Emergency Preparedness and Infection Control and Prevention Practices Among Urgent Care Centers, New York City, 2016–2017

BACKGROUND:   Nationwide, patients are increasingly using urgent care centers (UCCs) instead of emergency departments. In contrast to emergency departments, many UCCs are disconnected from healthcare networks with robust emergency preparedness (EP) plans, potentially leaving individual UCCs vulnerable to natural or manmade disasters. As a frequent first entry point into the healthcare system, UCCs play an important role in preventing disease spread. However, little information exists on how prepared UCCs are to do so. The New York City (NYC) Department of Health and Mental Hygiene (DOHMH) sought to assess the degree to which UCCs implement nationally-recommended EP and infection prevention and control (IPC) practices.

METHODS:   Investigators conducted a cross-sectional study, identifying all healthcare facilities within NYC meeting industry-defined UCC criteria (accepts “walk-in” patients, extended hours, etc.) and points of contact for each facility or network. A survey tool was developed and electronically disseminated to collect facility- or network-specific demographics and key measures for EP and IPC practices. Responses were weighted by number of UCCs represented by respondent.

RESULTS:   Nineteen respondents representing 145 (48%) of 299 total NYC UCCs completed the assessment. Respondents reported a weighted average of 287 patient visits (range: 50–700) per week and 36 visits (range: 10–150) per day. Participating UCCs employed twice as many physicians as physician assistants. Eight respondents (representing 81 facilities, or 56%) reported facility accreditation from an organization such as The Joint Commission, while one indicated regulation by New York State. Concerning IPC practices of respondents’ respective facilities, 118 UCCs (81%) had existing written IPC policies, though policy contents vary widely; 140 UCCs (97%) had written protocols to screen patients for communicable diseases, however, patients got screened at different times during the visit; 144 UCCs (99%) had hand hygiene stations; and 96 (66%) had a separate isolation area for presumptively infectious patients. Regarding EP practices of respondents’ respective facilities, 38 UCCs (26%) were not associated with an organization or network that can provide support during a disaster, and 34 (23%) lacked emergency preparedness policies.

CONCLUSIONS:   UCCs responding to our survey applied nationally-recommended IPC and EP practices inconsistently, and many UCCs were disconnected from networks that could strengthen these practices. Uncaptured UCCs might be even more disconnected than those that responded. Public health involvement could increase NYC UCCs’ resiliency to disasters and ability to prevent communicable disease outbreaks. DOHMH intends to engage UCCs with existing city-wide preparedness, response, and infection control activities.