Those folks who slice a finger chopping vegetables, come home from work to a feverish baby or break a bone in a weekend football game have, at last count, just over 4,000 emergency departments scattered across the country from which they can seek care.
But they had better have plenty of time.
As emergency room visits in the United States have ticked steadily upward, reaching 119.2 million annually, waiting for treatment has become a central feature of emergency-department care.
Patients spend an average of 3.3 hours to be seen, treated and discharged, according to a 2006 report by the federal Centers for Disease Control and Prevention. Last June, a 49-year-old woman died on the waiting room floor of a New York hospital ER -- one of the almost 400,000 patients who, the CDC found, had waited 24 hours or more to be treated in a hospital emergency room. In Arizona, where hospital emergency rooms are most crowded, patients wait just less than five hours on average for care in an ER.
Many people would rather stitch themselves up, splint their own fracture or endure a fussy baby through the night than brave that wait -- not to mention many ER staffs' seeming indifference to their less-then-life-threatening affliction.
Instead, a growing number appear to be voting with their feet. Those walk-in patients are fueling the growth of a kind of healthcare provider now making a comeback -- the urgent care center -- and at some hospitals, a flurry of efforts to improve the ER experience.
The Urgent Care Assn. of America, a trade organization that did not exist until 2004, last year counted a total of 8,000 urgent care centers around the country. For patients with illness or injury that is not life-threatening but can't wait for an appointment with a primary care doctor, these hybrids are a growing alternative to hospital emergency departments.
In the absence of a single standard, the Urgent Care Assn. is currently drafting a list of criteria that would let consumers know what to expect from an urgent care center. Such centers now vary widely: Most keep evening and weekend hours, although few are open 24/7; many are heavily staffed by physician assistants, with at least one physician on site or on call; most have X-ray machines and rudimentary lab facilities, though centers separate from a full-service hospital lack the sophisticated blood chemistry tests, MRIs and CT scans that ER docs use to diagnose and treat serious illness. Urgent care center staff can generally detect and set a simple fracture, administer breathing treatments and write prescriptions to treat sprains, allergic reactions and infections. But if you walk into one with signs of stroke or heart attack, or are about to give birth, they'll call 911 faster than you can say "triage."
