Transcription:
Should I Go To The Urgent Care Or The Emergency Department?

Denise Schnabel (Host): Hi, everyone. Welcome to Outer Banks Health, the official podcast series of the Outer Banks Hospital and Medical Group. Each month, we will be featuring guests who will discuss not only health-related topics, but community topics as well. We are your hosts, Denise Schnabel.

Wendy Kelly (Host): And I'm Wendy Kelly. Today's guest is a long time medical care provider on the Outer Banks. This Michigan native arrived in the year 2000 after a stint with the Baptist Healthcare Emergency Department in Memphis, Tennessee. Her first job here on the Outer Banks was at the old medical center in Nags Head. She has extensive experience in emergent care, her own business known as Medical House Calls and currently works at the Outer Banks Urgent Care Center in Kitty Hawk and has been with them since it began in 2012. This physician assistant leads a team of six full-time advanced practice providers. Please help me welcome the fabulous Rikki Schuster.

Denise Schnabel (Host): Hey, Rikki.

Rikki Schuster: Hi.

Denise Schnabel (Host): Thanks for being here.

Rikki Schuster: Thank you.

Wendy Kelly (Host): We're thrilled.

Denise Schnabel (Host): We are. So, Wendy and I were actually talking about it and we really don't want to talk to you. We want to hear about your amazing daughter, Catherine. For the one or two listeners who might not know who she is, please tell us why she's an Outer Banks phenom.

Rikki Schuster: Oh, geez. Well, I do feel more comfortable talking about her than myself actually. So, Catherine is doing great. She's starting her sophomore year at Clemson University playing on the women's golf team and we're hoping for a great year.

Denise Schnabel (Host): That's awesome.

Rikki Schuster: So, yeah. We're very proud of her.

Denise Schnabel (Host): Good. Very good.

Wendy Kelly (Host): You know, we did a whole month of podcasts on the history of the hospital. But I don't think we ever spoke to anybody that worked at the medical center.

Rikki Schuster: Oh, really?

Wendy Kelly (Host): Yeah. What was that like when you started there and what was it like without the hospital when you were there?

Rikki Schuster: Well, it was very interesting because you never knew what you were going to get. I mean, we took in absolutely everything at that, I guess they call it an urgent care. No, they called it the medical center.

Wendy Kelly (Host): I don't know. I wasn't here. The medical center--

Rikki Schuster: Outer Banks Medical Center, yeah.

Wendy Kelly (Host): Where was it in Nags Head?

Rikki Schuster: Well, I actually worked at the one that's next to ACE hardware at off Barn Street.

Wendy Kelly (Host): Oh, okay. Yeah.

Rikki Schuster: So, it was open 24 hours. It was essentially a freestanding emergency department.

Wendy Kelly (Host): Oh, wow.

Rikki Schuster: Yeah. So everything got shipped.

Denise Schnabel (Host): Oh, okay. Yeah. How many providers were there?

Rikki Schuster: Oh, wow. You talking like more than 20 some years ago. Let's see...

Denise Schnabel (Host): Like more than a handful or one or two?

Rikki Schuster: There were usually at least three.

Denise Schnabel (Host): Yeah. That's neat. Yeah, I don't really know anything about it.

Rikki Schuster: And we were attached to-- It was called Healtheast Family Practice.

Wendy Kelly (Host): Right. Neat. And the county had a lot to do with it too, right? Yeah. Wow. What a difference today.

Denise Schnabel (Host): Okay. To clarify for our listeners, you are a physician assistant, which is an advanced practice provider. Tell us about an advanced practice provider and why it is such a valuable resource in our community.

Rikki Schuster: Well, we call ourselves APPs now. Typically, we have a master's level degree. And we all have numerous hours of hands-on patient experience before we even get accepted into our program. So, quite a bit of experience before we even start our education.

Our community of APPs are exceptional with many seasoned professionals in all of the specialties. So, not only in the emergency department and the urgent care, but also primary care, OB-GYN. We have APPs in wellness and now urology and oncology as well. To give you an example, our office in Kitty Hawk is over 120 years of practice experience between the six providers.

