Urgent care sites are popular with families. Parents seek out this care for their children when they cannot get an appointment at their child’s medical home due to timing (e.g., evenings, weekends, holidays) or availability.
In the wake of the COVID-19 pandemic, the scope of care in the evolving field of pediatric urgent care (PUC) medicine has changed to meet the needs of patients and families.
The most notable changes have been adjusting to different virus seasonality, improving access to care and increasing attention on behavioral health needs. Since 2020, PUC centers also have been challenged by increases in workplace violence, mistrust in routine health care and workforce shortages.
Changing patterns of illness
Seasonal variation in illness prior to the pandemic was quite predictable, with bronchiolitis and influenza typically occurring in early and late winter, respectively. Since 2020, respiratory illnesses have surged in the late summer and fall.
For urgent care, this creates staffing dilemmas as it becomes more difficult to navigate illness surges that drive much of the patient volume when other care settings are over capacity. The lack of predictability of respiratory viruses has forced urgent care centers to be more strategic and dynamic about staffing.
Broadening pediatric-specific access
Expanded access is trending in many urgent care systems.
In 2023, The Journal of Urgent Care Medicine reported that 8 a.m. is the busiest hour in general urgent care centers, highlighting barriers to same-day access at primary care offices. While some PUC systems focus only on after-hours care, broader pediatric-specific access is improving in response to community needs, especially in large metropolitan areas where PUC centers are more prevalent.
The AAP Section on Urgent Care Medicine (SOUCM) has noted anecdotally that parents are having more difficulty accessing acute care at their child’s medical home in many areas. Primary care providers, already busy providing preventive care and care for chronic disease, have few appointments for acute illnesses. Many rely on nurse triage systems or telemedicine, which results in frequent referrals to urgent care centers. Some of these children seek care at facilities that lack pediatric expertise, resulting in subsequent visits to PUC clinics. These additional visits are both inconvenient and expensive for families.
Providing behavioral health services
Behavioral health in children, while always a priority, took center stage during the pandemic as isolation and social media use became more prevalent. As shortages of community and hospital-based pediatric mental health services have continued, urgent care centers and emergency departments have seen demand increase for behavioral health care as well as care for patients in acute crises (Manuel M, et al. Child Adolesc Ment Health. 2023;28:488-496).
Some PUC centers are screening for suicide risk, and some have added staff and expanded scope to offer behavioral health services via remote or in-person care.
Challenges for PUC centers
While PUC clinics have adapted to changes brought on by the pandemic by expanding access, modifying staffing models and preparing for behavioral health emergencies, they have struggled because of 1) changes in societal views on science/vaccinations, 2) increases in impatience/frustration, which sometimes results in violence against clinicians and 3) workforce shortages.
SOUCM members report seeing more children who have missed vaccinations during the pandemic, and some have not caught up due to changing parental views on the necessity of routine immunizations. The result has been outbreaks of diseases such as measles and pertussis. PUC centers have adapted infection control measures and consider these conditions more routinely in the differential diagnoses for sick children.
Additionally, SOUCM members report increases in parental demands and impatience, sometimes leading to threats of violence toward health care personnel. In response, some PUC clinics have increased security measures such as barriers, cameras and personnel.
Lastly, like much of pediatric health care, workforce shortages continue. These shortages may limit how much care PUC clinics can provide and may put additional pressure on staff, leading to burnout.
Urgent care centers can provide appropriate care for children who don’t need emergency care. Ideally, centers should have the expertise to care for pediatric conditions.
To ensure continuity of care and safe transitions of care, primary care clinicians will need access to urgent care records. In some cases, these records are visible through electronic health records. In other cases, parents can share paper records with the child’s primary care clinician.
Dr. Casher is a member of the AAP Section on Urgent Care Medicine Executive Committee.
