Data from the 2014 Urgent Care Chart Survey of 150 million visits by patients to more than 800 different urgent care clinics, conducted by the Journal of Urgent Care Medicine, reveal that the top three most-prescribed medications at U.S. urgent care centers were, in descending order: Zithromax (azithromycin), for 12.12% of visits Amoxil (amoxicillin), for 8.25% of visits Deltasone (prednisone), for 7.07% of visits The top 20 medications are shown here. We will report on …
Read MoreExcludes Notations and Code Notes
Q. How do I use Excludes 1 and Excludes 2 instructions in International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10CM)? A. Put simply, the Excludes 1 notation means that you cannot code any excluded code with the main (listed) code. Conditions listed with Excludes 1 are mutually exclusive. For example, code E11 (type 2 diabetes mellitus) has an Excludes 1 notation with the following codes listed: Diabetes mellitus due to underlying condition (E08.-) Drug …
Read More
Clinical Challenge: March 2016
A 36-year-old man comes to an urgent care center reporting pain in his back that began the previous day. The pain is sharp and worse with certain changes in position. He does a lot of lifting at his job stocking shelves in a grocery store, but he cannot relate the onset of the pain to any specific lifting that he has done. View the image taken (Figure 1) and consider what your diagnosis would be.
Read MoreAbstracts in Urgent Care: March, 2016
SEAN M. McNEELEY, MD Inhaled Steroids Do Not Reduce Growth in Children with Asthma Key point: Inhaled steroids did not reduce growth velocity in a 1-year study. Citation: Wardenier NR, Klok T, de Groot EP, Brand PL. Height growth in children with asthma treated with guidelinerecommended dosages of fluticasone and electronically assessed adherence. Arch Dis Child. 2015 December 7. doi: 10.1136/archdischild-2015-309654. Adherence to therapy is important for children with asthma. Many factors, including fear of …
Read MoreTurning Over Patient Records on Request
Urgent message: Urgent care providers subject to the privacy regulations of the Health Insurance Portability and Accountability Act of 1996 need compliant procedures for handling patient requests for medical records, including transfer of patient records to other providers. U.S. federal and state laws require providers to allow patients access to their medical records. This includes records supplied by another provider (e.g., a specialist who has forwarded a report to the primary-care physician) that may be …
Read More
Sore Wrists with Soft-Tissue Hypertonicity and Swelling
Urgent message: It is important for urgent care providers to be able to recognize the lesser-known arthritides as causes of acute joint pain and to recognize their specific manifestations on x-rays. Further work-up is warranted because some of these diseases can be associated with various metabolic disorders. MAY MOHTY, MD, FAAP, FAAUCM, and HAMILTON WHITE, MS4 Introduction The deposition of calcium pyrophosphate dihydrate crystals in and around joints is called CPPD (calcium pyrophosphate dihydrate deposition) disease. This condition manifests in a variety …
Read More
Zika Virus—Near Pandemic Proportions?
Urgent message: The clinical manifestations of Zika virus infection are generally mild in adults; the primary concern is the potential link to microcephaly in children of infected pregnant women. There is no cure, so prevention is paramount. MIZUHO SPANGLER, DO, and MICHAEL B. WEINSTOCK, MD Introduction The Zika virus epidemic is gaining a lot of media attention, deservedly so; there have been large outbreaks of infection in Brazil, South America, and the Caribbean, with numbers …
Read More
We’re All in This Together: Four Attributes of Effective Medical Center Teams
Urgent message: Creating and cultivating cohesive, goal-oriented, and patient-focused urgent care teams starts with visible front-line leaders who emphasize a strong service culture, open communication, personal accountability, and management transparency. ALAN A. AYERS, MBA, MAcc Practice Velocity Introduction The stress, resentment, and dissatisfaction that one experiences being part of a disconnected and ineffective team are not easily forgotten. Common sense may lead one to believe that the safest path is to ignore the team’s dysfunction and consider it just a part of …
Read More
Evaluation and Management of Ankle Injuries in Urgent Care
Urgent message: Acute ankle injuries can progress to chronic issues. It is essential that the urgent care clinician be aware of the mechanisms of common ankle injuries, their pathophysiology, essential diagnostic tests, and which injuries require transfer for a higher level of care. LISA SCHUERMAN, RN, MSN, APNP Introduction The ankle is one of the most common sites for acute musculoskeletal injuries, with sprains accounting for 75% of ankle injuries. The ankle joint is composed of the tibia, fibula, and talus. …
Read MoreAnalytics and Performance Metrics: The Good, the Bad, and the Ugly
It seems like metrics and analytics are the buzzwords to watch in 2016. Everyone— from health-care administrators to carwash operators—is looking for ways to measure best practices, key business drivers, and employee performance to stand out. Even my beloved Cleveland Browns became the first team in professional football to hire a chief strategy officer to apply analytics in picking players who give the team its best chance of winning. Health care itself is into analytics, …
Read More