Urgent care center

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An urgent care center (UCC), also known as an urgent treatment centre (UTC) in the United Kingdom, is a type of walk-in clinic focused on the delivery of urgent ambulatory care in a dedicated medical facility outside of a traditional emergency department located within a hospital. Urgent care centers primarily treat injuries or illnesses requiring immediate care, but not serious enough to require an ED visit. In the United Kingdom, urgent treatment centres are provided by the National Health Service, which decided in 2019 that all areas of England should be served by a network of urgent treatment centres. In the United States, urgent care centers were first used in the 1970s and have since expanded to approximately 10,000 centers across the country.

Contents

Urgent care may be categorized as its own branch of medicine, as in New Zealand.

Description

They are intended for the treatment of conditions which require urgent medical attention but are not life-threatening, such as broken bones, minor infections, sprains and strains, cuts, grazes, minor burns or scalds, and bites and stings. [1]

Various media reports have examined the relative benefits of using an urgent care center. Some of the benefits cited include, shorter wait times, no need to make an appointment, and a large staff which can handle mutltiple tasks relatively quickly. [2]

By region

In the United Kingdom

Urgent Treatment Centre entrance at the Hospital of St. Cross, Rugby Rugby Urgent Treatment Centre 10.22.jpg
Urgent Treatment Centre entrance at the Hospital of St. Cross, Rugby

In the United Kingdom, urgent treatment centres (also called walk-in centres or minor injury units) are provided by the National Health Service, not on a commercial basis. They are intended for the treatment of conditions which require urgent medical attention but are not life-threatening, such as broken bones, minor infections, sprains and strains, cuts, grazes, minor burns or scalds, and bites and stings. [1]

Urgent treatment centres are not often located in retail facilities and are generally on hospital sites where they take patients who may not need the facilities of the Accident and Emergency Department, but can be transferred from one to the other if necessary. They are intended to divert patients from the A&E departments, which are under great pressure. [3] Some centres are run by hospital trusts. Royal Devon and Exeter NHS Foundation Trust took over Exeter's NHS walk-in centre from Northern Devon Healthcare NHS Trust in March 2018. It also runs Honiton Minor Injury Unit. The trust said they were more able to share skills and expertise and work as one team with the A&E department. [4] The Care Quality Commission reported in June 2018 that about 10% of the urgent care services in England require improvement. They inspected 64 urgent care and walk-in centres. [5]

Use of urgent treatment centre

There has been a lack of public information about what services are provided and when. It has been pointed out that people need guidance to overcome an historic reliance on accident and emergency. Different words—walk-in centres, minor injury units and urgent care centres—have been used for similar facilities, but without the public understanding what exactly was on offer. In Blackpool, the Walk-in centre and the Same Day Health Centre were both renamed Urgent Treatment Centres in August 2018. This was said to be a clear and comprehensive offer to patients. These urgent treatment centres were "open for at least 12 hours a day, every day of the week, every week of the year, including bank holidays—and offering pre-bookable appointments." [6]

About 230 walk-in centres were opened in England in the 2000s. 51 closed between 2010 and 2014. 95 more were closed between 2014 and 2017 according to 38 Degrees. [7] The Yeovil centre, opened in 2009, closed in 2017; the Somerset clinical commissioning group said too many people were misusing the town centre facility because it was convenient for them. It was replaced by an urgent care service at the hospital open from 10am to 6pm on Saturdays and Sundays. [7] Walk-ins in North Ormesby and Eston were closed in 2017 and replaced by the South Tees Access Response service, run by ELM Alliance Ltd, an alliance of local general practitioners (GPs), which offered late night and weekend appointments at four GP surgeries. [8]

NHS England decided in 2019 that all areas of England should be served by a network of urgent treatment centres which must be GP-led, open at least 12 hours a day, every day, offer appointments that can be booked through NHS 111 or through a GP referral, and be equipped with basic diagnostic equipment. They are intended also to relieve the pressure on general practice. The many units with local names and differing levels of service are to be subsumed into them [9] and some will close. [10] The programme is led by the local sustainability and transformation partnerships. [11]

