Models Of Urgent Care Research Articles

A unique model of care for youth in crisis: A pilot open trial.

Suicide is the second leading cause of death for those ages 10-24 years in the United States, and emergency department (ED) visits due to youth self-injurious thoughts and behaviors (SITB) and increased substantially between 2016 and 2021. Although ED services are essential for an effective system of care, the ED setting is typically not well-suited for the comprehensive, collaborative, and therapeutic evaluation of SITB; treatment planning; and care coordination that youth in a suicidal crisis need. As a result, an urgent care model for mental health designed to provide comprehensive crisis triage and intervention services is needed within outpatient psychiatry. This pilot trial examined the feasibility, acceptability, and preliminary clinical outcomes of a brief, urgent care model, the Behavioral Health Crisis Care Clinic (CCC), designed to provide comprehensive outpatient triage and intervention services aimed at reducing suicide risk for youth in crisis. Participants were 189 youth (ages 10-20; 62.4% females; 58% Caucasian) who had past-week suicidal ideation or behavior and their caregivers. The results demonstrated the CCC model exceeded feasibility and acceptability benchmarks based on the Service Satisfaction Scale (M score > 3.00). CCC care was associated with significant decreases in self-reported suicide risk based on the Collaborative Assessment and Management of Suicidality Suicide Status Form with low levels of ED usage during CCC care (7.7%) and 1-month posttreatment (11.8%). Over 88% of patients without established outpatient care at the time of referral were connected to care during CCC treatment, almost all of whom (95%) continued with ongoing mental health care 1 month after ending CCC care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Interventions in primary and community care to reduce urgent paediatric hospital admissions: systematic review

BackgroundThere has been a rise in urgent paediatric hospital admissions and interventions to address this are required.ObjectiveTo systemically review the literature describing community (or non-hospital)-based interventions designed to reduce emergency...

Dermatology urgent care model reduces costs and healthcare utilization for psychodermatology patients - a retrospective chart review.

Patients with psychiatric dermatoses may be high users of healthcare, especially emergency services. A dermatology urgent care model may reduce healthcare utilization in this population. To determine whether a dermatology urgent care model can reduce healthcare utilization among patients with psychiatric dermatoses. We conducted a retrospective chart review of patients seen in dermatology urgent care at Oregon Health and Science University between 2018 and 2020 with diagnoses of Morgellons disease and neurotic excoriations. Rates of diagnosis-related healthcare visits and emergency department visits were annualized before and during engagement with the dermatology department. Rates were compared using paired t-tests. We found an 88.0% reduction in annual rates of healthcare visits (P<0.001) and 77.0% reduction in emergency room visits (P<0.003). Results were unchanged when controlled for gender identity, diagnosis, and substance use. We could not account for healthcare use not included in electronic health record. Urgent care models in dermatology may reduce overuse of healthcare and emergency services among patients with psychiatric dermatoses.

A novel PA-led urgent care model for medical oncology patients at a large academic cancer center.

37 Background: Oncology patients are high users of the emergency department (ED), which often results in hospital admissions for management of cancer symptoms or cancer treatment toxicities. Interventions such as urgent care (UC) models can decrease such visits, and help improve patient management, health care utilization, and patient experience. Sunnybrook Health Sciences Centre, a large tertiary care hospital in Toronto, Canada has a high volume of medical oncology ED visits (average 4 per day) with about 50% admitted for management. Methods: A novel physician-assistant (PA) led and physician supervised UC model was developed to assist in medical oncology patient phone triage, assessment, and management of cancer or treatment related issues that would otherwise have been sent to the ED by the oncology team. There were two phases: 1) due to COVID, the patients were managed in a dedicated stream primarily using space and nursing in the ED, 2) a dedicated UC clinic with nursing support was opened for these patients. Results: In phase 1, there were 424 referrals over 24 months; 84% would have otherwise been sent through the usual ED process. 26% of patients were managed with PA navigation outside the UC program in other hospital settings. Of the 204 patients formally treated in the UC stream, 67.7% were discharged home. At 48 hours, 89% of discharged patients were stable or improved; this was 80% at 14 days, and 17.3% came back to the ED or were admitted within 14 days of the UC visit. In phase 2, there have so far been 214 referrals over 5 months; 83.6% would have otherwise been sent to the ED. Of the patients who were assessed, 77.9% were discharged home. Outcomes of these patients are being collected. The top 3 patient issues managed during both phases were: fever, pain, and dyspnea. Fifteen patient telephone surveys were completed, and 93.3% were either satisfied or highly satisfied with their UC experience. Conclusions: A novel PA-led triage and management model for urgent medical oncology patient issues was found in initial phase to be feasible and effective with streamlined care through the ED. Once a dedicated UC clinic was opened, referral volumes increased, and a high rate of ED diversion, patient discharge, and effective care was continued. Patients were also highly satisfied. Several ongoing process and outcome measures are being evaluated to help expand the scope and impact of this resource.

