What can we learn from urgent care in the US?

Urgent care clinics (UCC) were born from a need to absorb patient overspill from the US’s overburdened emergency departments (ED) – but decades on, they have overtaken them in popularity, seeing almost twice as many annual visits.

With walk-in access to medical teams, the clinics are an attractive proposition for low-acuity patients, who can be seen faster than in general practice and more cost-effectively than in an ED.

But how well do UCC models meet healthcare needs at the population level? And are they adequately equipped for expansion here in Australia, where the concept is relatively new?

Ahead of the Urgent Care Clinics Conference, we sought answers from Associate Professor Lindsey Fish – Chief of the Division of Urgent Care at Denver Health and Hospital in the USA – who gave some tips for urgent care excellence.

Upholding standards through quality metrics

Central to the success of UCCs are clearly-defined quality metrics, A/Prof Fish said – but even in medically-advanced countries, like the US, these are still being defined.

While there are various ways to measure care quality in both inpatient and outpatient settings, metrics have not yet been identified for urgent care.

“These need to be context specific,” A/Prof Fish said. “So, in an urgent care setting, we might ask questions like, what is the best way to treat someone presenting with chest pain? Are we to give the patient an electrocardiogram and look at their heart right away, for example? Likewise, when we handle infections, is the patient receiving antibiotics when they need them, and being denied them when they don’t?

“We need to explore these questions and create some standardisation to weigh different sites and hold people accountable across the system for good versus bad care. Not just fast care, or “what the patient wants” care, but objectively good medical care.”

Striking the balance between resources and quality

A/Prof Fish claims quality is often a balancing act in UCCs, which are less resourced than EDs and more time-pressured than GP clinics.

With insurer reimbursement also a factor in non-funded sites, she said it pays to remember that care quality should not be determined solely through a business lens.

“We really need business executives, operational and clinical teams on the same page and working together collaboratively. Obviously, we understand that money must be made, to keep the doors open. But we are not, of course, willing to provide subpar medical care to help do that. And so, where do we find that middle ground?”

Thankfully, this balancing act is becoming less subjective, with A/Prof Fish and colleagues having recently published several case reports in the Journal of Urgent Care Medicine.

The reports detail examples of best clinical care and practice workflows to help manage various conditions, common in urgent care settings.

“They show how to treat them efficiently, whilst upholding those all-important standards of care,” she said.

Getting the model right

In the US, several organisations also play a role in balancing quality and resources.

The Urgent Care Association deals with financial and operational issues, helping to define which health conditions and level of care should fall under UCC standards. Meanwhile, The College of Urgent Care Medicine and The Urgent Care College of Physicians help define and advance clinical care in UCC settings.

Between these organisations, one of the biggest discussion points is the optimisation of staffing models.

“In the US system, we have nurse practitioners and physician assistants practicing urgent care medicine, along with physicians, which is not the case for Australia, where physicians are the primary clinician in the model.

“And so, we must continually look at the care quality provided under our US staffing arrangement, particularly in relation to other countries where there is greater physician experience on care teams.”

Dedicated training

A/Prof Fish and her colleagues monitor and share this intelligence through dedicated training programs when onboarding providers.

She says this training is crucial in countries like the US and Australia, where urgent care is not a recognised speciality.

“Here in the US, our urgent care clinics contain physicians who have specialised in emergency, internal or family medicine, which would be closer to a GP model,” she said.

Providers can also receive continuing medical education via organisations such as EB Medicine and Hippo Education, or through podcasts like Urgent Care RAP and EM RAP.

“These can be really useful for growing your skills exclusively for urgent care settings,” she said.

Understanding the point of difference

While UCCs do see the same kinds of presentations as seen in general practice, A/Prof Fish says the care emphasis in UCCs is different.

“Just like GPs, we see a lot of respiratory conditions – COVID, influenza, bronchitis, pneumonia. People who aren’t catastrophically ill, but if they don’t get seen and start treatment soon, they could wind up really sick. Same story for urinary tract infection, rashes, or smaller injuries, like sprains, lacerations or cuts on the skin that we can sew up.

“But unlike in primary care, the emphasis within a UCC is appropriate triage – identifying the sick versus the not sick. It’s about rapid access to the right treatment and testing in those scenarios to be able to define that.”

Further insight

A/Prof Lindsey E. Fish is Chief of the Division of Urgent Care at Denver Health and Hospital. She is an Associate Professor of Medicine in the Division of General Internal Medicine at the University of Colorado School of Medicine and an Adjunct Associate Professor in the School of Health at the University of the Sunshine Coast. She is the President of the College of Urgent Care Medicine and the Urgent Care College of Physicians. She is the Editor-In-Chief of the Journal of Urgent Care Medicine.

Sharing more practical tips for urgent care excellence, she will join a stellar line up of speakers at the upcoming Urgent Care Clinics Conference.

This year’s event will be held 16-17 June at the Swissotel Sydney.

Learn more and register your tickets here.