Alan A. Ayers, MBA, MAcc is Vice President of Strategic Initiatives for Practice Velocity, LLC and is Practice Management Editor of The Journal of Urgent Care Medicine. Urgent Message: As urgent care expands into traditional retail space, it’s important to understand the obligations of leases that require tenants to act as property “owners” responsible for all taxes, utilities, and maintenance of the real estate. While the defining characteristic of urgent care facilities across the country …
Read MoreAbstracts in Urgent Care October 2017
Validating a Quantitative EEG-Based Brain Function Index Key point: A novel EEG-based point of care, handheld, and noninvasive head injury assessment device, utilizing an index based on EEG measures reflective of concussion, was demonstrated to provide a quantitative index of brain function impairment in mild traumatic brain injury (mTBI). Citation: Hanley D, Prichep LS, Badjatia N, et al. A brain electrical activity (EEG) based biomarker of functional impairment in traumatic head injury: a multisite validation …
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Acute Occlusion of the Abdominal Aorta in a Patient with Severe Peripheral Vascular Disease and Untreated Atrial Fibrillation
Urgent message: Acute aortic obstruction should be suspected in all patients with back pain and a history of peripheral vascular disease and atrial fibrillation, as over 50% of these cases are misdiagnosed, resulting in high mortality rates in affected patients. Kristopher Palmer, DO and JM Alderson, DO Introduction Aortic occlusion is a rare but potentially fatal vascular phenomenon that must be considered in all patients with peripheral vascular disease (PVD) complaining of severe pain. Here, …
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Clinical Challenge 3: October 2017
A 40-year-old woman visits your urgent care center several days after first noticing a rash of pruritic smooth papules on her trunk and intertriginous areas. She reports that she had been spending a lot of time in the pool with her children before they returned to school. Now she also has a fever and swollen glands, and complains of general malaise. View the photo and consider what your diagnosis and next steps would be. Resolution …
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Clinical Challenge 2: October 2017
A 42-year-old woman with a history of anxiety presents, complaining of intermittent palpitations over the past 2 weeks. She says she has not taken any medication and denies chest pain, shortness of breath, diaphoresis, fever, or dizziness. Upon exam, you find: General: Alert and oriented X 3 Lungs: Clear to auscultation bilaterally Cardiovascular: Regular and tachycardic without murmur, rub, or gallop Abdomen: Soft and nontender without rigidity, rebound, or guarding Extremities: No pain or swelling, …
Read MoreClinical Challenge: October 2017
The patient is a 25-year-old male who presents with pain over the distal phalanx of the middle finger. He says he hit it with a hammer while hanging a picture frame in his new apartment a short while ago. Pain is evident upon palpation over the distal phalanx of the middle finger, but there are no cuts or breaks in the skin. Neurovascular status is intact. View the image taken (Figure 1) and consider what …
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Why Urgent Care Needs More Controllers, Fewer Empathizers
Urgent message: The rise of self-service technologies means that when patients actually do need to interact with frontline staff to resolve a service issue, their more complicated issues, more stringent demands, and higher expectations require an opinionated and outspoken “controller” personality type to take control of the situation. As urgent care relies on positive of word-of-mouth to drive new and repeat visits, a center not only must deliver an exceptional patient experience, but also resolve …
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Approach to the Child with Chest Pain
Urgent message: Chest pain is both more common and, typically, less concerning in children than in adults. If anything, however, this underscores the importance of guarding against a false sense of safety in low-risk causes, and maintaining vigilance for life-threatening etiologies. SABAH F. IQBAL, MD, FAAP and HANSEL OTERO, MD The case: A 12-year-old healthy African-American boy presents to urgent care with 2 days of midsternal chest pain, which is worse when he’s taking big …
Read MoreDoing the MACRA’ena—Part II
In my last column, I tried to explain the complicated math involved in calculating the potential financial impact of MACRA/MIPS on urgent care centers. I made the case for a significant return on investment for a typical urgent care with a typical mix of Medicare patients. Of course, all of the potential return depends on implementation of practical and efficient quality improvement programs that meet the measurement and reporting expectations outlined by the Centers for …
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CDC Calls for More Prevention Against a ‘Persistent Enemy’
The Centers for Disease Control and Prevention is calling for a “renewed commitment from all players” to fight sharp increases in sexually transmitted diseases. In the past year alone, more than 2 million cases of chlamydia, gonorrhea, and syphilis were reported in the U.S. While 1.6 million of those cases were chlamydia, there were 470,000 cases of gonorrhea and nearly 28,000 cases of primary and secondary syphilis. Calling STDs “a growing threat,” the agency stressed …
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