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What's the Real Difference Between Emergency and Urgent Care
When faced with a pressing medical issue, it can be tough to know where to seek medical care. Dr. Pawan Suri, Chief of the Division of Observation Medicine, discusses emergency care versus urgent care.
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Learn more about Pawan Suri, MD
Pawan Suri, MD
Pawan Suri, MD has 26 years of experience. His specialties include Emergency Medicine and Internal Medicine.Learn more about Pawan Suri, MD
Transcription:
Scott Webb (Host): The emergency room has been around for ages but new terms like urgent care and free-standing emergency rooms have entered the scene. Sometimes it’s hard for patients to know whether they are experiencing a true emergency and if so, where they should go. My guest today is Dr. Pawan Suri, the Medical Director of Observation Medicine in VCU Medical Center’s Emergency Department and he is going to try to clear things up for us. This is Healthy with VCU Health. I’m Scott Webb. Doctor, thanks so much for joining me today. What is the difference between traditional emergency rooms, urgent care centers and free-standing emergency rooms?
Pawan Suri, MD (Guest): The emergency rooms are as some people like to call them, emergency departments, are very familiar to the public. Usually it’s an area you go to when you have an emergency which is associated with a hospital. And you expect that they have a comprehensive set of services available which include pretty much all the routine blood tests, and that they have advanced imaging. They may have CT scans, MRIs, things like that. And usually, in an emergency department or room, you will have some access to specialty services as well.
We are also very familiar with the concept of urgent care where people can go to for minor things that can be handled quickly, such as the flu, maybe abscesses, minor injuries, things of that nature. There is a limited set of resources available and the person you’ll be seeing may or may not be trained in, or specialized in emergency medicine, but they can take good care of you and usually send you home after a brief amount of testing. And if they think that you do need some further care that they cannot provide, they will send you to a traditional emergency department.
A relatively recent option for patients is a type of facility that we call the free-standing emergency department. The easiest way to understand this is that it is like an emergency room, but it is not attached to a hospital. A free-standing emergency room can provide a wider range of services when compared to an urgent care. It will have things like CAT scans, and other tests traditionally not available in an urgent care center. Some free-standing emergency rooms like the one that VCU Health is opening at New Kent will offer distinct advantages. The major advantage of this kind of free-standing emergency room is that it is staffed with the same physicians that work on the main VCU Health campus downtown. Physicians go back and forth, and the level of expertise is very similar to what you would find if you made your way downtown. The advantages that you can have access to all the specialists who work at the main campus either via phone or computer, such as we are doing with Telemedicine, is going to probably become routine. So, that you don’t have to have physically see an ENT doctor or an eye doctor in person, they can, in most cases, do Telemedicine and give a fairly robust opinion on what to do next, in my mind.
The main advantage of going to a free-standing emergency room that is associated with a university or a hospital is that if you do need an admission to the hospital, the process becomes quite seamless. The provider who is working in a free-standing emergency department can call the inpatient hospitalist or the doctor and directly admit you. Big advantage in my opinion. Now, I must caution, that not all free-standing emergency rooms have close hospital affiliations and there may be some entities that are independently staffed that may have an agreement with a hospital, but they are not associated with that hospital.
So, someone who is trying to decide between the three entities should understand the differences and then also understand what kind of services can be offered.
Host: Doctor, thanks so much for that great explanation. Is the level of care, treatment, or expertise better at one or the other? What do you recommend to patients?
Dr. Suri: Let me start with the most obvious which is when do you call 9-1-1? For some conditions, it is quite clear. For example, if you see someone having severe chest pain who collapses in front of you, or somebody who has an obvious stroke in that they can’t move their hands or their legs or speak, or someone is experiencing shortness of breath from congestive heart failure or asthma, call 9-1-1-. These are true emergencies and you call 9-1-1. And sometimes the signs of a stroke or a heart attack can be subtle or even misleading. So, my advice is to always trust your instincts and when in doubt, call emergency medical services who will always help you sort things out. They’ll be able to activate the right response and get you to the right facility in the shortest possible time.
I also want to mention medical conditions that affect children or pregnant women that are best treated in the hospital with specialized OB GYN or pediatric services. All of these are available at major centers like VCU Health. You must consider where I am, what kind of services I might need and then decide where do I want to go. When in doubt, go for the higher level of care, is always my suggestion to people. There are too many people who try to either minimize or talk away their symptoms.
Host: Doctor, it’s so great to have your expertise. You mentioned calling 9-1-1 and the role that EMS personnel play. We’ve touched on this relationship with Drs. Aboutanos and Rossi in the context of why VCU Health has invested in prehospital provider education and training. Can you discuss the importance of EMS personnel and how they save lives?
