Deborah Howell (Host): As parents, we worry constantly about our kids and all the bumps and scrapes they get into. But when is it time to take our children to the emergency room or urgent care? In this episode, Dr. Leslie Young, pediatrician at MemorialCare Medical Group Lakewood and board member of Miller Children's Care Network, will discuss when parents should take their kids to the emergency room versus urgent care. He'll share the services urgent care can provide before going directly to the ER. And tell us about the services offered by MemorialCare's Virtual Urgent Care Center. Welcome, Dr. Young.

Leslie Young, MD: Thank you, Deborah, for this opportunity.

Host: Lovely to have you. Can you explain the key difference between urgent care and the emergency room when it comes to treating children?

Leslie Young, MD: Yes. I think most parents and most patients for that matter don't realize that the ER is actually considered part of the hospital, because it is generally physically connected to the hospital, whereas urgent care facility is a standalone outpatient clinic. The ER is capable of treating patients who are much sicker typically than people who go to urgent care.

Host: Got it. Now, what are some of the common symptoms or situations where urgent care is the best option for a child?

Leslie Young, MD: Urgent care is specifically useful when it comes to conditions that are not life-threatening. And typically, any problem that's not causing respiratory distress can be handled in urgent care, such as thing like simple infections, uncomplicated infections, like ear infections, strep throat, bladder infection, or even influenza unless it's complicated, or pneumonia. I think a lot of people find it surprising that pneumonia could be treated in urgent care, but pneumonia in children are quite common and it can easily be treated in the outpatient setting in the urgent care instead of going to the ER.

Host: And at what point should a parent skip urgent care and then just head straight to the ER?

Leslie Young, MD: Especially in children, any problem with their breathing, difficulty breathing, and I'm not just referring to congestion or cough. If they're really having labored breathing, they're breathing noisily. They seem to be struggling when they're breathing or they have this look of anxiety on their face, definitely that's a situation for the emergency room. In addition, any type of injury that's likely needed to have surgical intervention. For example, if you have a broken bone, you can go to the urgent care. But if you have a broken bone that's sticking out from your skin, you need to go to the ER.

Host: Absolutely. And many parents get concerned when their child has a fever. You spoke to this a little bit when talking about pneumonia. When is high fever considered an emergency, and when is urgent care sufficient?

Leslie Young, MD: This is kind of a tricky question, not intentionally, but because there's not really a specific threshold for how high the fever gets when it becomes an emergent situation. Fever is not what we are worried about in the child. What's causing the fever is what really get us worried. So, fever itself is actually rather harmless. But if fever is lingering for typically more than three, four days, then it's much more likely that it is caused by something bacterial or something more dangerous. So, it's the duration of fever rather than the severity or the degree of fever that make us more worried, primarily because it has implication about what's underlying that's causing the fever.

Host: So if someone has a fever for a couple hours or a full day, or what are you talking about?

Leslie Young, MD: Right. I make the threshold usually around three days. So, three days fevers or less, typically doesn't worry me too much, but fever lasting more than three days makes me more worried. And certainly, a fever that has lasted for more than five days, I get very gravely concerned because it's likely that it's caused by something that requires medical intervention.

Host: And are you talking about 101 and above when you say fever?

Leslie Young, MD: Technically, the threshold for fever for both children and adults is 100.3. But to simplify matters for my parents and patients, I consider anything over a hundred potentially a fever, because the threshold between 100 and 100.3 is so slight that measuring error could push the temperature to either over or under. So, I would say I make the cutoff at a hundred considering fever.

Host: Got it. Now, there is another option for folks. Beyond brick and mortar, urgent care, locations with set times. What other virtual care is offered for parents?

Leslie Young, MD: Well, I'm glad you mentioned that, because MemorialCare offers 24 hours, seven days a week virtual urgent care for the patients, for the members. And it's available online, as it says, you can have access to triage doctors anytime of the day. The best way to ask is that you can go to memorialcafe.org/virtualcare.

Host: That is absolutely fantastic news for so many parents listening right now. Can you tell us a little bit more about MemorialCare's Virtual Urgent Care, and how it can benefit parents when they're unsure whether their child needs immediate care?

Leslie Young, MD: Well, the best part is you can leave the decision-making for the professional who are going to be hearing your concern. If you're not sure, then this is the best first step where we can triage the situation after obtaining a very detailed history of what's going on in order to make the best decision for your child.

