Joey Wahler (Host): It's filling a gap between emergency room visits and primary care appointments. So, we're discussing urgent care at MIT Health. Our guests from MIT Health, Dr. Justyna Notargiacomo, an Emergency Medicine physician and the Clinical Lead for Urgent Care; and Lauren Condon, she's a registered nurse and the Nurse Practice Manager for Urgent Care and Primary Care.

This is Conversations with MIT Health. Thanks for joining us. I'm Joey Wahler. Hi there, both Dr. Notargiacomo and Lauren, we appreciate you taking the time, thanks for being with us.

Justyna Notargiacomo, MD: It's great to be here.

Host: Absolutely. So first, how about how long have each of you been with MIT Health? Let's start with you, doc.

Justyna Notargiacomo, MD: I joined MIT Health on July 1st of this year. So, I think it's been about six weeks now. I'm coming from Newton-Wellesley Emergency Department. I've been an emergency medicine physician for 19 years. And this is my first foray into MIT Health, and it's been a wonderful, warm welcome.

Host: I'm sure that must be exciting, getting started. And so, how about you, Lauren? You've been there a little bit longer, yes?

Lauren Condon, RN, BSN: Yes, thank you. So, I have been here at MIT Health going on my ninth year. I have been a registered nurse for almost 14 years, taking on this role as nurse practice manager for just about a year now.

Host: Gotcha. So, let's start with you, doctor. When should a patient go to urgent care versus the emergency room? What can you and can't you treat there?

Justyna Notargiacomo, MD: So, when people are deciding whether or not to go to the Emergency Department versus Urgent Care, the most important thing to think about is whether time is of the essence. So, the classic example is a heart attack. You don't want to come to urgent care with chest discomfort, shortness of breath, if you're feeling a little sweaty, if you're feeling a little nauseated. You really need to go to the emergency department, and you really should call an ambulance first, because time is muscle. And the longer you wait for treatment by coming into urgent care, waiting to be seen, and being evaluated by us, the more compromised your heart muscle could potentially be if you are having a heart attack.

Similarly for stroke, if you develop numbness, tingling, or weakness on one side or the other, or a facial droop, or you're worried that you may be having a stroke, you should really call 911. There's a very well-defined window of time during which we can start medications in the emergency department to reverse the symptoms of a stroke. And the longer you wait, the more risky that medication becomes and the less benefit you get from it. So certainly, whenever there's a timing issue and it's potentially life-threatening, please go to the emergency department. Otherwise, at Urgent Care, we can treat lacerations, sprains, strains, rashes. We can see pediatrics. There's a lot that we can do, but our resources are somewhat limited in terms of evaluating certain conditions.

Host: Understood. So for you, Lauren, Urgent Care at MIT Health, how many patients do you typically see and what are some of the basic services that are offered there?

Lauren Condon, RN, BSN: Thank you. Yeah. So, we have different times of the year that are busier times than others. Currently, we are seeing about 30 to 45 patients a day during these summer months of June, July, and August. We do start to pick up a bit at the end of August, definitely ramping up in September, October, getting into flu season. So during the school year, we're seeing about maybe 65 to 80 patients a day, roughly, on average. We offer services for the MIT community, you know, of course in the urgent care setting. We have some point-of-care testing so we can do urine pregnancy tests. We can test for bacteria in the urine. We can test for blood sugar. We can test for strep. We have a Liat machine, which tests for flu and COVID, which takes 20 minutes to return the result, so that's pretty quick for folks. And then. We work very closely with our lab and x-ray department. If, you know, anyone comes in with an orthopedic complaint or maybe they've fallen or they have an injury, they can have an x-ray right away. And also, our lab department as well, we can, you know, run labs for whatever the complaint is for the patient as ordered by the provider. With that being said, our lab and x-ray department are only open Monday through Friday 8:00 to 5:00, so we are a little limited there, but we do work very closely with them and have a great partnership. So, we're able to get our patients all the care they need here.

Host: And Lauren, what's roughly the size of your provider staff? And also what are some of the more common conditions that you treat in urgent care?

Lauren Condon, RN, BSN: Yeah. So right now, we have four nurse practitioners and three medical doctors. We do run on a seven days a week operation. So, those folks are covering all seven days, various days and times. We are able to see anything from a sore throat, or maybe, you know, an infection in the fingernail, cold and flu symptoms, which is very prevalent in the winter months, orthopedic injuries if there's a slip and fall.

With that being said, sort of going off what Dr. Notargiacomo mentioned, is that we do get the folks who walk in with more critical complaints such as chest pain or maybe stroke symptoms or anaphylaxis. And we, you know, do what we can in the department and then we stabilize those folks and send them by ambulance off to a local emergency room.

Host: Understood. So back to you, doctor. And you were talking earlier about the rule of thumb for determining whether what you're suffering from should mean a visit to the ER as opposed to urgent care. Two questions for you. One is what if someone's unsure might it be a good idea for them to contact urgent care first to spare the emergency room if necessary, if they don't know which way to go. And also, if patients do go to the ER and it's not an ER matter, what kinds of problems does that cause on your end?

