Urgent Care: Lending a Hand to Patients and to the Hospital

Steven Larsen , MD

Published January 15, 2013

When I hear people talk about lack of access to healthcare in our society, I realize right away that they are not talking about where I work. At our Urgent Care Center (UCC), our mission is to help people feel better as soon as possible and to transition them quickly to the additional service they may need. Our Center is designed to increase access to medical care for low-income patients and for low-acuity patients who do not have a primary care physician.

The UCC concept of making access to healthcare more convenient appears to be resonating with the ‘fix it now’ mentality of our society. The number of UCCs in the country is growing fast. Of the 8,700 UCCs currently operating in the US, only about half of them have been in business for over five years.

Last year, our Center saw approximately 48,000 patients. The scope of sickness ran the gamut from splinters to heart attacks. Our patient population includes a high percentage of Medicaid patients, and often Medicaid does not cover the full cost of service. Nevertheless, the hospital network to which we belong has a financial incentive to support us, and here’s why: under the Emergency Medical Treatment and Labor Act (EMTALA), all patients coming to an emergency department must be treated and stabilized regardless of their ability to pay. Because ED treatment is so much more expensive than treatment in a UCC, the diversion of non-paying patients from the ED to the UCC can be a money-saver for the hospital.

We have set ourselves the goal of diverting 130 patients per day from the ED. Because our hospital network sees the consistently growing traffic in the ED as important, we are committed to treating those 130 patients each day whether they pay or not. Because our hours are limited, it is crucial that we work with maximum efficiency to try to close at our designated time.

Besides limited hours, UCCs have other challenges to overcome as well. One is finding tertiary care for patients who cannot pay for service. At times, we are on the other end of a phone call with a specialist who is not able to see our Medicaid patient, and we are left looking someone in the eye who is just like millions of un- and under-insured patients across America who have trouble affording a specialist. Another challenge, because many UCCs are not equipped with the full life-saving capacity of an ED, is rapid diagnosis and transition to an ED for patients with life-threatening emergencies.

To be able to work with maximum efficiency, and to meet the challenge of rapid identification and transport of patients in imminent danger, we have designed our Center to have clearly defined “back end” and “front end” processes. Once rooms are full, the nursing staff is instructed to take vital signs in the lobby in the first eight minutes after the patient arrives. This not only identifies ticking time bombs for rapid transfer to the ED, it also frees up back end staff to do procedures other than vitals.

Everyone wants to do a great job, so it is important to know what a good job looks like. In our break room we have all the data metrics posted for staff to see, data such as: daily census, left without being seen, door to nurse, door to provider, door to discharge, and patient satisfaction. Even the budget is posted. As we see our numbers improving, we are motivated to keep working hard. And we do work hard. With only one physician, three mid-levels (nurse practitioners or physicians assistants), and seven support staff, working from 9 am to 8 pm, we take care of the aforementioned 130 patients per day.

We are proud to have served 48,000 patients in 2012. However, considering that our partner ED is still at or near their maximum capacity, I know that they need even more support and solutions. But most of all, we are just proud to be an integral part of the Acute Care Continuum, which takes care of everyone in our society who needs medical help, regardless of ability to pay.

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