By Deborah Jeanne Sergeant
If you or your child need healthcare, how do you determine the urgency of the need? Should you wait for a primary care provider appointment, rush to the local urgent care center or call an ambulance for an emergency room visit?
Local experts offered a few guidelines:
— Physician Michael Merrell, medical director at Independent Health, Buffalo:
• “You should go to the emergency room if you have severe bleeding, significant trouble breathing, head injury, loss of consciousness, signs of stroke or heart attack.”
• “It’s hard to give a rule since medicine is complicated. Anything you don’t have to go to the ER for, call your primary doctor to see what you should do. The PCP is the coach for your health. They help you navigate the system.
• “Also think about convenience. Can you just pop in somewhere? You likely won’t get the care from an urgent care as you would from your primary care physician. If you want a fast answer, going to urgent care is faster. But some PCPs can see you immediately.
• “There’s also the cost. A primary could be $1,000 if out of network and the PCP would be much less.
• “Another option is a 24-hour nurse line you can call if you have questions or want advice.”
— Physician Kathy Grisanti, president and owner of Pediatric Urgent Care in Rochester and Buffalo:
• “We generally encourage the parents to contact the pediatrician to help make that decision. The pediatrician knows the child and family and can help make that decision. It might need additional testing not available at an urgent care center.
• “In general, injuries that require stitches or injuries that are possible fractures are usually something pediatricians don’t do in their office. That usually requires an urgent care center. CAT scans or ultrasound are not done at most urgent care centers and require a hospital ER.
• “Difficulty breathing can be taken care of at any of the locations, but the pediatrician could refer to the ER or urgent care. Difficulty breathing is always something we worry about, especially with young babies.
• “The extreme things should go to the ER. Anything life threatening parent should call an ambulance. You can get intervention right at the home. Many urgent care centers can intervene and help stabilize the patient.
• “Getting their fever under control can slow down respiratory rate and make them more comfortable.
• “If a baby or young infant is breathing fast, has blueness of fingers, lips, toes, lethargic, and is dehydrated, those require medical attention. Babies or young infants are the ones that struggle the most with RSV or influenza. Particularly those under 8 weeks who have a fever, it’s important to be evaluated or something that looks like a seizure.
• “Some parents get alarmed by the height of a fever, if it’s over 104 or 105. We don’t necessarily worry about the height of the fever if the child is comfortable. Treat with ibuprofen or Tylenol. It’s the length of the fever that concerns us. Generally, the fever itself — unless in a young infant — we don’t worry about it if the child is well appearing and not dehydrated.
• “Pain is something that usually requires more immediate attention. If the child has fallen and refuses to bear weight and is crying or wakes up crying with ear pain,those are difficult to wait until the next day if the child is really uncomfortable. If the child can bear weight, it can probably wait.
• “Pay attention to noisy breathing. We see a lot of croup, typified by a barky cough. The pediatrician often is able to decipher what can wait until the morning. We are staffed by pediatricians so we’re very comfortable in seeing children and making those decisions about which children can be managed at home.
• “The primary care provider almost always has someone available on call after hours to help direct which patient needs to be seen immediately.”
— Jenilee Foster, urgent care regional lead provider, WellNow Urgent Care, with locations in Rochester and throughout Upstate New York:
• “For your run-of-the-mill cold, cough, congestion, sprain, sutures, they can come to urgent care.
• “For higher acuity symptoms like chest pain, stroke, heart attack, go to the ER. That doesn’t mean we can’t stabilize them, but the ER has the capability to do more in-depth testing.
• “If they’re not sure if it’s life-threatening, we’re happy to help them whether to treat or refer them to primary care or the ER. We’d rather see them than have them sit at home and let someone worry. We can try to determine if it’s life threatening versus non-life threatening. Urgent care is quick, convenient care. We want to be able to give back to our communities.
• “If someone’s out of town and they’re at their kid’s house for a week and they forgot their blood pressure medication, we can fill that gap. We can accommodate people with whatever they need: IV hydration, sutures, and things to keep people out of the emergency room. I had an ER doctor tell me that we see 70 patients a day that aren’t in their hospital. We can handle the strep, stitches and other patients in a more timely manner so they can see the acute patients.
• “We’re open seven days a week. We have a few clinics with extended hours.