Urgent Care to ER

Arrival and Check-in at Urgent Care

  • Patient arrives within the designated 30-minute time frame and notifies the front desk of their arrival.
  • If the patient didn’t use the My Memorial app, they wait in line for walk-in registration.
  • Patient provides identification and insurance details (photo ID and insurance card required).
  • Staff manually complete registration forms due to the absence of an online registration system.
  • Staff enter patients’ information into a tracker system, manually verifying incomplete data.
  • Patient waits in the lobby for their name to be called.

Triage Assessment and
 Initial Clinical Evaluation

  • Triage nurse evaluates patients, documenting symptoms, vital signs and medical history.
  • Urgent care provider calls patients into a treatment room where the provider performs an initial evaluation. This includes symptom checks, a physical exam and any necessary testing (e.g., swabs or basic lab work).
  • Patient’s condition is categorized as urgent, nonurgent or emergent based on triage protocols.
  • Provider determines whether the patient requires additional care that cannot be performed in urgent care setting, such as advanced imaging or specialized diagnostics (e.g., CT scans or Doppler studies).

Decision and Coordination
for ED Transfer

  • Based on the assessment, the urgent care provider decides the patient needs to be sent to the ED for further treatment.
  • Provider identifies the specific reason for the transfer (e.g., need for advanced imaging, surgical evaluation or specialized care, such as cardiology).
  • If the case is critical (e.g., chest pain), the provider contacts the ED directly via phone to provide a verbal handoff and alert the ED team about the incoming patient.
  • For Memorial-affiliated EDs, electronic records are available in Cerner, including notes, diagnostic test results and medications.
  • An ambulance is requested, and paramedics are briefed on the patient’s status upon arrival.
  • The ambulance team stabilizes the patient if needed and transports them to the designated ED.
  • For nonurgent cases (e.g., suspected abdominal pain), the provider informs the patient and their family of the need to visit the ED. Transportation is typically self-arranged.
  • Patients are able to choose which ED they prefer to visit. In cases where it is not a Memorial-affiliated ED, a packet of patient information is sent with them.
  • The patient is informed of the need for transfer and the reasoning behind it, with instructions on the next steps.
  • Family/caregiver is informed of patient’s pending transfer.
  • A packet of lab or imaging results is sent with the patient to help ensure no unnecessary duplicate testing occurs at the ED.

ED
Admission

  • Patient arrives at the ED and provides identification and insurance information to the front desk.
  • For noncritical cases, the patient waits in the lobby until triage nurses call them for evaluation. Critical cases are brought directly to the ED bay.
  • ED staff reevaluate the patient using triage protocols, repeating vital signs and gathering additional history as needed.
  • Diagnostic tests, such as imaging or blood work, are prioritized based on the severity of the condition.
  • Patient undergoes advanced diagnostic testing, such as CT scans, MRIs or lab work, depending on the presenting symptoms.
  • If needed, specialists (e.g., cardiologists, neurologists) are consulted for further evaluation and treatment.
  • If the ED is Memorial-affiliated, findings and treatment plans are recorded in Cerner, making them accessible to the urgent care provider for follow-up.
  • Staff have discussions with the patient about referral to a PCP for continuity of care.
View Technology Map

Step

Technology/Touchpoints
Arrival and Check-in at Urgent Care
  • Tracker System
  • Cerner
  • Cerner FirstNet (Urgent Care EMR Module)
Triage Assessment and
 Initial Clinical Evaluation
  • Cerner PowerChart
Decision and Coordination
for ED Transfer
  • Cerner FirstNet
  • Phone
  • Memorial Health Website
ED
Admission
  • Cerner
  • Spectralink Device
  • Symplr
  • Manual Data-entry Tools
  • External Diagnostic Platforms (General Systems)

Step

Pain Points
Arrival and Check-in at Urgent Care
  • Patients without app reservations create long physical queues at urgent care facilities.
  • Walk-in patients face a slower, less efficient registration process compared to app users.
  • All patient information must be entered manually into the tracker system.
  • Patients often arrive with missing or outdated documents that are required for registration.
  • Patients cannot complete registration forms online before arriving.
  • Limited staff availability causes delays in triage and patient care.
  • No technology exists to automate or accelerate triage evaluations.
Triage Assessment and
 Initial Clinical Evaluation
  • All triage is completed manually, relying on nurses and providers to gather and interpret patient data without technological aids, like symptom-checking software.
  • Records created in Cerner are available to PCPs, but the system does not create a task or automatically connect patients’ records to the PCP. This means most PCPs are unaware their patients went to an ER for care.
Decision and Coordination
for ED Transfer
  • Real-time data sharing between urgent care and non-Memorial affiliated EDs is not available.
  • Ambulance teams depend on verbal summaries during transfers.
  • Patients receive minimal guidance for next steps upon transfer to the ED during a high-stress time.
  • Noncritical patients are expected to arrange their own transportation.
  • Verbal communication is the primary method for critical case handoffs.
ED
Admission
  • ED wait times can increase patient frustration, especially if patients are unclear where they stand “in line.”
  • Information that has already been provided at the urgent care is needed again when arriving at the ED.
  • Patients must use separate portals for primary care and hospital records to access their health information.