Grants support CBHCs, schools' partnership youth BH care pilot

Providing comprehensive behavioral health (BH) urgent care to children and adolescents in Massachusetts is the crux of a new initiative that involves the collaboration among five community BH centers (CBHCs) and several school partners. The centers have been awarded nearly $500,000 in grants by the Massachusetts Association for Mental Health (MAMH) and Mass General Brigham to implement this new partnership‐based BH urgent care model for K‐12 students.

Applying an Urgent Care Model to the Skilled Nursing Facility Setting

Reducing readmissions to hospitals and ED visits has been a priority among health systems and skilled nursing facilities. Approximately 20% of Medicare-funded hospitalizations result in discharge to a skilled nursing facility (SNF). Transitions to and from the hospital setting frequently occurs. In an analysis of SNF hospital readmissions 23% were found to be preventable. To reduce hospital readmissions from SNFs, we have deployed the Urgent Care model (UCM) within the SNF setting. Urgent care is typically defined as healthcare that is needed for a condition that requires prompt attention (within 24 h) but is not a life-threatening emergency. UCM are designed to manage unscheduled conditions, which often arise outside core office hours. The UCM has rapidly emerged over the last several decades out of demand to alleviate ED wait times and visits for patients. Several studies found that UCM have reduced visits to nearby EDs.

Orthopaedic Urgent Care Versus the Emergency Department: Cost Implications for Low-energy Fracture Care.

This study compared costs, length of visit, and utilization trends for patients with fractures seen in an immediate care orthopaedic center (I-Care) versus the emergency department (ED) in a major metropolitan area. A retrospective chart review of consecutive patients seen on an outpatient basis in the ED and I-Care over a 6-month period was conducted. Patient demographics, procedures done, care category, estimated costs, and disposition information were included for statistical analysis. Within the low-acuity fracture care group, a cost-comparison analysis was conducted. A total of 610 patients met inclusion criteria with 311 seen in I-Care and 299 in the ER. I-Care patients were more likely to have low-acuity injuries compared with ED patients (60.1% versus 18.1%, P < 0.001). The length of visit was longer for patients seen in the ED compared with I-Care (6.1 versus 1.43 hours, P value < 0.001). A cost analysis of low-acuity patients revealed that an estimated $62,150 USD could have been saved in healthcare costs by the initial diversion of low-acuity patients seen in the ER to I-Care during the study period. These results suggest that the I-Care orthopaedic urgent care model is a more cost-effective and more efficient alternative to the ED for patients with fractures requiring procedural treatment and low-acuity patients managed on an outpatient basis.

Transfers From a Pediatric Urgent Care to an Academic Pediatric Emergency Department.

