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To explore Indigenous patients’ use of a primary urgent care centre (PUCC) at a co-located general medical practitioner (GP)-led primary healthcare service (GP service) in regional Queensland, Australia, secondary data analysis was conducted using the 65,420 deidentified PUCC patients from 1 July 2020 to 30 June 2021, including Indigenous status. A Mann–Whitney U test and Chi-Square test were used to analyse patients’ arrival times, reasons to attend PUCC, and frequency of attendance. The proportion of Indigenous patients from the communities attending the PUCC was 9.8% while the proportion of Indigenous people in the general population was only 3.8%. Indigenous patients were more likely to be new patients to the GP service (13.6% never visited the GP service prior to PUCC) compared to non-Indigenous (9.6%) patients. The peak hours of attendance for Indigenous people were 11 a.m.–12 p.m. and 2 p.m.–3 p.m. while it was 10 a.m.–12 p.m. for non-Indigenous patients. The most common reason for attending PUCC for both patient groups was superficial injuries. The second most common reason was digestive issues for Indigenous patients and musculoskeletal issues for non-Indigenous patients. These findings provide insights for enhancing future PUCC models to better meet the community needs, especially the underserved Indigenous population in regional areas.

In 2020, the Ministry of Health (MoH) in Ontario, Canada, introduced a virtual urgent care (VUC) pilot program to provide alternative access to urgent care services and reduce the need for in-person emergency department (ED) visits for patients with low acuity health concerns. This study aims to compare the 30-day costs associated with VUC and in-person ED encounters from an MoH perspective. Using administrative data from Ontario (the most populous province of Canada), a population-based, matched cohort study of Ontarians who used VUC services from December 2020 to September 2021 was conducted. As it was expected that VUC and in-person ED users would be different, two cohorts of VUC users were defined: (1) those who were promptly referred to an ED by a VUC provider and subsequently presented to an ED within 72 hours (these patients were matched to in-person ED users with any discharge disposition) and (2) those seen by a VUC provider with no referral to an in-person ED (these patients were matched to patients who presented in-person to the ED and were discharged home by the ED physician). Bootstrap techniques were used to compare the 30-day mean costs of VUC (operational costs to set up the VUC program plus health care expenditures) versus in-person ED care (health care expenditures) from an MoH perspective. All costs are expressed in Canadian dollars (a currency exchange rate of CAD $1=US $0.76 is applicable). We matched 2129 patients who presented to an ED within 72 hours of VUC referral and 14,179 patients seen by a VUC provider without a referral to an ED. Our matched populations represented 99% (2129/2150) of eligible VUC patients referred to the ED by their VUC provider and 98% (14,179/14,498) of eligible VUC patients not referred to the ED by their VUC provider. Compared to matched in-person ED patients, 30-day costs per patient were significantly higher for the cohort of VUC patients who presented to an ED within 72 hours of VUC referral ($2805 vs $2299; difference of $506, 95% CI $139-$885) and significantly lower for the VUC cohort of patients who did not require ED referral ($907 vs $1270; difference of $362, 95% CI 284-$446). Overall, the absolute 30-day costs associated with the 2 VUC cohorts were $18.9 million (ie, $6.0 million + $12.9 million) versus $22.9 million ($4.9 million + $18.0 million) for the 2 in-person ED cohorts. This costing evaluation supports the use of VUC as most complaints were addressed without referral to ED. Future research should evaluate targeted applications of VUC (eg, VUC models led by nurse practitioners or physician assistants with support from ED physicians) to inform future resource allocation and policy decisions.

Urgent care centers (UCCs) are increasingly popular with an estimated number of 9600 stand‐alone centers in the United States compared to emergency departments (EDs). These facilities offer a potentially more convenient and affordable option for patients seeking care for a variety of low‐acuity conditions. Because of the limitations of UCCs, patients occasionally are referred to EDs for further care. Prior studies have attempted to evaluate the appropriateness of these UCC referrals. Our study is the first to consider if these referrals require ED‐specific care and the diagnostic concordance of these referrals. We performed a retrospective chart review to identify patients who were referred from UCCs to our ED between October 2020 and June 2021. We used a Boolean search strategy to screen charts for the terms urgent care, emergency department, referral, or transfer. Cases were manually screened until 300 met the inclusion criteria. Cases had to feature the patient being seen by a UCC provider and directly referred to the ED on the same day. Patients who presented to the ED of their own volition were excluded. Three independent abstractors reviewed the charts. All abstractors and a senior investigator piloted the use of a data collection sheet and discussed the management of any ambiguous data. A senior physician reviewed all discrepancies among abstractors. Data collected included ED final diagnosis and whether the final diagnosis was similar to the UCC diagnosis. A referral was deemed to require ED‐specific care and resources if (1) the patient was admitted, (2) imaging (other than an x‐ray) was performed, (3) specialist consultation was required, or (4) care was provided in the ED that is not conventionally available at UCCs. From the 300 patient charts, 55% of patients referred from UCCs to the ED did not require ED‐specific care or resources and 64% had discordant diagnoses between UCC diagnosis and ED diagnosis. A total of 41% of patients underwent advanced imaging studies, 26% received specialty consultations, and 15% were admitted. Subgroup analysis for lacerations, extremity/fracture care, and abnormal electrocardiograms (ECGs) showed disproportionally high levels of discordant diagnoses and referrals that did not require ED‐specific care or resources. Our data found that 55% of patients referred to EDs from UCCs did not require ED‐specific care or resources and 64% carried a discordant diagnosis between UC and ED diagnosis. We suggest quality remedies, such as educational sessions and engagement with telemedicine sub‐specialists as well as a coordinated formalized system for UCC to ED referrals.

