Pediatricians should expect high quality care from freestanding urgent care facilities for their patients and should reconsider whether to send children to facilities that can’t meet that standard of care.
That’s according to a policy statement from the American Academy of Pediatrics published April 28 (Pediatrics 2014;133:950-3).
Among the tenets of the new policy statement:
• Emergency preparedness. Freestanding urgent care centers serving children should be able to provide timely assessment and stabilization, resuscitation if needed, and to initiate the transfer of children with emergencies.
Providers at freestanding urgent care centers should be capable of initiating pediatric life support during all hours of operation, according to the policy statement. Facilities should have prearranged triage, transfer, and transport agreements with area hospitals and local emergency medical services, and participate in community disaster plans.
• Scope of practice: Freestanding urgent care centers should set limits on intensity and scope of care, use evidence-based treatment approaches for common pediatric complaints, and know how to identify and manage child abuse or neglect and how to manage children with special needs.
• Medical home: Such centers should support the medical home model by providing services not routinely available in medical homes and offering an alternative if the medical home is unavailable.
Referring physicians should provide necessary clinical information to urgent care centers and be available "to provide consultation and context" for patients’ management, according to the policy statement. Facilities, in turn, should keep appropriate records and communicate promptly with medical homes.
Nationwide, urgent care centers in the United States handle more than 160 million adult and pediatric visits annually, according to the Urgent Care Association of America. Overall, 14% of people seeking treatment at such facilities are aged 13 years or younger, and another 15% are between the ages of 14 and 22 years.
State regulation of freestanding urgent care centers varies greatly, the AAP policy statement notes, as do facilities’ services, though often they include simple suturing and splinting, laboratory tests, and x-rays.
Dr. Gregory Conners of the AAP Committee on Pediatric Emergency Medicine and lead author of the policy statement cites the need to define clearly when urgent care is appropriate for children and make sure it is well integrated with the child’s primary care.
"The medical home provider ought to make sure the urgent care center is meeting these [AAP] standards," Dr. Conners said. "If not, the primary care provider should reconsider whether to send children there or not."
Dr. Conners, chief of the division of emergency and urgent care at Children’s Mercy Hospital in Kansas City, Mo., also stressed the need for more research into the nature, scope, quality, and outcomes of pediatric urgent care to determine what is and isn’t working.
Dr. Nathan Newman, president of the urgent care association, said in an interview that the urgent care association is pleased with the collaborative nature of the AAP policy.
"Well-managed urgent care facilities do improve the health of children in their communities ... and the key going forward is integration, because health care is a local phenomenon and urgent care centers are not competing with primary care physicians," he said. "We want to extend the capability."
He noted that the association launched a new accreditation program in March for urgent care centers that includes standards for governance, patient care processes, quality improvement, physical environment, health record management, and patient privacy.
The AAP policy statement does not address pediatric care at hospital-based urgent care facilities, hospital-based or freestanding emergency departments, or retail-based clinics.