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TEREM Immediate Medical Care. Rechov Ha Mem Gimmel 7. Jerusalem, Israel

PEDIATRIC USE OF A 24 HOUR URGENT CARE CENTER (“MOKED CHERUM”) Deena Zimmerman MD MPH and Nahum Kovalski MD. TEREM Immediate Medical Care. Rechov Ha Mem Gimmel 7. Jerusalem, Israel. Background.

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TEREM Immediate Medical Care. Rechov Ha Mem Gimmel 7. Jerusalem, Israel

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  1. PEDIATRIC USE OF A 24 HOUR URGENT CARE CENTER (“MOKED CHERUM”)Deena Zimmerman MD MPH and Nahum Kovalski MD. TEREM Immediate Medical Care. Rechov Ha Mem Gimmel 7. Jerusalem, Israel

  2. Background Published statistics show that one in four children in Israel are referred on an annual basis from the community to a hospital based emergency department (ED)1. The overall number referred to urgent care centers (mokdim) nor the care delivered in such settings has not been reported in the literature. This study relays one year’s usage by children of one such emergency care facility. [1] Ben Arieh AB, Danon YL. Epidemiological trends of pediatric emergency referrals in Israel. Isr Med Assoc J. 2001 Mar;3(3):231-2.

  3. Materials and Methods TEREM is a privately owned company, with financial arrangements with each of the health funds, that establishes and manages free standing emergent care clinics. TEREM’s central clinic, located near the entrance to Jerusalem, is open 24 hours per day, 365 days per year. Physicians are on site at all hours – ranging in number from 2 -7 depending on expected usage during those hours. There are on site radiology and laboratory services also available 24/7. TEREM uses an in house developed computer system known as PARPAR to register, clinically manage and administer all visits to the clinics. This study reports on recorded demographic data and doctor-specified diagnoses for the calendar year of 2005 for this one clinic.

  4. Results The total number of visits in 2005 was 100,149. Children up to age 18 represented 41% of the total. The distribution of leading diagnoses by age is presented in Table 1.

  5. Age Breakdown by Shift Eve Shift 18:00 – 00:00 Day Shift 08:00 -18:00 Night Shift 00:00-08:00

  6. Table 1. Leading Diagnoses by Age

  7. Figure 1. Hospital Referral Rates Percentage of children discharged home was over 90% of the total with little variation between age groups.

  8. Figure 2. Ambulance Referral Rate Among those sent a hospital based ED, the youngest group was more likely to be sent by ambulance than the older groups.

  9. Discussion • The number of annual pediatric visits to this one moked is similar to the annual visits reported by Schneider Children’s Hospital emergency department.1 • The percentage of pediatric visits from the total is similar to that reported by The percentage of pediatric visits to TEREM (41%) is similar to that found by Ben Arie and Danon (37%).2 It is, however, strikingly different from a study of pediatric visits to general emergency departments in one US state (18%).3 This may be due to the more ready accessibility of primary care physicians to their patients during non office hours, but further study is needed. • Differences have been reported in usage patterns between general and pediatric EDs in the United States.[i] As most hospitals in Israel now have designated pediatric EDs, this comparison is not locally relevant. On the other hand, it would be of interest to compare the spectrum and frequency of care between mokdim and pediatric emergency departments. All those interested in comparing such data are welcome to contact us at nk@terem.com. [1] Hemmo-Lotem M, Jinich-Aronowitz C, Endy-Findling L, Molcho M, Klein M, Waisman Y, Danon YL, Merrick J. Child injury in Israel: emergency room visit to a children's medical center. ScientificWorldJournal. 2005 Mar 28;5:253-63. [2] Ben Arieh AB, Danon YL. Epidemiological trends of pediatric emergency referrals in Israel. Isr Med Assoc J. 2001 Mar;3(3):231-2. [3] Zimmerman DR, Allegra JR, Cody RP. The epidemiology of pediatric visits to New Jersey general emergency departments. Pediatr Emerg Care. 1998 Apr;14(2):112-5. [4] Nelson DS, Walsh K, Fleisher GR.Spectrum and frequency of pediatric illness presenting to a general community hospital emergency department. Pediatrics. 1992 Jul;90(1 Pt 1):5-10.

  10. Conclusions • Many children are cared for in free-standing urgent care centers in Jerusalem. • This number is greater than that reported in most other hospital based EDs in that city. • Leading diagnoses vary by age group. Infectious diseases dominate the younger groups and trauma is predominant in the older groups. • Most of these children seen in this moked are sent home after treatment. • Their visits incurs a lower cost than that of a visit to a hospital based ED.

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