**4. Discussion**

This study shows that waiting times for the patients studied who were referred to the UCC were reduced, both in terms of TTP and LOS. There was also a reduction in the number of blood tests performed at the UCC. Accordingly, there was a substantial cost reduction for UCC visits compared to the ED on the studied population. These components contribute to cost-effective and sustainable care. However, the sample was too small to draw any conclusions regarding the outcome in terms of assessment and treatment accuracy, though it was not possible to register any increase in revisits.

The most important effect was probably the reduced LOS. The UCC relieved the ED of low-urgency patients and, in the long run, potential crowding. This might consequently have contributed to fewer complex and diversified assignments at the ED. Extrapolating the results, a consequence of establishing a UCC might contribute to EDs maintaining their focus on emergencies and avoid time-consuming challenges such as maintaining continuity and follow-up routines [21]. The UCC studied cut the LOS by two-thirds in relation to the population studied, which may improve disaster preparedness [22]. An integrated UCC/ED may also be used as a fast track and flexible area of care during pandemic peaks and emergencies [23,24].

It can tentatively be suggested that one more important function of UCC in crisis is its networking capacity as part of the primary care system. Non-urgent and non-MID patients can easily be referred to other primary care centres for follow-up [1]. Patients who have access to continuous primary care are known to have an improved health status and lower rates of unnecessary hospitalisation compared to those which do not have such access [25]. In contrast, crowding in the emergency room not only contributes to patient dissatisfaction, but it also increases the risk of spread of infection, misdiagnosis and delayed administration of drugs and, in the long run, prolongs hospitalisation [22].

The proximity of the UCC used in this study seems to be an advantage, not only for peacetime use but also for a future MID, when immediate staff and material and structures are essential factors in successful MID management. The close distance between the UCC and the ED may not only alleviate the ED's burdens but also improve close interprofessional collaboration between colleagues from both units. A study four months after the establishment of an integrated ED/UCC reported inter-organizational and inter-professional collaboration. The staff, physicians and nurses crossed a stairwell and a corridor to discuss common challenges. Questions about the parties' capacity for diagnosing and treating patients were sorted out, and non-conventional solutions were occasionally invented to handle strenuous situations and tricky cases. Mistakes in assessments and patients whose health conditions rapidly changed could easily be handled by swift re-referrals from the UCC back to the ED [17].

The differences observed in this study regarding the utilization of medical services by UCC and ED on a similar population may simply reflect the ability of UCC to adjust to new conditions, procedures and perspectives when assessing patients. The ED staff may be more focused on recent symptoms and a rapidly emerging illness. The UCC staff, on the other hand, may be focused on long-term medical history [26]. While the ED assesses and reassesses the patient in a broad manner, the UCC may use anamnesis and bedside information to construct a picture of the status of the patient [16]. However, when comparing the strengths of the two units, the UCC has the potential to optimize care for both urgen<sup>t</sup> and non-urgen<sup>t</sup> patients. The difference in working methods can be considered an asset when providing sustainable care to the mix of needs in the population of attendees, and during pandemics and disaster managemen<sup>t</sup> [27]. Despite fewer blood tests and X-rays at the UCC, the results obtained did not indicate any incorrect assessments or treatments at UCC. However, generalising the results of this study will require studies of larger populations. Placing a UCC close to an ED may, however, become a promising establishment in terms of reduction in costs, LOS, TTP and the use of medical services, which is beneficial in the managemen<sup>t</sup> of an MID.

The pressure on EDs during COVID 19 underscores the need for further studies on interventions aiming to relieve and facilitate ED capacity. Even though a silver bullet for the issue of ED crowding has not ye<sup>t</sup> been found, different methods may be combined to improve preparedness. UCCs are one promising method when it comes to preparedness, along with cost-reductions and improved continuity.
