research medical center urgent care

• Locations & Hours
• Pay Your Bill

Locations & Hours

Research medical campus.

2340 E. Meyer Boulevard (Bld 1) Ste. 200, 208, 318 Kansas City, MO 64132

816-753-5144

Hours of Operation

Monday 8:00 am - 5:00 pm

Tuesday 8:00 am - 5:00 pm

Wednesday 8:00 am - 5:00 pm

Thursday 8:00 am - 5:00 pm

Friday 8:00 am - 5:00 pm

Saturday Closed

Sunday Closed

Directions & Parking

Located in the Research Medical Campus, near the intersection of Prospect Ave and 63rd Street. If coming from US-71, take the 63rd Street Exit and go West. From 63rd Street, go South on Prospect Ave and turn right into the first entrance to the hospital. Park in the first open parking lot on the left. Parking is free. Enter Building 1 under the blue awning and take the elevator or stairs to the 2nd floor and enter Suite 200.

Bus Transportation

KCATA lines 71, 163, and 54

After Hours

For medical emergencies call 911 or go to the nearest emergency department. If you are an established patient and have urgent concerns or questions after clinic hours please call 816-753-5144.

Browse Services

URGENT CARE

Urgent care

Atlanta, GA

Charlotte, NC

Chicago, IL

Detroit, MI

Houston, TX

Los Angeles, CA

Nashville, TN

New York, NY

Philadelphia, PA

Phoenix, AZ

San Antonio, TX

San Francisco, CA

Seattle, WA

Pediatric urgent care

Baltimore, MD

Washington DC

Telemedicine

Connecticut

EVERYDAY HEALTH

Tdap vaccine

Charleston, WV

Ontario, CA

DOT physical

Albuquerque, NM

Cleveland, OH

Fort Worth, TX

Memphis, TN

Oklahoma Label, OK

School physicals

Ear wax cleaning

Jacksonville, FL

WOMEN'S HEALTH

Urinary tract infection

Pregnancy test

POPULAR TESTS

Allergy testing

COVID testing

Diabetes testing

Drug testing

Std testing

Research Medical Center

Accepts insurance & self-pay

See self pay prices

See accepted plans

COVID services available

See details

Location and hours

Office hours, accepted insurance plans.

While Research Medical Center partners with the below insurances, we recommend giving your insurance provider a call to confirm coverage and benefits.

Services and payment options

Insurance is accepted as payment for visits and services at this clinic. See accepted plans .

This clinic accepts payment without insurance. Self-pay prices include an office visit charge unless noted. For more details, call the clinic .

Is this your clinic?

Patient ratings and reviews

No ratings yet

All reviews are opinions of patients and do not represent the opinions of Solv.

Frequently asked questions

This location is not bookable on Solv.

Need care ASAP?

Is this your business?

Claim this listing now to edit business details and hours.

Find in-person or video care now

See why 29 million people trust Solv.

• Urgent Care
• Kansas City

Urgent Care Penfield

2134 Penfield Road Suite 1 Penfield, NY 14526-1736

 Get Directions

Open Daily 9 a.m.−8 p.m.

Holidays 9 a.m.−4 p.m.

No appointment necessary.

View Wait Times 

Urgent Care is for an illness or injury that requires quick care but is not life-threatening.  It’s meant to support, not replace, care from your regular doctor. When possible, check with your primary care physician before seeking urgent care.

You can walk into any of our many locations without an appointment. Common conditions we treat include abdominal pain, broken bones, coughs, earaches, fevers, flu, infections, minor burns/trauma, nausea, rashes, sore throat, sprains, strains, vomiting.

Imaging and lab services are available on site for quick diagnosis. So, for example, you won't need to wait to find out if a bone is broken, or if you have strep or a urinary tract infection. 

Important Information Regarding COVID Testing

• COVID/Flu/RSV Testing: UR Medicine Urgent Care treats patients with symptoms. Testing is not available for those without symptoms. 
• Those with mild symptoms or who need COVID testing should use public testing locations or check with their Primary Care Provider.
• It is not necessary to confirm a positive rapid COVID test. Unless you need medical care, you should remain isolated.
• Unless you need medical care, you should remain isolated at home per CDC guidelines.
• UR Medicine Urgent Care is not a COVID testing only site.

Using 'On My Way' doesn't guarantee a scheduled appointment time slot but we do our best to accommodate all our patients . This feature tells us you're coming to Urgent Care so we can reduce the information needed during check-in and better prepare for your visit. Please note that wait times are based on our best estimate, and we need to see patients based on the severity of their illness. Wait times begin for patients on site and checked-in. When you arrive, please come inside and your brief check-in process will take place.

Additional Information

Insurance & payment.

Below is a list of insurance carriers that UR Medicine Urgent Care accepts. Each carrier may offer several different plans, and UR Medicine may not accept all of these plans. Please contact your insurance carrier to learn if UR Medicine accepts your particular plan, and whether the services you need are covered under your plan.

• Excellus BlueCross BlueShield
• Monroe Plan/Your Care
• United HealthCare

As with most urgent care centers, we request payment at the time of your service. Fees vary depending on the level of service you need. If you have questions about insurance or payment, please ask our reception staff when you arrive. We are always happy to help.

You can pay your bill online using our online bill payment system.

• Open access
• Published: 14 June 2022

Cancer-related emergency and urgent care: expanding the research agenda

• Nonniekaye Shelburne   ORCID: orcid.org/0000-0001-6886-8373 1 ,
• Naoko Ishibe Simonds 2 ,
• Roxanne E. Jensen 1 &
• Jeremy Brown 3  

Emergency Cancer Care volume  1 , Article number:  4 ( 2022 ) Cite this article

3723 Accesses

9 Citations

5 Altmetric

Metrics details

Purpose of review

Cancer-related emergency department (ED) visits often result in higher hospital admission rates than non-cancer visits. It has been estimated many of these costly hospital admissions can be prevented, yet urgent care clinics and EDs lack cancer-specific care resources to support the needs of this complex population. Implementing effective approaches across different care settings and populations to minimize ED and urgent care visits improves oncologic complication management, and coordinating follow-up care will be particularly important as the population of cancer patients and survivors continues to increase. The National Cancer Institute (NCI) and the Office of Emergency Care (OECR) convened a workshop in December 2021, “Cancer-related Emergency and Urgent Care: Prevention, Management, and Care Coordination” to highlight progress, knowledge gaps, and research opportunities. This report describes the current landscape of cancer-related urgent and emergency care and includes research recommendations from workshop participants to decrease the risk of oncologic complications, improve their management, and enhance coordination of care.

Recent findings

Since 2014, NCI and OECR have collaborated to support research in cancer-related emergency care. Workshop participants recommended a number of promising research opportunities, as well as key considerations for designing and conducting research in this area. Opportunities included better characterizing unscheduled care services, identifying those at higher risk for such care, developing care delivery models to minimize unplanned events and enhance their care, recognizing cancer prevention and screening opportunities in the ED, improving management of specific cancer-related presentations, and conducting goals of care conversations.

Significant progress has been made over the past 7 years with the creation of the Comprehensive Oncologic Emergency Research Network, broad involvement of the emergency medicine and oncology communities, establishing a proof-of-concept observational study, and NCI and OECR’s efforts to support this area of research. However, critical gaps remain.

Introduction

An estimated 1.9 million new cancer diagnoses were made in the United States (US) during 2021 [ 1 ], with increasing frequency of treatment provided in the outpatient setting. Managing unexpected or acute side effects and adverse events from cancer and cancer therapy poses a challenge to ambulatory care patients, their caregivers, and the healthcare system. This often results in patients and caregivers seeking care outside of their oncology team. Retrospective studies of US emergency department (ED) visits by patients presenting with a cancer-related complaint report 4.2 million adult and nearly 300,000 pediatric visits annually [ 2 , 3 ].

