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Challenges at the ED Front Door:
Emergency Departments (EDs) face ongoing issues of crowding, ambulance ramping, and increased fast-track demands. Urgent Care Centres (UCCs) have the potential to alleviate pressure but require clear operational boundaries and governance.
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Proposed Integration Framework:'
Case Mix and Acuity Analysis:
Compare UCC and ED fast-track patient profiles, procedural needs, and outcomes.
Focus on low-to-moderate acuity cases, identifying presentations that can safely transition to UCCs (e.g., upper respiratory tract infections, lacerations, fractures).
Workforce Credentialing:
Establish training requirements and credentialing principles for UCC clinicians, ensuring they can meet first-hour emergency care standards.
Governance and Oversight:
Develop shared responsibility frameworks to prevent siloed accountability and ensure smooth escalation processes.
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Previous Australian UCC Research Insights:
UCC Utilisation Studies:
Previous single-site study (2023–2024) showed that the UCC handled a significant volume of low-acuity cases (N=29,056), with minimal transfers to EDs (3% transfer rates).
Common transferred cases involved abdominal pain, chest pain, and other higher-acuity risk factors (increased age, higher triage category, ambulance arrival, transport by family/friend).
Top three reasons for presenting to UCC: URTI (3.8), laceration/repair (2.8), wounds (2.0)
URTI more likely to occur in the morning vs. afternoon.
Fracture Management:
FACEM-led fracture clinics co-located within a UCC demonstrated successful integration, with most patients managed locally (N=1011) and minimal escalation (1.5%) to EDs.
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Proposed Health Services Research:
Phase 1: Multi-centre analysis of UCC/ED case mix, safety, and procedural profiles in diverse settings (urban, rural, low-SES).
Phase 2: Workforce and credentialing analysis across disciplines (GPs, NPs, ED specialists, etc.).
Phase 3: Governance studies to address accountability, risk management, and scope creep.
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Critical Integration Considerations:
Acceptable escalation rates and thresholds for UCCs.
Governance models to ensure shared responsibility for adverse outcomes.
Evidence-based principles for ACEM's constructive engagement in UCC reform.