The patient is a 20- year- old female who presents with pain one day after experiencing a blow to the knee during a fall. On exam, you reveal no significant findings beyond mild local tenderness. She is able to bear weight fully on both legs. View the image taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
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35-year-old female catches finger in banister
The patient is a 35-year-old female who got her finger caught in a metal staircase banister one day prior to presentation. Physical examination is significant for right fifth PIP hyperextension and DIP hyperflexion (swan neck deformity). The patient\’s PIP flexion appears to be limited to about 20 degrees, while her contralateral PIP joint shows about 100 degrees of flexion. No sensory or motor deficits are noted. View the x-ray taken and consider what your diagnosis …
Read MoreDeveloping Data: January, 2010
In each issue on this page, we report on research from or relevant to the emerging urgent care marketplace. This month, we offer an analysis of how patient satisfaction is affected by time spent in the emergency room, and how current scores compare with research done two years prior. Though not reflective of patient experiences in the urgent care settings, these data can serve as a lesson on the importance of respecting the patient’s time …
Read MoreEmbracing a Culture of Constant Change
Coding by Time, for Emergent Care, and for Nurse Practitioner Visits
Q. How does one determine whether an E/M code can qualify for coding according to time spent? Obviously, any psychiatric counseling would fit the criteria, but what about “teaching” (e.g. how to use an inhaler, how to perform a breast exam), or preventive medicine counseling? – Question submitted by Dr. Kim, Med7 Urgent Care, CA A. The key issues on counting counseling or coordination of care toward the E/M code are: Counseling and/or coordination of …
Read MoreDeconstructing the Ten Commandments of Urgent Care Medicine
Since the holiday season was just upon us, I will take the opportunity to borrow heavily from the 1956 Cecil B. DeMille movie, The Ten Commandments. The movie portrays the life of Moses, from an infant floating down the Nile through his return to Egypt to lead the Hebrews across the Red Sea. For the next few paragraphs, think of me as the Moses of Urgent CareWorld, as I attempt to lead you to the …
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Building Urgent Care Referral Relationships: Pharmacies and Retail Host Clinics
Urgent message: Viewing other community healthcare providers (e.g., pharmacists) or even possible competitors (e.g., retail clinics) as referral sources can increase revenues and bolster the urgent care center’s place in the healthcare system. The first of two parts. Alan A. Ayers, MBA, MAcc Urgent Care has evolved to the point that it is a vital part of a community’s healthcare infrastructure, offering access when primary care appointments are unavailable and relief when emergency rooms are …
Read MoreAbstracts in Urgent Care: January, 2010
CAP Treatment Recommendations: Guided in the Right Direction Key point: Results of two large cohort studies indicate that adherence to guidelines for treating community-acquired pneumonia is a good thing. Citations: Arnold FW, LaJoie S, Brock GN, et al. Improving outcomes in elderly patients with community-acquired pneumonia by adhering to national guidelines: Community-Acquired Pneumonia Organization International Cohort Study results. Arch InternMed. 2009;169:1515-1524. McCabe C, Kirchner C, Zhang H, et al. Guideline-concordant therapy and reduced mortality and …
Read MoreReducing Pediatric Medical Legal Risk in Your Urgent Care Center
Assessment, Intervention, and Disposition of Patients with Psychiatric Symptoms
Urgent message: Assessment of patients presenting with psychiatric conditions requires amodified set of skills compared with traditional medical assessment. Urgent care clinicians must be prepared to determine appropriate interventions—treatment, referral, or both. Gregory P. Brown, MD Introduction Typically, the interaction between clinicians and patients presenting with psychiatric conditions is guided by information obtained from the interview, history, and physical examination rather than emphasizing laboratory or radiological testing. Therapeutic options may be challenged by a lack …
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