Adult emergency department referrals from urgent care centers

• Published in: The American journal of emergency medicine Vol. 37; no. 10; pp. 1949 - 1954
• Main Authors: Siegfried, Isaac, Jacobs, Jennifer, Olympia, Robert P.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2019; Elsevier Limited
• Subjects: Abdomen; Adult; Ambulatory Care Facilities - statistics & numerical data; Appendicitis; Cellulitis; Chest; Complaints; Consultation; Continuity of Patient Care - statistics & numerical data; Cooperative Behavior; Cornea; Critical Illness - mortality; Critical Illness - therapy; Emergencies; Emergency department referrals; Emergency management; Emergency medical care; Emergency medical services; Emergency Service, Hospital - statistics & numerical data; Epidemiology; Eye injuries; Female; Headaches; Humans; Male; Medical referrals; Medical screening; Middle Aged; Pain; Patients; Pediatrics; Pneumonia; Practice Patterns, Physicians' - statistics & numerical data; Preparedness; Primary care; Prospective Studies; Referral and Consultation - statistics & numerical data; Transfer Agreement; Ulcers; Urgent care medicine; Urinary tract diseases; Urinary tract infections; Urogenital system; United States > US; Pennsylvania; Emergency department referrals; Preparedness; Urgent care medicine
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2019.01.029

Although urgent care centers (UCCs) can often evaluate and treat minor injuries/illnesses, patients may present with life threatening conditions that require immediate recognition, stabilization, and transfer to a higher level of care, beyond the capabilities of most UCCs.
To describe adult ED referrals from UCCs and to determine the percentage of referrals considered critical, complex, and simple.
A prospective study was conducted between 8/2016–8/2017 on patients >18 years referred directly to our ED from surrounding UCCs. Referrals were categorized based on investigations/procedures performed or medications/consultations received in the ED.
We analyzed 317 patient encounters; 23 (7.3%) considered critical, 254 (80.1%) complex, and 40 (12.6%) simple. The most common chief complaints for all ED referrals were abdominal pain (62 encounters), chest pain (28), shortness of breath (16), eye pain/injury (16), and leg pain/swelling (15). 68% of patients received laboratory diagnostic investigations and 69% received radiologic investigations. 37% of patients required consultation from a subspecialist. 78% of patients were discharged home. The most common primary diagnoses for all ED referrals were nonspecific abdominal pain (27 encounters), laceration (22), fracture (20), nonspecific chest pain (12), cellulitis (12), and pneumonia (12). The most common primary diagnoses for critical referrals were appendicitis (7) and fracture (3).
Many adult ED referrals in our sample were considered complex and few were considered critical. Individual UCCs should evaluate their current states of ED referrals, and develop educational and preparedness strategies based on the epidemiology of adult emergencies that may occur.