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PEDIATRICS Vol. 110 No. 6 December 2002, pp. 1117-1124

Regional After-Hours Urgent Care Provided by a Tertiary Children’s Hospital

Louis C. Hampers, MD, MBA*, S. Glenn Faries, MD* and Steven R. Poole, MD

Children’s Hospital Pediatric Urgent Care Network
* Section of Pediatric Emergency Medicine, University of Colorado School of Medicine, Denver, Colorado

--> Background. Ambulatory presentation to a tertiary pediatric emergency department (ED) is not convenient for many families. Yet many primary care pediatricians (PCPs) desire after-hours urgent care for their patients as an alternative to extended office hours or care by general emergency medicine providers at community hospitals.

Objective. To describe a regional, community-based pediatric urgent care network (PUCN).

Methods. The PUCN consists of 4 models: 1) pediatric emergency medicine faculty in a community hospital ED; 2) general pediatricians in a community hospital ED; 3) general pediatricians in a freestanding urgent care center; and 4) general pediatricians in a community hospital-based urgent care center. Physician staffing at all 4 sites is managed by our tertiary children’s hospital. Billing records were reviewed and a questionnaire was mailed to 55 PCP practices in our metro area.

Results. Year 2001 visits totaled 37 143. Minor trauma, ear complaints, and viral illnesses accounted for 70% of visits. Current Procedural Terminology codes for visits, reflecting complexity levels 1, 2, 3, 4, and 5 were billed at the following frequency: 1%, 35%, 44%, 17% and 3%, respectively. A total of 2.2% of visits required admission or transfer. Mean collection rates ranged from 37% to 68% across the 4 sites. Break-even average hourly patient volumes ranged from 1.1 (site 4) to 1.9 (sites 1 and 3).

A total of 110 PCPs, representing all 55 practices, responded to the questionnaire: 81% reported their patients used the PUCN often, 85% felt that communication between the PUCN and their practice was good, and 99% reported overall satisfaction with the network.

Conclusions. The PUCN effectively addresses the needs of regional PCPs; however, the cost-effectiveness of such a program depends on billing practices, local collection rates, and site-specific staffing patterns.

Key Words: urgent care • regional network • after-hours

Abbreviations: PCP, primary care provider • TCH, The Children’s Hospital • PUCN, pediatric urgent care network • ED, emergency department • PEM, pediatric emergency medicine • EMS, emergency medical services • GEM, general emergency medicine • EMTALA, Emergency Medical Treatment and Active Labor Act

Received for publication Jan 8, 2002; Accepted May 3, 2002.