Urgent Care takes its place in modern health service ecosystems
A staggering 131 million people—around four in 10 of the population—present themselves to United States Hospital Emergency Departments (EDs) every year. [1]
Any intrepid researcher who embarks upon a more detailed analysis or segmentation of this number is quickly struck by the enormous range of symptoms with which ED providers must cope – from the potentially fatal (heart attacks, strokes, serious accidents, knife or gun incidents, drug overdoses) to the rather more mundane (minor lacerations, mild respiratory problems, coughs, and colds). Anecdotal evidence suggests the challenge has worsened post-Covid, due to the inaccessibility of primary care appointments. When nervous patients are told that the next available slot is ten or 12 days away, it’s no wonder they prefer to jump in the car and head straight to the nearest ED, knowing it’s open 24/7 and staffed by some of the finest, most dedicated physicians.
There comes a point at which the core mission of ED services—to respond fast to genuine emergencies—is threatened by the operational distractions of non-emergency cases. The consequences can be devastating, especially in low- and middle-income countries, where it has been estimated that over half of all deaths result from conditions that could have been treated by trained emergency care professionals [2] WHO analysis confirms that, when emergency resources are diluted, the result is an increased “failure to recognize urgency, provide initial appropriate care, and delay in onward referrals”. While the headline numbers are not as stark, the same pattern is evident throughout the developed world whenever EDs come under inappropriate strain.
The purpose of Urgent Care centers (alternatively referred to as Walk-In or Minor Injury centers) is to provide an alternative ‘unplanned care’ solution. In the United States, many have been pioneered by emergency medicine physicians who were aware of the dysfunctional nature of existing services. While the earliest centers were launched as long ago as the 1970s, it’s only in recent years that the sector has mushroomed – today there are an estimated 10,000 centers across the country, with combined revenue of $14.5 billion [3] Urgent treatment centers have also been a recent priority for the United Kingdom’s National Health Service, which describes their role as “treating conditions that require urgent medical attention but are not life-threatening: This may typically include things like broken bones, minor infections, sprains and strains, cuts, grazes, minor burns or scalds, and bites and stings.” [4]
Healthcare leaders who are considering whether and how to integrate Urgent Care capabilities into a wider health system will need to be mindful of a few essential considerations:
Expected volumes: Unless there is a critical mass of cases with an Acuity of four or five, there is a risk that the Urgent Care service absorbs resources without providing any commensurate benefit – in particular, relief to ED.
Triaging: Patients cannot be expected to diagnose the severity of their condition themselves. Any system that is geared around differentiating between ‘emergencies’ and ‘urgency’ is only as good as the triaging pathways. Triaging will already exist even in a legacy emergency setting – however, the complexities multiply when there are two parallel services potentially involving separate facilities and workforces.
Workforce planning: At a rudimentary level, workforce planning often focuses on estimating the number of physicians, and of course that’s a required starting point for any healthcare services. However, no physician, regardless of their expertise, can function effectively without access to an array of allied professionals—nurses, lab technicians, radiologists, etc. Furthermore, receptionists, administrators, data analysts, schedulers, and others will all be vital to the smooth running of the service. Decisions for leaders will include whether separate support services are dedicated to each of ED and Urgent Care, or whether they are provided on a combined basis.
Scope of services: The investment required in establishing an Urgent Care center will be determined by precisely what range of services it will offer. There is no definitive list of ‘essentials. For example, in the United States, MedExpress Urgent Care centers tend to be stocked with X-ray machines, whereas One Medical Urgent Care centers are not. When designing the asset register for launch, some of the most common requirements for investment are likely to include ECG machines (for cardiac diagnosis), ultrasounds, spirometers (for measuring lung capacity), centrifuges (for producing lab samples), audiometers (for hearing tests), hyfrecators (for removing skin lesions), and IVs (for medication administration). On top of this, the patient experience will often require a sizeable investment in a spacious and tech-enabled waiting room that provides accurate information. And all alongside an Electronic Patient Record system that maintains timely data on eligibility and treatment.
Integration with telehealth and teleconsultations: As more health services migrate online, healthcare leaders will need to consider the nature of referral processes between virtual encounters and Urgent Care services (which are traditionally in-person). What are the protocols, when a mother calls an advice line at 3 a.m. about an unwell son or daughter, for determining whether the symptoms are best dealt with face-to-face? Another option is to provide telehealth within the Urgent Care setting as part of the pre-screening or triaging arrangements; benefits include reducing the burden of the ‘worried well’.
Risk management and mitigation: Agreement on targeted Key Performance Indicators that are robustly measured can ensure an Urgent Care service is adding incremental patient benefit without any commensurate risk. Commonly adopted metrics to control risk include Category four and five attendees as a percent of the total; Category one and two patients seen within 30 minutes; Category three patients seen within 30 minutes; LFWS (left without being seen) ratios; referral rates from Urgent Care to ED; 72-hour return rates; and of course the ubiquitous Patient Satisfaction rating.
Greybeard Healthcare has recently been supporting clients in the design and implementation of modern, patient-centred Urgent Care services. For more information, please don’t hesitate to contact any of the Greybeard directors.
References
[1] Centers for Disease Control and Prevention: https://www.cdc.gov/nchs/fastats/emergency-department.htm
[2] World Health Organization: https://www.who.int/initiatives/emergency-care-saves-lives
[3] New York Times: https://www.nhs.uk/nhs-services/urgent-and-emergency-care-services/when-to-visit-an-urgent- teatment-centre-walk-in-or-minor-injury-unit/
[4] NHS: https://www.nhs.uk/nhs-services/urgent-and-emergency-care-services/when-to-visit-an-urgent-treatment-centre-walk-in-or-minor-injury-unit/