Objective. The aim of this study was to develop a taxonomy of urgent care service models and their relationships within healthcare systems through concept mapping, and by addressing inconsistent terminology and service classifications. Methods. This descriptive study used an iterative mapping methodology to analyse and categorise urgent care services. Data collection involved literature describing urgent care models across international healthcare systems, focusing on terminology, operational characteristics, and integration points with primary and emergency care. This was complemented by an Australian urgent care model analysis, that is, a comparative review of publicly declared service characteristics and clinical scopes across Australian urgent care models, coded to ICD-10 (International Classification of Diseases, 10th Revision) and presented in tabular form. Results. The concept map presents a taxonomy of healthcare services across three distinct care pathways based on condition acuity: primary care for non-urgent needs, urgent care for non-life-threatening conditions requiring prompt, non-scheduled treatment, and emergency care for acute emergencies. The map establishes standardised nomenclature, including intersectoral areas such as co-located facilities and nurse practitioner walk-in services. Supplementary analysis highlights scope variation between models, particularly differences in procedural capability, diagnostics access and mental health response. These findings inform current Australian policy directions, particularly the Medicare Urgent Care Clinics rollout. Conclusions. This concept map provides a framework for examining urgent care services within the broader healthcare landscape. Alongside a comparative analysis of Australian models, it supports systematic investigation, highlights variation in service scope and design, and informs planning, integration and policy development across diverse urgent care settings.

Background: Over the past few decades, emergency departments (EDs) have experienced an increasing workload. However, the variation in the types of patient accesses to these departments remains poorly understood. Objective: To evaluate the 5-year temporal trend in the volume of patients attending EDs based on the urgency of their conditions. Methods: This multicenter observational retrospective study was conducted from 1 January 2019, to 31 December 2023, across seven Italian EDs located within the same province. All patients accessing the EDs during the study period were included, totaling 1,282,735 patients. The triage code was used as an urgency index; non-urgent patients were defined as those who received a code 4 or 5 in triage, while urgent patients were defined as those who received a code 3, 2, or 1 in triage. Temporal analyses of admissions were conducted, also evaluating individual age groups to understand behavior over time. Results: From 2019 to 2023, there was a significant 10% increase in ED attendances by non-urgent patients. This increase was observed during both daytime and nighttime shifts. Notably, all age groups showed an increase in non-urgent patients, except for pediatric patients aged 0 to 14. Conclusions: Over the past 5 years, there has been a consistent upward trend in ED attendances by non-urgent patients. Healthcare policies should consider implementing strategies to manage or mitigate the overload in EDs, particularly related to non-urgent patient accesses.

We studied the impact four new urgent care centers (UCCs) had on a hospital emergency department (ED) in terms of overall census and proportion of low acuity diagnoses from 2009 to 2016. We hypothesized that low acuity medical problems frequently seen in UCCs would decrease in the ED population. Since Medicaid was not accepted at these UCCs, we also studied the Medicaid vs non-Medicaid discharged populations to see if there were some differences related to access to urgent care. We conducted a retrospective review of computerized billing data. We included all patients from 2009 to 2016 who were seen in the ED. We used the Cochran-Armitage Trend Test to examine trends over time. As hypothesized, the proportion of ED patients with a diagnosis of pharyngitis decreased significantly over this time period from 1% to 0.6% (p < 0.0001). The rate of bronchitis in the total ED population also decreased significantly (0.5% to 0.13%, p < 0.0001).When we looked at the discharged patients with and without Medicaid, we found that significantly more Medicaid than non-Medicaid patients presented with pharyngitis to the ED with an increasing trend from 2009 to 2016: OR = 2.33, p < 0.0001. The overall census of the ED rose over the period 2009 to 2016 (80,478 to 85,278/year). Overall admission rates decreased significantly: 36.9% to 34.5% (p < 0.0001). With the introduction of four new urgent care centers (UCCs) within 5 miles of the hospital, the ED diagnoses of pharyngitis and bronchitis, two of the most common diagnoses seen in UCCs, decreased significantly. Significantly more Medicaid discharged patients presented to the ED with pharyngitis than in the non-Medicaid discharged group, likely because Medicaid patients had no access to UCCs.

