What are the intake pathways?
What is the staffing model?
Where and when should the service operate?
What services should be provided?
What is the funding model?
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.
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, upskilling to ensure providers are safely working to the top of their scope of practice. (Our colleague Dr Paul Eleftheriou has written more about workforce issues here.)
Where you locate your urgent care service needs to balance population needs, existing services and infrastructure. As to when you operate, hours of operation should include times of high ED demand, which usually extend from mid-morning to early evening, and not merely operate after hours. 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.
(Nous has written more about virtual care here.)
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.
Potential funding sources include out-of-pocket payments, activity-based funding (ABF), 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.
Prepare for implementation by identifying a pathway for change management. This requires providers to define the leadership roles required, equip the team with the necessary skills, maintain purposeful engagement with staff and clients, and implement robust governance to provide greater transparency on performance.