In early 2008, UCA revamped its annual survey in conjunction with researchers at Massachusetts general Hospital and Harvard University with the goal of assuring that the UCA Benchmarking Committee’s efforts produced a scientifically valid report. Here we present some of the findings from this landmark survey, to which 436 urgent care centers responded. In this issue: How much time do patients spend in urgent care centers, on average? These data support – and, perhaps just …
Read MoreClinical Challenge: July/August, 2009
9-year-old girl has painful breathing after falling on chest
The patient is a 9-year-old girl who presents after experiencing a fall and a blow to her right chest. She complains of pain on deep breathing. On exam, you find a pulse of 103, and SAT of 96. She is not in respiratory distress; her chest exam is clear. She has an abrasion over her right chest. The patient is generally healthy, is on no medications, and has no significant past medical history. View the …
Read MoreThe Story of Jonathan— One Week in January
The Patient’s Perspective Jonathan is a young man who changed the course of musical theatre and would still be making history today if things had turned out differently. Jonathan was born in Mount Vernon, NY in 1960. When he was 22, he moved to New York City to pursue his dream of writing a musical. Like most struggling artists, life wasn’t easy. He spent weekends waiting tables at the Moondance Diner in Soho. He spent …
Read More
Appendicitis Due to Squirrel Dinner
Introduction Appendicitis due to foreign bodies is a rare occurrence; most cases reported in the literature have occurred due to sharp objects such as pins, needles, toothpicks, and small nails. Solid foreign bodies – such as a bullet – rarely cause appendicitis. Appendicitis due to traumatic gunshot wounds has been described before, as have appendicitis cases due to ingested birdshot. Here, we describe an interesting case that demonstrates the importance of eliciting a history of …
Read More
32-year old female with fever, rash and scattered vesicles
The patient is a 32-year-old female who presents complaining of a fever and a rash, along with a sore throat, headache, and fatigue. On clinical examination, you note vesicles on the palms and soles. An erosion is present at the labial mucosa. A small vesicle is present on the hard palate. The patient\’s temperature is 100.5°F. Her blood pressure and vital signs are within normal limits. View the photos and consider what your next steps …
Read MoreOutpatient Management of Opioid Dependence in Urgent Care
Urgent message: Urgent care physicians may be well positioned to play a role in stemming the national epidemic of opioid dependence, providing much needed care for patients and adding a new facet to their own clinical practice. By Paolo T. Coppola, MD, FACEP and Matthew I. Salzberg Introduction The DSM-IV-TR defines dependence as “a cluster of cognitive, behavioral, and physiologic symptoms that indicate a person has impaired control of psychoactive substance use and continues use of …
Read More
June 2009
Medication Supplies, New Patient E/M, and Skin Shaving Vs. Skin Biopsy
Q. On our new superbill, there is a spot to code for Phenergan (generic is promethazine HCI) 50 mg when administered intramuscularly. How would we code for Phenergan when the physician orders Phenergan 25 mg IM? Do we mark the code x ½? Anonymous, Illinois A. If you administer 50 mg of promethazine or any portion of 50 mg, then you use code J2550 (injection, promethazine HCI, up to 50 mg). For example: 25 mg …
Read MoreAbstracts in Urgent Care: June, 2009
Incidence of AMI in Patients with Syncope Key point: In a cohort study of nearly 1,500 patients presented without ST-segment elevation. Citation: McDermott D, Quinn JV, Murphy CE. Acute myocardial infarction in patients with syncope. CJEM. 2009; 11: 156-160. Which patients with syncope require hospital admission? To answer this question, researchers studied the incidence of acute myocardial infarction within 30 days of presentation in a cohort of 1,474 consecutive emergency department patients who presented with …
Read More