Practice Management
Urgent message: With patients who have sustained head injuries related to both sports- and non–sports-related activities presenting to urgent care more than ever before, it’s essential for the provider to have a nuanced understanding of which patients truly require transfer or referral to a high-acuity level of care, and which can be managed successfully and safely in the urgent care setting. Anthony P. Doran, PsyD; Robert G. Graw, Jr., MD; Marc Weber, MD; Stanford Coleman, …
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Urgent message: Pharyngitis is a common chief complaint in urgent care, but not all sore throats are streptococcal (strep) pharyngitis. Delayed diagnosis and treatment of some causes of sore throat can lead to catastrophic outcomes. Epidemiology Acute pharyngitis accounts for 1%-2% of all visits in the ambulatory setting.1 Most pharyngitis seen in urgent care is viral in etiology. The most common bacterial cause of pharyngitis is group A beta hemolytic Streptococcus (GABHS), which is responsible …
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Urgent message: Acute otitis media (AOM) is the leading diagnosis for antibiotic prescribing in pediatric patients. As antibiotic stewardship becomes more essential in preventing antibiotic resistance, safe and effective management of AOM becomes all the more important in urgent care. The treatment path should reflect nuances in management to inform decisions regarding the necessity of antibiotics—and if they are deemed necessary, targeting the type, delivery vehicle, and duration to keep a narrow treatment effect. When …
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Urgent message: As understanding of COVID-19 in the pediatric age group evolves, it has come to light that children may contract the virus, yet be asymptomatic, more commonly than we initially believed. We have found a high prevalence of asymptomatic pediatric patients testing positive for COVID-19 in our urgent care clinics in the NY metro region. Katharine Miao MD, Frank Illuzzi MD, and Alexander C. Hwang IMPORTANCE SARS-CoV-2 is the novel virus that causes COVID-19. …
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Urgent message: Recent expert opinion has reshaped initial management for suspected acute renal colic. Clinicians often utilize computerized tomography imaging to diagnose acute renal colic; however, there is an increasing role for clinicians to instead use point-of-care ultrasound (POCUS) as the initial imaging modality when acute renal colic is suspected. Renal ultrasound is time and cost effective, radiation-free and completed by the clinician at the bedside. Chelsea M. Burgin, MD, FAAFP; James Frederick W. Pike, …
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Urgent message: While standards for pediatric emergency care have been defined for outpatient offices and emergency departments, guidelines have not been published for urgent care centers. This study assesses the presence of equipment, supplies, and medications necessary to manage emergencies in pediatric urgent care centers. Amanda Montalbano, MD, MPH, FAAP and Brian Lee, PhD, MPH Results from this project were presented in poster format the Pediatric Urgent Care Conference in Orlando, FL in 2018. No …
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Katie Jerzewski MD, Roshni Patel MD, and Joshua Rocker MD OVERVIEW The novel coronavirus, or SARS-CoV-2, first appeared in the Wuhan province of China in the winter of 2019. Due to the virus’s ability to spread from an asymptomatic carrier to the next new host and Wuhan being a pivotal commercial center, it spread quickly across the globe. Asymptomatic carrier rates have ranged from 1.6% to 56.5%, depending on clinical setting and testing availability.1 In …
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Urgent message: A validated platform effective in performing rapid point-of-care tests for SARS-CoV-2 would be ideal for use in urgent care centers. While reports of false negative results with one system called the viability of such a platform into question, results of this study support the use of POC testing using self-collected nasal swabs. Bronson Elizabeth Delasobera, MD; Amanda Joy, PA; Masashi Waga; Rita Malley, MS; Anisha Patel, MS; Sarah Greenwood, PA; Jerry Creighton, RN; …
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Urgent message: The risk in not “doing the math” with a patient’s risk factors is obvious for that patient. However, urgent care providers and operators also run significant legal risk when patients with multiple complaints present and there’s a bad outcome—even if the most pressing complaint is impossible to discern. Michael B. Weinstock, MD; David A. Farcy, MD FAAEM, FACEP, FCCM; and Ramin Vejdani, DO [This case was adapted from a chapter in the book Bouncebacks! …
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Urgent message: The urinalysis is a ubiquitous test in urgent care settings, though there is nuance and complexity in its interpretation. An evidence-based approach is essential to assuring correct interpretation and decision-making. Douglas W. Wallace, MD, Blakeley Hudson, MD, and Matthew Delaney, MD Introduction The urinalysis (UA) is one of the most commonly ordered tests across a variety of practice settings. Despite its ubiquity, interpreting a UA can be complicated and nuanced. Given the variable …
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