Due to varying levels of oncology care model implementation, resource availability, and the complexity of cancer treatment, patients experiencing acute complications (e.g., fever, shortness of breath) rely on urgent and emergency care providers to efficiently triage and stabilize medical presentations and coordinate follow-up care with oncology care teams. Clinicians and researchers continue to develop and test assessment tools that identify patients at greater risk for high care needs and strategies to provide support that minimizes the need for urgent and emergency care. Initiatives, such as the Centers for Medicare & Medicaid Services Oncology Care Model, encourage innovation to improve quality of care and reduce Medicare spending through financial incentives [ 4 ]. The results of these efforts have been mixed. Some of the barriers to providing patient-centered care for unplanned care needs include the limited ability of non-oncology providers to access cancer patient treatment documentation, a lack of evidence-based cancer-specific triage and management pathways, and fractured provider-to-provider communication.

In 2014, the National Cancer Institute (NCI) and the Office of Emergency Care Research (OECR) began collaborating to address the paucity of evidence surrounding cancer-related ED visits. They held the first scientific meeting on the topic in 2015 and published a research agenda to advance the understanding of emergency care of cancer patients. The identified knowledge gaps covered characterization of the cancer population utilizing ED care, the management of the patient with febrile neutropenia and acute events, and the role of palliative care in the ED [ 5 ].

To update the state of knowledge, evidence gaps, and research recommendations, the NCI and OECR convened a virtual, public workshop in December 2021, “Cancer-related Emergency and Urgent Care: Prevention, Management, and Care Coordination” [ 6 ]. The workshop brought together over 100 participants with clinical and research expertise in oncology, urgent care, emergency medicine, healthcare delivery, nursing, social work, and patient advocacy. The goal was to reassess the knowledge gaps and research recommendations in cancer-related urgent and emergency care prevention, management, and coordination of care. This report provides an overview of the current landscape of oncologic urgent and emergency care and the research recommendations identified by workshop participants.

Progress and advances in cancer-related urgent and emergency care

Since the 2015 Workshop identified research opportunities and established new collaborations across oncology and emergency medicine, progress has been made in understanding the care needs of those experiencing oncologic complications in the urgent and emergency care setting. NCI has a stated research interest in cancer and emergency medicine that focuses on the following: (1) utilization and drivers of cancer-related emergency care, (2) risk stratification, prediction models, and intervention strategies, and (3) minimizing emergency care use [ 7 ]. Numerous funding opportunity announcements are available to support new grant submissions across these interest areas (Table 1 ). Since 2015, NCI has seen a rise in grant application submissions related to oncologic complications. For example, recently funded applications include characterization of patients diagnosed with cancer in the ED, implementation of an ED cervical cancer screening program, and development of an ED-risk stratification tool for immune-related adverse events. In addition, NCI funds projects assessing and managing cancer-related symptoms and toxicities in the oncology setting that include ED visits, a key healthcare utilization study endpoint.

Another outcome of the 2015 Workshop was the establishment of the Comprehensive Oncologic Emergency Research Network (CONCERN), created to accelerate knowledge generation, synthesis, and translation of oncologic emergency medicine research [ 8 ]. This research network conducted a prospective, observational study of adult patients with active cancer presenting to the ED with oncologic complaints. CONCERN study publications include a descriptive study on key population characteristics [ 9 ], a validation of the Emergency Severity Index triage tool during active cancer treatment [ 10 ], the characterization of pain severity, medication utilization, and clinical outcomes [ 11 ], and a descriptive study on observation unit care utilization [ 12 ].

Even with this tangible progress, the 2021 Workshop participants noted that many challenges remain. The themes that emerged from the current workshop were (1) utilization and prediction, (2) care delivery models and strategies, (3) cancer prevention and screening, (4) managing acute cancer-related presentations, (5) cancer-related goals of care conversations, and (6) designing and conducting cancer-related urgent and emergency care research studies (Table 2 ).

Workshop findings and recommendations

Ed utilization and prediction.

Four percent of adult ED visits in the USA are for cancer-related reasons. These ED visits occur across the cancer care continuum, including initial diagnosis, active treatment, survivorship, and at end of life [ 3 , 13 ]. Higher ED use has been reported for some cancers (e.g., lung, brain, leukemia) compared to others (e.g., prostate, breast) especially during the first year after diagnosis [ 14 , 15 , 16 ], and frequent reasons cited for these visits are symptom management (e.g., pain, fever or infection, respiratory distress, gastrointestinal issues). Risk factors associated with ED visits include chronic conditions, frailty, advanced-stage disease, being at sociodemographic risk, and prior ED use [ 9 , 14 , 15 , 16 , 17 , 18 ]. Significantly, cancer-related ED visits result in an inpatient admission at a rate 3.5 times than that of non-cancer-related ED visits [ 3 , 9 , 13 , 17 ]. Despite growing knowledge of cancer-related ED utilization and population characteristics, workshop panelists noted that there are continued gaps in the epidemiology literature, some of which are limited by the quality of available data and inconsistent definitions of avoidable or preventable ED visits.

ED visits and unplanned hospitalization are common in the cancer population, and better prediction tools are needed to identify patients at increased risk for high symptom burden, adverse events, or poor outcomes. By identifying high-risk patients for whom proactive care management might be warranted, strategies such as increased symptom assessments (e.g., electronic symptom monitoring, virtual follow-up) and addressing social needs (e.g., prescription plans for symptom control medications, transportation support) could help prevent some unscheduled care. For example, machine learning-based risk tools for mortality, ED visit, and hospital admission outcomes have been developed and validated for pre-treatment [ 19 ] and after starting treatment [ 20 ]. Although these machine learning and artificial intelligence models have the potential to predict outcomes, additional studies addressing limitation of single-center studies, testing in single electronic health records (EHR) type, and population representation are needed. Additionally, there is a growing body of literature supporting the use of patient-reported outcomes to facilitate cancer symptom assessment [ 21 , 22 ] and its impact on daily activities and quality of life. However, these assessments have not focused on the risk of unplanned care. Additional studies on which patient-level variables (e.g., clinical risk factors, prior ED use, and sociodemographic factors) should be included in these models, and their impact on healthcare utilization is needed.

To better address the needs of cancer patients, understanding their experiences in the urgent and emergency care setting is required. Thus far, patient perspectives “in the setting of an unplanned acute care event remain poorly described” [ 23 ]. Some cancer survivor workshop participants shared their experiences managing oncologic complications, reporting challenges in navigating the healthcare system, such as not receiving clear instructions on how to contact the oncology team for guidance with acute events. When they did turn to the ED for care, they frequently felt they had to advocate for themselves, and that ED providers did not always take their concerns seriously. One panelist suggested that quicker time to triage and provider assessment are warranted for patients with cancer, in a model similar to that provided in pediatric emergency departments. Taken together, research is needed to better understand how care coordination and resources can be improved for patients.

Workshop discussions also identified several research opportunities to better understand urgent and ED utilization and improve risk prediction of visits. A first step is to consistently define what is an avoidable or preventable urgent care or ED visit; standardizing this definition is essential for outcome measures in future research in utilization and prediction. Linking existing data sources, such as EHR and claims and registry data, and applying machine learning algorithms could identify cancer patients at risk of unscheduled cancer-related needs, as well as help characterize the individual, system, and societal drivers of acute care. Furthermore, additional prospective observational studies of cancer-related ED visits, including underrepresented populations and settings, are warranted.

Care delivery models and strategies

Cancer-related ED visits result in hospital admission at rates well above that of non-cancer patients (60% vs. 16%) [ 3 ]. More significantly, it has been estimated that 30 to 60% of these admissions can be prevented [ 24 , 25 ], and nearly 50% of oncology care cost results from preventable toxicities [ 26 , 27 ]. Implementing effective care delivery models across different care settings and populations to minimize urgent care and ED visits will be particularly important as the population of cancer patients and survivors continues to increase.

Workshop speakers presented several care delivery strategies that have been tested to minimize unscheduled ED visits and inpatient admissions as well as improve care in these patients. For example, access and care coordination, such as patient navigation [ 28 ], web-based symptom self-reporting [ 29 ], oncology urgent care clinics, nurse triage [ 30 ], and post-discharge interventions [ 31 ] have all been shown to reduce ED visits and/or hospitalization. Some ED and urgent care center observation units provide outpatient acute care that lasts more than 24 h in duration but is typically less than 48 h, and these have been reported to reduce inpatient admissions [ 32 ]. They are, however, an underused and understudied resource. The recent global SARS-CoV-2 pandemic also required hospitals and outpatient practices to develop and implement cancer-related symptom management strategies focused on preventing ED visits to reduce the demands on the healthcare system as well as to minimize exposure, and the prevalence of telemedicine has grown rapidly. More studies investigating the impact, cost, and sustainability of these strategies on cancer outcomes are needed.

