The patient is a 29-year-old white male who presented three weeks after returning from a camping trip, during which he removed three ticks from his chest and back after being bitten. He reports a one-week history of fever, fatigue, hot and cold spells, and arthralgia, and a one-day history of popular rash on the dorsum of his feet (Figure 1 and Figure 2).
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The Quality of Care at Urgent Care Centers
Urgent message: New data reveal that urgent care compares favorably with other practice environments when it comes to select key quality indicators. Developing methods to assess the quality of healthcare in any clinical area is a complicated affair. Many individuals have devoted large parts of their careers to quality measurement, and several national organizations such as The Joint Commission and the National Quality Forum—exist solely for the purposes of measuring and ensuring the quality of …
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The Case of a 28-Year-Old Pregnant Female with Shortness of Breath
Management of Patients Presenting with Constipation
Urgent message: Constipation can be a sign of serious – even life-threatening – etiologies. Once non-benign causes have been ruled out, emphasis should be on evacuation and dietary and lifestyle changes to prevent recurrence. Claire West, MD, Samuel M. Keim, MD, MS, and Peter Rosen, MD Introduction Constipation is a common complaint, accounting for approximately 2.5 million doctor visits annually. With increasing difficulty in obtaining a quick appointment with a primary care physician, more and …
Read MoreThe Only Constant is Change
As I contemplate my own professional transition, from an academic mega-hospital to a private urgent care venture, I have been through the usual rollercoaster of emotions that accompany any major life changes: Stress (physical, mental, and emotional): Change requires simultaneously managing the process you are changing from and the process you are changing to. That’s double the work. In a complex profession like ours, I think everyone will agree there’s enough stress managing just one. …
Read MoreClinical Challenge: February, 2009
The Search for the Urgent Care Center
Urgent message: Efforts to define and accurately count urgent care centers in the U.S.—which may be crucial to the industry’s continued growth—are ongoing, and will require the commitment of trade organizations and individual urgent care owners alike. Our quest to provide accurate, scientifically rigorous benchmarking data for urgent care centers began with the decision to conduct a survey. Before you can administer a survey, though, you need to be able to identify the individuals or organizations …
Read MoreMaking a Case for Hospital Urgent Care
Urgent message: Availability of hospital-affiliated urgent care can not only lower the burden on overcrowded EDs, but also help capture new business and keep existing patients within the health system. Hospitals have operated urgent care centers for over 25 years; today, estimates of how many centers are affiliated with hospitals range from 15% to 20%. In recent years, hospitals grappling with overcrowded emergency rooms and increased competition for outpatient visits have rediscovered urgent care as …
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A 25-Year-Old Male Presenting with Tetanus
Urgent message: Unusual as the diagnosis may be in 2009, patients with symptoms of what is later confirmed to be tetanus may be more likely to present to urgent care than to other practice settings. Curtis G. Kommer, MD, Latha Shankar, MD, and Mario Kapetsonis, MD Tetanus, a toxin-mediated infection of gram-positive bacteria Clostridium tetani, is a rare presentation in the 21st century. Since 2000, there have been fewer than 50 cases per year reported …
Read MoreAbstracts in Urgent Care: January 2009
Who Needs a Blood Culture in the ED? Key point: Use of a prediction rule might reduce use of cultures in low-risk patients. Citation: Shapiro NI, Wolfe RE, Wright SB, et al. Who needs a blood culture? A prospectively derived and validated prediction rule. J Emerg Med. 2008; 35(3): 255-264. Although blood cultures often are obtained for patients in the emergency department, little evidence is available to guide patient selection for such testing. Currently, general …
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