Denise Schnabel (Host): That's great.

Rikki Schuster: Yeah. But the beauty of APPs is that you're essentially getting a two for one deal, you know? So in other words, if you think about that, whenever an APP runs into a medical situation that they aren't comfortable with, they always have a supervising physician in their corner to consult. So we are trained to know our limitations and know when to ask for help. So our community is fortunate to have many compassionate APPs that have practiced in the OBX for several decades. And we have roots here, and I believe our APP profession has an outstanding reputation in our community for being not only knowledgeable, but very compassionate.

Denise Schnabel (Host): That's great.

Wendy Kelly (Host): One of the reasons we wanted to do the podcast was to help folks understand where the best place to go for a care is here locally. So before we talk about that, can you elaborate on what the term non-emergent care means?

Rikki Schuster: Sure. Non-emergent care means basically a patient has an illness or an injury that is stable, which poses no present threat to life or risk of permanent disability, so non-life threatening illnesses or injuries. For instance, ear aches, rashes, cough, sore throat, sprained ankles, things like that.

Wendy Kelly (Host): Fish hooks.

Rikki Schuster: Fish hooks. Lots of fish hooks. We've actually had quite a few stingray.

Denise Schnabel (Host): Yeah.

Wendy Kelly (Host): Yeah. And jellies.

Rikki Schuster: Jellies. So things like that. That's exactly what the urgent cares are for.

Wendy Kelly (Host): Excellent. So you've done stints in the emergency department and urgent care. Can you speak to why it's important to know where to go from the standpoint of maybe faster attention from a provider or just the best use of the care that we have here on the Outer Banks?

Rikki Schuster: Absolutely. So, the emergency department should be really utilized when you're under acute significant duress, such as chest pain or pressure or shortness of breath, things like that, severe abdominal pain, head injuries, neck or back trauma. But the reason why it's so important to know the difference is because in the emergency department, patients are triaged and they're brought back to be seen by a provider in the order of severity of their complaint. So for instance, if you have a non-emergent complaint, such as a fish hook or a turned ankle or something, you might be in a lot of pain and you might think that fish hook is really important, which it is, but you know, you're going to wait longer in the emergency department because there's going to be people there that are utilizing it properly, like those with chest pains and whatnot. So you might wait quite a while for your sprained ankle. So, in the meantime you could have been in and out of the urgent care in a flash. It's usually typically within 90 minutes, is what we try to aim for anyway.

So, you know, the urgent care typically does not triage, so they're taken in the order in which they come in. First come, first serve. So if you come into the urgent care with your turned ankle, you'll be taken back in the order that you checked in. You won't have to wait for the other people to go ahead of you.

Denise Schnabel (Host): Oh, good point. That's a great point. So when you switched from the emergency department to the urgent care, did you have to change the way you practiced medicine? Tell us about that.

Rikki Schuster: So I practice medicine the same way. But in other words, I have to make the decision of whether or not this person is in an emergent situation or not. So, unfortunately, a lot of times people don't know which place to go to, which is obviously why we're talking. So we will get those few people that have maybe questionable illnesses or injuries and I have to think to myself, "Okay. If I were sitting in the ed right now, what would I do?" So if the answer is I would get cardiac enzyme test, for instance, then that means they have to go to the hospital to get their cardiac enzyme test.

Denise Schnabel (Host): Right.

Rikki Schuster: So my thought processes is the same, but I just don't have the tools that I were used to.

Denise Schnabel (Host): It's a different kind of care.

Rikki Schuster: It is. It is. I mean, it is a different kind of medicine. But essentially, you know, I can't change my brain from thinking what's the worst case scenario. So, number one is patient safety. So I have to think what's the best thing for them. And hopefully, I can take care of them in the urgent care.

Denise Schnabel (Host): Nice. So we didn't have it on our sheet. What about the COVID? How is that with all the COVID testing and the COVID patients? And tell us, was that your first ever pandemic that you've gone through?

