Bouncebacks The Case of an 18-Year-Old Male with Hand Pain Urgent message: A thorough history and physical exam are essential to positive outcomes and risk reduction when managing patients with hand injuries. Michael B. Weinstock, MD and Ryan Longstreth, MD, FACEP ouncebacks, in which we recount scenar- ios of actual patients who were evaluated in and discharged from an emergency depart- ment or urgent care facility and then “bounced back” for fur- ther treatment, appears semi- monthly in JUCM. Case presentations on each patient, along with case-by-case risk manage- ment commentary by Gre- gory L. Henry, past presi- dent of The American College of Emergency Physi- om cians (ACEP), and discus- s.c ge ma / r I sions by other nationally rec- ble Sta ognized experts are detailed on a B rt © in the book Bouncebacks! Emergency Department Cases: ED returns (2006, Anadem Publishing, www.anadem.com). The focus of the JUCM series will be a two-step process designed to improve pa- tient safety and reduction in legal risk in an urgent care practice: B Step 1 Identify high-risk patients—specifically, patients with the potential for serious medical illness masquerading w w w. j u c m . c o m 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, up- set patients, patients who have issues with billing, a long wait, or unmet ex- pectations, and patients who have bounced back. Step 2 Review the chart before the pa- tient leaves the urgent care clinic. Affirm consistent docu- mentation 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 findings, write a progress note explaining the medical decision-making process (if un- clear from the H&P), and assure that aftercare instructions are specific and that follow-up is timely and available. This month’s case highlights several patient care and risk management principles. On the surface, it seems straightforward: An 18-year- old presents with a hand laceration which is repaired, 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 | J u n e 2 0 0 7 19