While these care delivery models have been recognized as being important to improving the care of cancer patients seeking unscheduled care, there is no clear “best practice” model. Furthermore, it is not obvious how to scale up these resource-intensive models, and participants noted that some were cumbersome to implement. Participants noted that less than half of cancer patients call their care team for advice prior to seeking unscheduled care, even though many oncology teams provide a 24-h phone consultation service. Clearly, there is a critical need to better align the needs of cancer patients and caregivers to not only minimize unscheduled care needs but also provide supportive and accessible care. During the workshop, several important next steps were identified, including developing and testing care delivery models and strategies that have the most impact on minimizing urgent care and ED use, improving patient outcomes (e.g., mortality, hospital length o stay), and lowering costs of care delivery.

Cancer prevention and screening in the ED

Approximately, 2 million adults report using the ED as their usual source of care [ 33 ] presenting the opportunity to provide cancer control information and care. Those who seek care in the ED are more likely to be younger, socioeconomically disadvantaged, and racial/ethnic minorities [ 33 ] who do not have access to preventive care. There is a growing body of evidence showing that providing care that is typically thought of as preventive (e.g., vaccinations, tobacco, and alcohol cessation) while in the ED to be effective [ 34 , 35 ]. Moreover, it was noted that the ED is a “target-rich” environment with many patients needing cancer screening (e.g., Pap smear, mammography, colonoscopy), especially among those who do not have ready access to primary care. Participants further noted that using the wait time in the ED could be an opportunity to educate patients as they tend to be receptive. However, there were questions as to (1) how to incorporate screening and prevention efforts without overburdening staff, (2) which screening tests can and should be performed in the ED, and (3) how to ensure appropriate follow-up care.

To address these questions, a few key steps were identified by workshop participants, starting by characterizing the population who rely on the ED for planned care and who may most benefit from cancer prevention and screening services. Next, strategies to increase cancer screening uptake in the ED should be developed and tested. These could include providing simple or enhanced (e.g., mHealth) referral to local screening resources, placing a cancer screening/prevention unit near the ED, or actual in-ED screen. The development of technology solutions (e.g., smart EHR) to identify ED patients appropriate for cancer prevention and screening was highlighted as another research opportunity. Finally, identifying the best approach to ensure appropriate follow-up, such as using patient navigators, to improve preventive healthcare delivery to ED patients should be explored.

Managing cancer-related presentations in urgent care and the ED

Clinical pathways support evidence-based risk stratification and clinical decision-making for rapid assessment and treatment in the ED with the goal to predict resource utilization and improve patient outcomes. Pathways that are adopted address common clinical presentations and are easy to use. Pathways in non-cancer populations have been widely adopted in the ED, such as the HEART score for myocardial infarction with undifferentiated chest pain, pulmonary embolism rule-out criteria (PERC) for pulmonary embolism, and coronavirus rule-out criteria (CORC) for COVID-19. Workshop participants expressed that existing cancer-focused pathways, such as the Multinational Association for Supportive Cancer Care (MASCC) and Clinical Index of Stable Febrile Neutropenia (CISNE) for febrile neutropenia in cancer patients, are cumbersome and have not been validated prospectively. Furthermore, it was noted that frequently, the tools that appear promising at a single site are less effective when tested in other care settings.

Throughout the workshop, participants stated the need to develop and validate ED oncology-specific clinical pathways for commonly observed oncologic complications. Workshop attendees noted the need to adapt, test, and integrate existing care pathways used in oncology care settings into the ED and conduct research where gaps remain. Specifically, tools to assist with differential diagnosis of febrile neutropenia, pulmonary embolism, and immune-related adverse events for severity, resource utilization, and disposition were identified as an urgent need. In addition, it is important to develop and test diagnostic and prognostic biomarkers that can risk stratify patients, which in the ED setting, should have the following key features: easy to measure, fast time to result, and excellent predictive value. Comparing costs and efficiencies across care settings will support care pathways dissemination and implementation. Given the vital role these tools play in the ED, deriving risk stratification and clinical decision-making tools in a multicenter study that is subsequently validated in other populations and care settings is critical.

A lack of cancer-specific pathways in the ED also contributes to the high hospital admission rate for cancer-related ED visits. Tools that assess individual, system, and societal factors to inform the management of febrile neutropenia, for example, could assist providers in determining the safety of discharging patients home on oral antibiotics instead of admitting them for intravenous antibiotics. The goal of discharge to home comes with the need for improved post-ED communication between patients and provider teams. Workshop participants noted the need to standardize EHR data collection for oncology patient encounters in the emergency care setting to allow for sharing of medical records and supporting timely follow-up.

Cancer-related goals of care in the ED

Understanding the complexity of acute care ED visits for advanced stage patients with cancer and aligning care based on their needs and desires are an important research topics. Although there has been research demonstrating that specialized palliative and hospice care improves quality-of-life in cancer patients, palliative and hospice care referral is highly variable [ 36 , 37 ], in both oncology practice and the ED. However, many questions remain as to what approach and services best address these patients’ and caregivers’ needs. These include deciding which provider leads the “goals of care” conversation (social worker, nurse, physician), when the timing of the intervention should occur (episode of care: pre-, within-, post-ED visit), how it should be delivered (face to face, telephone), and what type of care should be provided (specialty palliative care, hospice care, community paramedicine, caregiver support).

This is further complicated by inadequate communication of care preferences throughout the various stages of disease progression. The “goals of care” conversation should preferentially occur in the outpatient oncology setting, yet it has been estimated that only about a third of patients with advanced cancer have this conversation with their oncologists [ 38 ]. When patients with advanced or late-stage cancer arrive in the ED seeking care, goals of care conversations can become a crisis communication, potentially leading to undesired invasive interventions. Although the ED visit is an opportunity to introduce such conversations, emergency physicians are often unsure of their roles in initiating these conversations and lack a practical method to guide discussions with seriously ill patients about their values and preferences in a time-pressured environment [ 39 ].

Several important research opportunities were identified to study cancer-related goals of care in the ED. Because identifying cancer patients in the ED who may benefit from palliative or hospice care services can be challenging for clinicians, implementing clinical decision support tools, such as EHR facilitated assessments, could improve a cancer patient’s quality of life. A better understanding of specific palliative care or end-of-life needs would facilitate targeting such interventions. In addition, research is needed to identify interventions that minimize the need for ED care in those with advanced cancer or near the end of life, as well as better coordinate care after such visits occur.

Designing and conducting oncologic emergency research

To support many of these research opportunities, workshop panelists and attendees stated that leveraging existing resources is key to generating knowledge related to oncologic urgent and emergency care. Several existing ED research networks were mentioned over the course of the workshop, including CONCERN, Geriatric Emergency care Applied Research (GEAR), Emergency Medicine Palliative Care Access (EMPallA), Pediatric Emergency Care Applied Research Network (PCARN), and the Multicenter Registry of potential COVID-19 in emERgency care (Project RECOVER). Additionally, oncology research networks, such as the NCI Community Oncology Research Program (NCORP), and existing cancer cohorts were noted as being potentially useful resources in conducting research related to oncologic complications. Although each resource has collected data with a specific focus — such as emergency medicine, dementia, palliative care, viral infections, and specific cancer types and treatment — they each represent opportunities to address identified evidence gaps.

As these existing resources highlight, workshop participants emphasized the role of persistent silos between specialties as hindering research and the delivery of optimal care. In particular, participants noted a separation between the emergency medicine and oncology departments (e.g., no dual appointments) that could be better bridged so that emergency medicine is recognized as an integral part of oncology care and research. Furthermore, the two disciplines tend to approach research differently (i.e., emergency medicine is more symptom-based, whereas oncology is organized by cancer type), and this distinction may have hindered collaborations. Participants also stated that many of the productive collaborations thus far have been at the individual investigator level rather than at a broader institutional level, and more effort to foster regional collaborations should be encouraged. Oncology and emergency medicine have a strong history of collaborating across disciplines where their clinical care and research interests intersect (e.g., oncology and cardiology for cancer-related cardiotoxicity and emergency medicine and neurology for stroke). These successful collaborative efforts should be replicated across oncology and emergency medicine at the investigator, institution, and professional organization level to help advance cancer-related urgent and emergency care research and expose junior clinicians and investigators to this emerging field.

