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***Spoiler This is a great question and there is no 100%, fool-proof way to know when to go to the Urgent Care or the Emergency Room. Unfortunately, in health, there are no guarantees and your own judgment should ultimately decide what to do.***

Emergency Room
There are some major problems when seeking help at the Emergency Room, even if it is convenient and open 24-hours and every day of the year.

1. Long Wait Times: Waiting in the ER can seem like an eternity sometimes. While the average wait time in Pennsylvania is 26 minutes in 2014, it most likely has gotten longer since then. When you are in the ER, you wait more to see the ER staff and to get tests done. In Pittsburgh, patients can expect to be discharged in about 3 hours on average. Wait times are influenced by many things that the ER cannot control (number of patients, who are the sickest patients, hospital factors, etc.). If the staff could get you out quicker, they would!

2. Expensive: Getting care at the ER is very expensive because of the resources required to have a functioning ER (staff, scanners, medicine, supplies, labs, etc.). The average cost of an ER Visit was $1389 in one study done in 2017. Having a test done in the ER can be magnitudes more expensive than if you got the same test done at an outpatient facility.

3. Rule Out, Not Diagnosis: The ER staff’s main goal is to determine who is really sick (and has to go to the hospital) and who they can send home (to be treated by another medical provider). Most of the time, they do diagnose and treat, but ruling out the most dangerous issues is the priority.

When to go to the Emergency Room:

One of the biggest problems for an Emergency Room is that people often go there unnecessarily. What may be an “emergency” for one person is not for others. Studies vary that between 30% and 70% of visits to the Emergency Room are “Unnecessary” and could have been treated elsewhere. This can be very, very tough on the Emergency Room when their priority is to find who is very sick and stabilize them.

As stated, there is no one single rule in medicine that will cover everyone, all the time. There will always be exceptions.
If you truly think you may need to go to the ER, then please go.
If it is about convenience (rather than seeing a PCP or Urgent Care) do NOT go.

Reasons NOT to go to the ER:

Ankle Pain (if you can walk at all)
Back Pain
Birth Control Prescriptions
Colds without Shortness of Breath
Cough without Shortness of Breath
Cuts that Stop Bleeding (includes insect and animal bites)
Foot Pain (if you can Walk at all)
Prescription Refills
Rashes (if Not on Entire Body or Painful)
Sore Throat
STD Checks
Tooth Pain

Reasons to go to the ER:

Battery Ingestion
Bleeding (moderate amount from coughing or vomiting)
Bleeding (that does NOT stop)
Change in Mental Status
Chest Pain
Diarrhea (that does NOT stop)
Fall (over 65 years old)
Fracture (through the skin)

Object Swallowed
Object Stuck in Body
Pain (severe – i.e. you can barely talk due to the pain)
Passing Out
Shortness of Breath
Suicidal or Homicidal Thoughts
Trauma/Injury (NOT minor injuries)
Tremors from Alcohol Withdrawal
Weakness (sudden onset)
Vision Change (sudden onset)
Vomiting (that does NOT stop)

There are a lot of conditions that are not included here and you’ll have to use your own judgment.

Most other medical conditions (again, there will always be exceptions and you need to use your own judgment) can be treated outside of the Emergency Room. Generally, if you think the issue can wait and isn’t in the “Reasons to go to the ER” list, going to an Urgent Care or Walk In Clinic would be fine.

If you are able to get to an Urgent Care or Walk In Clinic because it is safe to do so, it will this be cheaper and quicker for you, but also you are helping the ER staff focus on the sickest patients!

– iHealth Clinic

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