Justyna Notargiacomo, MD: So, the emergency departments in our community have become increasingly busy over the last several years, ever since COVID, because of difficulty of patients getting in to see their primary care physicians and just a whole slew of reasons, limited resources and such. So, wait times have really, really expanded recently.

So, understandably, our community members don't necessarily want to spend hours in the waiting room at an emergency department waiting to be seen. So, it is a viable solution to give us a call beforehand if you're not certain and speak with a triage nurse and they can help direct you on whether to come to urgent care for evaluation or whether to try to go to the emergency department to be seen. A lot of people showing up at the emergency department, you know, the more people there are, the longer the wait time is going to be. The emergency department does have a fairly sophisticated triage process. And they are seeing patients with life-threatening illnesses before patients with less severe illnesses. So, the more people that show up at an emergency department that could potentially be treated at an urgent care, the longer the wait time is for everybody. So, especially keeping in mind, the season of respiratory illnesses and nausea, vomiting, diarrhea that we're kind of entering into over the next few months, it's important to make the right call in order to expedite things and make things function as efficiently as they can.

Host: And of course, if you do go to Urgent Care and it turns out it's an ER matter, they can obviously send you there themselves, right?

Justyna Notargiacomo, MD: Yes, we have an ambulance service that will come and pick you up and take you to the emergency department to be seen.

Host: Gotcha. So, Lauren, back to you. And MIT Urgent Care is, of course, a walk-in service, no appointment needed, speaking of all that, waiting time, et cetera. But can patients do anything even with that to minimize their wait time once they arrive?

Lauren Condon, RN, BSN: Yes. Thank you. So, they can certainly walk in. We do encourage patients to use our online reservation system, which can be found right, on the MIT Health website, which is health.mit.edu, and there's a link right on the homepage and you can click on it and make a reservation for urgent care. So with that said, it's not a strict appointment time. So if you come in around the time of your reservation and you do get seen maybe about 10 minutes later, there are various reasons as to why that could happen. So, you may not be seen exactly at the time that you did sign up for, but it's a general idea of when you will be seen.

You can go online anytime of the day. And as long as there's appointments left, you're able to reserve your spot. Like I said, if there's anything, a critical complaint from another patient who comes in that needs to be attended to first, you know, it might bump you back by just a few minutes, but it is a general idea of when you will be seen in the department.

Host: And Dr. Notargiacomo, who can use MIT Health's Urgent Care from an eligibility standpoint?

Justyna Notargiacomo, MD: So, we are here for the MIT community to take care of our MIT community and their family members. So, anyone who is an employee, staff member, faculty member, student, graduate student, family members of those people, they are welcome to come to MIT Urgent Care.

Host: Just a couple of other things. Lauren, where is MIT Urgent Care located? What hours are you open?

Lauren Condon, RN, BSN: MIT Health is located at 25 Carlton Street, which is building E23. We are right in Kendall Square, just down from the new Kendall Square T Stop. We run on a seven-day a week operation. So, Monday through Friday, we are open 8:00 a.m. to 8:00 p.m., and Saturday and Sunday is 10:00 a.m. to 4:00 p.m. With that being said, we are closed for some of the major holidays, including New Year's Day, the 4th of July, Thanksgiving Day, and Christmas Day. And we run on a 10:00 a.m. to 4:00 p.m. schedule for some of the minor holidays. With that said, like I had mentioned before, our ancillary services, so our lab and x-ray, are only open for the Monday through Friday, 8:30 a.m. to 5:00 p.m. So, there is some limitation there. But other than that, our physicians and nurse practitioners are available seven days a week.

Host: And finally, doctor, for you to kind of sum things up here, we've touched on ER wait times often being very long and quick appointments with primary care doctors sometimes being hard to get. So, how effectively would you say MIT Urgent Care has helped bridge that gap in between the two that we mentioned? And what kind of a role has COVID played in making that happen?

Justyna Notargiacomo, MD: So, we try to have a very close relationship between urgent care and primary care. When patients are not able to see their primary care physician in a timely fashion, we are available for that person with an acute problem to come down to urgent care to be seen and evaluated. We try to keep the lines of communication between primary care and urgent care open as much as possible, so that we communicate with the patient's primary care when a patient is seen down in urgent care. And obviously, they have access to the notes that we write in urgent care about the patient visit.

Host: Well, great advice there indeed to ease the process for all concerned. Folks, we trust you're now more familiar with urgent care at MIT Health. Dr. Justyna Notargiacomo and Lauren Condon, thanks so much again.

Justyna Notargiacomo, MD: Thanks for having us.

Host: And for more information, please visit health.mit.edu/services/urgent-care. Now, if you found this podcast helpful, please share it on your social media. I'm Joey Wahler, and thanks again for being part of Conversations with MIT Health.