Patient transfers from outpatient urgent care centers are common occurrences in a pediatric emergency department (ED). A previous study done at our institution evaluated the clinical appropriateness of transfers from general urgent care centers into our pediatric ED, showing that a significant proportion (27%) of such transfers were discharged home with minimal ED resource utilization. This study investigated the hypothesis that transfers to a pediatric ED from a pediatric urgent care have higher rates of ED resource utilization when compared with patients transferred from general urgent care centers. A retrospective chart review was completed during an 11-month period on all patients transferred from a pediatric urgent care center to the pediatric ED. Demographic, diagnoses, reason for transfer, ED resource utilization, ED disposition, and 72-hour ED return data were collected from the electronic medical record. Each encounter was classified as acute or nonacute based on previously established resource utilization criteria. This data were then compared with findings from a prior study of transfers from all urgent care centers to our institution's pediatric ED. A total of 240 patients met the inclusion criteria. Of these, 160 (66.7%) were discharged from the ED. Twenty-six (10.8%) of the transferred patients met the nonacute transfer criteria. The odds of nonacute transfer from pediatric urgent care were 0.66 times lower than from general urgent care (odds ratio, 0.34; 95% confidence interval, 0.18-0.93). A significantly lower proportion of transfers from the pediatric urgent care center were classified as nonacute, as compared with transfers from general urgent care centers. This suggests that the pediatric urgent care model may help to reduce the number of nonacute ED visits, thus producing cost savings and better patient care.

An evaluation of service user experience, clinical outcomes and service use associated with urgent care services that utilise telephone-based digital triage: a systematic review protocol

BackgroundTelephone-based digital triage is widely used by services that provide urgent care. This involves a call handler or clinician using a digital triage tool to generate algorithm-based care advice, based on a patient’s symptoms. Advice typically takes the form of signposting within defined levels of urgency to specific services or self-care advice. Despite wide adoption, there is limited evaluation of its impact on service user experience, service use and clinical outcomes; no previous systematic reviews have focussed on services that utilise digital triage, and its impact on these outcome areas within urgent care. This review aims to address this need, particularly now that telephone-based digital triage is well established in healthcare delivery.MethodsStudies assessing the impact of telephone-based digital triage on service user experience, health care service use and clinical outcomes will be identified through searches conducted in Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science and Scopus. Search terms using words relating to digital triage and urgent care settings (excluding in-hours general practice) will be used. The review will include all original study types including qualitative, quantitative and mixed methods studies; studies published in the last 20 years and studies published in English. Quality assessment of studies will be conducted using the Mixed Methods Appraisal Tool (MMAT); a narrative synthesis approach will be used to analyse and summarise findings.DiscussionThis is the first systematic review to evaluate service user experience, service use and clinical outcomes related to the use of telephone-based digital triage in urgent care settings. It will evaluate evidence from studies of wide-ranging designs. The narrative synthesis approach will enable the integration of findings to provide new insights on service delivery. Models of urgent care continue to evolve rapidly, with the emergence of self-triage tools and national help lines. Findings from this review will be presented in a practical format that can feed into the design of digital triage tools, future service design and healthcare policy.Systematic review registrationThis systematic review is registered on the international database of prospectively registered systematic reviews in health and social care (PROSPERO 2020 CRD42020178500).

Unplanned readmission prevention by a geriatric emergency network for transitional care (URGENT): a prospective before-after study

BackgroundURGENT is a comprehensive geriatric assessment (CGA) based nurse-led care model in the emergency department (ED) with geriatric follow-up after ED discharge aiming to prevent unplanned ED readmissions.MethodsA quasi-experimental study (sequential design with two cohorts) was conducted in the ED of University Hospitals Leuven (Belgium). Dutch-speaking, community-dwelling ED patients aged 70 years or older were eligible for enrolment. Patients in the control cohort received usual care. Patient in the intervention cohort received the URGENT care model.A geriatric emergency nurse conducted CGA and interdisciplinary care planning among older patients identified as at risk for adverse events (e.g. unplanned ED readmission, functional decline) with the interRAI ED Screener© and clinical judgement of ED staff. Case manager follow-up was offered to at risk patients without hospitalization after index ED visit. For inpatients, geriatric follow-up was guaranteed on an acute geriatric ward or by the inpatient geriatric consultation team on a non-geriatric ward if considered necessary.Primary outcome was unplanned 90-day ED readmission. Secondary outcomes were ED length of stay (LOS), hospitalization rate, in-hospital LOS, 90-day higher level of care, 90-day functional decline and 90-day post-hospitalization mortality.ResultsAlmost half of intervention patients (404/886 = 45.6%) were categorized at risk. These received on average seven advices. Adherence rate to advices on the ED, during hospitalization and in community care was 86.1, 74.6 and 34.1%, respectively. One out of four at risk patients without hospitalization after index ED visit accepted case manager follow-up. Unplanned ED readmission occurred in 170 of 768 (22.1%) control patients and in 205 of 857 (23.9%) intervention patients (p = .11). The intervention group had shorter ED LOS (12.7 h versus 19.1 h in the control group; p < .001), but higher rate of hospitalization (70.0% versus 67.0% in the control group; p = .003).ConclusionsThe URGENT care model shortened ED LOS and increased the hospitalization rate, but did not prevent unplanned ED readmissions. A geriatric emergency nurse could improve in-hospital patient management, but failed to introduce substantial out-hospital case-management.Trial registrationThe protocol of this study was registered retrospectively with ISRCTN (ISRCTN91449949; registered 20 June 2017).

