
York City.
• Practiced EM at seven community hospitals in the Las
Vegas area and acted as Medical Director for an urban
and rural ED.
• Fellow of American College of Emergency Physicians,
Board Certified for over 10 years.
• Extensive experience in treating both critical and noncritical
illnesses and injuries within the emergency setting.
• Currently practice at SMG Urgent Care Center and
Emergency Physician at Overlook Medical Center.

6. Choices When Vertical and Sick
• Appointment
• Primary Care Provider
• Specialist
• No Appointment
• Emergency Department
• “Urgent Care”

7. What is an Emergency Department?
• Board Certified Emergency Doc - Usually
• Open 24/7, 365
• Ambulance Traffic
• Designations - Trauma, Stroke Center, etc.
• Everyone is evaluated- EMTALA
• Fast Track to Critical Care
• Radiologic Imaging, Lab
• On-site OR, Specialists, etc.
• Relatively consistent around here at least!

8. What’s a typical Urgent Care Center?
• IM/FP/EM, Board Certified- probably, APCs
• Hours vary, usually 7 days/week, ?holidays
• No ambulance traffic, No designation
• Not all patients are evaluated
• Acuity depending on UCC
• ?Blood Tests, ?Imaging
• ?Specialty Support/Follow-up
• Inconsistent

9. SMG UCC
• Board Certified Emergency Docs Always On-site
• M-F 8-8, SS 8-5, +Holiday services
• No Ambulance Traffic
• National Urgent Care Center Accreditation
• Voluntary process measures the quality of our UCC
practices/facility against national standards.
• All patients are evaluated.
• Comprehensive Lab, X-Ray, CT, US, Vascular
Studies, MRI

10. SMG UCC
• Multidisciplinary Team 1400+ Providers!
• Specialist Consultation
• Same Electronic Medical Record
• Close Follow-up
• Direct Admissions/OR
• Mini ER vs. Super UCC

11. UCC Patient Volume
0
25000
50000
75000
100000
2015 2016 2017 2018

12. ER or UCC
• Is this a life threatening/time dependent?
• Sudden onset worst pain ever!
• Pain not going away/worsening
• Does it feel like your last heart attack?
• History of serious medical conditions
• Heart attack/aneurysm/clots, etc.
• Recent surgery
• Less worrisome
• Mild, no longer in pain, no health issues

13. Cases
• Severe sudden-onset chest pain, worst pain ever
• Moderate diffuse abdominal pain for the past week,
fever on/off
• Cough worsening now with wheeze and mild
shortness of breath
• Severe headache, fever, neck stiffness for 24 hours
• Laceration to left hand while cutting a bagel
• High speed MVC/Roll over, rib/abdominal pain,
crawled out of vehicle took Uber to UCC

14. Conclusion
• You are not expected to be your own doctor, just try to
judge whether this is life threatening/time dependent
• UCC-can often make the diagnosis—can’t always
treat!
• Delay of Care
• UCC
• Great for making diagnoses/ initiating care/referring
to specialist, which is MOST of the time!
• Not great for treating immediate life threats
• If you feel sick enough for an ambulance, do not hesitate
to call.

15. Q/A Session