Workshop participants emphasized the need for research efforts to understand and reduce disparities in care delivery experienced by underserved and underprivileged cancer patients who visit urgent care and the ED for unscheduled care. Cancer patients in rural areas with limited access to specialists experience higher rates of cancer-related mortality and suboptimal treatment outcomes compared to patients in non-rural areas [ 40 ]. To improve access to specialists, innovative interventions, such as enhanced telehealth in rural and community settings, could be evaluated, and any reduction in ED transfers to an academic medical center could be measured. Research efforts should optimally target translation of findings and interventions to a variety of care settings and populations to reduce disparities in care delivery among these patients.

Another aspect that is essential to future research efforts is to incorporate the patient perspective in all phases of research. The careful consideration of study design that reflects the needs of cancer patients is one important step that was noted. For example, including stakeholder-driven outcomes and comparators that are clinically justified and appropriate for the care setting and population is a way to better meet patient needs and preferences in the research setting [ 41 , 42 ]. Understanding the unique perspectives of cancer patients and survivors who experience oncologic complications and designing future research studies that accurately reflect their needs are critical.

This report highlights the progress made in cancer-related urgent and emergency care since the 2015 NCI and OECR workshop and identifies new research recommendations aimed at improving outcomes for those with unanticipated complications of cancer and its treatment. The research recommendations from workshop participants include the need to characterize the utilization of acute care services by cancer patients, predicting at-risk patients, care delivery models to minimize and support unplanned events, cancer prevention and screening efforts in the ED, management of cancer-related presentations, cancer-related goals of care conversations, and key considerations for designing and conducting research in this area. These research recommendations, coupled with the collaborative efforts of CONCERN and other scientific groups, have the potential to address the key evidence gaps and clinical care needs of cancer patients seeking urgent and emergency care.

Availability of data and materials

Not applicable.

Abbreviations

Clinical index of stable febrile neutropenia

Comprehensive Oncologic Emergencies Research Network

Coronavirus rule-out criteria

Geriatric Emergency care Applied Research

Emergency department

Electronic health record

Emergency Medicine Palliative Care Access

Multinational Association for Supportive Cancer Care

National Cancer Institute

Office of Emergency Care Research

Pediatric Emergency Care Applied Research Network

Pulmonary embolism rule-out criteria

Multicenter Registry of potential COVID-19 in emERgency care

American Cancer Society. Cancer Facts & Figures 2021. Atlanta: American Cancer Society; 2021.

Mueller EL, Hall M, Carroll AE, Shah SS, Macy ML. Frequent emergency department utilizers among children with cancer. Pediatr Blood Cancer. 2016;63(5):859–64.

Article   Google Scholar  

Rivera DR, Gallicchio L, Brown J, Liu B, Kyriacou DN, Shelburne N. Trends in adult cancer-related emergency department utilization: an analysis of data from the nationwide emergency department sample. JAMA Oncol. 2017;3(10):e172450.

Center for Medicare & Medicaid. Evaluation of the oncology care model: performance periods 1-5. 2021. https://innovation.cms.gov/data-and-reports/2021/ocm-evaluation-pp1-5 . Accessed 16 Mar 2022.

Google Scholar  

Brown J, Grudzen C, Kyriacou DN, Obermeyer Z, Quest T, Rivera D, et al. The emergency care of patients with cancer: setting the research agenda. Ann Emerg Med. 2016;68(6):706–11.

National Institutes of Health. Cancer-related emergency and urgent care: prevention, management, and care coordination workshop, 2021.

National Institutes of Health. Cancer and emergency medicine. https://epi.grants.cancer.gov/concern . Accessed 16 Mar 2022.

Comprehensive Oncologic Emergencies Research Network (CONCERN). https://epi.grants.cancer.gov/concern . Accessed 16 Mar 2022.

Caterino JM, Adler D, Durham DD, Yeung SJ, Hudson MF, Bastani A, et al. Analysis of diagnoses, symptoms, medications, and admissions among patients with cancer presenting to emergency departments. JAMA Netw Open. 2019;2(3):e190979.

Adler D, Abar B, Durham DD, Bastani A, Bernstein SL, Baugh CW, et al. Validation of the Emergency Severity Index (version 4) for the triage of adult emergency department patients with active cancer. J Emerg Med. 2019;57(3):354–61.

Coyne CJ, Reyes-Gibby CC, Durham DD, Abar B, Adler D, Bastani A, et al. Cancer pain management in the emergency department: a multicenter prospective observational trial of the Comprehensive Oncologic Emergencies Research Network (CONCERN). Support Care Cancer. 2021;29(8):4543–53.

Klotz AD, Caterino JM, Durham D, Felipe Rico J, Pallin DJ, Grudzen CR, et al. Observation unit use among patients with cancer following emergency department visits: results of a multicenter prospective cohort from CONCERN. Acad Emerg Med. 2022;29(2):174–83. https://doi.org/10.1111/acem.14392 . Epub 2021 Dec 4. PMID: 34811858.

Hsu J, Donnelly JP, Moore JX, Meneses K, Williams G, Wang HE. National characteristics of emergency department visits by patients with cancer in the United States. Am J Emerg Med. 2018;36(11):2038–43.

Weidner TK, Kidwell JT, Etzioni DA, Sangaralingham LR, Van Houten HK, Asante D, et al. Factors Associated with emergency department utilization and admission in patients with colorectal cancer. J Gastrointest Surg. 2018;22(5):913–20.

Hong AS, Nguyen DQ, Lee SC, Courtney DM, Sweetenham JW, Sadeghi N, et al. Prior frequent emergency department use as a predictor of emergency department visits after a new cancer diagnosis. JCO Oncol Pract. 2021;17(11):e1738–e52.

Lash RS, Bell JF, Bold RJ, Joseph JG, Cress RD, Wun T, et al. Emergency department use by recently diagnosed cancer patients in California. J Community Support Oncol. 2017;15(2):95–102.

Elsayem AF, Merriman KW, Gonzalez CE, Yeung SC, Chaftari PS, Reyes-Gibby C, et al. Presenting Symptoms in the emergency department as predictors of intensive care unit admissions and hospital mortality in a comprehensive cancer center. J Oncol Pract. 2016;12(5):e554–63.

Lash RS, Bell JF, Reed SC, Poghosyan H, Rodgers J, Kim KK, et al. A systematic review of emergency department use among cancer patients. Cancer Nurs. 2017;40(2):135–44.

Hong JC, Niedzwiecki D, Palta M, Tenenbaum JD. Predicting emergency visits and hospital admissions during radiation and chemoradiation: an internally validated pretreatment machine learning algorithm. JCO Clin Cancer Inform. 2018;2:1–11.

Peterson DJ, Ostberg NP, Blayney DW, Brooks JD, Hernandez-Boussard T. Machine learning applied to electronic health records: identification of chemotherapy patients at high risk for preventable emergency department visits and hospital admissions. JCO Clin Cancer Inform. 2021;5:1106–26.

Noel CW, Sutradhar R, Zhao H, Delibasic V, Forner D, Irish JC, et al. Patient-Reported symptom burden as a predictor of emergency department use and unplanned hospitalization in head and neck cancer: a longitudinal population-based study. J Clin Oncol. 2021;39(6):675–84.

Howell D, Li M, Sutradhar R, Gu S, Iqbal J, O'Brien MA, et al. Integration of patient-reported outcomes (PROs) for personalized symptom management in “real-world” oncology practices: a population-based cohort comparison study of impact on healthcare utilization. Support Care Cancer. 2020;28(10):4933–42.

