The Doctor is Always In

Urgent care clinics fill after-hours health needs and help you avoid the ER
| FROM THE PRINT EDITION |
 
 

Many of us have been there. It’s 6:15 p.m. on a Friday evening, the pediatrician’s office is closed, and you are pacing the floor. Your sweet little toddler has suddenly come down with a rash and a high fever. She’s restless and won’t drink or eat anything. A few years ago, you’d head to the emergency room. Now you have another option, thanks to the growing number of urgent care clinics in our region.

Urgent care fills the medical-care gap between the 24/7 ER and the normal business hours offered by most primary care physicians. Patients find that urgent care clinics are convenient in terms of location (sometimes in their own neighborhoods), extended hours of service (available after work and school) and wait times (minimal when compared to two or three hours in the ER); and visits are far less costly at urgent care centers than at an ER. The American Academy of Urgent Care Medicine estimates that currently there are 9,300 stand-alone urgent care facilities in the United States and that 50–100 new clinics open every year. And they’re opening by the dozens in Seattle.

Institutional use of computerized patient data (providing access to patients’ medical records by doctors in multiple locations), a movement toward patient-centered care (making services available to patients where and when they need it) and concerns about spiraling costs all contribute to the rapid growth of urgent care clinics. If emergency care is for life-threatening conditions, such as heart attack, stroke or excessive bleeding, think of urgent care as an option for those times when “I need or want immediate attention, but my doctor isn’t available.”

“If you are experiencing a sudden and serious medical problem, the emergency room can be a lifesaver—sometimes literally. But too often ERs become the place where patients go with problems that are not emergencies,” says Nancy Giunto, executive director of the Washington Health Alliance. According to a report by the organization, more people go to the ER for a cold than for a broken leg, and the number-one reason for an ER visit in our region is for an uncomplicated headache (one in which there are no signs of a significant medical issue, such as concussion or stroke). All of this adds up to wasted resources, very long waits and excessive costs for both providers and patients—issues that urgent care clinics help alleviate.

“Urgent care is a good option for minor, acute, non-life-threatening illness or injury,” says Gregory Schroedl, M.D., a board-certified emergency medicine physician, and vice president and chief medical officer of UW Medicine’s Northwest Hospital & Medical Center. UW Medicine has four hospitals with emergency rooms and nine urgent care clinics in the greater Seattle area. “Urgent care is a key component of the system of care available to patients offered by UW Medicine. Primary care physicians typically provide services during normal business hours, while urgent care offers extended hours coverage, and the ER provides care for serious or life threatening situations 24/7,” Schroedl says.

Seattle Children’s Hospital created its three urgent care clinics, at the main Seattle campus, and in Bellevue and Mill Creek, three years ago in response to demand—parents often need after-hours care for their children—as well as the fact that such clinics are more efficient and less costly for acute care than the ER. The clinics are popular: More than 20,000 patients visit Seattle Children’s urgent care clinics each year; that is 40–60 patients per day, after hours. “After hours” can vary widely among urgent care clinics; the Seattle Children’s clinics are open until 10:30 p.m., Monday–Friday, and until 8 p.m. on weekends.

In general, patients often find urgent care clinics more comforting, approachable and less intimidating than the sometimes-chaotic environment of an extremely busy hospital ER. The Seattle Children’s centers also have the additional benefit of specialists. Parents feel more comfortable getting treatment for their children in a pediatric environment. “

We know kids,” says Tony Woodward, M.D., medical director of emergency medicine at Seattle Children’s. “We are 100 percent focused on pediatrics, and everybody we work with—including the lab technicians, social workers, nurses, imaging techs and doctors—are specially trained in pediatrics. We have the right equipment and don’t have to jerry-rig gear to fit a small child. Our medicine is in liquid form. We understand how illnesses affect children.”

When it comes to choosing an urgent care or ER facility, experts say it’s good to plan ahead. “You can’t choose your emergency room doctor, but in most cases, you can choose where to go for emergency room services—and should,” says Margot Kravette, manager of Seattle Children’s Emergency Management Program. It’s also important to check your insurance plan; although almost all plans cover life-threatening emergency treatment at any hospital, coverage varies widely, and some plans have in-network and out-of-network rates. An in-network ER or urgent care center will also have access to all of your patient records, and your primary care doctor will similarly be able to access your ER and urgent care records.

Schroedl recommends that you research the training, credentials and health system affiliations of your urgent care clinic in the same way you would an orthopedic surgeon or family care physician. Check staffing: who they are, what they do and where they were educated. Check affiliation: Is the facility part of a major provider network like MultiCare or UW Medicine, or is it independent? Check capabilities: Does it have an on-site lab and radiology? In the event of a situation that does require treatment in an ER, does the urgent care center have a transition and transportation agreement in place with an ER for patient transfers?

For added convenience beyond primary care, urgent care and emergency care, there are a number of options. Many neighborhood clinics, like the ones set up by EvergreenHealth Medical Center and walk-in clinics like Immediate Clinic, offer same-day appointments during regular business hours—a helpful option for those who don’t have a primary care physician. A busy mom out running errands who has a minor medical issue and about 30 minutes before picking up her child at school can stop in at the CareClinic at Bartell Drugs, a new retail clinic created in a collaboration between Group Health and Bartell Drugs. The CareClinic is designed to be an “in-store, walk-in, get-well place” and is open weekdays, evenings and weekends.

When it comes to convenience, think virtual, too. UW Medicine recently introduced the UW Medicine Virtual Clinic, says Schroedl. This makes urgent care available 24 hours a day. You can be at home or the office and chat with a physician via secure video or phone at any time. Other health systems, including Franciscan Health, also offer virtual clinics. “It’s very fast, convenient, cost effective, and they can write prescriptions when medically appropriate,” Schroedl says.