Headaches. Back pain. Urinary tract infections. An eye infection or earache. A sore throat or other cold symptoms. According to the Washington Health Alliance, these common maladies are also the top “potentially avoidable” reasons for a Puget Sound ER visit.

Yet many of us struggle with where to go if an injury occurs outside regular office hours, if we can’t get an appointment with our doctor — or if we suffer an injury that might require an X-ray or other imaging.

The health care system typically funnels individuals who can’t get into their doctor to the emergency department, leading to crowding, points out Dr. Mark Zeitzer of the Emergency Team at ZOOM+Care, a Pacific Northwest network of on-demand urgent and primary care clinics.

This ER funnel can lead to long wait times. According to a 2018 National Center for Health Statistics survey, the mean wait time was 48.7 minutes in emergency departments with 50,000 or more annual visits.

Emergency department wait time is an indication of overcrowding, the survey notes. More volume results in sending away ambulances, putting admitted patients in hallways, and increased wait times for small problems and even bigger ones, such as heart attacks. It’s a strain on the system.

Emergency room visitors may experience unpredictable costs, too. “Some people can’t pay for care, so that spreads costs across people who can pay,” Zeitzer points out. If we cut down on unnecessary ER visits, we could save $13 million in the Puget Sound region, according to the Washington Health Alliance.


Here’s how to determine where to go and when.

Primary care

Best for: Common illnesses (such as cold and flu symptoms, migraines, fever), and minor injuries (such as sprains, back pain) for which you can get an appointment during office hours, according to the Washington State Hospital Association.

Many providers and insurance companies offer an after-hours, nurse-staffed helpline. However, if you’re on the fence about where to go, or just want quick feedback on a potential problem, the COVID-19 era has expanded video visit availability. It’s easier to speak with your regular physician or with someone at an on-demand clinic — all without leaving your home.

For example, ZOOM+Care offers an instant “virtual visit” with a physician who can recommend further testing, whether a strep test or urine test. If the situation sounds serious or urgent, the physician may refer you to another clinic or hospital.

“VideoCare is a good way to enter the system,” Zeitzer says.

On-demand urgent care

Best for: Minor injuries and common illnesses (as above) when your regular doctor isn’t available or is too booked up, the Washington Health Alliance says. This is also a good option for issues that could grow worse with time, such as a urinary tract infection.

The Washington Health Alliance reports that headaches and respiratory infections are by far the most common emergency-room complaints — making up about half of all visits — yet can often be resolved at a neighborhood urgent-care clinic.

If your regular doctor isn’t available, or if you’re sick on evenings and weekends, urgent-care clinics can treat common illnesses and injuries, along with rapid-testing for mono, strep, TB, pregnancy, influenza, and COVID-19. However, most urgent-care clinics may not have technological diagnostic tools (such as ultrasound devices) or on-site labs.

Emergency room

Best for: Life-threatening issues such as chest pain, severe abdominal pain, coughing or vomiting blood, sudden blurred vision, facial numbness, seizures, and other crisis scenarios, according to the Washington State Hospital Association. In the case of life-threatening emergencies, it’s essential to avoid delay and call 911.

If you’re unwell enough to get yourself to a clinic, the emergency room is probably the wisest destination, Zeitzer says. “If you need an ambulance or major assistance, go to the ER,” he says.

Emergency rooms can also be the best — or only — option if you’re facing a painful medical problem at 2 a.m., when regular physicians and urgent care clinics aren’t open, and you can’t wait until morning.

A new alternative — enhanced urgent care

Best for: Serious but non-life-threatening issues such as broken bones, dehydration, severe headache, or abdominal pain — problems that may require testing or the expertise of an emergency-room physician, Zeitzer says.

In the Portland area, the ZOOM+Super clinic option was created for urgent issues such as these. A similar clinic is opening soon in Bellevue.

The goal? “To make this level of care more accessible and affordable –– and keep emergency departments open for true emergencies,” Zeitzer says. Board-certified ER physicians at ZOOM+Super can treat common ER conditions and either rule out or refer out for more serious issues like appendicitis or blood clots.

The physicians have access to tech tools commonly found in many emergency rooms — CT scanners, X-ray and ultrasound machines — along with a lab and the ability to provide medication and fluids.

If a situation needs more extensive treatment, the clinic arranges an ambulance transfer to the hospital of the patient’s choice. For example, a patient with appendicitis can be sent directly to the hospital for same-day surgery and skip the emergency department entirely.

Unlike an emergency room, patients can set an appointment, show up, and experience no waiting — versus the 48.7-minute average time spent at a hospital waiting room. ZOOM+Super is less expensive as well, and doesn’t charge the facility fees common at hospital ERs. “You’re only paying for the care you’re receiving,” Zeitzer says — ZOOM+Super visits cost a quarter of a traditional ER visit, with imaging included.

Clinics like these may also fill gaps for patients who need care early in the morning, or late at night — ZOOM+Super is open from 7 a.m. to midnight.

“We’ve been able to bring those services out of the hospital and make them accessible to patients who need them,” Zeitzer says.

ZOOM+Care makes going to the doctor easy, affordable, and even kind of enjoyable. No crowded sitting rooms, no long waits to see your family doctor, no aggravation with billing, and no annoying upcharging. Just amazing care that empowers patients, optimized for real life.