Effect of a new urgent care center on the amount and characteristics of upper limb injuries treated in a level Ⅰ trauma center in southern Israel.

PURPOSE: Reducing nonemergent use of the emergency department (ED) is an important public health policy goal. Urgent care centers (UCCs) have recently increased in number and their impact on the characteristics and number of cases presenting to the ED is not yet fully understood. In this retrospective study, we attempt to characterize changes in upper limb trauma admissions to the ED in southern Israel after the opening of a nearby UCC. METHODS: Data were collected from the medical records at ED, Soroka University Medical Center. Patients with related upper limb traumas during the years 2011-2017 were included. The cases were divided into minor injuries, defined as those not requiring surgery or prolonged admission, and major injuries. We compared the number of cases presenting to the ED between two time periods, prior to and after the opening of the UCC (Jan. 2011 to Aug. 2014 vs. Sep. 2014 to Oct. 2017). Time series analysis and interrupted time series analysis were used to identify variations in incidence. We were unable to control for socioeconomic status, education, family status, and geographic location of trauma. RESULTS: A total of 103,75 upper limb trauma cases were included. Upper limb trauma admissions to the ED declined after the opening of a new UCC in the same geographic location. Prior to the UCC opening, the number of admissions to the ED increased by 12.1 per month on average, whereas after the UCC opened, there was a decline of 28.6 admissions to the ED every month, on average. This decline was found for all diagnoses except cases of open fractures which increased after the UCC opened. CONCLUSION: This study demonstrated a decline in the number of ED admissions for minor injuries, after the opening of a nearby UCC. This may suggest a benefit in resource reallocation and should be taken into consideration when formulating policy regarding patients' use of urgent care. Future research should focus on population trends of urgent care use to elucidate how to most efficiently direct patients on the use of the ED versus urgent care.