In the United States

The initial urgent care centers opened in the United States during the 1970s. Since then, this healthcare sector has rapidly expanded to approximately 10,000 centers across the United States. Many centers were started by emergency medicine physicians, responding to a public need for convenient access to unscheduled medical care. A significant factor for the increase of these centers is significant monetary savings when compared to EDs. Many managed care organizations (MCOs) now encourage or even require customers to utilize urgent care options. [12] While urgent care centers are usually not open 24 hours a day, 70% of centers in the United States open by 8:00 a.m. or earlier and 95% close after 7:00 p.m. [13]

As of 2014, the urgent care industry is worth an estimated $14.5 billion. [14]

Distribution

In 2014, US communities with non-hospital-based UCCs were mainly urban, located in areas with higher income levels and higher levels of private insurance. [15] Kaissi et al., considered local multi-hospital systems in Florida, Maryland, Nevada, Texas, Virginia and Washington. In 2012, 50% of 117 hospital-based "clusters" included either UCCs, retail clinics, or both. 57% of systems in Washington operated an UCC, compared to 36% of systems in Washington, while systems in Florida had the largest share of UCCs (17.6%). Authors noted unexplained state-by-state variation in hospital system partnership with UCC and retail clinic models. [16]

Demographics of UCC patients

Corwin, et al., considered Medicare beneficiaries presenting to an UCC emergency department (ED) or physicians office with upper respiratory or urinary tract infections, bronchitis, sprains or contusions, and back or arthritic pain, in 2012. Patients who presented to an ED were more likely to be female (67% of ED presentations) compared to those who presented to a UCC or physicians office (65% and 64% respectively). Patients who presented to an UCC were significantly more likely to be aged over 85 (27%, compared to 15% of physicians office presentations, and 13% of ED presentations) or Black (11%, compared to 6% of physicians office presentations, and 4% of ED presentations). [17] In 2014, 3.1% of family physicians in the United States worked primarily in UCCs, with a male:female ratio of workforce is 6:7, and an urban:rural ratio of 2:1. This compares to 3.6% of family physicians working primarily in emergency care, with a male:female ratio of 5:3 and urban:rural ratio approaching 1:2. [18]

Organizations and certification

The Urgent Care Association (UCA) is an organization founded in 2004 to provide resources and training for the industry. [19] The UCA also publishes the Journal of Urgent Care Medicine (JUCM). [20]

The American Board of Urgent Care Medicine (ABUCM) was founded in 1997 to provide certification to urgent care physicians. [21]

Staffing and services

Urgent care centers are not emergency departments and as such do not offer surgical services, particularly invasive surgical procedures (more than cutaneous or subcutaneous procedures—those involving body organs and organ parts, and/or deep penetration of deep fascia, tendons, ligaments, bursae, joints, muscles, or bones), any procedures requiring the use of regional or general anesthesia (more than topical local anesthesia), those procedures requiring a full operating room or suite, having lengthy recovery times, or requiring more than the level of imaging or specialists available at the center. [22]

An estimated 13.7 to 27.1 percent of all emergency department care could be administered at an urgent care center, generating a potential cost savings of approximately $4.4 billion annually, according to a 2010 study in Health Affairs . [23]

In New Zealand

The Royal New Zealand College of Urgent Care (RNZCUC), was founded in 1995 originally as the Accident and Medical Practitioners Association (AMPA), and presently provides certification for urgent care physicians in New Zealand. The RNZCUC has branch of medicine recognition with the Medical Council of New Zealand (MCNZ), and is recognised as a separate branch of medicine in New Zealand. It is the 13th largest college in New Zealand by membership (of the 34 recognised by the MCNZ). [24]

Related Research Articles

<span class="mw-page-title-main">Emergency medicine</span> Medical specialty concerned with care for patients who require immediate medical attention

Emergency medicine is the medical speciality concerned with the care of illnesses or injuries requiring immediate medical attention. Emergency medicine physicians specialize in providing care for unscheduled and undifferentiated patients of all ages. As first-line providers, in coordination with emergency medical services, they are primarily responsible for initiating resuscitation and stabilization and performing the initial investigations and interventions necessary to diagnose and treat illnesses or injuries in the acute phase. Emergency medical physicians generally practice in hospital emergency departments, pre-hospital settings via emergency medical services, and intensive care units. Still, they may also work in primary care settings such as urgent care clinics.