Step

Thinking

Feeling

Quotes
Arrival and Check-in at Urgent Care

“Will my reservation help me avoid a long wait?”

“Why am I being asked for this information again?”

“Will they be able to help me quickly?”

Frustrated

Anxious

“The times aren’t accurate on your website it says 7 and 7:30. The door and Google say 8:00.”

“Why don’t we have it geofenced or whatever? Where you come to urgent care, it’s like, ‘We see you’re here. Do you want to check in online and complete all your forms?’ We don’t have anything like that. I can check in ahead of time at my dentist or my vet but not anywhere at Memorial.”

“That’s one of my biggest gripes—we don’t have online registration. It’s all people doing it, which can be a backlog, especially in the mornings during sick season. There’ll be 12 people in line waiting to register for two people.”

“With urgent care, the online booking is actually booking something, but then with primary care, it’s like holding your spot and then may or may not be what you get.”

“I don’t have easy access to internet… had to have son assist for call-ahead scheduling to hold spot 30 minutes. Would be nice if reception desk could also take phone call to do this for seniors who may not use internet regularly.”
Triage Assessment and
 Initial Clinical Evaluation

“I hope they know what’s wrong and I can get out of here quickly.”

Concerned

“I know there’s a lot of cool technology out there that does triage work for you instead of nurses doing it. It would be cool to implement some of those technologies, like symptom checkers, that could help pre-triage patients.”
Decision and Coordination
for ED Transfer

“What is the ED visit going to include? Who do I need to talk to to let them know what’s happening?”

“What does this mean? What is going to happen? How bad is it?”

Scared

Overwhelmed

“Doctor/PA felt bad that I waited this whole time and could not help me with my symptoms because they did not have the equipment. She sent me to ER.”

“The provider I saw that day was great. I explained all my problems to her and she recommended I go to the ER because everything I was saying sounded like my gallbladder … Went to ER and that was exactly the problem.”
ED
Admission

“When will I be seen?”

“How much should I be worried about my condition?”

“What happens after this?”

Scared

Confused

“I was near fainting, going into anaphylactic shock, stumbling through their main door. They were very quick entering my patient info & quickly got me to a room with a huge medical staff on me & called Chatham fire dept to rush me to Memorial ER. They rushed getting IV & blood draws in me & were a miracle. They had to give me EpiPen & I feel all saved my life.”

“There’s not much technology other than if you’re coming from urgent care to the ER, we’re on the same medical record, so they can see everything. At least once you get there.”

“Primary care is on Cerner TouchWorks, but they have some old outdated model that doesn’t talk with the hospitals. Urgent care is the same as the hospitals, but these things don’t automatically flow over.”

Step

Opportunities
Arrival and Check-in at Urgent Care
  • Create a separate check-in queue for app-based spot reservations.
  • Install a display to show the queue status for both app reservations and walk-ins.
  • Enable partial integration of app reservation data into the tracker system to reduce manual entry.
  • Allow patients to complete registration paperwork online before arriving.
  • Provide a digital symptom screener for patients to complete while waiting.
  • Add clear educational content in the app about what to expect during urgent care visits.
  • Allow patients to have a brief telehealth triage session before arriving at urgent care.
  • Develop a system to send real-time queue updates to patients’ phones.
  • Provide self-service kiosks for patients to check in at upon arrival and explore the opportunities that Epic offers.
  • Create a preregistration portal accessible via the web and the My Memorial app.
  • Enable patients to upload photos of IDs and insurance cards through the app.
  • Use automated tools to verify patient insurance eligibility in real time.
  • Provide nurses with mobile devices linked to Cerner for real-time triage documentation.
  • Implement a centralized dashboard to track triage progress in real time.
  • Leverage symptom information collected during preregistration or app use to speed up triage.
Triage Assessment and
 Initial Clinical Evaluation
  • Implement prefilled templates for triage documentation in Cerner PowerChart.
  • Provide patients with a checklist to complete before triage.
Decision and Coordination
for ED Transfer
  • Implement an integrated digital system for urgent care, ambulance transfers and ED to avoid manually relying on verbal or paper transfer of information. The system could include a check with fields for critical patient data, symptoms and initial treatments, ensuring thorough communication with ED staff.
  • Include maps, parking instructions and a checklist of necessary documents (e.g., ID, insurance), ensuring patients arrive prepared.
  • Enable urgent care to share patient data electronically with ambulance teams in real time.
  • Connect telemetry devices used in urgent care with systems accessible to both ambulance teams and ED staff, allowing real-time monitoring of patient vitals.
  • Develop an app feature that guides noncritical patients through the transfer process.
  • Explore opportunities to electronically share patient records with EDs from Memorial-affiliated urgent care/virtual appointments in markets such as Lincoln and Taylorville where they are not on the same EHR.
  • Develop a system for ED staff to send real-time updates back to urgent care providers.
  • Use automation to generate detailed transfer summaries for patients.
  • Develop a secure messaging platform for urgent care and ED providers.
  • Explore opportunities to route urgent care provider messaging to the ED based on physician availability and who will see the transferred patient.
ED
Admission
  • Pre-register referred patients into the ED system.
  • Use AI to assist ED staff in prioritizing patients based on the severity of their conditions.
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