Community paramedicine has emerged as a promising model to redirect persons with nonmedically emergent conditions to more appropriate and less expensive community‐based health care settings. Outreach through community paramedicine to patients with a history of high hospital emergency department (ED) use and chronic health conditions has been found to reduce ED use. This study examined the effect of community paramedicine implemented in 2 rural counties in reducing nonemergent ED use among a sample of Medicaid beneficiaries with complex medical conditions and a history of high ED utilization. A cluster randomized trial approach with a stepped wedge design was used to test the effect of the community paramedicine intervention. ED utilization for non‐urgent care was measured by emergency medicine ED visits and avoidable ED visits. The community paramedicine intervention reduced ED utilization among a sample of 102 medically complex Medicaid beneficiaries with a history of high ED utilization. In the unadjusted models, emergency medical ED visits decreased by 13.9% (incidence rate ratio [IRR], 0.86; 95% confidence interval [CI], 0.76–0.98) or 6.1 visits saved for every 100 people. Avoidable emergency department visits decreased by 38.9% (IRR, 0.61; 95% CI, 0.44–0.84) or 2.3 visits saved for every 100 people. Our results suggest community paramedicine is a promising model to achieve a reduction in ED utilization among medically complex patients by managing complex health conditions in a home‐based setting.

Background: Atrial fibrillation (AF) is a common diagnosis in patients presenting to urgent care centers (UCCs), yet there is scant research regarding treatment in these centers. While some of these patients are managed within UCCs, some are referred for further care in an emergency department (ED). Objectives: We aimed to identify the rate of patients referred to an ED and define predictors for this outcome. We analyzed the rates of AF diagnosis and hospital referral over the years. Finally, we described trends in patient anticoagulation (AC) medication use. Methods: This retrospective study included 5873 visits of patients over age 18 visiting the TEREM UCC network with a diagnosis of AF over 11 years. Multivariate analysis was used to identify predictors for ED referral. Results: In a multivariate model, predictors of referral to an ED included vascular disease (OR 1.88 (95% CI 1.43–2.45), p < 0.001), evening or night shifts (OR 1.31 (95% CI 1.11–1.55), p < 0.001; OR 1.68 (95% CI 1.32–2.15), p < 0.001; respectively), previously diagnosed AF (OR 0.31 (95% CI 0.26–0.37), p < 0.001), prior treatment with AC (OR 0.56 (95% CI 0.46–0.67), p < 0.001), beta blockers (OR 0.63 (95% CI 0.52–0.76), p < 0.001), and antiarrhythmic medication (OR 0.58 (95% CI 0.48–0.69), p < 0.001). Visits diagnosed with AF increased over the years (p = 0.030), while referrals to an ED decreased over the years (p = 0.050). The rate of novel oral anticoagulant prescriptions increased over the years. Conclusions: The rate of referral to an ED from a UCC over the years is declining but remains high. Referrals may be predicted using simple clinical variables. This knowledge may help to reduce the burden of hospitalizations.

Modern Clinic Design: Strategies for an Era of Change is a comprehensive guide to optimizing patient experience through the design of the built environment. Written by a team of veteran healthcare interior designers, architects, and engineers, this book addresses the impacts of evolving legislation, changing technologies, and emerging nontraditional clinic models on clinic design, and illustrates effective design strategies for any type of clinic. Readers will find innovative ideas about lean design, design for flexibility, and the use of mock-ups to prototype space plans within a clinic setting, and diagrammed examples including waiting rooms, registration desks, and exam rooms that demonstrate how these ideas are applied to real-world projects. Spurred on by recent healthcare legislation and new technological developments, clinics can now offer a greater variety of services in a greater variety of locations. Designers not only need to know the different requirements for each of these spaces, but also understand how certain design strategies affect the patient's experience in the space. This book explores all aspects of clinic design, and describes how aesthetics and functionality can merge to provide a positive experience for patients, staff, and healthcare providers.

Pediatric acute care delivery has changed dramatically in the last 20 years. While acute care options were once limited to only primary care and the emergency department, additional options now include retail based clinics, urgent care centers, and telehealth. These alternate settings have proliferated because of convenience, low relative cost, and the appeal of a patient-centric model aimed at customer service and efficiency of care. The patient-centered medical home has been slow to accept these changes with concerns about fragmentation of care and disruption to the medical home. Specialized pediatric urgent care centers may bridge the gap in the medical neighborhood offering acute care when access to a primary care physician is unavailable and the emergency department isn't required. This article discusses the evolution of pediatric urgent care and how acute care sites can work together with the medical home and maintain high quality of pediatric care.