Can Urgent Care Clinics actually take pressure off hospitals? Yes, but they’re not the only way

Written by The Conversation

When we’re acutely ill or injured, we want to be able to quickly access care in Australia’s hospital emergency departments (EDs). But more of us are seeking care in EDs. This went from 7.4 million in 2014–15 to 9.1 million in 2024–25. And the system is struggling to cope.

EDs are becoming more crowded and patients are staying in EDs for a lot longer. Around 10% of patents waiting for an inpatient bed spent 19 or more hours in an ED – six hours longer than they would’ve waited four years ago.

Around 10% of patients who were discharged home spent eight or more hours in an ED – almost two hours longer than four years ago.

Improving access to inpatient beds from the ED is an important part of reducing ED overcrowding. But so too are strategies to reduce the number of patients presenting at EDs.

Since the May election, the federal government has been spruiking its expanded network of Urgent Care Clinics to reduce ED presentations for patients with urgent but non-life-threatening conditions.

But how are they working? And how do they fit with other services that have a similar aim of keeping Australians out of hospital?

A composite of a health worker looking stressed

When it comes to public hospitals, everyone seems to be waiting – waiting for emergency care, waiting for elective surgery, waiting to get onto a ward. Private hospitals are also struggling. In this five-part series, experts explain what’s going wrong, how patients are impacted, and the potential solutions. What’s currently in place? Three free services are in place to divert patients who don’t need to go to hospital to more appropriate settings – or to direct them to an ED if they are critically ill: Healthdirect (called Nurse-on-call in Victoria) is a 24/7 phone advice service operated by nurses and has been in operation since 2006. It gives callers health advice, including whether they should see a GP or go to an ED. Urgent Care Clinics are a network of around 90 health services, mainly staffed by GPs, where patients can walk in without an appointment and receive treatment for urgent but non-life-threatening conditions. They’re open every day, from early in the morning until late at night and can provide diagnostic services such as blood tests and X-rays. Virtual ED services provide consults via a video link with specialist ED physicians and other clinicians. Over the past five years, virtual EDs have been established in Victoria, South Australia, Queensland, Western Australia and New South Wales. Health providers can call virtual ED services for advice about where to send a patient. Read more: What is a virtual emergency department? And when should you 'visit' one? We know little about their quality and safety There is little published evidence evaluating the three services, though significant evaluations of Urgent Care Clinics and virtual EDs are underway. The interim evaluation of Urgent Care Clinics reported no data on the safety and quality, but noted that before opening, clinical assessments were conducted to confirm their safety and readiness to operate. An evaluation of a virtual ED service in New Zealand reported similar seven-day re-presentation rates for virtual and traditional EDs. This means a similar proportion of patients need to go back for further care, suggesting patients receive a similar level of care in both types of EDs. Do they reduce pressure on hospitals? We want to be confident patients who would otherwise have presented at an ED are using these services and that they’re an efficient use of health budgets. The early evaluation of Urgent Care Clinics found 46% of Urgent Care Clinic patients would have otherwise presented at an ED. Some 5% of patients using an Urgent Care Centre were referred to an ED. So Urgent Care Centres avoided four in ten ED presentations and resulted in a small reduction in health service costs. Data from virtual EDs in Queensland and Victoria show 30% of patients are then referred to a physical ED. This suggests virtual EDs manage patients with more serious conditions than Urgent Care Clinics. An economic evaluation of an early virtual ED service in Victoria also estimated a small reduction in health service costs, assuming all patients would otherwise have presented at an ED, but none would have been admitted. Other scenarios generated larger estimated cost reductions. Published data on Healthdirect shows 69% of patients attended an ED and 65% consulted a doctor when advised. One review reported Healthdirect generated “modest but significant” reductions in ED usage and after-hours GP visits. How can these services improve? We can improve these services, in particular, how the services integrate with each other. Half of patients using an Urgent Care Clinic said they would have seen a GP if they hadn’t used the clinic. If patients had better access to GPs, it would free capacity for more patients who would have presented at an ED to get treated in Urgent Care Clinics. Most virtual EDs are relatively small scale, other than in Victoria, where the virtual ED takes more than 700 calls per day. This suggests there is capacity to increase the scale of virtual EDs, which should reduce average costs. Virtual EDs can refer patients to Urgent Care Centres to access diagnostic services, and Urgent Care Centres can call virtual EDs for specialist advice. Research is needed to evaluate the effectiveness of the linkages between Urgent Care Centres and virtual EDs. Healthdirect refers patients to GPs, Urgent Care Clinics, EDs and virtual EDs. We need more research to assess the appropriateness of these referrals to identify opportunities to improve the use of these different health services. While the three services target overlapping groups of patients, they’re currently evolving independently. Instead, we need to develop, implement and evaluate a plan for the integrated delivery of these services. Each service can help keep Australians out of hospital, but the value of an integrated approach will be greater than the sum of the individual services. Read more from the Hospitals in Crisis series here.

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Can Urgent Care Clinics actually take pressure off hospitals? Yes, but they’re not the only way

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