Date   

10/17/2022

Subject

Evaluation of Patients Presenting for Treatment When Required Care Is Outside the Scope the Urgent Care Center or Not Available

Patient Population

All

Rationale

Patients with a wide variety of medical complaints present to Urgent Care for evaluation and treatment, sometimes with conditions that require services that are beyond the scope of practice of the Urgent Care, exceed the capabilities of the Urgent Care, or require services that may be temporarily unavailable at the location of the Urgent Care. Urgent Care centers should have a policy in place delineating how to safely evaluate and direct these patients to the appropriate level of care. It is recognized that Urgent Care organizations vary in scope, and some may provide more extensive services than others. 

Discussion

A wide variety of patients of any age may present to an Urgent Care center (UCC) for evaluation and treatment and most patient presentations fit within the scope of an Urgent Care center. 

Clinical scenarios that need special attention and a written policy to safely evaluate the patient and determine the appropriate site of care: 

1. Non-acute or chronic conditions that may be outside the individual Urgent Care center’s defined scope. Examples may include but are not limited to: administrative physical exams, refills on routine medication, routine lab draws or X-rays for outside providers, routine screening tests/lab work that are more appropriately within the scope of another specialty of medicine, etc.
2. Acute conditions that normally could be handled in the UCC, but due to staffing or non-clinical issues, cannot be appropriately managed at the time of presentation. Examples include but are not limited to: X-ray staffing or machine down, supply shortages, etc.
3. Conditions beyond the scope of the UCC that may require a higher level of care. Examples may include but are not limited to: stroke, active MI, intracranial bleed, potentially major trauma. 

Patients in Category 1 have no risk of morbidity or mortality due to delay of care if evaluation and treatment is not provided at the time of presentation to the UCC. No harm would come to the patient should they be told by the front desk staff the care they are seeking is not available at the UCC. The UCC may elect to provide a list of these unavailable administrative services to be followed by the front desk staff. Medical staff should be consulted if any question exists. All actions should be taken in the best interests of the patient’s safety.

Patients in Category 2 have a risk of morbidity or mortality due to delay of care if evaluation and treatment is not provided at the time of presentation to the UCC. Good practice requires licensed personnel (LPN, RN, MD, DO, PA, NP) to evaluate the patient and determine if the care required can be provided, if the patient needs to be referred to another provider or another level of care, and if the care can be delayed or should be provided immediately. Any orthopedic injuries should be stabilized, and wounds dressed. Medication for pain should be considered, if necessary. Every effort should be made to assist the patient in securing appropriate transportation. The receiving facility should be notified if possible. A note, even if brief, should be placed in the patient’s chart. All actions should be taken in the best interests of the patient’s comfort and safety. 

Patients in Category 3 have a significant risk of morbidity or mortality due to delay of care if evaluation and treatment are not provided at the time of presentation to the UCC. Good practice requires evaluation by a licensed provider such as an MD, DO, NP, or PA to determine if the care required can be provided or if the patient needs to be evaluated at a different facility. The receiving facility should be notified if possible.  Recommendations should be made for the mode of transportation to the receiving facility, e.g., EMS vs private vehicle. A note, even if brief, should be placed in the patient’s chart. Initial stabilizing treatment should be provided if possible. All actions should be taken in the best interests of the patient’s safety.

Any patients with an acute medical complaint (Category 2 or 3) should be evaluated, even if briefly, by medical staff regardless of the patient’s insurance status or ability to pay.

Urgent Care centers subject to EMTALA or other government regulated programs should evaluate and treat patients according to these regulations.

Summary

The very nature of Urgent Care encourages patients with a wide variety of medical concerns to present for care which cannot always be provided. Urgent Care centers need to have written policies outlining which patients may be safely turned away, which should be assessed by staff to determine the appropriate site of care, and which should be seen by a provider and emergency care arranged. Regardless of their ability to pay, no patient with a potentially life or limb threatening complaint should be refused initial stabilization, and every effort should be made to direct the patient to the appropriate location for care. Documentation in the medical record is good practice. All actions should be taken in the best interest of the patient’s safety.