Emergency Room vs. Urgent Care: A Doctor's Guide to Making the Right Choice
Written by Julie Woon, MSJ
Navigating healthcare decisions during stressful moments can be overwhelming. Dr. Caitlin McCord Delaney, a US veteran and emergency medicine physician at Georgetown University, breaks down the key differences between emergency room and urgent care visits to help you make informed decisions about your health.
How would you explain the difference between emergency care and urgent care from a patient's perspective?
Dr. Delaney: The emergency department is set up to handle pretty much everything, no matter how severe or uncertain the situation is. We try to avoid having every patient come to the emergency department for their medical care, as that can lead to increased wait times.
Urgent care is a great option for more minor issues - like an ear infection or a cut that might need stitches. It's built for convenience and speed with lower risk issues. Think of it this way: if you could get a really fast appointment with your primary doctor, that would be ideal, but urgent care fills that gap when you need medical attention for less serious conditions.
The ER is primarily built for life-threatening emergencies that really can't wait, while urgent care handles things that need attention but aren't emergencies.
What specific conditions or symptoms should send someone to the ER versus urgent care?
Dr. Delaney: First, if you're ever really worried about a condition, feel like it's rapidly worsening, or you're unsure, you can always come to the emergency department.
Go to the ER for:
● Chest pain
● Severe difficulty breathing
● Stroke symptoms
● Major injuries
● Confusion or someone not acting like themselves
● Any condition that feels severe or is worsening rapidly
Urgent care is appropriate for:
● Cold or sore throat (possibly needing antibiotics)
● Sprained ankle or suspected fractures needing X-rays
● Minor cuts requiring stitches
● Ear infections
● UTIs
The American College of Emergency Physicians website has a comprehensive list of conditions appropriate for each type of care.
Are there gray area situations where the choice isn't clear?
Dr. Delaney: Absolutely. We don't expect patients to have medical knowledge to make these decisions perfectly. Some common gray areas include:
● Abdominal pain - Sometimes it just needs nausea medicine or an acid blocker, but other times it could signal something serious like appendicitis requiring surgery.
● Headaches - Gradual onset headaches that feel like your usual headache can often be handled in urgent care. But severe headaches that are out of character for you or come on suddenly from zero to ten should be seen in the emergency department.
● Remember, most emergency departments have areas to see lower acuity patients after triage, so if you're unsure, the ER is never the wrong answer.
How do factors like time of day, access, or cost play into these decisions?
Dr. Delaney: Emergency departments are open 24/7, while urgent cares typically have extended hours but aren't usually open around the clock. So time of day can definitely be a factor.
It's helpful to know your local options before you need them - both urgent care and emergency department locations, and what your insurance covers. Some people have high emergency department co-pays, and urgent care co-pays can vary too.
If it's a true emergency, the emergency department is worth it because you'll meet with a triage nurse who has expertise to sort you into the right category and ensure you're in a place where people can handle it if something worsens.
What misconceptions do you frequently encounter about urgent care or emergency rooms?
Dr. Delaney: There are three main misconceptions I see:
Assuming urgent care can do everything an ER can - Some people think urgent care can provide IV fluids for dehydration or advanced imaging like CT scans. Many urgent cares aren't equipped for these interventions, and you might end up transferred to an emergency department anyway.
Not considering primary care for acute issues - Some patients think primary care is only for preventive care and screenings, not for treating acute conditions like UTIs or sore throats. If your primary doctor has availability, they know you best and can often handle these issues.
Expecting faster service after urgent care transfers - When urgent care transfers you to the ER, you still go through the triage process. All patients are seen in order of how sick they are, regardless of how they arrived. The urgent care is essentially sending you for a specialist consultation with an emergency physician.
How does not having a primary care physician impact these situations?
Dr. Delaney: You have many more people ending up in the urgent care versus ER decision when they don't have a primary care doctor to turn to. This is especially true for people with chronic conditions that aren't being managed regularly by a primary doctor - they're more likely to end up in urgent care or emergency departments.
This is actually one reason we see big wait times in emergency departments - it's a downstream effect of not having a more robust primary care system. In the emergency department, we try to set people up with primary care appointments when they leave, especially for conditions that need follow-up.
What's the most important thing you wish millennials and younger adults knew about navigating healthcare emergencies?
Dr. Delaney: If you're truly worried that something could be life-threatening, don't hesitate and go to the emergency department.
Beyond that, think about having a primary care doctor before you feel like you need one. Also, know the lay of the land in your area - where the urgent cares and emergency departments are located.
If you have a chronic condition like asthma, think through ahead of time when it would be appropriate to go to urgent care versus when you'd need emergency care.
Is there a golden rule for deciding when someone should go to the emergency room?
Dr. Delaney: If you are worried to wait for a couple of hours, that's a sign that something more severe is probably going on, and it's a good idea to get yourself to an emergency department.
If it's something where you're worried to wait even a few minutes, that's what 911 is for. You're not just receiving transportation - you're getting trained medical personnel to come to you and start interventions even before reaching the emergency department.
Want to hear more from Dr. Delaney? Check out the YMyHealth podcast on streaming platforms and YouTube!
For more information on when to seek emergency versus urgent care:
● American College of Emergency Physicians (ACEP) website
● Emergency Medicine Residents' Association (EMRA)
● Your local urgent care and hospital websites for facility-specific information