Seamless care of patients requires good collaboration between medical care locations.
There is an ever increasing number of urgent care clinics popping up all across the country. They are in stand-alone locations, shopping malls, big box stores, and pharmacies. They are usually staffed by midlevel providers and sometimes by physicians. Additionally there is a growing number of free-standing emergency rooms (not physically located at a hospital). I think it's great for patients to have better access to healthcare when it is needed and not just during regular business hours at my office. After all, as much as our patients need us, it is impractical for a general pediatric practice to be open 24 hours a day.
My concern with urgent care clinics boils down to a very simple question: Why won't these clinics call to consult with me about my patients? And, why won't they at least send the records to me without my front desk badgering them to do so?
Most of my patients' parents are appalled that the urgent care didn't send the records (having been told that the records would be transferred). Hopefully with healthcare reform requirements for portability of medical records, this issue will resolve in the future. But until then, it is virtually impossible to know what happened to my patients at the urgent care clinic. Parents mean well but since they are non-medical, they can't usually relay the medical information accurately.
Most urgent care facilities are not staffed with pediatric specialists. Let's face it: Children are not little adults. There is a reason that pediatrics is its own specialty. While it is true that children get sick fast, they also get better equally as quick. However, that doesn't absolve urgent care clinics from providing best practices in pediatric medicine. Simply writing a prescription for antibiotics is not really the right answer. And shouldn't the pediatrician at least know about it? Urgent care clinics: Please send us the records!
Another point about the lack of pediatric specialization at urgent care clinics: Wouldn't it be a good idea to consult with a pediatric specialist about the best course of action? I actually have had patients follow up with me after a visit to a local urgent care clinic in which the parents were given a prescription for an oral steroid, but were told notto fill it until follow up! Why on earth would a provider write a prescription like that? It's not as if the parents could figure out when to use it. If the urgent care physician had consulted with us at the time, we would have been more than happy to discuss the prescription in question and give guidance based on our pediatric expertise.
When I send my patients to the emergency room, I always call to give report about why I need the help of the ER (it is usually something that is beyond the scope of my outpatient practice's ability to care for the patient's medical needs). I would really appreciate the same in return from urgent care clinics and emergency rooms.
Since the urgent care clinics never call me, and also never spontaneously send the records, it makes it really challenging to perform a true follow-up visit, which should be a shorter appointment than a regular office visit, and is usually scheduled for less time than a de novo medical problem. I only wish this were the case. Without the actual background information, these visits often take longer than scheduled. That causes me to run behind with my subsequent patients. It would be so much easier if we could have booked the time appropriately in the first place.
So, why won't these urgent care clinics and emergency rooms call me now? I can remember in past years being consulted regularly by physicians in the ER and urgent care clinics. I can only speculate on the reasons they don't call now.
Are these urgent care clinics too busy to call us? My days can be really hectic, but I can, and do, call specialists when it is warranted in the daily care of my patients. Even a call the next day would be appreciated.
Are they simply disinterested in consulting with us? To give them the benefit of the doubt, perhaps they are pressured by their administration to keep up with the assembly line of patients. Maybe their EHR is cumbersome with respect to completing the record of the visit. Possibly they have had unpleasant interactions with a patient's personal physician in the past? Could it actually be a policy of the urgent care clinic to not involve the private practice due to increased competition for the patient care dollar?
I have many more questions than I have answers. I want to understand, and more importantly, encourage an ongoing dialog between urgent care clinics, emergency room physicians, and the pediatrician. The goal is improving patient care. There is no substitute for good communication when it comes to patient care and there are simply no adequate excuses for the lack of communication.