Nurse-Led Visits Reduce In-Person Referral From Urgent Care Telehealth.

Document Type

Article

Publication Date

2-1-2026

Identifier

DOI: 10.1097/PEC.0000000000003501

Abstract

OBJECTIVE: To evaluate the impact of nurse-led visits on in-person referrals for clinical evaluation from pediatric urgent care telehealth.

METHODS: We conducted this quality improvement study within our 3 freestanding in-person pediatric urgent care clinics and telehealth service. In May 2022, we implemented nurse-led visits to offer diagnostic and therapeutic interventions including rapid group A streptococcal testing, urinalysis, respiratory viral testing, and intramuscular antibiotic injections without requiring an additional clinical evaluation following a telehealth encounter. We measured the percentage of telehealth encounters with in-person referrals as the primary outcome. We tracked the percentage of encounters with nurse-led visits and return visits within 72 hours as process and balancing measures, respectively. We used control charts to identify special cause variation over time.

RESULTS: In-person referrals following telehealth visits decreased from 23.0% to 12.3% after implementing nurse-led visits. The use of nurse-led visits increased over time from 4.0% to 6.8%. Rapid group A streptococcal testing accounted for most nurse-led visits (64.0%). Only 2.8% of nurse-led visits resulted in return visits within 72 hours. Nurse-led visits were associated with shorter length of stays (32 min) compared with in-person clinical evaluations (69 min) and had an average cost-savings of $135 compared with visits of similar medical complexity.

CONCLUSION: Integrating nurse-led visits into urgent care telehealth encounters provides a safe and effective option for diagnostic and therapeutic interventions in the virtual setting. The results support the use of nurse-led visits to expand access to high-quality acute care, reduce unnecessary referrals, and promote evidence-based practice.

Journal Title

Pediatric emergency care

Volume

42

Issue

2

First Page

114

Last Page

120

MeSH Keywords

Humans; Referral and Consultation; Telemedicine; Ambulatory Care; Quality Improvement; Child; Male; Female; Child, Preschool; Infant; Practice Patterns, Nurses'; Adolescent

PubMed ID

41177995

Keywords

antibiotic stewardship; diagnostic stewardship; group A streptococcal pharyngitis; influenza; nursing; quality improvement; referrals; strep throat; telehealth; urgent care; urinary tract infection; value-based care; viral testing

Link to Full Text
Library Record

Share

COinS