Dr. Suri: You’re absolutely right Scott. I think VCU Health is one of the most heavily invested institutions in the state that really values our relationship with EMS, and we have a dedicated EMS outreach group that provides continuous education to EMS personnel. We attempt to keep them up to speed with the latest of what is going on in the world of research and innovation and bring it to the field. The importance that EMS can make is the difference between life and death. A well-trained EMS team can easily detect and treat conditions even before you hit the emergency department or emergency room as you might call it. And they can alert us if you need to have things like airway support or intubation. We have trained EMS personnel to perform that in the field. There are countless studies that have shown that a well-run EMS system will decrease mortality which is a fancy way of saying that the likelihood of dying from a serious condition is dramatically reduced if you call EMS right away to take care of you.
Host: That’s well-said Doctor. I want to circle back and talk about the new free-standing emergency center in New Kent. This is really fascinating to me because it breaks the model of the patients going to the hospital. The hospital and the doctors are coming to this medically underserved community. It’s really cool. Let’s talk about that.
Dr. Suri: We have found that New Kent and the surrounding areas did not have adequate access to good emergency care. And patients would drive long distances to come to VCU Health. If they were somewhat stable, that would be okay. But sometimes we found that that long ride could result in negative consequences for the patient. And we thought long and hard about this. We said it aligns with our mission to provide services to an area that doesn’t have any and to bring this to the community in the best possible way. We toyed with various ideas and we found that a free-standing emergency room is the best option.
We see that in the underserved population will have some conditions that are not diagnosed. I’ll give you an example. A person presents with an abscess to the leg. In workup, you find that their blood sugar is 600. They don’t realize that they have been a diabetic for two years. This is the first time they are finding that their sugar is so high. This is a complex situation where you know that treating the abscess is only part of the problem. So, having a free-standing ED helps tremendously to get things started, send some further studies, contact endocrine specialty and have them be set up to be seen in the clinic in a couple of days. And that would not be possible if we just ran an urgent care. We put a lot of thought into opening a free-standing ED.
And another thing Scott is that approximately 70-80% of people who come to a free-standing emergency department will go home. And so, this is smack in the middle of what an urgent care or a traditional emergency room will provide. I think we have hit the sweet spot by opening a free-standing ED in the New Kent area, and believe it is going to be a boon to the entire population of the region.
Host: Dr. Suri thanks so much for your time today and helping patients know when to call 9-1-1 and to better understand the different levels of care that are available. Thanks for checking out this episode of Healthy with VCU Health. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library at www.vcuhealth.org/podcasts for topics of interest to you. Thanks, and we’ll talk next time.
Scott Webb (Host): The emergency room has been around for ages but new terms like urgent care and free-standing emergency rooms have entered the scene. Sometimes it’s hard for patients to know whether they are experiencing a true emergency and if so, where they should go. My guest today is Dr. Pawan Suri, the Medical Director of Observation Medicine in VCU Medical Center’s Emergency Department and he is going to try to clear things up for us. This is Healthy with VCU Health. I’m Scott Webb. Doctor, thanks so much for joining me today. What is the difference between traditional emergency rooms, urgent care centers and free-standing emergency rooms?
Pawan Suri, MD (Guest): The emergency rooms are as some people like to call them, emergency departments, are very familiar to the public. Usually it’s an area you go to when you have an emergency which is associated with a hospital. And you expect that they have a comprehensive set of services available which include pretty much all the routine blood tests, and that they have advanced imaging. They may have CT scans, MRIs, things like that. And usually, in an emergency department or room, you will have some access to specialty services as well.
We are also very familiar with the concept of urgent care where people can go to for minor things that can be handled quickly, such as the flu, maybe abscesses, minor injuries, things of that nature. There is a limited set of resources available and the person you’ll be seeing may or may not be trained in, or specialized in emergency medicine, but they can take good care of you and usually send you home after a brief amount of testing. And if they think that you do need some further care that they cannot provide, they will send you to a traditional emergency department.
A relatively recent option for patients is a type of facility that we call the free-standing emergency department. The easiest way to understand this is that it is like an emergency room, but it is not attached to a hospital. A free-standing emergency room can provide a wider range of services when compared to an urgent care. It will have things like CAT scans, and other tests traditionally not available in an urgent care center. Some free-standing emergency rooms like the one that VCU Health is opening at New Kent will offer distinct advantages. The major advantage of this kind of free-standing emergency room is that it is staffed with the same physicians that work on the main VCU Health campus downtown. Physicians go back and forth, and the level of expertise is very similar to what you would find if you made your way downtown. The advantages that you can have access to all the specialists who work at the main campus either via phone or computer, such as we are doing with Telemedicine, is going to probably become routine. So, that you don’t have to have physically see an ENT doctor or an eye doctor in person, they can, in most cases, do Telemedicine and give a fairly robust opinion on what to do next, in my mind.
