Impact of pediatric urgent care clinics on emergency department utilization and patient flow: a pre-post cohort study in Saudi Arabia.

Abstract

Background: Pediatric emergency departments (PEDs) frequently experience overcrowding, much of it related to low-acuity visits that may be manageable in outpatient settings. Pediatric Urgent Care Clinics (PUCCs) have been introduced to help accommodate such demand, but evidence from the Gulf region remains limited.

Objectives: To evaluate changes in PED utilization, acuity mix, and patient-flow indicators following implementation of a PUCC at the Maternity and Children's Hospital in Alahsa, Saudi Arabia.

Methods: We conducted a retrospective pre-post observational cohort study using electronic health record data from October 2023 to June 2024 (pre-implementation) and October 2024 to June 2025 (post-implementation). Variables included Canadian Triage and Acuity Scale (CTAS) level, timestamps for triage, physician start, and discharge, and demographic characteristics. Outcomes included PED visit volume, acuity distribution, door-to-doctor time, and length of stay (LOS). Continuous variables were summarized using medians with interquartile ranges (IQRs) and 5% trimmed means; categorical variables were compared using chi-square tests, and effect sizes for binary outcomes were expressed as risk ratios (RRs) with 95% confidence intervals.

Results: A total of 147,175 PED encounters were analyzed, including 84,595 in the pre-implementation period and 62,580 in the post-implementation period. In the post-implementation period, an additional 24,962 encounters were managed in the PUCC. The proportion of low-acuity PED visits (CTAS 4-5) decreased from 81.1% to 50.2% (RR 0.62; 95% CI 0.61-0.62; p < 0.001). Mean daily PED encounter volume declined from 308.7 to 229.2 encounters/day (incidence rate ratio 0.74; 95% CI 0.74-0.75; p < 0.001). Median door-to-doctor time was 37 min (IQR 22-63) before implementation and 39 min (IQR 22-65) after implementation, while median LOS increased from 62 min (IQR 34-112) to 76 min (IQR 43-131) (p < 0.001 for distributional comparisons).

Conclusion: Implementation of a PUCC was associated with lower PED visit volume, a reduced proportion of low-acuity PED encounters, and a small absolute difference in door-to-doctor time, while PED LOS was longer in the post-implementation period. These findings suggest that a PUCC model may help redistribute lower-acuity pediatric encounters within a hospital-based urgent and emergency care system. Further studies are needed to evaluate safety outcomes and to better account for operational confounding.