When Urgent Care Centers Meet Infectious Disease Emergencies

The rise of urgent care seems to be very rapid and has now opened up a third option in medicine to supplement physician's offices and hospital-based emergency departments. Such access is welcomed as it is convenient, free of the hassle of waiting rooms, and incurs less cost. Broadly speaking, I classify the nation's 9000 urgent care centers into two types: hospital-owned or hospital-independent. About three quarters of urgent care centers are not owned by hospitals and about half of the physicians who work in such center are specialists in Family Medicine. 

With 96% of cases not requiring the patient to be directed to an emergency department, it appears that a niche is being filled--especially for minor orthopedic ailments and wound care. However, in my biased infectious disease and disaster medicine worldview (as well as a board-certified emergency medicine physician and fellow of the American College of Emergency Physicians), I have a few concerns regarding urgent care centers that arise in a specific context.

No urgent care center is a substitute for an emergency department but there is, in my experience, a clear variation in operations between hospital and non-hospital affiliated centers. One specific concern that applies to non-hospital based urgent care centers is the degree of their integration into the public health communicable disease infrastructure in their locality. During outbreaks of important diseases widespread 2-way communication occurs between public health authorities and hospitals that urgent care centers--when not affiliated with a hospital--may never hear especially if staffed with locum physicians who may not even know which county they are practicing in, let alone the local epidemiology.

Recently, in a Pittsburgh suburb a non-hospital affiliated urgent care center not only gave a patient an erroneous diagnosis of measles--a public health emergency--but failed to order the appropriate confirmatory test, notify public health authorities, or perform any sort of infection control procedure. Thankfully the patient was clearly not a case of measles and no delayed contact-tracing had to performed, but that didn't prevent a social media panic from ensuing when the patient's father posted the false diagnosis, he had every reason to believe accurate, on Facebook. Were this an urgent care center affiliated with a hospital, numerous red flags would have tripped and hospital infection control would have been involved the moment the word "measles" was mentioned.

I wonder how many other infectious diseases of consequence may slip through the cracks in situations much like this (I'll save my rants on the poor antibiotic stewardship that occurs in urgent care centers for another time).

A solution to this shortcoming  is to embrace urgent care centers in health care emergency coalitions. Health care coalitions are largely hospital based but have increasingly began to involve entities from other realms of healthcare. Not only do such coalitions plan for infectious disease emergencies jointly, they adopt an integrated all-hazards approach that makes a community more resilient to a whole host of threats including weather emergencies and mass casualty accidents. As many hospital-independent urgent care centers are multi-state I estimate, and from research my colleagues and are conducting, not many are incorporated into hospital coalitions--a situation that is clearly suboptimal and, in a public health emergency, dangerous.