<span class="mw-page-title-main">Emergency department</span> Medical treatment facility specializing in emergency medicine

An emergency department (ED), also known as an accident and emergency department (A&E), emergency room (ER), emergency ward (EW) or casualty department, is a medical treatment facility specializing in emergency medicine, the acute care of patients who present without prior appointment; either by their own means or by that of an ambulance. The emergency department is usually found in a hospital or other primary care center.

<span class="mw-page-title-main">General practitioner</span> Generalist medical doctor working in primary care

A general practitioner (GP) or family physician is a doctor who is a consultant in general practice.

A trauma center, or trauma centre, is a hospital equipped and staffed to provide care for patients suffering from major traumatic injuries such as falls, motor vehicle collisions, or gunshot wounds. A trauma center may also refer to an emergency department without the presence of specialized services to care for victims of major trauma.

<span class="mw-page-title-main">Ambulatory care</span> Medical care provided for outpatients

Ambulatory care or outpatient care is medical care provided on an outpatient basis, including diagnosis, observation, consultation, treatment, intervention, and rehabilitation services. This care can include advanced medical technology and procedures even when provided outside of hospitals.

<span class="mw-page-title-main">Family medicine</span> Medical specialty

Family medicine is a medical specialty within primary care that provides continuing and comprehensive health care for the individual and family across all ages, genders, diseases, and parts of the body. The specialist, who is usually a primary care physician, is named a family physician. It is often referred to as general practice and a practitioner as a general practitioner. Historically, their role was once performed by any doctor with qualifications from a medical school and who works in the community. However, since the 1950s, family medicine / general practice has become a specialty in its own right, with specific training requirements tailored to each country. The names of the specialty emphasize its holistic nature and/or its roots in the family. It is based on knowledge of the patient in the context of the family and the community, focusing on disease prevention and health promotion. According to the World Organization of Family Doctors (WONCA), the aim of family medicine is "promoting personal, comprehensive and continuing care for the individual in the context of the family and the community". The issues of values underlying this practice are usually known as primary care ethics.

St George's University Hospitals NHS Foundation Trust, formerly called St George's Healthcare NHS Trust, is based in Tooting in the London Borough of Wandsworth, and serves a population of 1.3 million across southwest London. A large number of services, such as cardiothoracic medicine and surgery, neurosciences and renal transplantation, also cover significant populations from Surrey and Sussex, totalling about 3.5 million people.

<span class="mw-page-title-main">King George Hospital, London</span> Hospital in Goodmayes, London

King George Hospital is an NHS hospital located on Barley Lane in the Goodmayes area of Ilford, in the London Borough of Redbridge. The hospital is part of Barking, Havering and Redbridge University Hospitals NHS Trust.

<span class="mw-page-title-main">Croydon University Hospital</span> Hospital in London, England

Croydon University Hospital, known from 1923 to 2002 as Mayday Hospital and from 2002 to 2010 as Croydon Hospital, is a large NHS hospital in Thornton Heath in south London, England run by Croydon Health Services NHS Trust. It is a District General Hospital with a 24-hour Accident and Emergency department. The hospital is based on a 19-acre (7.7 ha) site in Thornton Heath to the north of central Croydon.

<span class="mw-page-title-main">Walk-in clinic</span>

A walk-in clinic is a medical facility that accepts patients on a walk-in basis and with no appointment required. A number of healthcare service providers fall under the walk-in clinic umbrella including urgent care centers, retail clinics and even many free clinics or community health clinics. Walk-in clinics offer the advantages of being accessible and often inexpensive. It is estimated that there are nearly 11,000 walk-in clinics in America, although it is impossible to calculate an exact number given the variable and ill-defined nature of the category. Urgent care centers make up the largest percentage of walk-in clinics in America with an estimated 9,000 locations nationwide. In fact, consumers often erroneously refer to all walk-in clinics as urgent care centers, and vice versa. Retail clinics are the next most prevalent in the industry with 1,443 locations as of July 1, 2013.

