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Analysis of self-initiated visits for cervical trauma at urgent care centers and subsequent emergency department referral

  • Author Footnotes
    1 Co-first authors, equal effort.
    Azan Z. Virji
    Footnotes
    1 Co-first authors, equal effort.
    Affiliations
    Harvard Medical School, Boston, MA, United States

    Department of Radiology, Massachusetts General Hospital, Boston, MA, United States

    Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA, United States
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  • Author Footnotes
    1 Co-first authors, equal effort.
    Abraham Z. Cheloff
    Footnotes
    1 Co-first authors, equal effort.
    Affiliations
    Harvard Medical School, Boston, MA, United States

    Department of Radiology, Massachusetts General Hospital, Boston, MA, United States

    Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA, United States
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  • Soham Ghoshal
    Affiliations
    Harvard Medical School, Boston, MA, United States

    Department of Radiology, Massachusetts General Hospital, Boston, MA, United States

    Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA, United States
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  • Baily Nagle
    Affiliations
    Harvard Medical School, Boston, MA, United States

    Department of Radiology, Massachusetts General Hospital, Boston, MA, United States

    Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA, United States
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  • Teddy Z. Guo
    Affiliations
    Harvard Medical School, Boston, MA, United States

    Department of Radiology, Massachusetts General Hospital, Boston, MA, United States

    Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA, United States
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  • Michael H. Lev
    Affiliations
    Harvard Medical School, Boston, MA, United States

    Department of Radiology, Massachusetts General Hospital, Boston, MA, United States

    Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA, United States
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  • Ali S. Raja
    Affiliations
    Harvard Medical School, Boston, MA, United States

    Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States
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  • Michael S. Gee
    Affiliations
    Harvard Medical School, Boston, MA, United States

    Department of Radiology, Massachusetts General Hospital, Boston, MA, United States

    Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA, United States
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  • Marc D. Succi
    Correspondence
    Corresponding author at: Massachusetts General Hospital, Department of Radiology, 55 Fruit Street, Boston, MA 02114, United States.
    Affiliations
    Harvard Medical School, Boston, MA, United States

    Department of Radiology, Massachusetts General Hospital, Boston, MA, United States

    Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA, United States
    Search for articles by this author
  • Author Footnotes
    1 Co-first authors, equal effort.

      Highlights

      • Only 1.4% of patients with self-initiated visits at an Urgent Care Center (UCC) required referral to an Emergency Department (ED) in the specified follow-up periods
      • UCCs are estimated to result in a savings of $437,928 over the course of a year for this population
      • Our UCCs are estimated to have saved $437,928 over the course of a year for this specific population.

      Abstract

      Background

      Following trauma involving the cervical spine (c-spine), patients often seek care at urgent care centers (UCCs) or emergency departments (EDs).

      Purpose

      The purpose was to assess whether UCCs could effectively image acute self-selected c-spine trauma without referral to the ED as well as to estimate costs differences between UCC and ED imaging assessment.

      Materials and methods

      This retrospective study identified patients receiving c-spine imaging at UCCs affiliated with a large academic hospital system from 5/1/-8/31/2021. Patients receiving c-spine X-rays with an indication of trauma following low acuity injury, at UCCs were compared to patients receiving any c-spine imaging in the main campus ED. Medical record numbers were cross-referenced to identify patients receiving imaging at both a UCC and ED within 24 h and within 7 days. Work relative value units (wRVUs) for each UCC and ED imaging type were calculated. For the hypothetical scenario of patients presenting to the ED in the absence of UCC, patients were assumed to receive c-spine computed tomography (CT) without contrast per “usually appropriate” designation by the American College of Radiology Appropriateness Criteria®.

      Results

      Among 143 self-selected, low acuity, patients who received c-spine X-rays at UCCs with an indication of trauma, one required referral to the ED within 24 h and two required referrals to the ED within 7 days. During the 4-month study period, 105.94 wRVUs ($3696.25) were saved by performing a c-spine X-ray in an UCC instead of a CT in the ED, extrapolated to 317.82 wRVUs ($11,088.74) per year. Using the average total costs of an UCC visit versus an ED visit, a total $145,976 was estimated to be saved during the study period or $437,928 per year.

      Conclusion

      Offering access for patient-initiated visits at UCCs for low-acuity c-spine trauma may help reduce the need for an ED visit, reducing imaging and healthcare visit costs.

      Summary statement

      Urgent Care Centers (UCCs) reduced the need for an Emergency Department (ED) referral visit in nearly 100% of self-selected, low acuity, patients with cervical trauma.

      Key results

      • Only 1.4% of patients required referral to an ED after a UCC visit for acute cervical trauma in this specific population.
      • In our system, UCCs are estimated to result in a savings of $437,928 over the course of a year in reduced ED visit costs, and $11,088.74 in wRVUs for this specific population.

      Abbreviations:

      c-spine (cervical spine), ED (Emergency Department), RVUs (Relative Value Units), UCC (Urgent Care Center), wRVU (work RVU)

      Keywords

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