Journal of Community Health

, Volume 38, Issue 6, pp 1042–1049 | Cite as

A Nurse-Run Walk-In Clinic: Cost-Effective Alternative to Non-urgent Emergency Department Use by the Uninsured

  • Alexandra BickiEmail author
  • Adam Silva
  • Valerie Joseph
  • Ryan Handoko
  • Sheryl-vi Rico
  • Jacqueline Burns
  • Anna Simonelli
  • Jordan Harrop
  • Jennifer Nedow
  • Anne S. De Groot
Original Paper


Non-urgent healthcare problems are responsible for more than 9 million visits to the emergency department (ED) in US hospitals each year, largely due to patients’ lack of access to a primary care physician. To avoid costly and unnecessary ED usage for non-urgent health problems, a walk-in clinic run by nurses (CHEER Clinic) was developed as an extension of the services provided by an existing free clinic in a low-income neighborhood of Providence, RI, with the goal of providing uninsured patients with a convenient, no-cost means of accessing healthcare. An evaluation and cost-effectiveness analysis of the clinic’s first 5 months of operation were performed. During this pilot period, 256 patients were seen. When incorporating the quality-adjusted-life-year value of preventive services rendered, an estimated $1.28 million in future healthcare costs was avoided. Dividing these cost-savings by the clinic’s operational cost yielded a mean return on investment of $34 per $1 invested. Adding nurse-run walk-in hours at a free clinic significantly expanded access to healthcare for uninsured patients and was cost-effective for both the clinic and the patient. Ultimately, replication of this model in community clinics serving the uninsured could reduce ED burden by treating a substantial number of non-urgent medical concerns at a lower cost than would be incurred for treatment of the same problems in EDs.


Uninsurance Emergency department Free clinic QALY Healthcare access 



The authors gratefully acknowledge Blue Cross & Blue Shield of Rhode Island for their visionary financial support of the pilot study, and Lauren Levitz for her careful review of the manuscript. The assistance of Reuben Hirsch is also gratefully acknowledged.


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Alexandra Bicki
    • 1
    Email author
  • Adam Silva
    • 1
  • Valerie Joseph
    • 1
  • Ryan Handoko
    • 1
  • Sheryl-vi Rico
    • 1
  • Jacqueline Burns
    • 1
  • Anna Simonelli
    • 1
  • Jordan Harrop
    • 1
  • Jennifer Nedow
    • 1
  • Anne S. De Groot
    • 1
    • 2
    • 3
  1. 1.Clinica Esperanza/Hope ClinicOlneyville, ProvidenceUSA
  2. 2.University of Rhode IslandKingstonUSA
  3. 3.EpiVax, Inc.ProvidenceUSA

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