An Emergency Care Practitioner (ECP) generally come from a background in paramedicine and most have additional academic qualifications, usually at university, with enhanced skills in medical assessment and extra clinical skills over and above those of a standard paramedic or qualified nurse. It has been recommended by the College of Paramedics that ECPs be trained to PgDip or MSc level, although not all are. Evidence of the best way to target Emergency Care Practitioners is limited with utilisation of traditional Ambulance dispatch codes not always being shown to be most effective and referrals from GPs also potentially failing to deliver management of demand that would be appropriate for this different level of practitioner. Evidence however clearly demonstrates that in discreet groups of patients the use of these extended role staff responding to emergency calls can reduce admissions and thus improve patient outcomes as well as delivering a clear cost saving to the NHS.

<span class="mw-page-title-main">NHS Borders</span>

NHS Borders is one of the fourteen health boards within NHS Scotland. It provides healthcare services for the Scottish Borders, the south east region of Scotland. NHS Borders is headquartered in Melrose.

Imperial College Healthcare NHS Trust is an NHS trust based in London, England. It is one of the largest NHS trusts in England and together with Imperial College London forms an academic health science centre.

Healthcare in England is mainly provided by the National Health Service (NHS), a public body that provides healthcare to all permanent residents in England, that is free at the point of use. The body is one of four forming the UK National Health Service, as health is a devolved matter; there are differences with the provisions for healthcare elsewhere in the United Kingdom, and in England it is overseen by NHS England. Though the public system dominates healthcare provision in England, private health care and a wide variety of alternative and complementary treatments are available for those willing and able to pay.

<span class="mw-page-title-main">Hospital</span> Health care facility with specialized staff and equipment

A hospital is a healthcare institution providing patient treatment with specialized health science and auxiliary healthcare staff and medical equipment. The best-known type of hospital is the general hospital, which typically has an emergency department to treat urgent health problems ranging from fire and accident victims to a sudden illness. A district hospital typically is the major health care facility in its region, with many beds for intensive care and additional beds for patients who need long-term care.

<span class="mw-page-title-main">Health facility</span> Any location at which medicine is practiced regularly

A health facility is, in general, any location where healthcare is provided. Health facilities range from small clinics and doctor's offices to urgent care centers and large hospitals with elaborate emergency rooms and trauma centers. The number and quality of health facilities in a country or region is one common measure of that area's prosperity and quality of life. In many countries, health facilities are regulated to some extent by law; licensing by a regulatory agency is often required before a facility may open for business. Health facilities may be owned and operated by for-profit businesses, non-profit organizations, governments, and, in some cases, individuals, with proportions varying by country. See also the recent review paper,

<span class="mw-page-title-main">Crawley Hospital</span> Hospital in England

Crawley Hospital is a National Health Service hospital in Crawley, a town and borough in West Sussex, England. Since 2006 it has been part of the Sussex Community NHS Trust, which has overall management responsibility. Surrey and Sussex Healthcare NHS Trust also provides some services. The hospital is located in the West Green neighbourhood of Crawley, near the town centre.

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Healthcare in London, which consumes about a fifth of the NHS budget in England, is in many respects distinct from that in the rest of the United Kingdom, or England.

<span class="mw-page-title-main">Gosport War Memorial Hospital</span> NHS hospital in Hampshire, England

Gosport War Memorial Hospital is a hospital in Gosport, Hampshire, England, part of the Southern Health NHS Foundation Trust.

