I read with some interest the article which stated, 1 in 4 visits to PIMC to Emergency Room.
The numbers highlight a major dysfunction in the system initially established by PIMC, which virtually eliminated urgent care at the clinic and replaced it with emergency care delivered in the Emergency Department.
Ambulatory Care (patients who are not admitted to a hospital) is usually classified as, appointed, walk-in, urgent and emergent. Appointed is when an appointment is made in a doctor's office or clinic for common illnesses, minor injuries, and routine health examinations. Walk-in and urgent care are frequently lumped together as care delivered when the patient arrives at the office or clinic and asks to be seen without an appointment. The difference in these two types of care is the walk-in is usually for the convenience of the patient, like being seen after work to avoid taking time off, while urgent care is for non-life threatening medical problems that could become worse if you wait, such as an ear ache or fever. Emergent care is delivered in the specially equipped and staffed emergency room or emergency department for very serious or life threatening problems. Hospital emergency rooms are not the place to go for common illnesses or minor injuries.
Who says? Well, after thirty years in health care administration, I do. But wait, I am in good company. The Washington State Hospital Association, the Washington State Medical Association, and the American College of Emergency Physicians (Washington Chapter) all say so. Pick up a copy of their joint brochure at PIMC reception counters in the clinic and emergency department entitled, Where you go for your care matters”. It tells patients to get their care at their doctor's office or when their doctor is not available, at an urgent care clinic. It also says stay out of the Emergency Department (ED)if you just have a common illness or minor injury. The brochure lists some of the illnesses that would be seen in each of the above three settings and is a good guide.
Why should we care as long as somebody is available to treat us? Cost and quality. Emergency care is the most costly form of ambulatory care. The intensity of the examination and treatment, the cost of the staff, the building and equipment are all higher. Care delivered in an emergency department, as Dr. Sullivan pointed out, assumes you are dying and they are trying to prevent that. When you are dying this high cost care is worth the price. But when you go to the ED for things that could well be treated in a doctor's office, all this intensity is not only wasteful but can be bad medicine, subjecting patients to unnecessary tests and procedures relative to what might be done in a doctor's office. Emergency care is billed with a facility fee attached, which doubles the price. This hurts if you are uninsured, but even if you have insurance, the high deductible for hospital care means the facility fee will likely come out of your pocket.
So, why would someone go to the ED with non-life threatening problems and face a big bill? There are a number of reasons, but an important one is lack of available urgent care 24/7. Urgent care on San Juan, used to be available all 168 hours per 7 day week, as it still is on Orcas, Lopez, Anacortes, Skagit etc.. With the PIMC clinic being full during its' 42.5 hours of operation and closed for the remaining 125.5 hours each week, we are forced full time to go to the ED, an outside doctor or do without care.
I wrote a letter to PIMC, fifteen days ago, asking if it was their intention to staff the clinic to allow 24/7 access to urgent care without having to go to the ED. Staffing takes time, but commitment to the goal can be done now.
Bill Williams, MHA San Juan Island
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