Pediatric Urgent Care – A Three-year Institutional Experience

Background: Pediatric Emergency Departments (PED) evaluate a large number of sub-acute conditions. PED is convenient but expensive resource for sub-acute care to providers and patients alike. Pediatric Urgent Care (PUC) is rapidly reshaping the landscape in delivering subacute care for children. This report is to share our experience.

Methods: Data analyzed included demographics, chief complaints (CCs), throughput, cost, satisfaction and quality. The analysis describes basic operational statistics and compared CCs and volumes during different “seasons”. We compared PUC and PED length of visit (LOV) and cost. Patient satisfaction was measured by 5-point Likert scale. Data are presented as percentages, means or p values.

Results: We analyzed 15,482 visits. Daily average volume; 18.4 patient (range 7-67). Visits increased 60% from year 1 to year 2 and a 25 % in year 3. Weekends accounted for 39% of the visits. Fall/winter season was busier and Sundays were most crowded. The first hour on Sunday mornings had the highest arrival rate. The least arrivals were in the last hour of weeknights. 51% were males. Age average was 12.9 years (SD: + 9.9). Most common CCs were respiratory infection, fever, extremity injury and sore throat; 14%, 13%, 12%, and 10% respectively. There was no significant difference between CCs during fall/winter with more infectious etiologies compared to spring/summer with more injures (P>0.5). PUC LOV was 52 minutes and 117 in PED. Percent of 48-hours returns to PUC was 1.1 % (95% CI: 0.8-1.4) and percent of patients transferred to PED was 1.5% (95% CI:-1.1-1.9). Adherence to clinical standard work was > 97%. Satisfaction score was 83.5% using score of 5. PUC charges for similar visit level was 47-61 % lower than PED.

Conclusions: PUC are efficient and economical alternative to PED. We described one institution’s experience that could prove valuable benchmark to similar practices.