Risk Factors for Clinical Failure in Cellulitis and Skin Abscess Key point: Hospitalized patients with obesity may experience clinical failure because of inadequate antibiotic dosing. Citation: Halilovic J, Heintz BH, Brown K. Risk factors for clinical failure in patients hospitalized with cellulitis and cutaneous abscess. J Infect. 2012; 65(2): 128-134. Although most individuals with cellulitis or skin abscess are managed as outpatients, hospital admission is sometimes necessary. Several risk factors for hospitalization have been identified. …
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Infectious versus Inflammatory Flexor Tenosynovitis: A Little, Big Problem
Urgent message: Infectious flexor tenosynovitis is an orthopedic emergency that can cause long-lasting disability through tendon necrosis and permanent digital contracture if unrecognized or mismanaged. MARY A. LANE, MD Flexor tenosynovitis is an inflammation of the tendon sheath that can be caused by either introduction of infection or various inflammatory conditions ranging from autoimmune arthropathies to crystal joint depositions. Flexor tenosynovitis caused by infection is an orthopedic emergency. It can cause long-lasting disability through tendon …
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Hiring As If Your Patients’ Health and Satisfaction Depended Upon It
Urgent message: Hiring the right candidate for a job at an urgent care center is an art and a science, but a variety of tools exist to facilitate the process. WILLIAM MARTY MARTIN, PSYD, MPH, MA, MS This article is designed to equip urgent care clinic owners with the tools they need to hire better than they have in the past. After reading it, you will be able to: (1) organize your hiring process around …
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An Urgent Care Approach to Excessively Crying Infants
Urgent message: Infants who cry excessively pose a challenge to physicians and parents. A systematic approach to the history and physical exam can guide the diagnostic approaches to determine if a benign – or serious – condition is responsible. Toni Clare Hogencamp, MD Crying is a primitive form of communication that infants rely on to communicate their distress. Because infants cannot verbalize their discomfort, they must rely on their cry to communicate with caregivers. Estimates …
Read MoreShow Me the Money: Alternative Access in Acute Care Delivery
Lee A. Resnick, MD, FAAFP In my last column I examined the recent study by the Center for Studying Health System Change which reviewed data from the 2008 National Hospital Ambulatory Medical Care Survey (NHAMCS). I identified critical flaws in the definitions used to distinguish “appropriate” emergency department (ED) visits from “non-urgent” or so-called “routine” visits. I concluded that the study missed a tremendous opportunity to identify alternatives for the vast majority of patients with …
Read MoreOctober 2012
Developing Data: October, 2012
These data form the 2010 Urgent Care Benchmarking Survey are based on responses of 1,691 US urgent care centers; 32% were UCAOA members. The survey was limited to “full-fledged urgent care centers” accepting walk-ins during all hours of operation; having a licensed provider and x-ray and lab equipment onsite; the ability to administer IV fluids and perform minor procedures; and having minimal business hours of seven days per week, four hours per day. In this …
Read MoreTetanus Code Change, Coding Injections and Infusions, Facility and After Hours Codes
DAVID STERN, MD (Practice Velocity) Q. What codes should we use in place of the discontinued 90701 (tetanus vaccines, diphtheria, tetanus toxoids, and whole cell pertussis vaccine [DTP], for intramuscular use) and 90718 (tetanus and diphtheria toxoids [Td] absorbed when administered to individuals 7 years or older, for intramuscular use) that were discontinued effective July 1, 2012? A. You should use 90714 (Tetanus and diphtheria toxoids [Td] absorbed, preservative free, for use in individuals 7 …
Read MoreWhat Does Obamacare Mean for the Urgent Care Industry?
JOHN SHUFELDT, MD, JD, MBA, FACEP Chief Justice Roberts, writing for the majority, published the Supreme Court’s decision in National Federation of Independent Business v Sebelius on June 28, 2012. With a few exceptions, the decision upheld the bulk of the Patient Protection and Affordable Care Act (PPACA), also known as Obamacare. In the next few paragraphs I will attempt to make some sense out of the ruling and how, if applicable, it applies to …
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8-year-old girl with a blow to her right elbow
The patient, an 8-year-old girl, presented with a blow to her right elbow and could not straighten her right arm. View the image taken (Figure 1) and consider what your diagnosis would be.
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