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View Full Version : doctor vs. "urgent care" vs. ER


kadiera
01-29-2010, 10:54 AM
Alexander is sick again. He'd been improving steadily last week and into Tuesday, but Tuesday night his cough and mucous and wheezing came back with a vengence. Today he's running a low grade fever again, typically between 100 & 101.

There are no openings at our pediatrician until Monday.

The nurse there recommends parents take kids to the pediatric "urgent care" after hours clinic at the hospital.

We've heard (but not seen for sure) that going there with a trach, we will be turned away and sent to the ER, because, you know, trach + any wheezing = life threatening emergency.

If he was really that sick, we'd already be in the ER. He's not. I'm concerned about this bug coming back, because that suggests to me either a secondary bacterial infection or that he's developing pneumonia, and I'd rather nip it in the bud.

Suggestions? Advice?

MomofTwoBoys
01-29-2010, 11:09 AM
Will your ped call in a script prophylactically? You could bring him in on Monday if not any better, but at least have him on something to start off with.... I try and avoid ER's if at all possible (most don't have the experience with trach kids and just admit).

bryantem
01-29-2010, 11:17 AM
I would call Urgent Care and ask if they will look at a kid with a trach.
When Addy is sick, we call her pulmonologist. Our orders from him are to always call when she is sick. He will treat her away from the ER as much as possible.

kadiera
01-29-2010, 11:21 AM
Oh good. The nurse called back. Apparently my explanation that Alexander really isn't sick enough for the ER, and my concern about urgent care led to her asking the doctor for an opinion. They will work him in tomorrow morning.

That being said...I may yet call urgent care and ask, just so we know.

The ER will admit him if we walk in the door, and it's just plain silly to admit a kid with what acts like a bad cold who's mostly playing normally, just because he has a tube in his neck, you know?

mylesmom
01-29-2010, 11:21 AM
We went thru a similar thing last week. He had a low grade fever that came and went then the wheezing, retractions........it was pneumonia....we went to the ER, they know us at the hospital and treat him well even though it's not our pediatric hospital. Tough call. If you need a chest x-ray would Urgent care have that access?

lynn
01-29-2010, 01:21 PM
our insurance doesnt cover the urgent care.. so our only option is doc or er.. I usually call on pulmo if i cant get in doc.. but knowing Josephs history the nurses try working him in ASAP or at least have a script called to the lab for xry or will give me abx if I feel he needs it.

kadiera
01-29-2010, 01:37 PM
our insurance doesnt cover the urgent care.. so our only option is doc or er.. I usually call on pulmo if i cant get in doc.. but knowing Josephs history the nurses try working him in ASAP or at least have a script called to the lab for xry or will give me abx if I feel he needs it.

One nice thing about our "home" hospital, they have an "after hours" urgent care clinic, 6-10 pm weeknights and Saturday afternoon and into the evening for pediatric patients. Because it's a service of the hospital, the insurance covers it with a regular doctors' copay rather than an ER copay.

I hadn't thought about calling pulmo, honestly. His response is always, "you know where the ER is - right downstairs from my office" He's not at our home hospital anyway, and their ER is awful.

lynn
01-29-2010, 01:46 PM
I hadn't thought about calling pulmo, honestly. His response is always, "you know where the ER is - right downstairs from my office" He's not at our home hospital anyway, and their ER is awful.

I would not be happy with that response!! Our pulmo tries to keep us out of ER at all costs.
I will say, our home ED is pediatric hospital, and they leave it up to me whether to admit or not.. If I feel confident enough to care for him at home they will discharge with the meds..(after discovering I know way more about his condition and care than most of the residents) I usually only go there if it is weekend or late nights when I cant get in touch with any of his docs.

kadiera
01-29-2010, 01:55 PM
I'm not overly impressed with our pulmo, but we don't really have any other option. I'm not overly impressed with the hospital he's at either, but it is what it is.

