Consider this: It’s Sunday afternoon and your touch football game included a touch that may have broken your leg. Or it’s Friday evening and you are developing a really compelling urinary tract infection, which makes the weekend prospects really bleak. Emergency room or urgent care center?

    Your football injury could be treated at a new center, Orthopedic Urgent Care of America, run by orthopedic surgeon Dr. Stephen Benz.

    “Orthopedics forms a large part of emergency room (ER) business, so I created orthopedic urgent care,” Benz says. “It has the advantages of not exposing patients to others who may be ill and contagious, and it eliminates a step in the process. If a person presents to the emergency room with an orthopedic injury, he may get an X-ray and have it stabilized, but then he will need a second visit to an orthopedic surgeon.”

    Benz says it’s often difficult to get into an orthopedic specialist quickly. That’s why his special center in South St. Louis County is open evenings and has Saturday and Sunday hours. “We can actually see the patient cheaper than an ER because typically insurance co-pays for urgent care are lower than ERs,” Benz notes.

    An open fracture or complicated injury may still need the services of a fully-equipped emergency room, he adds.  The injuries he sees most often are slips and falls, children’s athletic accidents, hands slammed in car doors and back injuries.

    Dr. Elizabeth Lucas is medical director of St. Luke’s Urgent Care Centers and says the best use for an urgent care center is for things you would be comfortable having treated by a primary care physician. Some of the most common conditions include simple lacerations that need stitching, insect bites, urinary tract infections, strains and sprains, and animal bites. Problems that may be life-threatening, such as shortness of breath, severe pain, drug overdoses, situations that require a CAT scan or complex lacerations should be seen at an emergency room.

    “We can diagnose broken bones and splint them, and do a variety of lab tests,” Lucas says. “One of the really great services is a quick strep test, so on a Monday night we can tell a mom whether the child has strep throat and should be out of school the next day. We can get the antibiotics started and save her some time. For a bladder infection, most people don’t want to spend the night with those symptoms, but they don’t need an ER, either.”

    St. Luke’s has five centers now and is opening a sixth in Creve Coeur this month. Some conditions they see really need an ER, so their physician-staffed centers can call ahead to the emergency room with details and arrange for an ambulance or transportation, if needed, Lucas says. “Some complex lacerations need a plastic surgeon, so we can call the ER ahead and alert them to that,” she says. “In children, sometimes a laceration requires that the child have conscious sedation to keep him still, and our urgent care centers don’t do that.”

    The urgent care centers also bill insurance companies and take co-pays, which can vary by plan but are typically less than for an ER visit. There are differences between certified urgent care centers, and walk-in or retail clinics, including strict requirements for staffing, emergency care, hours of operation and screening services available.

    Dr. Leonard Winer is chief of emergency medicine and the director of the Missouri Baptist Medical Center Emergency Room, and says most patients who come there really need an ER. “Patients may not know the credentials of doctors staffing urgent care centers, but Missouri Baptist has physicians credentialed in Emergency Medicine staffing our emergency room,” Winer notes. “For example, our pediatric emergency room is staffed by board-certified pediatricians from Children’s Hospital.”

    Their average co-pay for an ER visit is $100. He says they also are the only hospital in the area to have a physician staffing the triage desk 18 hours a day. That doctor can start and even complete care for some patients. At Missouri Baptist, the average length of stay for patients not admitted to the hospital is 2.5 to 3 hours. “People sometimes don’t realize that it takes time to evaluate and treat someone,” Winer says. “If they need imaging or lab tests, those have to be completed and interpreted. People with severe vomiting may need a couple of hours of intravenous fluids before they can go home.”

    He reports seeing more patients who have primary care physicians, but don’t call them when they go to an ER or urgent care, which is not a positive trend. “Their primary doctor knows them and their history,” he says. “It’s important to see the primary care physician when possible.”