Kaufmann TL, Rendle KA, Aakhus E, Nimgaonkar V, Shah A, Bilger A, et al. Views From patients with cancer in the setting of unplanned acute care: informing approaches to reduce health care utilization. JCO Oncol Pract. 2020;16(11):e1291–e303.

Panattoni L, Fedorenko C, Greenwood-Hickman MA, Kreizenbeck K, Walker JR, Martins R, et al. Characterizing potentially preventable cancer- and chronic disease-related emergency department use in the year after treatment initiation: a regional study. J Oncol Pract. 2018;14(3):e176–e85.

Gallaway MS, Idaikkadar N, Tai E, Momin B, Rohan EA, Townsend J, et al. Emergency department visits among people with cancer: frequency, symptoms, and characteristics. J Am Coll Emerg Physicians Open. 2021;2(3):e12438.

PubMed   PubMed Central   Google Scholar  

Brooks GA, Abrams TA, Meyerhardt JA, Enzinger PC, Sommer K, Dalby CK, et al. Identification of potentially avoidable hospitalizations in patients with GI cancer. J Clin Oncol. 2014;32(6):496–503.

Neugut AI, Bates SE. Emergency department visits for emesis following chemotherapy: guideline nonadherence, OP-35, and a Path Back to the Future. Oncologist. 2021;26(4):274–6.

Article   CAS   Google Scholar  

Colligan EM, Ewald E, Ruiz S, Spafford M, Cross-Barnet C, Parashuram S. Innovative oncology care models improve end-of-life quality, reduce utilization and spending. Health Aff (Millwood). 2017;36(3):433–40.

Basch E. Missing patients’ symptoms in cancer care delivery--the importance of patient-reported outcomes. JAMA Oncol. 2016;2(4):433–4.

Bischof JJ, Bush M, Shams RB, Collichio FA, Platts-Mills TF. A hybrid model of acute unscheduled cancer care provided by a hospital-based acute care clinic and the emergency department: a descriptive study. Support Care Cancer. 2021;29(12):7479–85.

Montero AJ, Stevenson J, Guthrie AE, Best C, Goodman LM, Shrotriya S, et al. Reducing unplanned medical oncology readmissions by improving outpatient care transitions: a process improvement project at the Cleveland Clinic. J Oncol Pract. 2016;12(5):e594–602.

Lipitz-Snyderman A, Klotz A, Atoria CL, Martin S, Groeger J. Impact of observation status on hospital use for patients with cancer. J Oncol Pract. 2015;11(2):73–7.

Primm K, Muraleetharan D, Gilreath T. Use of emergency departments for preventative care among adults in the united states: estimates from the 2017 National Health Interview Survey. J Emerg Med. 2019;57(4):578–86.

Bernstein SL, D'Onofrio G. Screening, treatment initiation, and referral for substance use disorders. Addict Sci Clin Pract. 2017;12(1):18.

Lemhoefer C, Rabe GL, Wellmann J, Bernstein SL, Cheung KW, McCarthy WJ, et al. Emergency department-initiated tobacco control: update of a systematic review and meta-analysis of randomized controlled trials. Prev Chronic Dis. 2017;14:E89.

Nitecki R, Diver EJ, Kamdar MM, Boruta DM 2nd, Del Carmen MC, Clark RM, et al. Patterns of palliative care referral in ovarian cancer: a single institution 5year retrospective analysis. Gynecol Oncol. 2018;148(3):521–6.

Wang X, Knight LS, Evans A, Wang J, Smith TJ. Variations among physicians in hospice referrals of patients with advanced cancer. J Oncol Pract. 2017;13(5):e496–504.

Wright AA, Zhang B, Ray A, Mack JW, Trice E, Balboni T, et al. Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA. 2008;300(14):1665–73.

Ouchi K, George N, Schuur JD, Aaronson EL, Lindvall C, Bernstein E, et al. Goals-of-care conversations for older adults with serious illness in the emergency department: challenges and opportunities. Ann Emerg Med. 2019;74(2):276–84.

Levit LA, Byatt L, Lyss AP, Paskett ED, Levit K, Kirkwood K, et al. Closing the rural cancer care gap: three institutional approaches. jCO Oncol Pract. 2020;16(7):422–30.

Forsythe LP, Carman KL, Szydlowski V, Fayish L, Davidson L, Hickam DH, et al. Patient engagement in research: early findings from The Patient-Centered Outcomes Research Institute. Health Aff (Millwood). 2019;38(3):359–67.

Parry C, Johnston-Fleece M, Johnson MC Jr, Shifreen A, Clauser SB. Patient-centered approaches to transitional care research and implementation: overview and insights from patient-centered outcomes Research Institute’s Transitional Care Portfolio. Med Care. 2021;59(Suppl 4):S330–S5.

Download references

Acknowledgements

The authors thank the workshop speakers, panelists, and attendees.

Open Access funding provided by the National Institutes of Health (NIH). This work was supported by the National Cancer Institute and National Institute of Neurological Disorders and Stroke.

Author information

Authors and affiliations.

Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, 20850, USA

Nonniekaye Shelburne & Roxanne E. Jensen

The Scientific Consulting Group, Inc., Gaithersburg, USA

Naoko Ishibe Simonds

Office of Emergency Care Research, National Institute of Neurological Disorders and Stroke, Bethesda, USA

Jeremy Brown

You can also search for this author in PubMed   Google Scholar

Contributions

Conception/design, all authors; provision of content, all authors; recommendation analysis and interpretation, all authors; manuscript writing — all authors; final approval of manuscript, all authors.

Corresponding author

Correspondence to Nonniekaye Shelburne .

Ethics declarations

Ethics approval and consent to participate, consent for publication, competing interests.

The authors declare that they have no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ .

Reprints and permissions

About this article

Cite this article.

Shelburne, N., Simonds, N.I., Jensen, R.E. et al. Cancer-related emergency and urgent care: expanding the research agenda. Emerg Cancer Care 1 , 4 (2022). https://doi.org/10.1186/s44201-022-00005-6

Download citation

Received : 11 April 2022

Accepted : 23 April 2022

Published : 14 June 2022

DOI : https://doi.org/10.1186/s44201-022-00005-6

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Emergency care
• Emergency medicine
• Cancer care delivery
• Urgent care

Emergency Cancer Care

ISSN: 2731-4790

• Submission enquiries: Access here and click Contact Us
• General enquiries: [email protected]

Duke Urgent Care

In-person and virtual visits available.

Urgent care provides the quick evaluation and treatment you need when you experience a minor illness or injury. If you have a life-threatening illness or injury, call 911.

In-Person Care

• We encourage you to use On My Way  to find the shortest, estimated wait times and reserve your spot at  Duke Urgent Care clinics  across the Triangle. We don’t offer urgent care reservations by phone but using the online tool can shorten your wait time and expedite the check-in process. Select the location that meets your needs, and let us know when you will arrive. Walk-ins are always welcome.
• Most Duke urgent care centers are open from 8:00 am - 8:00 pm, 7 days a week, 365 days a year. Scroll down to view wait times, pick a clinic, and use the On My Way tool to reserve your spot.

Virtual Care

• Schedule a  virtual primary care and urgent care  visit through My Duke Health (previously Duke MyChart). A virtual visit is covered by insurance as a primary care visit. Co-payments, co-insurance, and deductibles apply.
• Use  Duke Health Anywhere  after hours. Visits cost $59.

Schedule a video appointment with a Duke provider and receive care for a minor medical concern from the comfort of your home. A My Duke Health account is required. Insurance is accepted.

Why Choose Duke

Fully Equipped to Meet Your Needs Every Duke urgent care center has on-site laboratory and x-ray services to diagnose, treat, and manage urgent medical conditions and minor trauma.

On-Site Pediatricians at Select Duke Urgent Care Centers A licensed pediatric specialist is available at  Duke Urgent Care Brier Creek  and  Duke Urgent Care Croasdaile  seven days a week and is dedicated to treating younger patients, from newborns up to 25-year-olds.  View wait times .

Orthopaedic Urgent Care You can receive immediate care for an injury at  Duke Sports Injury and Orthopaedic Urgent Care at Arringdon . You'll get fast service with no unnecessary exposure to sick people.

Sports Physicals Our providers perform sports physicals . Duke Urgent Care no longer performs Department of Transportation (DOT) physicals.

