As the holidays approach, emergency room physicians once again are girding for an influx of seasonal injuries. Falls from ladders while stringing lights, lacerations from broken glass ornaments and other holiday-related afflictions send about 250 patients a day to the hospital every November and December, according to the U.S. Consumer Product Safety Commission.
But some ER doctors worry too many patients are confused about whether to seek care at their local urgent care center or the hospital, according to a new poll by a major medical specialty society.
More than 75 percent of ER physicians harbor concerns patients with serious medical conditions will visit urgent care centers that are unequipped to treat them, according to the online poll conducted by the American College of Emergency Physicians. Ninety percent said patients are redirected to emergency departments because their medical conditions were more serious than urgent care centers could handle.
“It’s hard for patients to know two things: when is their problem more serious and the capabilities of the different places,” Dr. Charles Pattavina, head of the emergency department at St. Joseph Hospital in Bangor, said.
More than 2,800 emergency physicians responded to the poll, including 19 in Maine. The margin of error was 1.8 percent.
The poll adds a new twist to an ongoing move in health care toward greater reliance on urgent care centers. The facilities, along with clinics operated by retail chains including Wal-Mart and CVS, have gained popularity with consumers seeking to avoid long waits and limited hours at the doctor’s office and the high bills from emergency room visits.
Health advocates have encouraged their use as a way to stem the flow of patients who visit costly emergency rooms with less serious illnesses and injuries. The median cost of a visit to the ER is $1,233, 40 percent more than the typical American pays in monthly rent, a 2013 study found.
While urgent care centers save money by treating patients who otherwise would wind up in the ER, they also raise health care spending by diverting patients from their primary care doctors, according to a study by the Center for Studying Health System Change.
Urgent care centers in several states have siphoned patients from hospitals, competing for more lucrative insured patients, while hospitals continue serving uninsured populations that stress their bottom lines.
Just over half of ER physicians reported local urgent care centers market themselves as alternatives to the emergency department, the poll found.
Urgent care centers may work well for common medical issues, such as sprains and minor cuts, but they are no substitute for emergency care, the American College of Emergency Physicians argues. Urgent care centers may lack certain equipment, such as imaging or lab testing technology, and physicians specially trained in emergency care, the medical society said.
Capabilities vary from one urgent care center to the next, Pattavina said. Without a CT scanner, for example, clinicians may fail to diagnose appendicitis or a gallbladder problem in a patient with belly pain, he said. Those conditions require admission to a hospital and a surgeon.
Another concern is whether urgent care staff can access patients’ electronic medical records. Facilities affiliated with large health systems, such as Eastern Maine Medical Center’s walk-in center in Bangor or Maine Medical Center’s in Portland, can view and update those records, but standalone clinics may not be tied into the network, Pattavina said.
Even clinicians with access to electronic medical records may not fully review them in a rushed emergency room or urgent care setting, said Lisa Letourneau, former emergency physician and executive director of Maine Quality Counts, a nonprofit that advocates for improving health care. Primary care providers, on the other hand, offer less expensive and more thorough care, she said.
Consumers also should keep in mind that urgent care clinics run by retail chains seek to treat patients quickly and send them out the door, ideally with a purchase from their shelves, she said.
“They [have incentives] to sell you things,” Letourneau said. “They want you buying the Tylenol and the cold medicine and the antibiotics you may not need.”