Up to 60% of emergency department visits are considered non-urgent. Depending on a person’s symptoms and circumstances, another care setting may be more appropriate.
Knowing where to go may save time and money, depending on your symptoms, plan benefits, and available care options. It can also help to keep ERs available for true emergencies and things that require immediate medical attention, says Dr. Bertram Prosser, a medical director at BlueCross BlueShield of Tennessee.
“Emergency departments are designed to rapidly treat life-threatening conditions, and they require capacity to do so,” Dr. Prosser says. “Choosing the appropriate setting may help patients receive timely care and avoid unnecessary emergency care.
Where to go for different health conditions
Dr. Prosser: A key consideration is whether symptoms may be life-threatening or rapidly worsening. If there’s risk to airway, breathing, circulation, or neurologic function, emergency care may be appropriate. If symptoms are uncomfortable but stable, urgent care may be able to provide the appropriate level of care.
If you are uncertain about which is best, you may be able to contact a nurse advice line, if available through your health plan. Or you can contact your primary care provider.
If you think your symptoms may be life-threatening or rapidly worsening, call 911 or seek emergency care right away.
Here’s what to consider about where to seek care:
Primary care may be appropriate for things like:
- preventive care and check ups
- chronic disease management
- minor illnesses such as colds and mild flu symptoms
- uncomplicated infections
- routine skin conditions
- medication management
Primary care settings emphasize continuity and long-term health maintenance.
Urgent care centers may be appropriate for some non-life-threatening issues which need same-day evaluation. This may include:
- certain fractures or sprains
- minor cuts requiring stitches
- minor burns
- rashes
- urinary tract infections
- ear infections
- moderate symptoms like fever, sore throat, and upper respiratory illnesses
Emergency departments are intended for serious or life-threatening conditions that require immediate care or which could result in lasting harm if not treated quickly.
Symptoms that may require emergency care
Dr. Prosser: Emergency care may be appropriate for symptoms that could indicate a serious or life-threatening condition, such as:
- Chest pain
- Severe difficulty breathing
- Signs of stroke including facial drooping, arm weakness, or speech difficulty
- Uncontrolled bleeding
- Altered mental state like confusion or being unresponsive
- Severe trauma
- Sudden neurologic problems like vision loss, new weaknesses, sudden severe headaches, or seizures
- Persistent severe abdominal pain
- High-risk pediatric symptoms such as
- fever in infants under 3 months
- lethargy (extreme tiredness)
- difficulty breathing
- poor feeding
- Concerning dehydration which can include
- Very little urine
- dizziness
- dry mouth
- inability to keep fluids down
This list is not exhaustive.
If symptoms seem serious, sudden, rapidly worsening or concerning, ER care may be appropriate. If you think it may be a medical emergency, call 911.
Common misconceptions about going to the ER
Dr. Prosser: A common misconception is that severe pain alone always requires ER care. An overall clinical picture can be more important. Symptoms such as breathing difficulty, neurologic changes, or bleeding are considered. In some cases, severe but stable symptoms may be managed in facilities other than emergency departments. However, severe pain can sometimes signal an emergency, especially if it is sudden, worsening or accompanied by other concerning symptoms.
Another misconception is that urgent care centers can’t manage fractures or perform procedures. Many urgent care centers can splint simple fractures. They can also suture wounds and drain minor abscesses. They also may offer basic imaging such as X-rays. Services vary by location, so consider calling ahead when appropriate.
Some patients also think will be seen faster in the emergency room. But those with conditions that are not immediately life-threatening may experience longer waiting times based on triage assessment of patients. Wait times vary, and emergency departments prioritize patients based on the urgency of their symptoms.
Cost may be another important consideration. Depending on your plan benefits, network status and the services provided, primary care or urgent care may cost less than an ER visit. When it’s possible, it’s a good idea to confirm that a health care location is covered by your insurance. Do not delay emergency care to confirm coverage.
Why appropriate use matters
Dr. Prosser: Many patients go to the ER for non-emergency concerns like minor infections, medication refills or chronic pain flare-ups. These may be more appropriate for primary care or urgent care, depending on the person’s symptoms and circumstances.
“When in doubt, choose safety and timely evaluation,” Dr. Prosser says. “But using the appropriate care setting may help reduce patient costs, depending on the person’s plan benefits and care needs. It can also help the health care system to operate more efficiently for when you or others need it.”
Get more information about specific health terms, topics and conditions to better manage your health on bcbst.com. BlueCross BlueShield of Tennessee members can access wellness-related discounts on fitness products, gym memberships, healthy eating and more through Blue365®. BCBST members can also find tools and resources to help improve health and well-being by logging into BlueAccess and going to the Managing Your Health tab.