Access to Duke Primary Care Doctors If you need a primary care doctor to follow up on your urgent care visit, our primary care clinics are located throughout the Triangle.

Referrals to Specialists If you need specialty care, we can direct you to specialists who are ranked among the best doctors in the country. As part of a nationally-ranked medical center, our specialists have access to the latest research, technology, and medical advances, many of which were discovered at Duke Health.

Our secure website makes it easy for you to schedule appointments, pay your bills, and send a message to your doctor’s office when you have non-urgent medical needs. If you would like to sign-up for My Duke Health, you need an activation code. To receive one, you can call us at 919-620-4555, ask your doctor at your next appointment, or request an activation code by visiting this page and clicking the Sign-Up Online button.

• Career Center
• Member Login

Research Suggests Urgent Care Centers Reduce Health Care Costs by Providing Alternative to Emergency Department

A new study published in HSR, an official journal of AcademyHealth, found that urgent care centers reduce costly emergency department (ED) visits, especially in areas with long ED wait times as well as among Medicaid enrollees and the uninsured.

Urgent care centers could substantially improve health care access and reduce costs, but few studies have estimated their effect on emergency department (ED) demand. This is important because care in these freestanding, non-emergency facilities is 10 times less expensive than the ED and previous research found that an estimated 36 million ED visits could be shifted to urgent care centers. One challenge in examining a causal relationship between urgent care centers and ED use is the lack of reliable data on the years that urgent care centers opened or closed in a given area.

A new study published this month in the journal HSR takes a novel approach to this issue by shifting the focus from years open to daily operating times of urgent care centers. In this way, the authors were able to find out how ED demand changes when they are open or when they are closed. Drawing from data on almost all urgent care centers in the U.S. and the largest collection of all-payer, encounter-level U.S. ED visit data , the study included 8.5 million visits made across six states from 2012 to 2013.

The team, led by Lindsay Allen, Ph.D., M.A., of Northwestern University, found that urgent care centers reduce costly ED visits, especially in areas with long ED wait times, and among Medicaid enrollees and the uninsured.

Across the six states studied, researchers found that the existence of an urgent care center in a zip code reduced the number of ED visits by about 17 percent. Multiplying the difference in costs between the two settings, the authors estimate that urgent care centers save about $3.3 billion annually. However, they note that this number does not consider other ways in which urgent care centers might offset those savings by, for example, encouraging new health care use or acting as a substitute for lower-cost primary care clinics.

The researchers also examined the results from the EDs with the longest wait times and found that urgent care centers reduced the number of visits to these EDs by nearly 80 percent. This finding has implications beyond the reduction of cost as shifting less urgent cases away from crowded EDs may relieve adverse outcomes such as increased mortality, hospital length of stay, and medication errors.

Researchers noted that the largest impacts of urgent care centers occurred among Medicaid enrollees and the uninsured. This is particularly noteworthy as these two groups use the ED for non-urgent conditions at higher rates, often because of insufficient access to other care settings, pointing to opportunities to both reduce health care costs and provide additional care access. Finally, using an algorithm to classify the urgency, preventability, and optimal care site of ED visit, the team found the largest reduction in non-urgent visits, which decreased by more than a quarter (27%), suggesting that urgent care centers are acting as an ED substitute during their hours of operation.  

Results of the study point to opportunities for greater investments in urgent care centers as a means of improving access to care and reducing health care costs, especially among patient populations that are more vulnerable to access barriers.

For more information on this study, please contact Lindsay Allen at [email protected].

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• J Gen Intern Med
• v.37(4); 2022 Mar

Delivering Urgent Care Using Telemedicine: Insights from Experienced Clinicians at Academic Medical Centers

Natalie laub.

1 Division of General Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA USA

2 Center for Pediatric Clinical Effectiveness and Policy Lab, The Children’s Hospital of Philadelphia, Philadelphia, PA USA

3 Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA USA

Anish K. Agarwal

4 Penn Medicine Center for Health Care Innovation, Philadelphia, PA USA

5 Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA USA

6 Department of Emergency Medicine, Perelman School of Medicine at the Hospital of the University of Pennsylvania, Philadelphia, PA USA

Catherine Shi

7 Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA USA

Arianna Sjamsu

8 New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY USA

Krisda Chaiyachati

Care delivered using telemedicine has been steadily growing in the USA but represented a small fraction of overall visits before the COVID-19 pandemic as few clinicians had been providing care using telemedicine. Understanding how experienced clinicians have practiced telemedicine can help guide today’s exponential adoption of telemedicine.

The objective of this study was to explore barriers and facilitators to providing effective, high-quality urgent care using telemedicine (“tele-urgent care”) from the perspective of clinicians experienced in telemedicine.

We conducted semi-structured interviews between July 2018 and March 2019 of clinicians who had been providing tele-urgent care services to patients as a part of their routine clinical practice. Themes were identified using content analysis with a constant comparative coding approach.

Key Results

Among the 20 clinicians interviewed, the majority were female (90%) and nurse practitioners (65%). We identified four themes related to barriers and facilitators to providing effective, high-quality tele-urgent care. Workplace factors such as a strong information technology (IT) infrastructure, real-time IT support, an electronic health record, and a collegial work environment, often virtual, were necessary standards. Communication and exam techniques from in-person encounters were adapted to tele-urgent care including active listening skills and teaching patients to conduct specific exam maneuvers virtually. The convenience of tele-urgent care should be preserved to support improvements in access to care. Finally, patients and clinicians occasionally had mismatched expectations about what could or would be provided during a tele-urgent care encounter. Managing the added tension that can occur during a telemedicine encounter was important.

As telemedicine becomes an integral part of the care continuum, incorporating and accounting for these key insights when we train and support clinicians will be necessary to provide effective, high-quality care to patients in the future.

INTRODUCTION

Care delivered using telemedicine—virtual visits connecting patients and clinicians through videoconferencing—has been steadily growing in the USA but represented a small fraction of overall visits as few clinicians were historically offering telemedicine to their patients. 1 , 2 In March 2020, the novel coronavirus (COVID-19) pandemic resulted in federal and state de-regulation of telemedicine policies to help facilitate health care’s accelerated shift towards telemedicine to prevent viral spread and maintain access to care for patients where in-person outpatient practices were limiting who could be seen in-person. 3 – 5

The monumental transition of the US health care system towards telemedicine has been and will continue being a challenge for clinicians. A national survey of chief executive officers of US health care systems indicated that 38% of health systems had no digital health strategy in 2019. 6 Even in health systems with digital health strategies, greater investments in technology infrastructure will be required to support clinicians with higher volumes of telemedicine visits, local information technology (IT) expertise to support their ongoing technical needs, and clinicians will need to develop proficiencies and clinical skills when caring for patients using telemedicine. While not all clinicians have historically used telemedicine, some academic medical centers have clinicians who adopted telemedicine early on. Understanding how experienced clinicians have practiced telemedicine can inform how we train and support clinicians who adopt telemedicine into if they are to provide high-quality, safe, and evidence-based care. 7

The objective of this study was to identify barriers and facilitators to providing effective, high-quality urgent care using telemedicine (“tele-urgent care”) from the perspective of clinicians experienced in telemedicine.

Study Participants and Setting

We conducted in-depth, semi-structured interviews of clinicians who provided direct-to-consumer, real-time (“synchronous”) telemedicine as a substitute for in-person urgent care appointments at primary care practices or dedicated urgent care clinics (“tele-urgent care”). Tele-urgent care clinicians were purposefully interviewed because tele-urgent care has been commonly employed as a strategy to compete with surrounding urgent care and retail health clinics. 8 During the study period, few primary or specialty care clinicians had adopted telemedicine due to restrictive payment policies at the state and federal levels. 9

Participants were recruited from academic medical centers between July 2018 and March 2019 using multiple approaches: direct emails, phone calls, and the email listserv for the American Telemedicine Association’s Academic Medical Center Group. Snowballing techniques were used to identify clinicians who delivered tele-urgent care by asking participants if they knew of other academic medical centers delivering tele-urgent care. Eligible participants included physicians, nurse practitioners, or physician assistants who provided tele-urgent care for either or both adult and pediatric patients. Participants were compensated $50 USD for their time.

