O2171: Virtual Urgent Care May Reduce Unnecessary Emergency Department Utilization in Children

Background: The utilization of direct-to-consumer virtual urgent care (VUC) to assess and treat pediatric patients has the potential to avoid unnecessary emergency department (ED) visits for low-acuity conditions. However, outcomes of pediatric VUC visits, including ED referrals and admissions as well as unplanned ED visits requiring hospitalizations, have not been well characterized. This study aims to describe current ED referral rates and short-term VUC outcomes to better understand the evolving role of VUC in augmenting pediatric emergency medicine practice.

Methods: We performed a retrospective cohort study of patients presenting to the ED after VUC visits from March 1, 2021 to February 28, 2023 based on monthly automated reports of patients returning to any of our seven affiliated hospitals. Manual chart review of 72-hour return visits was conducted to assess ED referral rates and disposition of ED visits including hospitalization, admission to the intensive care unit (ICU), or discharge home.

Results: We evaluated 5901 VUC patients during this two-year study period. We found that 8.5% (501/5901) of all VUC patients were seen in our ED within 72-hours for related concerns. We referred 4.6% (274/5901) of patients to the ED and 3.8% (227/5901) presented to the ED without referrals, mostly for persistent symptoms. We admitted 19% (52/274) of all patients referred to the ED with 3.6% (10/274) requiring ICU admission. We admitted 6.2% (14/227) of all patients that presented to the ED without referrals with 1.3% (3/227) requiring ICU admission, all for progression of respiratory illness. Only 0.2% (14/5901) of patients had an unplanned 72-hour ED visit resulting in hospitalization after a VUC visit.

Conclusion: This study found lower ED referral rates compared to previous studies, possibly indicating that providers are becoming more comfortable with virtual assessments. Only 0.2% of all VUC visits resulted in unplanned ED visits requiring hospitalization. This data supports prior studies that VUC can provide safe and often complete care to pediatric patients that may help decrease unnecessary ED visits and alleviate overcrowding, resource saturation, and burden on families. Future studies are needed to explore patient experience with VUC and identify reasons for unplanned ED visits to further advance and optimize VUC as a resource for health care access.