Host: As an example, a child may cut his finger. Is it deep enough for the ER or can you just call the virtual center? And they can let you know, take a look at it, maybe.

Leslie Young, MD: Absolutely. That's the perfect scenario that the triage can occur. Depending on where the cut is happening, how much bleeding is occurring, whether the bleeding is stopping on its own or it's continuing, there's so many factors that need to be taken into consideration when it comes to making the best decision and figuring out the best setting for the condition.

Host: And I'm sure you err on the side of safety.

Leslie Young, MD: Of course. And one of the best things is that, really, if your condition is sick enough, you really need to go to the ER, but you accidentally end up in an urgent care setting, you will always be arranged so that you can be transferred in an expedited fashion to the emergency room setting. The doctor will triage patients in urgent care. That happens fairly often, so you don't have to worry about actually going to urgent care and being stuck there.

Host: Okay. So, they can maybe get the situation controlled, and then make the decision whether an ER trip is necessary. All of the above.

Leslie Young, MD: And then, there's certain conditions specifically in Pediatrics I want to mention that could be considered very emergent situations. So for any baby that's less than two months old and having a fever, that's a situation where you want to take the baby to the emergency room because most likely the baby will have to end up staying in the hospital overnight. Any child with fever and a stiff neck needs to go straight to the emergency room.

Host: And why is that?

Leslie Young, MD: Because that's when we worry about the cause for the fever and the stiff neck being caused by meningitis. More specifically bacterial meningitis, which is potentially a deadly condition for children. I have seen many healthy children die within a short period of time from meningitis.

Host: Oh, it's heartbreaking. Okay. So, stiff neck and what was the other syndrome?

Leslie Young, MD: Any baby who's less than two months old with a fever.

Host: And I meant symptom, not syndrome, of course.

Leslie Young, MD: And there's several other things I want to mention. Anyone but especially babies, if they're throwing up green stuff, which is indicative of bile, this is an emergency because that could mean there's some obstruction in the intestine. And intestine needs to be saved surgically within hours, otherwise the intestine could die. And it has devastating consequences.

Host: And choking?

Leslie Young, MD: If there's choking, you really need to call 911. There's not enough time for you to drive. You can't intervene yourself if you're properly trained, but choking is where you have to call 911 and call for the paramedics. There's not enough time for you to drive to even in the ER, in a private vehicle.

Host: This is such valuable information, Dr. Young. Thank you. Now, do urgent care centers offer followup recommendations or referrals if a child needs more specialized care?

Leslie Young, MD: Yes, urgent care. In fact, both urgent care and the emergency room, they're always very conservative in arranging followup care, and they will explain and give clear instruction on where and who to follow up with. So yeah, this is similar to even in any outpatient setting, clear instructions should be given. If it's not given or if it's not being made clear to you, make sure that you ask the professional, to clarify what exactly needs to be done after leaving the facility.

Host: And what about children who have recurring symptoms?

Leslie Young, MD: Recurrent symptoms if it's not urgent and they can be discharged from the ER or the urgent care, it needs to be follow up with the primary doctor who's very familiar with the condition for the trial. This way, there's one responsible party who primarily will keep track of the changing the symptoms and the progress.

Host: Do you have anything that you'd like to add to our conversation before we wrap up?

Leslie Young, MD: I just want to mention that the pros and cons of ER versus urgent care. The downside of the ER is that they're typically longer wait. And it can be significantly more costly for some people depending on their insurance coverage. This is both true for the copay and the total cost. Advantage of the ER is that it does not require an appointment, of course, and it's open 24/7.

And one last thing to keep in mind is that all patients will be evaluated in the ER, regardless of their ability to pay, which is not necessarily true for urgent care. And this is insured by a federal law that's passed in 1986. So if you end up in emergency room, they're professionally obligated to treat you to stabilize your condition.

Host: Thanks for the update on that. And thank you so much, Dr. Young, for your time and your expertise today. We definitely learned a lot and really enjoyed having you on the podcast.

Leslie Young, MD: Thank you so much for this opportunity.

Host: For more info, you can go to memorialcare.org/virtualcare to book a virtual care appointment. That's all for this time. I'm Deborah Howell. Have yourself a terrific day.