Hypertonic Saline in Bronchiolitis Key point: Consider using hypertonic saline for bronchiolitis.Citation: Zhang L, Mendoza-Sassi RA, Klassen TP, Wainwright C. Nebulized hypertonic saline for acute bronchiolitis: a systematic review. Pediatrics. 2015;136:687–701. Bronchiolitis continues to be difficult to treat despite its high prevalence. With the exception of nasal bulb suction, few techniques have shown significant benefit, to the frustration of both patients’ parents and health-care providers. A Cochrane Review suggested that hypertonic saline (HS) may benefit …
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Urgent Care Solutions for Health Systems to Improve Access
Urgent message: Although the Patient Protection and Affordable Care Act expands health insurance coverage to millions of previously uninsured, many of the newly insured grapple with lack of access to quality, on-demand care, which leads to increased emergency department use. Urgent care provides a solution for health systems to expand access, reduce the number of unnecessary emergency department visits, and realize the goal of integrated population health management. MICHAEL F. BOYLE, MD, MBA, FACEP Introduction …
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Palatine Mass: Physiologic or Pathologic?
Urgent message: Urgent care physicians often encounter patients with masses in the mouth. If they are aware of the existence of toripalatinus and know how to treat them, they can reassure patients who may mistake this benign, congenital bony growth for cancer. JOSHUA WILSON, MS3, and SHAILENDRA SAXENA, MD, PhD Introduction Urgent care and primary-care physicians often must evaluate masses within the mouth. These masses commonly originate from the submandibular or sublingual gland, but a …
Read MoreClinical Challenge: November, 2015
Case A 56-year-old woman presents to an urgent care center with severe ankle pain after stepping off a curb. The physician obtains a radiograph of her ankle. View the image taken (Figure 1) and consider what your diagnosis would be. Resolution of the case is described on the next page.
Read MoreRediscovering Your Service Mission
It comes as no surprise to anyone that health care is broken. Too many interest groups, too much regulation, too many poorly aligned incentives, too many unrealistic expectations, and too many myopic solutions. Worse, the physician voice has been weakened and handicapped by a combination of our patient-first mission and by the distraction inherent in a profoundly complicated professional discipline. Think of it this way: If your primary mission was profit and the financial engineering …
Read MoreHow to Recognize and Handle Potentially Litigious Patients
Angela T. Burnette, JD Urgent message: Although any urgent care center could potentially face litigation at any time, the risks of being sued can be reduced by focusing on provider behaviors that build strong relationships with patients, by recognizing patient behaviors that may increase the odds of litigation, and by having a plan for handling dissatisfied patients. Lawsuits do not discriminate. They are filed against all types of health-care providers—new or experienced, group practice or …
Read MoreTop 3 Rapid Tests Performed at U.S. Urgent Care Centers in 2014
Data from the 2014 Urgent Care Chart Survey of 1,778,075 blinded visits by patients to more than 800 different urgent care clinics, conducted by the Journal of Urgent Care Medicine, reveal that the top 3 rapid tests performed at U.S. urgent care centers in 2014 were as follows, in descending order: • Rapid group A Streptococcus test—15.59 million tests • Rapid influenza test—13.91 million tests • Rapid chlamydia test—0.92 million tests The survey’s methodology and …
Read MoreClinical Challenge 2: October, 2015
Case A 17-year-old presents with hard, painless masses on the shin. View the image taken (Figure 1) and consider what your diagnosis would be. Resolution of the case is described on the next page.
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Making a Business Case for Urgent Care Holiday Hours
URGENT MESSAGE: Whether an urgent care center should be open 365 days per year or close on major or minor holidays depends upon factors that influence profitability, such as patient demand, competitive positioning, staff availability, payer reimbursement, and the branding impact of after-hours accessibility. Alan A. Ayers, MBA, MAcc is Practice Management Editor of The Journal of Urgent Care Medicine, serves on the Board of Directors of the Urgent Care Association, and is Vice President …
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ACP Calls for Scope of Practice Limits on Retail Clinics
The American College of Physicians has called for scope of practice limits on retail health clinics such as those built into chain drugstores. In the executive summary of a policy position paper by Hilary Daniel and Shari Erikson and published on the website of the Annals of Internal Medicine, ACP expressed concern over recent efforts to manage chronic conditions in the retail setting, suggesting that research into potential negative outcomes may be desirable. It acknowledged …
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