Interview Guide Development

We created a semi-structured, open-ended interview guide (see appendix A) designed to identify barriers and facilitators to providing tele-urgent care. The guide was initially created by authors NL, AKA, and KC. The interview guide was reviewed and pilot tested with two colleagues specializing in qualitative research. It was revised based on this feedback. It was then pilot tested with the first two participants. Pilot testing did not identify any significant content issues, so the guide was not revised any further. Questions were open-ended and included follow-up probes to allow for participants to expand upon answers as needed. Questions included “What do you think are the limitations of providing care via telemedicine?”; “Describe your experience of providing care through telemedicine.”; “What do you imagine are the skills necessary to be a good telemedicine provider?”; and “Describe what you think is different about telemedicine versus in-person care.” Demographic data, including age, gender, race, specialty, occupation, and years in clinical practice were collected from study participants at the completion of each interview.

Data Collection

Semi-structured interviews were conducted in person or over the phone by three study team members (NS, CS, AS). Interviewers received training from an experienced qualitative methods researcher (NS). Training included meetings to develop and refine the interview guide, direct observation of two interviews, and feedback to enhance the quality of interviews. Interviews lasted approximately 30 min.

Data Analysis

Interviews were recorded, professionally transcribed, and subsequently coded and analyzed in NVivo 12.0 (QSR International). The interview content was analyzed using the constant comparative coding approach. 10 – 12 We began our analysis with codes aligned to the interview guide. During the coding process, we labeled sections of transcripts with the established codes. Three study team members (NS, CS, AS) coded the first four transcripts and developed consensus definitions for codes. Two more transcripts were coded by the study team (NS, CS, and AS), resulting in 30% of the interviews being triple-coded. Initial transcripts were re-coded based on emerging themes and final revisions were made to the code definitions. The study team met regularly to examine results and inter-rater reliability, resolving coding disagreements by consensus and clarify code definitions. Records were kept of decisions to ensure consistency in coding. The average inter-rater reliability was 0.74 with a range of 0.59–1.00, noting excellent reproducibility. 13 Sections of the interview transcripts representing the study’s main objectives were reviewed to discover additional emerging themes and identify representative quotations. All study protocols and instruments were reviewed and deemed exempt by the University of Pennsylvania’s Institutional Review Board.

A total of 20 clinicians from academic medical centers in the Northeast, Midwest, and South were interviewed prior to thematic saturation. Ninety percent were female, 61% were White, 90% practiced in the Northeastern portion of the USA, 50% specialized in family medicine, 65% were nurse practitioners, 30% were physicians, 5% were physician assistants, and the average number of years (SD) in clinical practice was 9.7 (9.2) (see Table ​ Table1). 1 ). Four major themes were identified and are listed below (see Table ​ Table2 2 ).

Characteristics of Population Interviewed

Themes and Illustrative Quotes

Theme 1: Workplace Factors Can Promote the Delivery of High-Quality Care

Workplace factors consisted of system-level factors that were essential for providing high-quality care, including (a) reliable videoconference technology with real-time IT support; and (b) easy access to the electronic health record (EHR) to review patients’ medical history and communicate with other clinicians, either when consulting or to hand off patients’ care needs. The need for reliable videoconference technology with real-time IT support was described in the following ways,

I’ve only had one frustrating experience because of the video. The patient couldn’t see me…we didn’t know how to fix the problem.

There needs to be an [IT] person ingrained into the team because, and an IT person that understands all the intricacies of the connection. When our IT guy was on vacation, the other people had no idea, they didn’t understand all the pieces

The need for easy access to the electronic health record was highlighted here,

Truthfully [tele-urgent care] the easiest visit in the world, in an office visit there are so many buttons to click and 12,000 things you have to do before you can sign a chart. In tele-urgent care charting is so easy, you don’t need 25 minutes, you report the complaint, the diagnosis and the plan, then sign the chart.

Most clinicians highlighted the need to feel connected. This was described in two ways. First, clinicians believed a supportive clinical team environment was necessary, even if other colleagues or administrators were remote or virtual. Clinicians relied on other colleagues to review cases and felt more confident in their medical decision-making when they could discuss cases with others. Similarly, clinicians wanted to feel connected to the larger health care system. Second, even in a tele-urgent care model, where continuity of care may be disrupted with individual primary care clinicians, clinicians felt patients needed to have continuity of care within the larger care network. The EHR was used to electronically communicate patient visits and clinical decision-making to patients’ primary care provider or specialists, if they were using the same EHR.

Theme 2: Clinicians Adapted Communication and Exam Techniques from In-Person Care to Tele-urgent Care Encounters

The need for developing virtual competency by using lessons from in-person care was frequently discussed. Clinicians suggested that core competencies in virtual care were important and essentially learned skills, as none received any formal training prior to providing care through telemedicine. To develop these skills, many clinicians reported the importance of having prior in-person clinical experience before practicing tele-urgent care, such as,

In order to do telemedicine, you have to have experience. You have to feel very comfortable diagnosing or doing certain things such as going to the emergency room. Not having experience could make it very daunting.

In telemedicine my skills have to be sharp enough that by just looking at the patient, observing, hearing the history I can determine if they are sick, not sick, if they need to be treated right now or if they can try things at home.

Giving the patients time to express their concerns while displaying intentional and active listening was also identified as essential to achieve a high-quality virtual visit. Clinicians were more attune to these needs during a telemedicine encounter, as highlighted by the following,

Be a good listener, give the patient time to talk. Don’t put words in their mouth. I had to learn this because I am a talker. I would be like ‘is the pain dull’ and I would be putting words in their mouth and that’s really not what you want to do.

Based on prior in-person care experiences, clinicians believed the essential skills needed to provide effective virtual care included non-verbal cues (e.g., body language) and the creative capacity to help aid patients in examination techniques.

I use my body as a model. I demonstrate (lifting arm) because I can’t do it for them. I show them on my body and ask, ‘okay you have a pain here does it go down to here.’

I had a woman palpate her own abdomen…I was like ‘I’m really sorry to tell you this but you likely have acute appendicitis and need to go to the ED.’ She was in the OR within 2 hours.

In addition, clinicians identified the need to exhibit confidence when they had made a clinical decision because patients might be questioning their diagnosis or escalation plan because of the virtual platform. Finally, because time spent examining patients was reduced in the virtual environment, time could be substituted by longer, more in-depth education and counseling relative to what the clinician would have provided during an in-person encounter.

Theme 3: the Convenience of Tele-urgent Care Was Beneficial to Patients

From the clinicians’ perspectives, the convenience aspect of tele-urgent care made it an important delivery option because patients benefited from better access to care. Patients could avoid the time inconvenience of seeking an in-person visit as described here,

In our school telemedicine program, parents don’t have to take off work, we are able to see them and treat them so that is a huge benefit for our patients.

Patients gain convenience, they don’t have to leave their home, maybe they’re calling at 2 am, and maybe transportation is an issue, maybe cost.

The ability to provide timely reassurance to a patient or family was an important aspect of quality which tele-urgent care facilitated. Clinicians provided a number of examples where patients were at home worried, such as,

Number one they gain some reassurance… [Parents] are really concerned about their child and they want someone just to look at them. So, I think that’s truly the best part of telemedicine.

When conditions could be managed virtually, the convenience of tele-urgent care had the potential to reduce patient’s health care costs (e.g., co-pays for some in-person visits).

Sick visits are sometimes just so silly, when I have to see them in the office. I’m like ‘yea you have poison ivy.’ That you (the patient) have to come in, pay a co-pay and have me look at it to confirm, seems silly sometimes. Telemedicine would eliminate a lot of that.

Theme 4: Mismatched Expectations between Patients and Clinicians Resulted in Added Tension during the Clinical Encounter

Clinicians perceived added tension during some telemedicine encounters because of mismatched expectations between them and patients. Clinicians believed that the convenience of using telemedicine carried over to patients’ expectations to receive prescriptions or diagnostic testing more easily, as expressed here,

“I think sometimes with the virtual visit it feels kind of consumeristic, meaning I paid for this visit, I expect to get something out of it. Meaning a prescription.