The main advantage of going to a free-standing emergency room that is associated with a university or a hospital is that if you do need an admission to the hospital, the process becomes quite seamless. The provider who is working in a free-standing emergency department can call the inpatient hospitalist or the doctor and directly admit you. Big advantage in my opinion. Now, I must caution, that not all free-standing emergency rooms have close hospital affiliations and there may be some entities that are independently staffed that may have an agreement with a hospital, but they are not associated with that hospital.
So, someone who is trying to decide between the three entities should understand the differences and then also understand what kind of services can be offered.
Host: Doctor, thanks so much for that great explanation. Is the level of care, treatment, or expertise better at one or the other? What do you recommend to patients?
Dr. Suri: Let me start with the most obvious which is when do you call 9-1-1? For some conditions, it is quite clear. For example, if you see someone having severe chest pain who collapses in front of you, or somebody who has an obvious stroke in that they can’t move their hands or their legs or speak, or someone is experiencing shortness of breath from congestive heart failure or asthma, call 9-1-1-. These are true emergencies and you call 9-1-1. And sometimes the signs of a stroke or a heart attack can be subtle or even misleading. So, my advice is to always trust your instincts and when in doubt, call emergency medical services who will always help you sort things out. They’ll be able to activate the right response and get you to the right facility in the shortest possible time.
I also want to mention medical conditions that affect children or pregnant women that are best treated in the hospital with specialized OB GYN or pediatric services. All of these are available at major centers like VCU Health. You must consider where I am, what kind of services I might need and then decide where do I want to go. When in doubt, go for the higher level of care, is always my suggestion to people. There are too many people who try to either minimize or talk away their symptoms.
Host: Doctor, it’s so great to have your expertise. You mentioned calling 9-1-1 and the role that EMS personnel play. We’ve touched on this relationship with Drs. Aboutanos and Rossi in the context of why VCU Health has invested in prehospital provider education and training. Can you discuss the importance of EMS personnel and how they save lives?
Dr. Suri: You’re absolutely right Scott. I think VCU Health is one of the most heavily invested institutions in the state that really values our relationship with EMS, and we have a dedicated EMS outreach group that provides continuous education to EMS personnel. We attempt to keep them up to speed with the latest of what is going on in the world of research and innovation and bring it to the field. The importance that EMS can make is the difference between life and death. A well-trained EMS team can easily detect and treat conditions even before you hit the emergency department or emergency room as you might call it. And they can alert us if you need to have things like airway support or intubation. We have trained EMS personnel to perform that in the field. There are countless studies that have shown that a well-run EMS system will decrease mortality which is a fancy way of saying that the likelihood of dying from a serious condition is dramatically reduced if you call EMS right away to take care of you.
Host: That’s well-said Doctor. I want to circle back and talk about the new free-standing emergency center in New Kent. This is really fascinating to me because it breaks the model of the patients going to the hospital. The hospital and the doctors are coming to this medically underserved community. It’s really cool. Let’s talk about that.
Dr. Suri: We have found that New Kent and the surrounding areas did not have adequate access to good emergency care. And patients would drive long distances to come to VCU Health. If they were somewhat stable, that would be okay. But sometimes we found that that long ride could result in negative consequences for the patient. And we thought long and hard about this. We said it aligns with our mission to provide services to an area that doesn’t have any and to bring this to the community in the best possible way. We toyed with various ideas and we found that a free-standing emergency room is the best option.
We see that in the underserved population will have some conditions that are not diagnosed. I’ll give you an example. A person presents with an abscess to the leg. In workup, you find that their blood sugar is 600. They don’t realize that they have been a diabetic for two years. This is the first time they are finding that their sugar is so high. This is a complex situation where you know that treating the abscess is only part of the problem. So, having a free-standing ED helps tremendously to get things started, send some further studies, contact endocrine specialty and have them be set up to be seen in the clinic in a couple of days. And that would not be possible if we just ran an urgent care. We put a lot of thought into opening a free-standing ED.
And another thing Scott is that approximately 70-80% of people who come to a free-standing emergency department will go home. And so, this is smack in the middle of what an urgent care or a traditional emergency room will provide. I think we have hit the sweet spot by opening a free-standing ED in the New Kent area, and believe it is going to be a boon to the entire population of the region.
Host: Dr. Suri thanks so much for your time today and helping patients know when to call 9-1-1 and to better understand the different levels of care that are available. Thanks for checking out this episode of Healthy with VCU Health. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library at www.vcuhealth.org/podcasts for topics of interest to you. Thanks, and we’ll talk next time.