The Evolution of the Urgent Care Center

by Marc Margulies

 

The Urgent Care Center (UCC) serves as a unique delivery component clearly paving the way for the future of healthcare. Different types of UCCs are dictated by various approaches, cost structures, and clinical capabilities; each type comes with its own unique set of design and construction implications.

When sick or injured, you have several possibilities for care: your primary care provider, hospital emergency department (ED), or a UCC. Your local UCC may be the optimal choice for two primary reasons:

Convenience: Locations near patients’ homes and work; extended hours of operation; no appointments necessary and often a shorter wait time than alternatives.

Cost: Lower construction expense to build; patient payments typically less than a hospital ED anad staffing by nurse practitioners and physicians assistants lowers operating costs.

Although similarities exist between the various models, and the Urgent Care Association of America provides guidelines for operation, it’s easy to overlook their differences. UCCs generally fall into three categories:

– Convenient care clinics  are  small and most often located in retail stores, supermarkets, and pharmacies, this type of clinic generally deals with colds and flu, bruises and strains, sore throats and ear infections, and intestinal distress. Clinic staff can take blood samples that they send to outside labs, but they do not offer radiology. Due to the retail environment, these types of UCCs are visually accessible, non-clinical feeling, and focused more on efficiency than nurture.

– Walk-in clinicshave over 9,000 stand-alone sites in the U.S. and usually provide radiology, lab, phlebotomy, and an on-site physician. These clinics do not provide the acute care that an ED offers, but they can set broken bones, suture lacerations, and provide hydration. They have the training and equipment to provide injections and vaccinations, as well as the monitoring of chronic conditions like high blood pressure and diabetes. UCC operators understand their patients want a non-threatening atmosphere, so they are designed with more of a hospitality environment. Margulies Perruzzi Architects (MPA) has designed multiple UCCs of this type for ReadyMed, a Reliant Medical Group subsidiary. Experience has shown that patients prefer an ambiance more like a hotel lobby than a hospital waiting room, with soft lighting, lounge seating, televisions, a children’s play area, and non-clinical finishes.

– Hospital or clinic-based UCCs reduce cost and wait times at EDs. A separate department for walk-in patients is often created at hospitals or multi-specialty clinics. The adjacency of full-service medical care benefits patients whose condition may warrant a higher level of care. Unfortunately, the capital and operational expense of being co-located with more acute-care facilities can drive the costs higher than at either of the other two models. Furthermore, the construction and operational standards (i.e. Department of Public Health) may increase expenses. However, one benefit to this type of UCC is the ability to share radiology, lab, phlebotomy, and other resources with the host hospital or clinic. Single chairs likely line the walls of the waiting area, like the traditional ED waiting room. Exam areas may be more like ED “bays” than family-practice style exam rooms. The assumption is that these facilities act somewhat as triage for a certain percentage of the ED population, so the environment (both finishes and equipment) may be more robust and sterile.

Patients appreciate having access to UCCs, and providers love working there. Due to a UCC’s typical long hours of operation, there are opportunities for some staff members to work non-traditional shifts, providing flexibility and variety. Providers are not “on-call” and can schedule their hours in advance. At some UCCs, rigid hierarchies and segregated responsibilities have given way to cross training and the ability to assist patients from the moment they arrive through their departure, removing the repetition of primary care.

Some UCC staff handles all paperwork, including insurance documentation and co-pays, directly in the exam rooms, increasing both privacy and efficiency. During discussions about the operations of ReadyMed clinics, the entire staff was engaged in lean process improvement sessions to construct the most efficient way of servicing patients. Patients do not want to sit in waiting rooms without clear expectations of how long they will be there, and placing them as quickly as possible into an exam room with cross-trained providers was one solution.

Urgent Care Centers will inevitably be the choice for a large part of the population needing ready access to non-acute treatment, particularly at times when a traditional family practice doctor is unavailable. It is also a critical part of the solution for managing our nation’s healthcare costs. Designers and operators need to understand patient population, the competition, and the financial constraints before deciding which UCC model is the best fit for any given community.

Marc Margulies, AIA, LEED AP,  is a principal at Margulies Perruzzi Architects