During her annual physical exam, one of my patients recently asked me, “Are urgent care centers any good, Dr. P?”

She recounted an incident a few months earlier where she awoke with an acute illness and was sick enough that she felt she needed to receive care — at least some medical attention — more imminently than she could get from waiting to speak to my office in the morning. She said she thought about calling the answering service, but thought they would have told her to go to the emergency department.

She woke with an incredibly high fever, but no other specific localizing symptoms, and she went into an urgent care center near her home. She reported it was a wonderful environment, beautiful furnishings, soft music, comfortable chairs. She was seen by a practitioner there who told her they thought she had strep throat. They did a rapid strep test in the office, which was negative, and told her they were going to give her an antibiotic, and do another test which was sent to the lab for follow-up the next day.

She said she was a little confused, but went home, filled the prescription, started taking it, and called them as directed the next morning. She said she reached them easily, they were very polite on the phone, told her that her culture was negative, that she should stop the antibiotic, and that she probably had a virus.

Now we know it is easy for us to second-guess someone’s clinical care. Someone working in an urgent care center sees someone only for a brief snapshot, a single moment in time, having no long-term relationship with the patient. The same is true of emergency departments. They get to see someone only in that slender window of opportunity when they are dropped into their realm, and usually have no choice but to maximize to optimize care.

A colleague of mine once said that it takes 30 seconds to give someone a prescription, and 30 minutes not to give someone a prescription.

We have all seen patients coming out of urgent care centers and emergency departments with prescriptions for antibiotics that were probably not necessary, and with opiate pain medicines which we are then left to sort out whether they are needed. We have also seen extensive scans and lab tests that we now need to take care of and follow up on, that likely are not clinically relevant.

I’m not saying that in the primary care setting our care is always perfect, efficient, always evidence-based. We have all given antibiotics for a cold (admit it, you know you have), and ordered too many labs and scans because we could.

But these other settings, these alternatives to the primary care office, serve an incredibly important and useful purpose, and can become critical cogs in the healthcare team that we’re trying to build in the patient-centered medical home model.

We know that ideal care requires 24/7/365 access but, as we know, none of us want to be on call 24 hours a day, 7 days a week, 365 days a year.

I recently had a nearly perfect interaction with an urgent care center and the staff who provided care. My patient was seen there urgently late on a Friday night, and they actually followed up with her 2 days later (then Sunday morning) and provided ongoing, and appropriate, care for this clinical situation. Monday morning I arrived in my office and received an email communication from the provider at the center, detailing what had happened, explaining their thought process, and recommending follow-up with me.

For most of us busy primary care providers, after-hours care is usually telephone care. It’s hard for us to come into the office at 12:30 at night when a patient is sick and wants to be seen. There certainly are exceptions to this, where we may come into the emergency department to see a sick patient, but for many things it is nice for patients have an option for walk-in care that is safe, clinically rational, and available.

Wouldn’t it be nice if the urgent care centers and emergency departments became an integrated part of our team, rather than us continuing the sometimes somewhat adversarial relationships that currently exist between these different settings?

Having a safe after-hours location for our patients to receive care, where their medical records were available to prevent duplicated care and inappropriate care, as well as open lines of communication, safe sharing of medical records and results, and collegial relationships between providers, would create and extend this wider model of team-based care.

In the emergency department, the paradigm is evaluate and stabilize, and then a branch decision happens about whether to admit or send home. At the time of discharge, a safe follow-up plan needs to be arranged for patients, and this is often a sticking point for the emergency department.

Recently our practice, in conjunction with our affiliated emergency department, developed a plan to allow protected next-day appointments at our practice for patients being sent home from the emergency department, who need this urgent interim care as a safe “conclusion” of their discharge plan.

We are “hanging” multiple appointments frozen in our next day’s schedule, on a website which the emergency department physicians have access to. When they find an appropriate patient who needs a next-day appointment in primary care, they enter the patient’s demographics, contact information, medications, and plan, and our scheduler picks that up first thing the next morning.

We are exploring ideas to enhance provider-to-provider communication, so that a better and safer handoff can happen, but for now a review of the discharge summary is all we’ve got. We envision e-mail messaging, or even someday direct sign-out through video chat. Anything to make the transition smoother.

As you can imagine, this has had some growing pains, as any project like this usually does at the start. Patients who should have been kept in the hospital were sent here to our practice. Patients who have another outside primary care doctor who should be able to see them the next day were sent here. Patients who didn’t need to come here the next day were sent here.

But we are learning, and we feel that this is a useful addition to extended care for our patients, which will help keep them at the center of care, and keep things from falling through the cracks.

In the idealized format, in a truly patient-centered medical home, our patients would access these other sites for care, and then care would flow back to us as appropriate. We hope that this emergency department project helps optimize the emergency department discharge process and provides for high-quality, after-visit care. Next steps will be to work to enlist local urgent care centers, but we need to build relationships with these nonaffiliated sites as we move forward.

But an urgent need is clearly there.

Fred N. Pelzman is an associate professor of medicine, New York Presbyterian Hospital and associate director, Weill Cornell Internal Medicine Associates, New York City, NY. He blogs at Building the Patient-Centered Medical Home.