Should You Go to the Emergency Department—or Urgent Care?

If you have a painful broken bone, crushing chest pain, sudden dizziness, trouble breathing, or any sign of heart attack or stroke, you should call an ambulance and go straight to the nearest hospital emergency department (ED). That’s a clear-cut emergency.

But what about a hacking cough, a sprained ankle, or a child’s fever? It’s not always obvious whether you should seek help at the emergency room or an urgent care center—and making the wrong choice can mean hours of waiting or a much higher bill.

EDs are often packed. If people in front of you have more urgent problems, you could wait several hours or more to get the attention you need. It’s worse in the winter, when respiratory illnesses such as flu and respiratory syncytial virus (RSV) are circulating, and COVID-19 tends to rise to a peak. Comparatively, visiting an urgent care center might take an hour and a half or less.

“Emergency departments across the country, whether at a community hospital or an academic medical center, are extremely busy with capacity constraints and challenges,” says Vivek Parwani, MD, a Yale Medicine emergency medicine specialist and chief medical director of the Yale-New Haven Adult Emergency Department. “We want to get the right patient to go to the right place at the right time.”

Another consideration is the cost of care. While fees vary greatly depending on such factors as a person’s insurance coverage—or lack of it—you might pay hundreds of dollars or less for an urgent care compared to potentially thousands for an ED visit for the same complaint, Dr. Parwani says.

For anyone who has a worrisome complaint and isn’t sure what to do, the choice can be difficult. What is the best place you can afford to visit to get the best treatment? Should you go to the ED regardless of the cost? And what if the sick or injured party is your child?

If you think you're having a life-threatening problem—even if you’re unsure—go to the ED. Emergency rooms are staffed by board-certified emergency medicine physicians and have access to cardiologists, neurologists, orthopedists, and other specialists.

Call 911 for an ambulance if it’s difficult to get to an ED on your own—and you have symptoms that are clearly urgent, such as signs of stroke, chest pain, or a bodily injury that is limiting your mobility, says Dr. Parwani. “If it is life-threatening, we can treat you. You’re going to get the best possible care for that type of urgent problem in the emergency room.” And while ambulance transport may be billed to the patient, emergency technicians can start treatment and alert the hospital before you arrive.

The treatment of life-threatening conditions is the primary responsibility of the ED, and doctors who specialize in emergency medicine want people to come in if they feel they have such a condition. If it’s determined that your problem isn’t an emergency, you may be discharged and advised to follow up with your primary care provider.

According to the American College of Emergency Physicians, adults should go to the ED for:

• Difficulty breathing or shortness of breath
• Chest or upper abdominal pain or pressure lasting two minutes or more
• Changes in vision or difficulty speaking
• Sudden weakness, dizziness, or loss of balance (possible signs of stroke)
• Choking
• Head or spine injury
• Injury due to a serious motor vehicle accident, burns or smoke inhalation, near drowning, deep or large wound or other serious injuries
• Ingestion of a poisonous substance
• Confusion or changes in mental status, unusual behavior, difficulty waking
• Suicidal or homicidal feelings

If your condition isn’t life-threatening, an urgent care clinic can often provide faster and more affordable treatment. “Urgent care centers are a great option if your primary care doctor isn’t available,” Dr. Parwani says. “You can walk in, get care quickly, and avoid the long waits typical of emergency departments.”

These centers are typically open outside of regular business hours and allow for walk-in visits. They usually have doctors, physician assistants, and nurse practitioners who may specialize in such areas as family medicine, emergency medicine, and sports medicine.

Some of the conditions treated at urgent care centers, including Yale New Haven Health Urgent Care Services, include:

• Asthma
• Colds, coughs, or bronchitis
• Eye infection
• Low-grade fevers or mild rashes
• Minor cuts and burns
• Ear infections and sore and strep throat
• Sprains and muscle strains
• Tick bites and Lyme disease

In addition to treating minor conditions, they may also offer X-rays, some diagnostic tests such as blood tests and urinalysis, COVID tests, flu shots, and other vaccines. They may also offer intravenous (IV) medication administration and specialized services, such as sports physicals.

An increasing number of urgent care centers have sprung up around the country in the last couple of decades—the Urgent Care Association notes that almost 90% of the U.S. population lives within a 20-minute drive of an urgent care center, and patient visits have increased by 60% since 2019, fueled in part by the COVID-19 pandemic.

If you aren’t sure whether you should take your child to the ED, start by calling your pediatrician. Many pediatric providers have a nurse on call 24/7, Dr. Parwani says. “I would expect to talk to a nurse within 10 minutes,” he says. “If you can’t reach someone within 20 minutes and you think your child is in danger, go to the ED.”

Your child should go to the emergency room if they have symptoms including:

• A fever in an infant under 3 months old
• Severe headache or vomiting (especially after a head injury)
• Choking or difficulty breathing
• Blue, purple, or gray skin or lips
• Unsteady walking or inability to stand
• Persistent or severe pain
• Sudden behavior changes or confusion
• Suspected poisoning

“If your child is under 3 months old and has a fever, go to the ED,” Dr. Parwani says. “If your child isn’t acting normally, or you’re just not sure, it’s always safest to go to the emergency department.”

But urgent care centers can treat common illnesses in children, including low-grade fevers in children older than 3 months, ear infections, colds, sore throats, mild skin rashes, and minor injuries such as cuts or sprains.

Your primary care provider or pediatrician (if the patient is a child) is always a good place to start, Dr. Parwani says. If your doctor is not available, many practices will provide a callback from a nurse who can help with the decision.

Another option is a virtual care visit, which may be available through your local urgent care network or hospital, your health insurance company, or a national company.

“Telehealth is a great option,” Dr. Parwani says. “Often an online provider can be available within a short period of time and can quickly determine whether your condition needs emergency care.”

While insurance coverage for online support varies, telehealth visits are often covered by private insurance, Medicare, and Medicaid in some states, he says. It's important to check with your insurance coverage for teleheath visits.

Sometimes where you go for help will depend on how serious the problem is. For instance, a sprained arm that is mobile and not very painful may be X-rayed and initially treated with pain medication at an urgent care center, Dr. Parwani says. The provider may then make a referral to an orthopedist, just as an ED doctor would. “But if the arm is deformed or discolored, and painful, you generally should call an ambulance and get to the ED as fast as you can,” he says, explaining that these symptoms may be signs of a more serious injury, such as a dislocated joint. It’s also important to remember that children are especially vulnerable to strains and sprains because they can involve a growth plate injury, which can affect development.

Similarly, if you have tested positive for COVID-19, but you aren’t feeling seriously ill—perhaps you’re coughing and have a fever, but you’re able to breathe—you can be treated at an urgent care center. But if you’re having trouble breathing, or you have a pulse oximeter that shows your oxygen saturation is low, you need to go to the hospital, Dr. Parwani says. “When you are having trouble breathing, the ED is always the right place to go,” Dr. Parwani says.

If you are concerned about waiting a long time to see a doctor, check your closest hospital’s website to see if they provide the current wait—the time between a patient’s arrival and the moment they are seen by a qualified medical professional. Yale New Haven Health provides ED and urgent care wait time updates every 15 minutes, though these times may change if patients with life-threatening injuries or illnesses arrive.

Dr. Parwani emphasizes the bottom line: Go to the emergency room for life-threatening symptoms or if you’re unsure. Choose urgent care for non-emergencies when you want quicker, more affordable treatment. And when in doubt—call 911 or your doctor’s office for guidance. “The goal is simple,” Dr. Parwani says. “Get the right care, in the right place, at the right time.”