title: Regional after-hours urgent care provided by a tertiary children's hospital.
abstract: BACKGROUND
  Ambulatory presentation to a tertiary pediatric emergency department (ED) is not convenient for many families. Yet many primary care pediatricians (PCPs) desire after-hours urgent care for their patients as an alternative to extended office hours or care by general emergency medicine providers at community hospitals.
  
  
  OBJECTIVE
  To describe a regional, community-based pediatric urgent care network (PUCN).
  
  
  METHODS
  The PUCN consists of 4 models: 1) pediatric emergency medicine faculty in a community hospital ED; 2) general pediatricians in a community hospital ED; 3) general pediatricians in a freestanding urgent care center; and 4) general pediatricians in a community hospital-based urgent care center. Physician staffing at all 4 sites is managed by our tertiary children's hospital. Billing records were reviewed and a questionnaire was mailed to 55 PCP practices in our metro area.
  
  
  RESULTS
  Year 2001 visits totaled 37 143. Minor trauma, ear complaints, and viral illnesses accounted for 70% of visits. Current Procedural Terminology codes for visits, reflecting complexity levels 1, 2, 3, 4, and 5 were billed at the following frequency: 1%, 35%, 44%, 17% and 3%, respectively. A total of 2.2% of visits required admission or transfer. Mean collection rates ranged from 37% to 68% across the 4 sites. Break-even average hourly patient volumes ranged from 1.1 (site 4) to 1.9 (sites 1 and 3). A total of 110 PCPs, representing all 55 practices, responded to the questionnaire: 81% reported their patients used the PUCN often, 85% felt that communication between the PUCN and their practice was good, and 99% reported overall satisfaction with the network.
  
  
  CONCLUSIONS
  The PUCN effectively addresses the needs of regional PCPs; however, the cost-effectiveness of such a program depends on billing practices, local collection rates, and site-specific staffing patterns.
authors.affiliation: Children's Hospital Pediatric Urgent Care Network, University of Colorado School of Medicine, Denver, Colorado 80218, USA. hampers.lou@tchden.org
authors.forename: Louis C
authors.initials: LC
authors.lastname: Hampers
authors.forename: S Glenn
authors.initials: SG
authors.lastname: Faries
authors.forename: Steven R
authors.initials: SR
authors.lastname: Poole
mesh_terms: D039602:After-Hours Care / Q000458:organization & administration*; D000553:Ambulatory Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D002648:Child; D003120:Colorado; D019058:Community Networks / Q000458:organization & administration* / Q000706:statistics & numerical data; D004630:Emergencies; D006776:Hospitals, Pediatric / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D008962:Models, Theoretical; D017060:Patient Satisfaction; D011159:Population Surveillance