Unplanned Readmission prevention by Geriatric Emergency Network for Transitional care (URGENT): protocol of a prospective single centre quasi-experimental study

BackgroundInternational guidelines recommend adapting the classic emergency department (ED) management model to the needs of older adults in order to ameliorate post-ED outcomes among this vulnerable group. To improve the care for older ED patients and especially prevent unplanned ED readmissions, the URGENT care model was developed.MethodsThe URGENT care model is a nurse-led, comprehensive geriatric assessment based care model in the ED with geriatric follow-up after ED discharge. A prospective single centre quasi-experimental study (sequential design with two cohorts) is used to evaluate its effectiveness on unplanned ED readmission compared to usual ED care. Secondary outcome measures are hospitalization rate, ED length of stay, in-hospital length of stay, higher level of care, functional decline and mortality.DiscussionURGENT builds on previous research with adaptations tailored to the local context and addresses the needs of older patients in the ED with a special focus on transition of care. Although the selected approaches have been tested in other settings, evidence on this type of innovative care models in the ED setting is inconclusive.Trial registrationThe study protocol is registered retrospectively with ISRCTN (ISRCTN91449949).

Urgent Care: the evolution of a revolution

The rapid and global growth of urgent care centers has had a revolutionary, though poorly understood, impact on the health care delivery system. The consumer-driven care model inherent in urgent care and other so-called convenience care models is permeating into more conventional health care models. In addition, physician and hospital payment models are evolving, especially in the United States and are creating new market forces that will impact the organization and importance of integrated health care networks in the future. Together, these transformative changes are creating evolutionary pressures on traditional urgent care. Lessons learned from both the Israeli and American experience can be especially helpful for drafting a successful urgent care model for the future. This is a commentary on http://www.ijhpr.org/content/2/1/38/.

Evaluation of a general practitioner-led urgent care centre in an urban setting: description of service model and plan of analysis

Estimates of patients attending with conditions deemed non-urgent or inappropriate for accident and emergency services vary widely, from 6 to 80%. Previous research suggests that general practitioners (GPs) working in emergency departments can reduce referral rates, diagnostic testing, the proportion of patients who become emergency hospital admissions, and inappropriate attendances. However, little of this previous research is recent and new models of care for GPs working in emergency departments have now been developed, which remain to be evaluated. In this paper, we describe an integrated urgent care model, which was commissioned by NHS Hammersmith and Fulham in 2009 to manage the rising number of urgent attendances at local hospitals and its associated evaluation. The evaluation will include examining the effect of the system on outcomes such as utilization of diagnostic tests and effect on unplanned hospital admissions. If the new model of care is shown to be both clinically effective and cost-effective, the model and the proposed plan of evaluation will also be helpful to other areas that are considering the introduction of similar models of GP-led urgent care.

Avanços e retrocessos da enfermagem obstétrica no Brasil

Objectives: to describe the trajectory of midwifery in Brazil over the decades through a literature review. Methods: literature narrative review. Results: from the recent concept of humanization in the process of midwife, nurse midwife's work became more ordered as it was perceived, over the years, serious problems with excessive and unnecessary medicalization in childbirth, which proposed changes in urgent care model, especially in low-risk, as well as changes in the formulation and implementation of public policies related to obstetric context. Conclusion: after analyzing the course of nursing in the field of obstetrics, there is a considerable advance in this area of work of nursing in Brazil, mainly confirmed by the law creating the professional and national programs that encourage the inclusion of obstetric nurses in several areas of health