Different medical situations call for different levels of care

By Michelle Tevis, Lawrence Journal World reporter

Emergency rooms are there to take care of people. But are they always the best place for someone who needs medical care?

Health care professionals agree that different situations involve different levels of care; sometimes the ER is the right place, and other times an urgent care visit or a primary care doctor's help are in order.

Patti Doncouse, director of the Emergency Department at Lawrence Memorial Hospital, doesn’t want to rule out anyone coming to the emergency room. “Your emergency is our emergency,” she said.

“All of those things can be life threatening,” she said. “And I would recommend you call 911, activate EMS and come to emergency.”

Calling 911 is an important step in the process for someone having serious symptoms because first responders can start lifesaving care immediately, such as an IV, oxygen or EKG. Also, it wouldn’t be advisable for anyone experiencing acute health problems to drive to the emergency room, Doncouse said.

There are costs associated with choosing emergency care. The city of Lawrence has fees for ambulance service through Lawrence-Douglas County Fire Medical that start at $476 for basic life support services, not including mileage fees. Whether insurance covers any or all of those services and fees depends on the individual policy.

And generally, care provided by Emergency Department staff will cost more than care provided by a primary care doctor.

“We are very efficient in the emergency department,” Doncouse said. “We can provide care within two to three hours that would take four to seven days at the doctor’s office.”

However, she does not want to discourage anyone from choosing the Emergency Department. A patient is assessed by a triage nurse on arrival, and care can be directed from there depending on the patient’s complaint and needs.

“There aren’t really unnecessary visits, but there are some that can be managed at a lower level of care,” she said.

Lawrence Memorial Hospital has a service in the Emergency Department called Fast Track that is staffed by a nurse practitioner and a physician assistant who are overseen by the Emergency Department physicians.

“Those patients who maybe have a lower triage level who are not acutely ill can be seen by those providers and can be seen quicker,” Doncouse said.

She does recommend anyone visiting the Emergency Department follow up with a primary care doctor within a week of the emergency visit.

Some situations aren’t true emergencies, such as colds, sinus infections, cuts and broken bones. In those cases, an urgent care clinic provides services for those kinds of conditions.

Darin Elo, staff physician at PromptCare in Lawrence, says his clinic is particularly suited to handling injuries, as he and his partner, Michael Geist, are emergency medicine physicians. But most urgent care clinics are equipped to handle illnesses and injuries from simple to moderate complexity, including bronchitis, pneumonia, fractures and infections.

He said the clinic fills a need for patients who are generally healthy people.

“A lot of our patients don’t even have a primary care. They just come to us when they feel sick,” Elo said.

Urgent care typically does not require an appointment, and clinics are usually open after business hours, seven days a week.

He recommended that prospective patients check with their insurance before coming in, as some insurance companies bill urgent care separately and some bill it at the same rate as a specialist.

“No one bills them as a family practice, so it does generally have a higher co-pay,” Elo said.

Primary care doctors should still be the first line of defense for patients, and Doncouse recommends that everyone have one.

“If someone has an established relationship with a primary care physician, and have symptoms of a cough, cold, rash — maybe just haven’t been feeling good for a couple days — that would be great to call their primary care physician,” Doncouse said.

People with primary care physicians have better experiences and better outcomes when they do have to visit the emergency room, Doncouse said. And, she said, “They’re great resources.”

WellCommons editor Michelle Tevis can be reached at mtevis@ljworld.com or 832-7255.