Evaluation of the Impact of a Pediatric Urgent Care Center in Reducing Non-Emergent Emergency Department Visits in Singapore

OBJECTIVES: The Children’s Urgent Care Clinic (CUCC) @ Bukit Panjang is a community-based pilot by the National University Hospital in Singapore which aims to optimise healthcare resources by redirecting non-emergent paediatric cases (up to 18 years old) away from tertiary Children’s Emergency (CE) care towards the CUCC. This evaluation assesses the effectiveness of the CUCC in reducing non-emergent paediatric attendances from the CEs using a difference-in-difference approach.

METHODS: We conducted a difference-in-difference (DID) analysis to evaluate the CUCC's effectiveness in reducing non-emergent CE cases. To measure this reduction, we hypothesised that only patients residing near the CUCC would modify their CE utilisation behaviour. As geospatial analysis showed that about 90% of CUCC patients resided within an 8-km radius of the CUCC, we defined the treatment group as the postal codes of Singapore Residents aged 0-17 years who lived within 8km of the CUCC and the control group as the postal codes of those Singapore Residents aged 0-17 years residing outside of this 8km radius. The DID approach of estimating the treatment effect involved comparing changes in per-capita non-emergent CE visits before and after the CUCC's establishment between regions near the CUCC (the treatment group) and regions farther away (the control group). The first half of 2019 and the first half of 2022 were determined as pre-CUCC implementation and post-CUCC implementation respectively.

RESULTS: The DID showed that the CUCC resulted in an estimated daily reduction of 14 daily non-emergent paediatric CE attendances nationally in the first half of 2022, which accounted for 6% of daily historical non-emergent national CE attendances.

CONCLUSIONS: The pilot has been successful in right-siting non-emergent CE cases to the CUCC. Further monitoring and evaluation will be essential to assess the long-term impact and sustainability of CUCC in the broader context of paediatric urgent care in Singapore.