When we discharged from our home NICU, the options for pulmonology were the children's hospital downtown that is in-network from the insurance, or the children's hospital at the university, about an hour and a half's drive the other direction, which is out of network for the insurance. Our home hospital didn't have anyone who'd take a vent kid, nor do they "technically" have an ENT that does trachs (though the ENT we're seeing downtown does have admitting priv at our home hospital too)

Our home hospital is now a "children's" hospital as of last spring, and we're hearing rumors from our cardiologist (we switched back to a cardio at our home hospital due to our dislike of the way things work downtown) that they have gotten a pulmo in the last few months that will take vent kids, but we don't know for sure.

At this point in the game, I'm not sure it'd be worth switching even if they did, since we're pretty solidly off the vent (we had a few nights on it when he first got sick, but even our night in the PICU, they never turned the vent on) and when not sick, we were running at a half liter of O2. At least at the pulmo we're seeing now, their PA did his residency in the NICU with Alexander, and their NP is one of our former night nurses, so the people who do most of the work and answer most of the questions are super familiar with Alexander.

LKN
01-29-2010, 04:13 PM
Our ped will always squeeze us in--no matter how busy his schedule is. If it is afterhours and they are not open, we call him and then meet him at the ER.

Niff
01-29-2010, 06:09 PM
I bounce between pulmo and our pedi. I use pulmo on the weekend or if I don't agree with the pedi's decision. We've never had a problem (knock on wood) getting in at our pedi's office. Our doc makes sure Mackenzie gets worked in.

We have, however, gone to the ED before for issues that were non-life threatening but could be if we waited... like what you're saying. We've gone a couple times for tracheitis that was starting to get ugly. They go ahead and do chest xrays and all that. Our ED doesn't like to admit patients, or at least haven't been all hoorah about admitting Mackenzie.

Melisande
01-29-2010, 09:14 PM
Most of our care, even with D on the vent, has been with our pediatrician. The only time we use the pulmo is when there's a vent issue. Our pediatrician handles everything else and he's awesome to take great care of us. He always calls me back when I have a question himself. (So does our pulmo too for that matter.) If it's an acute infection not requiring hospitalization the pediatrician is easy and works us in. We live in a rural area anyway and there is only one pediatric pulmo doc in the area. We have always maintained our primary specialist at our children's hospital which is 4 hours away and those docs have worked great with our local pediatrician. That was process of trial and error over the years, however. We did see the local pediatric pulmo yearly for the first few years just in case we ended up in the hospital too urgently. We've only made 2 ER visit though Donovan's whole life, though. (knock on wood)

It's great if you can find a doctor who will give you some personal attention.

drct1245
01-29-2010, 10:11 PM
That is the nice thing about our ped's practice, it's huge, so every time you call, you can get a same day appt. They are even open on Sat mornings for sick visits.

We only have gone to the ER once when we were out of state and he had an ear infection - otherwise we have had no urgent care visits or ER visits. (knock on wood and cross our fingers)

TaraB
01-30-2010, 10:35 AM
Our hometown hospital has worked with us so well--we have a protocol in place, so if I feel Logan needs to be seen after hours or weekends, I just call the pediatric unit and let them know what is going on. Even if he just needs a once-over and not to be admitted, I go straight to the peds unit and the doctors will look at him there. That way we don't have to wait in any waiting rooms. We had to call a meeting of all his caregivers, primary care docs, and the staff of the peds floor to put the plan in place. Of course, if anything of a more serious nature pops up, we have to be transferred out to Iowa City. But, nice to know that the option is there for him to be checked out in his own "space"...
We still try to avoid the hospital like the plague, though.. :)

kadiera
01-30-2010, 06:30 PM
Our ped is usually really great; one of the docs is out on maternity leave right now and that's part of the issue with getting a same-day appointment.

Turns out Alexander has a pretty bad ear infection, secondary to the virus he'd had before.

We also had a long chat with the ped we saw today (not our regular, but one we've seen numerous times) about the ER. I feel a bit better since she's pointed out that we should feel free to call if we do take him in, and explain why we think he does or doesn't need to be admitted and they'll back us up on not admitting him unless there's something serious going on.