ERs vs. Urgent Care: Rapid Paces But Different Cases

HYANNIS –Craig Cornwall, MD, has spent most of his career in the high-pressure atmosphere of an emergency room, so you might think that the time he spends working at one of Cape Cod Healthcare’s urgent care centers would be relaxing in comparison.

Not necessarily so.

“In the summer time, especially, the pace at an urgent care can actually be higher,” he said. “You may end up moving faster. It’s a lot less intense in terms of the medical complexity – simpler cases that turn over quicker. It’s a nice change.”

Along with the pace, the types of cases vary with the seasons.

“During the summer, you end up seeing beach-related injuries – foot lacerations from clamshells and fish hook injuries – and lots of tick-borne illness,” he said. “During the off-season, you see a lot of flu and colds and sore throats.”

The ER doctors and advanced practitioners at Cape Cod Hospital are on a rotation that has them spending about 15 percent of their time working shifts at Urgent Care – Hyannis and Urgent Care – Harwich at Fontaine Outpatient Center, said Dr. Cornwall.

“There are urgent care centers all over the Cape and all over the world,” he said. “The advantage that the Cape Cod Healthcare centers offer is that we have emergency medicine-trained physicians there, so we have a higher level of expertise for all types of injuries and illnesses.”

Another advantage of an urgent care center affiliated with Cape Cod Healthcare is that they’re connected to the same electronic medical record, Dr. Cornwall said.

“We use the specialists within the system and the primary care doctors get notification via secure email, fax, or EMR that their patient was there and they get all the records.

“Between our ERs and urgent care centers, we have all the diagnostic tools and can call all the specialists. We have it all pretty well covered here on the Cape.”

Who Should Go Where?

While urgent care centers are capable of handling a flood of cases, they sometimes see some patients who should have gone directly to an ER, according to Dr. Cornwall.

“Urgent care is designed for quick, relatively simple disease processes,” he said. “There is limited testing compared to an ER. You have X-ray, you have EKG, point-of-care tests for strep, flu, pregnancy.

“The complaints at urgent care are supposed to be relatively straightforward. If it can be treated with an X-ray, suturing, simple strep testing or flu testing, that kind of stuff, urgent care is perfect.”

Situations involving life-threatening issues or requiring an advanced diagnostic workup are best handled at a hospital, he said.

“We don’t have advanced tests such as ultrasound and CAT scan at the urgent cares,” he said. “If you think you’re sick enough that you might have to be admitted or you might have something life-threatening, you really shouldn’t be going to urgent care. That’s what the ER is designed for.

“By the same token, if you think you have something where you might consider going to your primary care doctor, like bronchitis or an ankle sprain or a laceration, then urgent care is perfectly designed for that. We’re perfectly equipped for acute, episodic minor care.

Both the Hyannis and Harwich urgent care centers transfer people to the hospital by ambulance on almost a daily basis, he said.

“The one at Fontaine sees more transfers just because it’s further away,” he said. “People will try to use it as an ER a little bit more than they might in Hyannis. Some people in Harwich and Orleans are averse to going what they consider the big city. But the clients over a period of time have gotten a little more aware of what we have and don’t have.”

By BILL O’NEILL, Cape Cod Health News

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