ER, urgent care or retail clinic? How to choose

More health care options mean more decisions. How do you know whether to seek care at a hospital emergency room versus a free-standing ER? When is an urgent care center appropriate? And what about the walk-in retail clinic at the local pharmacy?

These are important questions when it comes to advocating for yourself or a family member because knowing where to seek medical help could make a significant difference not only in the cost of treatment, but in the care itself.

Here are the basics of each:

Hospital emergency room

The question to ask before heading to the hospital ER is: "Is this condition life-threatening?" If the answer is yes, either dial 911 or have someone take you to the emergency room. In general, chest pains, difficulty breathing, unconsciousness, severe bleeding or serious injury merit a trip to the ER. If you might need a CT scan or MRI, go to the ER.

Hospital ERs are open 24/7 with experienced doctors, nurses and paramedics. When you walk in, you'll be triaged - in other words, the medical staff will ask questions and take vitals to determine how serious your medical emergency is. If, in their opinion, it's not life threatening, you may have to wait a while to be seen.

All of the specialists, operating rooms and equipment are on hand to meet any emergency. That said, everyone should have a friend or relative with them in the ER. An emergency room doctor may only spend a few minutes with you and, without them knowing your medical history, it may not be obvious how seriously ill you are.

You have to state clearly and succinctly what the problem is to get the attention of providers who are overwhelmed by the number of nonemergency patients. I had a patient recently who was having a stroke and sat in the ER for an hour before I was able to get there and clearly state: "My patient is having a stroke and she needs to be seen NOW."

Most insurance plans have an ER co-pay, which is waived if the patient is admitted. There may be multiple billings for diagnostic procedures and different physicians. If you're uninsured, ask about financial aid or discounts.

Free-standing ER

A free-standing emergency room is not attached to a hospital and may either be hospital or privately owned. It provides round-the-clock care for everything from broken bones to heart attacks, and the costs are similar to those of a hospital-based ER.

You might consider one of these facilities based on convenience. There may only be one hospital, but there could be several free-standing ERs closer to where you live. Free-standing ERs are fully staffed and equipped, so if you visit for a severe sore throat or earache, you'll end up paying about the same as if you went to the hospital ER.

But they don't offer surgery. If it's a heart attack that requires immediate angioplasty and insertion of a stent, you'd be transferred to a hospital with an operating room, costing valuable time.

Check your insurance network before heading to a free-standing ER to make sure you'll be covered.

Urgent care clinic

As the gap between patients' access to primary care and emergency care has widened, urgent care (or sometimes called immediate care) has expanded to fill it. And because a primary care provider is not usually available nights and weekends, these centers - unfairly derided as a "doc-in-a-box" - provide convenient and affordable care for minor illnesses and injuries.

An urgent care clinic is just what the doctor ordered if you're experiencing:

• Allergic reaction

• Sore throat or ear infection

• Sprain

• Animal bite

• Flu symptoms

• Minor burns

• Broken bones

• Minor injuries

Being treated at an urgent care clinic can be tedious because they usually won't have your medical history and you'll have to answer a lot of questions and possibly undergo some testing. Again, make sure the clinic you choose is within your insurance network.

Retail walk-in clinic

In the never-ending quest to drive down health care costs, the retail walk-in clinic is the latest innovation. Located in pharmacies, grocery stores and big box stores, such as Target (operated by CVS) and Walmart (operated by Optum Health), these clinics offer weekend and evening hours, walk-in availability and short wait times. Pricing is typically fixed and transparent.

The clinics treat a limited range of health conditions, such as minor infections, respiratory illnesses and minor injuries. They're also becoming the go-to location for vaccines, including COVID vaccines. Care is usually delivered by a nurse practitioner or physician assistant; pharmacists may deliver vaccines.

Illinois is one of five states with the highest concentration of retail clinics. The typical user is young and has no regular doctor or insurance. The clinics generally accept Medicare, Medicaid and private insurance, as well as cash payments.

So there you have it. In a nutshell, choose your emergency health care provider based on the scope and seriousness of your condition.

• Teri Dreher is a board-certified patient advocate. A critical care nurse for 30+ years, she is founder of NShore Patient Advocates (www.NorthShoreRN.com). She is offering a free phone consultation to Daily Herald readers; call her at (847) 612-6684.