Bouncebacks A 45-Year-Old Man with Cough and Sore Throat: A Two-Step Approach to Avoiding a Bounceback Urgent message: The clinician must address unexpected findings with further questions or testing. Michael B. Weinstock, MD and Ryan Longstreth, MD, FACEP his is the first article in a series that will appear every other month in JUCM, in which we will recount scenarios of actual patients who presented to an emergency department or urgent care facility, were eval- uated and discharged, and then “bounced back.” Each of these cases is detailed in the book Bounce- backs! Emergency Depart- ment Cases: ED Returns, (2006, Anadem Publishing, m www.anadem.com) which .co es ag I / m includes case-by-case risk ler tab management commentary nS t ar o B © by Gregory L. Henry, past president of The American College of Emergency Physi- cians (ACEP), and discussions by other nationally recognized experts. The focus of the JUCM series will be a two- step process designed to improve patient safety and reduction in legal risk: potential for serious medical illness mas- querading as a benign problem—or patients likely to be litigious. Examples include high-risk discharge diagnoses such as chest pain, fever and headache, abdominal pain, upset patients, patients who have issues with billing, a long wait, or unmet expectations, and patients who have bounced back. T Step 1 Identify high-risk patients—specifically, patients with the 24 Step 2 Review the chart before the patient leaves the urgent care. Affirm consistent doc- umentation between the nurse/ tech and physician, address all documented complaints in H&P, confirm that the history is accurate, review potentially serious diag- noses, explore abnormal find- ings, write a progress note explain- ing the medical decision-making process (if unclear from the H&P), and assure that aftercare instructions are specific and that follow-up is timely and available. The following case is an example of this approach. On the surface, the evaluation seems well thought out, but JUCM T h e J o u r n a l o f U r g e n t C a r e M e d i c i n e | A p r i l 2 0 0 7 w w w. j u c m . c o m