Virginia Urgent and Emergency Care Options

Patient perceptions about emergency room (ER) wait times are one of the common complaints people cite when asked what they dislike most about going to the hospital. Changes in the way emergency care is provided can help reduce such gripes. One alternative is an urgent care center or retail clinic. Some clinics also specialize in specific types of urgent care such as orthopedics or pediatrics. Another change: establishing freestanding emergency rooms apart from a hospital. Virginia has all three options available (see Figure 1 below, or visit this link). Retail clinics and urgent care offices provide care for urgent problems rather than true emergencies. They offer more convenience than physician offices due to the availability of extended operating hours, including weekend care. Despite their extended hours, these facilities do not provide 24-hour care, as hospitals do. At these clinics, patients can walk in for treatment without a prior appointment. These facilities are often located in retail settings, and are sometimes co-located within a retail establishment, a supermarket, or a pharmacy. They often treat ailments such as acute sinusitis, otitis media, abscesses, and sprains, strains and lacerations. They may also conduct testing to satisfy school athletic physicals. Laboratory and imaging services may be available on site. Treatment from these clinics can be less expensive than emergency level services, yet private insurers may require higher patient co-pays, and these facilities may not accept all forms of insurance coverage. A freestanding emergency department (FSED) is physically separate from a hospital that provides emergency or urgent care. FSEDs are more likely to be built in recently expanded residential areas off-site from a centrally located hospital. In Virginia, FSEDs operate under a hospital’s license and must provide 24-hour, year-round care to all patients regardless of ability to pay. Freestanding emergency rooms are staffed similarly to hospitals.  They frequently examine patients for complaints of abdominal pain, chest pain, septicemia, dehydration, broken bones, and trauma. FSEDs usually have a full laboratory on-site, as well as scanning, ultrasound, and X-ray capability, just as a hospital ER does. If admission to a hospital is necessary, the FSED can transfer patients to the hospital. The demand for easily accessible care with shorter wait times has generated new types of services. These services are offered for differing levels of care. They don’t require an appointment, are likely open after work hours, on weekends, and are often located away from a city’s core. Different types of facilities address specialty services, uncomplicated minor illnesses, and full-blown emergencies. In Virginia, the newer models for urgent and emergency care appear to be clustered in proximity to the Interstate 95 and Interstate 64 corridors east of Richmond. (9/8)

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