References

  1. 1 2 "When to visit an urgent treatment centre (walk-in centre or minor injury unit)". NHS. 9 November 2020. Archived from the original on 9 April 2021. Retrieved 8 April 2021.
  2. ↑ The Upside (Mostly) of Urgent Care: ‘Why Did It Take Me So Long to Figure This Out?’, By Andrea Sachs, February 24, 2024.
  3. ↑ "Patients urged to avoid A&E this bank holiday". Eagle Radio. 25 August 2018. Archived from the original on 7 September 2018. Retrieved 7 September 2018.
  4. ↑ "Exeter's walk-in centres will no longer be run North Devon Healthcare Trust". Devon Live. 22 March 2018. Archived from the original on 7 September 2018. Retrieved 7 September 2018.
  5. ↑ "One in 10 primary care urgent care services in England not up to scratch". OnMedica. 22 June 2018. Archived from the original on 25 July 2023. Retrieved 7 September 2018.
  6. ↑ "Fresh new name for Fylde health centres". Blackpool Gazette. 20 August 2018. Archived from the original on 7 September 2018. Retrieved 7 September 2018.
  7. 1 2 "NHS Mass closure of NHS walk-in centres is fuelling winter crisis, claim campaigners". Guardian. 7 January 2018. Archived from the original on 7 September 2018. Retrieved 7 September 2018.
  8. ↑ "Out-of-hours GP service which replaced walk-in centres is dragged out of 'special measures'". Teesside Live. 24 May 2018. Archived from the original on 7 September 2018. Retrieved 7 September 2018.
  9. ↑ "Urgent treatment centres". NHS England. 2019. Archived from the original on 29 December 2019. Retrieved 26 February 2020.
  10. ↑ "Urgent treatment centres could open in four Surrey towns but some walk-in clinics could shut". Get Surrey. 31 January 2020. Archived from the original on 26 February 2020. Retrieved 26 February 2020.
  11. ↑ "'Distrust' of United Lincolnshire Hospitals NHS Trust over Grantham A&E, says its chief executive". Grantham Journal. 25 February 2020. Archived from the original on 26 February 2020. Retrieved 26 February 2020.
  12. ↑ "Blue Cross of GA Uses Google Maps to Encourage Use of Urgent Care". Urgentcarenews.com. Archived from the original on 22 June 2015. Retrieved 22 June 2015.
  13. ↑ "'2012 Urgent Care Benchmarking Survey Results.' Urgent Care Industry Information Kit. 2013" (PDF). Urgent Care Association of America. Archived (PDF) from the original on 2013-12-07. Retrieved 2015-06-26.
  14. ↑ "Race Is On to Profit from Rise of Urgent Care". The New York Times. 2014-07-09. Retrieved 2015-12-18.
  15. ↑ Le, S T; Hsia, Renee Y (7 April 2016). "Community characteristics associated with where UCCs are located: a cross-sectional analysis". BMJ Open . 6 (4): e010663. doi:10.1136/bmjopen-2015-010663. PMC   4838716 . PMID   27056591. Open Access logo PLoS transparent.svg
  16. ↑ Kaissi A, Shay P, Roscoe C. Hospital Systems, Convenient Care Strategies, and Healthcare Reform. Journal of Healthcare Management 61:2 March/April 2016
  17. ↑ Corwin, GS; Parker, DM; Brown, JR (2016). "Site of Treatment for Non-Urgent Conditions by Medicare Beneficiaries: Is there a role for Urgent Care Centres?". The American Journal of Medicine. 129 (9): 966–73. doi:10.1016/j.amjmed.2016.03.013. PMC   6567985 . PMID   27083513.
  18. ↑ Petterson, S.; Peterson, L.; Phillips, R. L.; Moore, M.; Finnegan, S.; Coffman, M.; Bazemore, A. (2014-07-01). "One in Fifteen Family Physicians Principally Provide Emergency or Urgent Care". Journal of the American Board of Family Medicine. 27 (4). Jabfm.org: 447–448. doi: 10.3122/jabfm.2014.04.130307 . PMID   25001998. S2CID   42338029. Archived from the original on 2015-07-10. Retrieved 2015-06-26.
  19. ↑ "About UCA". ucaoa.org. Archived from the original on 2022-12-05. Retrieved 2022-12-05.
  20. ↑ "Journal of Urgent Care Medicine". www.ucaoa.org. Archived from the original on 2022-12-05. Retrieved 2022-12-05.
  21. ↑ "ABUCM Home". www.abucm.org. Archived from the original on 2018-11-03. Retrieved 2018-11-03.
  22. ↑ "Adaptive Support Ventilation Reduces the Incidence of Atelectasis in Patients Undergoing Coronary Artery Bypass Grafting: A Randomized Clinical Trial". Archived from the original on 2019-09-23. Retrieved 2019-09-23.
  23. ↑ Weinick, R. M.; Burns., R. M.; Mehrotra, A (September 2010). "Many Emergency Department Visits Could Be Managed At Urgent Care Centers and Retail Clinics". Content.healthaffairs.org. Archived from the original on 2015-07-01. Retrieved 2015-06-26.
  24. ↑ "Royal New Zealand College of Urgent Care". Archived from the original on 2021-09-29. Retrieved 2021-10-15.
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