Before I contact the patient, I’m thinking to myself, ‘Oh god, what if I don’t think they need an antibiotic, and this becomes an argument?’

Clinicians highlighted the perception that patients were looking for quick fixes and instant gratification.

It’s a world of instant gratification now, with everything at our fingertips. I think people are pleased that telemedicine is available, and we feel it as clinicians. For me I can hear the satisfaction in their voice. We live in a busy world where everyone is multi-tasking.

The consumerism experienced by tele-urgent care clinicians resulted in many having to develop routinely used skills when navigating the tension between providing evidence-based care, while not wanting to disappoint patients. Many clinicians began to routinely emphasize to patients that they wanted to do what was best for the health of the patient, even if that meant they were not going to meet the patient’s expectations.

As health systems integrate telemedicine into how they deliver care today and beyond, supporting and training the current workforce to be skilled at telemedicine while achieving quality, safe, and evidence-based care will be important. Perspectives and lessons from more experienced telemedicine clinicians can help guide how health systems, educators, and medical societies approach this challenge. In our qualitative study of experienced clinicians, we identified four key facilitators and barriers to delivering tele-urgent care.

First, workplace factors such as a strong information technology (IT) infrastructure, real-time IT support, an electronic health record, and a collegial work environment are necessary standards. Health systems and administrators need to adequately invest in infrastructure (e.g., high-speed broadband and hardware) to support the technical requirements for a high-quality videoconference encounter. While our study is from the perspective of the clinicians, we recognize that telemedicine is a dyad interaction between clinicians and patients. Even if the clinicians have access to the right technology, patients may not. Closing this technology gap will be important especially as we try to reduce disparities in care experienced by low-income and minority patients. Real-time IT support was frequently emphasized. Many of the clinicians interviewed staffed tele-urgent care after hours. Having accessible IT support for virtual support beyond regular business hours will important to maintain patient satisfaction and ensure effective clinical care.

Administrators and managers need to create a team-like atmosphere and foster connections between colleagues even in a virtual practice. Clinicians commented that clinical and collegial support were necessary for effective patient care and was tied to their satisfaction as a tele-urgent care clinician. At a broader systems level, tele-urgent care programs should be integrated within the greater health care system or care network to simplify referrals and streamline communications between tele-urgent care clinicians and primary care providers or specialists. The EHR facilitated these communications.

Second, communication and exam techniques can be adapted to tele-urgent care from in-person encounters. Active listening skills were used by all clinicians when caring for patients. While active listening is vital for fostering a therapeutic relationship during in-person encounters, patients may have a higher awareness of the clinician’s body language during telemedicine encounters. Most videoconferencing technology only allows the patient to visualize the clinicians head to their upper torso. Therefore, patients may be increasingly critical if clinicians look away from the camera, even if the clinician is reviewing the patient’s medical record on an adjacent screen. The videoconference setup limits the patient’s ability to contextualize what the clinician is doing when not maintaining eye contact with the camera. Changing clinicians’ body language or eye movements will require frequent feedback from patients, simulated patient experiences, and self-awareness. Facilitating these changes is seemingly basic but will likely be important for generating positive patient experiences.

Clinicians commonly had patients replicate exam maneuvers that would guide decision-making, including abdominal examinations and active range of motion maneuvers for joints. While clinicians universally recognized that exam options were limited and vital signs were more difficult to collect, clinicians strived to gather as much information as possible to guide the patient’s next steps such as watch and waiting or proceeding to the emergency department. Training clinicians to be comfortable with what is possible and impractical during telemedicine encounters will be important if telemedicine is to be used effectively.

Third, clinicians in our study overwhelmingly felt that the convenience of tele-urgent care was beneficial to patients and should be maintained. Telemedicine provided access to care that patients expressed having struggled with in the past. Patients could avoid time spent traveling or higher co-pays in emergency department settings when conditions could be managed using tele-urgent care. At the same time, clinicians recognized tradeoffs that occurred when providing a more convenient form of care. Patients may seek advice for conditions they might not have seen a provider for in the first place. For the clinicians we interviewed, the benefits of convenience outweighed the costs of overuse. Should health systems and payers create more barriers to care, the gains in access that patients achieve through tele-urgent care may be lost and preserving access to care was felt to be an important principle to uphold.

Fourth, telemedicine visits were occasionally perceived as confrontational. Clinicians were acutely aware of “pressure” from patients to prescribe medications such as antibiotics, and clinicians worried about dissatisfying patients. The risk of dissatisfaction was felt highest among patients that were technologically savvy and were more likely to prefer more convenient care options. The experience of these clinicians may reflect a higher proportion of telemedicine users preferring an informed or consumerism style of clinical decision-making, as opposed to patients who prefer shared decision-making or paternalism. 14 Patients who prefer consumerism can be as high as 28% of patients and is characterized as patients who do not often deliberate treatment options with clinicians and independently choose which treatment plans should be implemented. 15 Patients using tele-urgent care may be more likely to represent patients who prefer a consumerism approach to clinical decision-making.

At the same time, clinicians want patients to be satisfied with their encounter and face pressures to practice evidence-based medicine. The countervailing forces of patient preferences and clinicians’ desires to achieve high patient satisfaction may partly explain the high rates of inappropriate antibiotics prescribed among tele-urgent care clinicians. 16 – 18 Health care systems and clinicians should consider structured, guideline-driven approaches to support clinical decision-making within tele-urgent care practices. Effective examples include evidence-based contraceptive prescribing practices using direct-to-consumer telemedicine approaches. 19 Behavioral economic principles could be tested through nudges and default options when managing common conditions encountered in tele-urgent care with the goals of reducing overprescribing of clinically inappropriate medications and unnecessary testing. While understanding how to implement, monitor, and enforce evidence-based practice is universally important for in-person and virtual encounters, tele-urgent care clinicians may face unique pressures if patients are more likely to prefer a consumerism style of decision-making. Therefore, clinicians will benefit from greater training and practice working with patients who prefer a consumerism approach to care.

Limitations to our study include selection bias. Clinicians who enjoy using telemedicine were most likely to agree to participate and early adopters of telemedicine are likely to be positive about their early telemedicine experiences. The participants interviewed here likely represent early adopters within academic medical centers and thus may have represent a cohort of clinicians who fundamentally support health care’s shift towards virtual care and have greater interests in seeing virtual care expand. Therefore, they may be less critical of virtual care. Late-adopters or non-adopters were not interviewed in this study. The sample of clinicians was limited to employees at large academic medical centers prior to the COVID-19 pandemic, limiting the generalizability of our findings to today’s clinicians. Additionally, these larger centers may have more experience in deploying telemedicine and resources to support staff and IT which may bias the sample. While the sample size may be perceived as small, extensive efforts to identify additional clinicians for interviews were employed and thematic saturation was reached. Despite these limitations, we feel that the perspectives of a diverse set of clinicians providing tele-urgent care is an important contribution to the limited literature and provide important, universal insights for clinicians who are learning how to deliver high-quality telemedical care.

Clinicians with experience providing tele-urgent care identified key areas which promote quality care including workplace factors such as a strong technology infrastructure, adapting communication and exam techniques from in-person encounters, preserving tele-urgent care’s convenience, and managing to adhere to evidence-based treatments despite potential mismatched expectations from patients. Health systems, educators, and medical societies should use these insights to guide how they educate, train, and equip clinicians to provide quality, safe, and evidence-based care using telemedicine. Understanding how best to deliver care using telemedicine will serve today’s clinicians and guide health care’s future.

Authors’ Contributions

KC and AA conceived and designed the study. KC obtained grant funding. KC, AA, and NL supervised the conduct of the trial and data collection. KC and AA undertook recruitment of participating centers and participants. KC, AA, NK, CS, and AS managed the data, including quality control. KC, AA, NL, CS, and AS provided statistical advice on study design and analyzed the data. NL drafted the manuscript, and all authors contributed substantially to its revision. All authors take responsibility for the paper as a whole.

Eisenberg Scholar Research Award from the University of Pennsylvania’s Robert Wood Johnson Clinical Scholars Program.

Compliance with Ethical Standards

All authors have no conflicts of interest to report.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.