From doctors to hospital administrators, paramedics to nurses, governments to patients, everyone knows that it is clear our hospitals are critically overcrowded.
One proposed solution currently getting attention is urgent care – a service to treat non-life threatening urgent medical conditions and accidents.
Australian governments, both national and state, have pledged to invest in urgent care services, but there has been push back from peak bodies who do not feel this will be the solution to the problems plaguing the health system.
While urgent care services alone are unlikely to solve these problems – evident in an ageing population, funding gaps, lack of access to GPs and workforce shortages – they can provide tangible benefits to patients, providers and the healthcare system.
So how can system designers ensure urgent care services deliver the outcomes clinicians, managers and patients are seeking?
In my experience, the crucial factor is the how the service is implemented.
Below are five questions that can be the difference between a transformational success and a noble failure. Drawing on the experience of experts and others who have tried it before can help guide you to the answers that are right for your context.
What are the intake pathways?
You need a person-centred approach to understanding how the target population accesses healthcare services. This provides insight into where urgent care services can connect and integrate with available services to recruit and divert patients away from emergency departments.
Intake pathways can include ambulance transfers and GP referrals. For walk-in patients, a triage system is vital to avoid overwhelming the system and to ensuring patients who need emergency care are rapidly identified and transferred.
What is the staffing model?
Your staffing model is impacted by funding models, location, service provision and workforce availability. We have seen a range of models, including GP-led, RN-led and use of physiotherapists and/or allied health professionals.
A multidisciplinary staffing model can lower administrative burden on providers, offer comprehensive services to patients and optimise the workflow. System designers need to consider broadening their pool of potential staff and upskilling their staff to ensure providers are safely working to the top of their scope of practice.
Where and when should the service operate?
Your urgent care service needs to be in a place that balances population needs, existing services and infrastructure.
Some communities may benefit from community-based urgent care in a location with a high demand for services, minimal access or long travel time to other care options. Community offerings can also promote community behavioural change.
But in other communities, services may be more appropriate near or on hospital campuses due to lack of infrastructure elsewhere, high demand for services from communities surrounding the hospital campus, or a smaller geographic region with minimal travel. With the evolution of virtual care, hub-and-spokes models to reach more remote communities can be effective.
As to when you operate, hours of operation should include times of high ED demand, which usually extend from mid-morning to early evening.
What services should be provided?
The services you provide will depend on the available infrastructure, workforce and integration with existing services. Designers should focus on providing services that match common, low-acuity ED presentations.
The data shows for true ED diversion, at a minimum an urgent care service needs onsite x-ray as well as providers skilled in caring for fractures, minor wounds, cuts and abrasions. It may include mental health services if other services are not adequate.
Urgent care services should be tailored to local needs, including integration with and connection to other services where appropriate. This could even include in-person re-evaluation of Hospital in the Home patients or telehealth provision of care to remote areas.
What is the funding model?
Potential funding sources include out-of-pocket payments, activity-based funding, Medicare Benefits Schedule (MBS) payments, grants, or a mix of these sources.
A funding model relying on MBS payment can be challenging – there is not a wide scope for nurse practitioners to operate in an MBS-only clinic, so MBS alone has not previously been sufficient to fund urgent care services, though this may change with future reforms.
Most urgent care initiatives use a mixed funding model.
Urgent care services may soon be a part of the urgent healthcare ecosystem in every state and territory. As system designers consider the right model for their community, I encourage them to consider these five key questions.
Raj Verma is a Sydney-based Principal at Nous Group, an international management consultancy.