Is it an Emergency or Just an Urgency?

Featuring: Russell Grant, Euthym Kontaxis
When seeking medical care, taking a minute before deciding where to go can mean better, more efficient care for everyone. And it can even save your life!

In this panel discussion, Russell Grant, MD, Medical Director, Eisenhower Urgent Care, and Euthym Kontaxis, MD, Medical Director, Eisenhower Tennity Emergency Department, discuss when to call an ambulance, when to go to the emergency department and when to choose urgent care.


Russell Grant, MD, is the Medical Director- Eisenhower Urgent Care Clinic.

Learn more about Russell Grant, MD

Euthym Kontaxis, MD, is the Medical Director - Eisenhower Emergency Department.

Learn more about Euthym Kontaxis, MD


Bill Klaproth (Host): When seeking medical care, taking a minute before deciding where to go can mean better, more efficient care for everyone and it can even save your life. Here to discuss with us when it is appropriate to go to the emergency room versus urgent care is Dr. Russell Grant, medical director of Eisenhower Urgent Care Clinics, and Dr. Euthym Kontaxis, medical director of Eisenhower Emergency Department. Thank you for your time today. Dr. Grant, let's start with you. What's the main difference between an urgent care facility and the hospital ER?

Dr. Russell Grant, MD (Guest): Urgent care facilities provide quick convenient medical care on a walk-in basis for minor acute illnesses or injuries that are not serious or life-threatening, but do require same day care. Conditions that are life-threatening or potentially life-threatening, those patients should be seen in the emergency room.

Bill: Minor acute injuries, we got that, and more urgent care. Dr. Kontaxis, how do we know if a medical problem is critical and needs emergency service?

Euthym Kontaxis, MD (Guest): That's a good question and I think that's one of the confusions that people have and I think it's very clear that people need to realize that any time you're at risk for coronary disease, or any kind of heart problem or arrhythmia, all those need to be going to the emergency department. If you're an adult with chest pain or an irregular heartbeat or severe shortness of breath, those are symptoms that warrant an emergency department visit. The other things are things like a stroke. Stroke has a time-sensitive window for treatment, so anytime you have symptoms that may be related to a stroke where you have a drooping mouth or weakness on one side or difficulty with speech, those all need to be an emergent call to 911 to get you into the emergency department soon. The other area that I think people mistakenly wait on is severe abdominal pain. Not talking about mild gastritis or dyspepsia, but I'm talking about a severe abdominal pain. Those are best worked up in the emergency department. Of course, sepsis, severe blood pressure problems, any of those need to come to the emergency department.

Bill: Dr. Grant, once you determine that this is a bigger issue than waiting for a doctor, is there an easy way to determine whether you should call an ambulance, go to the emergency room or visit urgent care? I know Dr. Kontaxis just gave us an overview there. Is there a simple way to understand which of the three you should do?

Dr. Grant: Like Dr. Kontaxis says, it really depends on your initial symptoms. If it is a minor illness like a cough or a cold or influenza, a UTI, a minor laceration or fracture, minor burns, any eye irritation or redness, those patients should be directed to the urgent care, which helps alleviate the emergency room and helps offload some of those volumes. If you are having any symptoms such as chest pain, shortness of breath, irregular heartbeat, if you think you are having a stroke, then you should definitely call 911 in those situations. It's best to always call 911. They can come and access you and do an initial assessment to see if you do need to be transported to the emergency room.

Bill: Speaking of 911, Dr. Kontaxis, it's a common misconception that driving a loved one to the emergency room is faster or better. Can you tell us why that's not a good idea?

Dr. Kontaxis: It's not a good idea because if your loved one decompensates and you're driving, there's not much you can do and I've had that happen many a time where someone's pulled up to the ER honking their horn while their loved one is collapsed in the car not breathing. We've gone out and extracted people from cars on multiple occasions, so there's a risk there. There's a risk with driving in general just because you're anxious and you're not concentrating. The other thing what happens when you call 911 is the assessment starts at home. Let me give you two examples. A person with an acute heart attack can have an EKG in the ambulance. It can be transmitted to us and we can activate the cath lab so when the patient arrives, if there's a heart attack going on, we can actually have the patient in the cath lab within 10 minutes. Other things like stroke, we can activate the stroke protocol and the team so that we're waiting and ready for the patient when they arrive in that 15 or 20 minutes that the initial call comes in or even five minutes. It helps us to get a jump on things and much better outcomes are clear when patients come through EMS and when they come through the lobby or they drive up and walk in.

