Nighttime Care Center Provides Quality Care for After-Hours Health Concerns

By Muphen R. Whitney

Most doctors' offices close at 5 p.m. However, accidents, injuries and illnesses can't tell time and tend to occur randomly throughout a 24-hour day, with a preponderance occurring before midnight. Even if there is a need for medical attention during the day, it often is not possible to get a patient - especially a young child - to a medical facility before 5 p.m.
It was this reality that provided the impetus for Robert G. Graw, Jr., M.D., and nine other pediatricians to open the first Nighttime Care facility in Annapolis in 1989.
"In the late 1980s, it became apparent that most families were living a double-income lifestyle with both parents working, so they couldn't take their children to the pediatrician during the day," explained Graw. "They needed to be able to access quality pediatric care between 5 p.m. and midnight. They didn't need an emergency room. They needed primary health care after hours."

Fulfilling a Need
So Graw and his partners opened their first facility in Annapolis, followed by two others in Anne Arundel County (in Gambrills and Pasadena). Graw has since opened facilities in Montgomery (Rockville) and Howard (Columbia) counties with other partners. And the need for this type of care is such that more offices are in the planning stages.
"We plan to open another one in Montgomery County and expand into Harford and Baltimore counties. We are also looking to expand to the Northern Virginia area," Graw said.
Expansion has come in the form of additional medical services as well as opening new offices. "In 1998 we added adult care based on the need for it we saw during the previous decade," explained Graw. "Adult care now accounts for 50% of our services."

Philosophy and Procedures
"We offer our patients the right care at the right time," said Graw. "We focus on the problem they are having that day and either solve it or transfer them to an emergency room.
"We accept all insurance, and we see people even if they are uninsured," he explained. "During the initial telephone conversation we try to determine if this is a situation for the emergency room. If it isn't, we schedule an appointment to minimize waiting and so that people can wait in the comfort of their homes and not in the waiting room. We coordinate all care with the patient's private physician."
The most prevalent situation at Nighttime Care that requires transfer to an emergency room is major unintentional trauma that requires sophisticated diagnostic facilities. The ailments that are seen most often are upper and lower respiratory infections (in the winter) and minor trauma injuries (in the summer).
According to Graw, all five of his facilities are equally busy. Monday is one of the busiest days, and early evening until about 10 p.m. is the busiest time. Although walk-ins are accepted, Graw urges patients to call ahead for an appointment. He also reminds patients that, "This is not for primary care or chronic illness."
With expansion plans in the near future, Graw said that all the Nighttime Care physicians will remain true to the philosophy upon which the initial practice was based.
"This is a practice that is driven by the physicians' consciences," he said. "We believe a lot in what we do, and that belief has never let us down."

Other Options
If you have ever sat for hours - many and long hours - in a hospital emergency room, you will probably want to avoid that experience again. So if you have a medical problem, or if you need care for any condition after hours, what can you do?
"The first thing to do is to try to call your physician in their medical home," said Martin P. Wasserman, M.D., J.D., executive director of MedChi, the Maryland State Medical Society. "Does that office have on-call services or services available after hours? Most doctors have some mechanism for a 24/7 response.
"People need a medical home where a doctor takes responsibility 24/7, so that if you get sick you have a place to go. If you don't have a physician, you can try one of the retail clinics or an urgent care type of facility. Be aware that these types of facilities may not be staffed by doctors, but they offer some type of health assistance. Also make sure that you have an illness for which they have a protocol. Sometimes they are limited in the types of problems they can handle.
"Last, but not least, make sure you understand their payment policy. Most of them require immediate payment."

Resources
There are several facilities in Maryland - listed below - that provide health care outside of a regular doctor's office. These facilities are helpful in that they provide a service to the community, can act as a referral source to hospital/health system primary care physicians and reduce non-emergency visits to emergency rooms.
- MinuteClinic has several clinics located in CVS drug stores in Maryland. Their locations, hours and policies can be found at www.minuteclinic.com/en/USA. They are open seven days a week, do not require appointments and accept most forms of insurance.
- Doctors Express (www.drsexpress.com) is an urgent care facility located in Towson. Its hours are Monday through Thursday, 8 a.m. to 8 p.m., Friday 8 a.m. to 6:30 p.m., and Saturday 10 a.m. to 5 p.m.
- Immediate Care Medical Center (www.immediatecaremedical.com) has offices in Reisterstown and Glen Burnie. It is open 365 days a year from 8 a.m. to 8 p.m., and has a physician on call after regular hours.
- Maryland Urgent Care (www.mdicare.com) is a full-service urgent care medical clinic and medical testing facility that accepts walk-ins. It is located in Prince George's County and is open Monday through Friday, 8 a.m. to 7 p.m.