Rikki Schuster: Oh my goodness. I never thought that I would have to experience something like that. It was rather interesting. In the very beginning, everybody was staying home and we actually got really slow in the beginning. But it was unfortunate because then people that were actually needing help wouldn't come in. So, that shifted to then everybody coming in. I mean, there were days last summer, oh, my goodness, we would see over 200, 250 patients.

Wendy Kelly (Host): Which is not possible, you know.

Rikki Schuster: Well, it's not sustainable for sure.

Denise Schnabel (Host): Right.

Rikki Schuster: I mean, the Outer Banks, it was Vidant at the time, but it's now ECU, was very good about helping us with staffing. I mean, we were very well staffed and supported . And they made sure we had food and water.

Denise Schnabel (Host): That's good.

Rikki Schuster: Yeah, we were very well supported. But yeah, it was a little bit insane. And seeing a lot of people in the parking lot, which I never thought I'd see people in a parking lot when I was training, you know, had plenty of patients make the comment that it looks like a MASH unit.

Denise Schnabel (Host): Well, it was because you were all gardened up, right?

Rikki Schuster: Yeah. So anyway, it's definitely calmed down since then, but we're still seeing a fair share of COVID.

Denise Schnabel (Host): But now you can do the others that don't have COVID, right? So they can feel like they can get in probably right away.

Rikki Schuster: And we've always had separate entrances and exits. And I have always kept one side, a well side and one side is a sick side. So, I think that we've done a really good job.

Wendy Kelly (Host): Very good. Putting on your emergency room provider cap, can we help folks with the whole idea of I'm going to drive myself to the ER versus maybe I'll dial 911? And I've had friends and in the moment it's like, "I can get there fast." You think you can get there faster, but let's talk a little bit about why it's important to perhaps call emergency services.

Rikki Schuster: Just remember again, emergency services are for those things that are potentially life-threatening, especially things like chest pain, possible heart attack, you know, strokes. And if you think about it, if you call 911, the paramedics that respond to you can start treatment immediately and they can start their evaluation immediately. So whether you can get there faster doesn't really make a difference because you'll get treatment faster.

Wendy Kelly (Host): Right. That's a good point.

Rikki Schuster: And what you need to remember is that time is essential, time is of the essence. So it's very important when you have a potential life-threatening emergency, please call 911.

Wendy Kelly (Host): And the emergency room can be prepared, right? Because I'm sure there's conversation between the--

Rikki Schuster: Absolutely. Paramedics call the medical command in the emergency department, and they're waiting for them when they get there.

Denise Schnabel (Host): Very cool. So you were located at the urgent care in Kitty Hawk, right?

Rikki Schuster: Yes.

Denise Schnabel (Host): Tell us, have you been to the new urgent care in Nags Head that we just built, which used to be the Applebee's?

Rikki Schuster: I actually haven't. But I've heard wonderful things about it. I've heard it's beautiful and clean and efficient. Yeah. And I need to get over there.

Denise Schnabel (Host): But we just want to make sure people know where it is.

Rikki Schuster: Right. It's in the Outer Banks Mall. And they have a group of mid-level or APPs. I'm sorry, that's a old school term, Who are as fantastic as the ones in Kitty Hawk. So I just want everybody to know that if you're down this end of the beach, that there's an urgent care there for you as well.

Wendy Kelly (Host): You just go in the Outer Banks Mall Entrance, across from the Dollar Tree. All right. Anything else you want to talk about, Rikki, that you think is important for folks to know?

Rikki Schuster: Well, I was just going to mention that location's perfect because if you are really thinking, "Okay. Maybe I really don't need to go to the ER," they're literally, what, walking distance.

Denise Schnabel (Host): Walking distance. So yeah, that's a good point.

Rikki Schuster: Yeah. I mean, it's a really, really smart location for people to be able to go there.

Denise Schnabel (Host): That's a great point. if you've enjoyed this podcast, share it on your social channels. To hear more Outer Banks Health, check out the library at theobh.com/podcast. Rikki, thank you so much for being with us today.

Rikki Schuster: Thank you.

Denise Schnabel (Host): And this is your host, Denise Schnabel. Stay safe.