Bill: If you suspect heart attacks, stroke or any other life-threatening emergency, make sure you call 911.

Dr. Kontaxis: I think you should know because if you feel like there's an emergent need for you to see a doctor, whatever that is, whatever that gut feeling is, that tells you probably need to call 911. That feeling should prompt you to call 911.

Bill: Let's continue with you for a minute. If someone is going to the ER or hospitalized, what should the family member bring or be prepared to bring? Are there things that you always need? Is there certain identification or grab the person's wallet? What should a loved one bring to the hospital if they have time?

Dr. Kontaxis: I can tell you that the main things to bring are a medication list, who their primary physician is if they have one, who their specialists are if they have one, and they generally need to have some form of insurance if you have it to bring the card so it helps us to sort that out for their sake on the back end, but that doesn't change our care at all. It just allows for them not to have a big convoluted mess in terms of the billing and all that. Those are the main three things in some form of identification. Everything else I would leave home. You don't want to bring any valuables, you want to leave your watch or your rings and such - you just don't want to take a chance on something getting lost in the shuffle - and we've seen that before. Cell phones for the patient is not a bad option if you can think of it in case they want to make a call or need to reach out to somebody - that's not a bad thing.

Bill: Dr. Grant, same question for you. When someone's going to urgent care, are there certain things you need to see or would like them to bring?

Dr. Grant: It's pretty much what Dr. Kontaxis listed. It's very important if they have a list of medications to bring with them. Certainly, their photo ID and their insurance ID is important in an urgent care environment, if they have any previous documentation from their other physicians that they see is always helpful. What's helpful now at Eisenhower is that all Eisenhower facilities are linked to the one electronic medical record, so whether they get seen in the emergency room, the urgent care, primary care, cardiology, orthopedics, inpatient, outpatient, all those notes are not visible in one portal, which makes it great for continuity of care and patient safety. Having that access online if they've been to Eisenhower before is very beneficial.  

Bill: If we can stick with urgent care for a minute, one of the things about urgent care is you can also get routine vaccinations and school physicals at an urgent care location. Is that correct?

Dr. Grant: Absolutely. We do a lot of school and sports physicals at the beginning of the school year and throughout the year as well. We do offer adult routine vaccinations, so this time of year, influenza and pneumococcal vaccines. We offer tetanus and diphtheria, and then hepatitis A and B vaccines. The urgent cares do not provide pediatric vaccinations doses because we always like to be done in the physicals with their primary care providers.

Bill: Dr. Kontaxis, if you could wrap it up for us on the emergency department side of things. Is there anything that we should know that we haven't talked about today?

Dr. Kontaxis: I think the expectation from people in an emergency department is sometimes a little bit skewed. The bottom line is we are a resource of an entire community and we see patients 24 hours a day, seven days a week, 365 days a year without regard with their ability to pay and we can't always predict how busy or how acute the population is in our emergency department at any given time. I think people need to realize that as a community resource, we are limited to some degree and people need to be patient. Even though you're not feeling well, it doesn't mean you're the sickest person. On the other side of the coin, we try to treat everybody with respect and consideration and do the best we can to make sure everybody gets the proper care. I think we just have to realize we're all in this together in the emergency department and we have to think of our neighbor as well as ourselves. I think if we do that, things go a lot better.

Bill: That's great perspective on the emergency department. Thank you for sharing that with us. Dr. Grant, if you could wrap it up for us on the urgent care side, is there anything that we should know about that we haven't talked about today?

Dr. Grant: Our goal is always to get patients in and out as quickly as possible. Our throughput time, our goal is to have people from the time they arrive to the time that they leave in under 60 minutes. Everybody has a busy schedule and we appreciate that, but also there are times when volumes increase unexpectedly and sometimes there is an additional way. Like Dr. Kontaxis mentioned, being patient, thinking of your neighbor or the patient sitting next to you, is a good idea and a good rule of thumb. We try to get patients in and out as quickly as possible and that depends on the workup we do in the clinics. Our goal is less than 60 minutes and we've been successful at that.  

Bill: Thank you both for your time today. For more information, please visit That's This is Living Well with Eisenhower Health. I'm Bill Klaproth. Thanks for listening.