When should I recommend urgent care?

When to Recommend Urgent Care

Urgent care should be recommended for patients with moderate severity conditions requiring prompt attention but not immediate life-saving interventions. This includes conditions that fall between emergency department needs and routine primary care 1.

High-Risk Conditions Requiring Emergency Department (Not Urgent Care)

Cardiac Conditions

• Chest pain with any of the following features 1:
  • Continuous and ongoing chest pain lasting >15 minutes
  • Pain associated with dyspnea, cold sweating, constriction, heaviness
  • Radiation to throat, shoulder, arms or epigastrium
  • Abnormal vital signs (heart rate <40 or >100/min, systolic BP <100 or >200 mmHg)
  • ECG changes (ST-elevation/depression)
  • Patients with history of coronary artery disease or high risk factors

Respiratory Conditions

• Refractory hypoxemia (SpO2 <90% on non-rebreather mask) 1
• Respiratory acidosis with pH <7.2
• Clinical evidence of impending respiratory failure
• Inability to protect or maintain airway

Circulatory Conditions

• Hypotension (SBP <90 mmHg) with clinical evidence of shock 1
• Signs of end-organ failure refractory to volume resuscitation
• Cold extremities with elevated jugular venous pressure

Trauma

• Severe trauma with high predicted mortality 1
• Hemorrhagic shock with unidentified source of bleeding 1
• Significant free intra-abdominal fluid with hemodynamic instability 1

Appropriate Conditions for Urgent Care

Moderate Severity Conditions

• Minor traumatic injuries (simple lacerations, stable fractures) 2
• Non-specific abdominal pain without signs of peritonitis 2
• Non-specific chest pain in low-risk patients (normal vital signs, no concerning ECG changes) 2, 3
• Mild to moderate respiratory symptoms without respiratory distress 2
• Eye pain/injury without vision loss 2
• Cellulitis without systemic symptoms 2
• Mild to moderate pain requiring management 4

Key Decision Points

1. Hemodynamic stability: Patients should have stable vital signs
2. Symptom duration and progression: Symptoms should not be rapidly worsening
3. Resource requirements: Condition should be manageable with resources typically available at urgent care centers
4. Follow-up needs: Condition should not require immediate specialist consultation

Urgent Care Limitations

Urgent care centers have important limitations that must be considered 2:

• Limited advanced imaging capabilities
• Limited specialist consultation
• Limited critical care capabilities
• Limited surgical capabilities
• Limited observation periods

Decision Algorithm for Urgent vs Emergency Care

1. Assess vital signs:

   • If unstable (SBP <90, HR >100 or <40, RR >24, SpO2 <90%), recommend emergency department
   • If stable, continue assessment

2. Evaluate symptom severity:

   • If severe pain (especially chest pain >15 minutes), recommend emergency department
   • If moderate pain responsive to basic measures, consider urgent care

3. Consider risk factors:

   • High-risk patients (advanced age, multiple comorbidities) with concerning symptoms should go to emergency department
   • Otherwise healthy patients with isolated symptoms may be appropriate for urgent care

4. Evaluate resource needs:

   • If condition likely requires advanced imaging, specialist consultation, or critical care monitoring, recommend emergency department
   • If condition can be managed with basic lab tests, x-rays, and outpatient medications, urgent care is appropriate

Common Pitfalls to Avoid

• Underestimating cardiac symptoms: Any chest pain with concerning features should be directed to emergency department, not urgent care 1
• Delaying care for trauma patients: Significant trauma with unidentified bleeding sources requires immediate emergency evaluation 1
• Overlooking respiratory distress: Patients with significant breathing difficulty should go to emergency department 1
• Misinterpreting abdominal pain: Severe or persistent abdominal pain may indicate serious conditions requiring emergency evaluation 2

By following these guidelines, appropriate triage decisions can be made to direct patients to the level of care that best matches their clinical needs.