Impact of Pediatric Urgent Care Clinics on Emergency Department Utilization and Patient Flow: A Pre–Post Cohort Study in Saudi Arabia

Background Pediatric emergency departments (PEDs) face persistent overcrowding, largely driven by low-acuity visits that could be managed in outpatient settings. Pediatric Urgent Care Clinics (PUCCs) have been introduced to redirect such demand, yet evidence from the Gulf region remains limited. Objectives To evaluate the impact of implementing a PUCC on emergency department utilization, patient acuity mix, flow indicators, and disposition patterns at the Maternity and Children’s Hospital in Alahsa, Saudi Arabia. Methods A retrospective pre–post cohort study was conducted using electronic health record data from October 2023–June 2024 (pre-implementation) and October 2024–June 2025 (post-implementation). Variables included Canadian Triage and Acuity Scale (CTAS) level, timestamps (triage, physician start, discharge), demographics, and disposition. Predefined cleaning rules excluded implausible or negative intervals. Outcomes were visit volumes, acuity distribution, door-to-doctor time, length of stay (LOS), and admission fraction. Comparative analyses used risk ratios (RR), interquartile ranges (IQR), trimmed means, and chi-square or rank-sum tests as appropriate. Results A total of 147,175 encounters were analyzed (pre: 84,595; post: 62,580). The proportion of low-acuity visits (CTAS 4–5) decreased from 81.1% to 50.2% (RR 0.62; 95% CI 0.61–0.62; p < 0.001). Median door-to-doctor time remained stable (37 vs 39 min; p = 0.12), while median LOS increased from 62 to 76 min (trimmed mean 78.7 vs 92.7 min; p < 0.001). Harmonized admissions rose from 1.8% to 11.6% (RR 6.48; 95% CI 6.14–6.84; p < 0.001), partly reflecting changes in disposition coding. Conclusion PUCC implementation was associated with a marked reduction in low-acuity PED visits and stable front-end performance, accompanied by a modest rise in overall LOS. PUCCs represent a promising component of pediatric emergency care optimization, but sustained system-wide improvements will require integration with broader hospital flow and capacity measures.