Children's Health

Primary care, urgent care or emergency room – which one?

Primary care, urgent care or emergency department - which one?
Written by Natalie Lane

When you have a sick child, deciding whether you need to be seen for immediate care can be challenging. You might wonder if you should make an appointment with your pediatrician, or if more urgent care is necessary.  An emergency room visit may seem like the best option for immediate care, but is it necessary? Recent research shows that the majority of people who visit an emergency department don’t have actual medical emergencies, and they end up paying six times more than necessary. Knowing the differences and deciding on the right type of health care for your child can save time, money and insure appropriate use of the health care system.

When to choose your doctor?

Primary care is the health care your child receives from your family doctor or pediatrician. This physician has records of your child’s personal health and keeps track of his or her general wellness. Primary care physicians are trained to manage the general well-being of your child but also can also evaluate your child for acute medical or injury complaints. You should see your doctor for complaints that do not involve excessive signs of respiratory distress, bleeding, pain or hydration. If you have attempted some home therapy without improvement and you believe your child could be seen within 24 hours safely. Call your pediatrician and make an appointment or speak with the on-call service.

When to seek urgent care?

It is ideal to turn to your pediatrician for most of your health inquiries, since he or she knows your child’s personal health history best. When in doubt, you should call your physician to receive direction. Primary care offices are not always open or available without an appointment, but many pediatricians provide after hour’s care. If you believe you need medical help that cannot wait for a next day appointment with your physician then perhaps you should visit an urgent care center or pediatric after hours clinic. Urgent care clinics can provide immediate care for conditions that are not emergencies.

When choosing an urgent care, recognize some of the limitations in services they can provide. Urgent care facilities have a variety of services they can provide in a limited fashion while some laboratory studies, therapy and radiologic capabilities are available. It is rare for urgent cares to be staffed with physicians who have extensive training or comfort with very young patients unless it is specifically an urgent care for children. The risk will be excessive testing and evaluation by persons who are less comfortable with a young child.  The American Academy of Pediatrics recommends urgent cares to be staffed with personnel that are familiar with all ages of patients and be readily equipped with personnel and equipment for the initial care of a very sick patient. A good urgent care additionally communicates the care provided to your pediatrician. Simple things like colds, flu-like symptoms, minor vomiting or diarrhea, sore throats, minor cuts, sprains and bruises can be reasonably managed by personnel at an urgent care.

Should I seek immediate care in an emergency department?

By definition, an emergency medical condition or injury is something that needs immediate attention because of risk of loss of life, limb or vision. It is also important to recognize that any condition that may worsen over a fairly rapid time period should be seen in an emergency department.

Emergency departments are generally equipped for the worst injuries and illnesses. Preparation for extremely ill or injured pediatric patients is not created equal at every emergency department. The services provided extend much further than primary care or urgent care centers. The pediatric emergency department at Children’s Hospital of Georgia is the only facility in the area that provides access to pediatric trained emergency physicians, pediatric specialists and pediatric surgeons if necessary. It is appropriately equipped and staffed by emergency physicians and nursing staff specifically trained in the care of severely ill or injured children.

Conditions or symptoms that should be recognized as emergencies may include:

  • Difficulty breathing
  • Any severe or unexplainable pain
  • Uncontrollable bleeding
  • Head or eye injuries
  • Broken bones with obvious swelling or deformity
  • Cuts that need suturing with the help of medications to decrease anxiety
  • Change in level of alertness
  • Seizures or stroke symptoms
  • Severe injury from falling or fainting
  • Severe burns
  • Young children with high fevers or fevers with a rash
  • Sudden impaired vision, speech or hearing
  • Concerns for dehydration such as no urine output for an extended period

As a rule, if your child is able to walk, talk, interact and play, chances are whatever she or he has is not an emergency. The cost of emergency care is much higher than that provided by your pediatrician or an urgent care. Seeking the right type of medical care needed for your situation can be beneficial for both you, your child and the medical professionals. If you are unsure about a certain symptom, follow your gut instincts.

If you need to establish a medical home, call 706-721-KIDS (5437) to schedule an appointment or visit to learn more.

Sources: Patch, Scripps, AAP

About the author

Natalie Lane

Medical Director, Children’s Hospital of Georgia Emergency Department, and Professor, Department of Emergency Medicine in the Medical College of Georgia at Augusta University