Urgent Care Center: Alternative to Separate ED
At the University of Kentucky Medical Center, an after hours urgent care center (UCC) for children was created, located across the street from the main ED. "We don't have the volume to require a separate pediatric ED," says Carol Steltonkamp, MD, FAAP, medical director of Twilight Children's Clinic at the University of Kentucky in Lexington. "But we determined that the majority of pediatric visits to the ED are urgent but not emergent, so we are able to handle the majority of after hours visits."
UCCs can be cost effective alternatives to pediatric EDs. "Our rates are a little less because we don't have to maintain the staff and the expense of an ED. We can also staff for only the hours that the bulk of pediatric patients are seen in," says Steltonkamp. "Parents are generally happy because our turnaround time is approximately 30 minutes, and the children are seen by a pediatrician as opposed to a general ED physician."
The UCC also reduces volume in the ED during the busiest hours, operating from 5-9 p.m. on weekdays, and 12-5 p.m. on weekends. "We are taking those patients out of the ED, so the ED physicians can handle appropriate patients in a more time effective way,"says Steltonkamp.
The self-triaging of patients is often a concern with UCCs, but it hasn't been a problem, reports Steltonkamp. "If the child truly needs an ambulance, we are not the appropriate place to go. But parents understand how severe something is," she says. "In the four years of our existence, we've had to transport a child to the ED by ambulance less than six times. Our staff assesses children immediately upon arrival."
The UCC provides a telephone triage system to take calls for primary care physicians after hours. "It's marketed to them, not the public," Steltonkamp explains. "If a call comes in to the physician's office at 6 o'clock in the morning about a baby who is feverish and crying, the parent is given the number to talk to our to nurse who uses standardized pediatric protocols to triage," she says. A form is later faxed to the physician's office with a complete record of the phone call and visit.
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