Journal of Urgent Care Medicine

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 …

The 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. …

Clinical 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 …

Making 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 …

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 …

Abstracts 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 …

Managing Foot Fractures in Urgent Care

Second in a Two-part Series Urgent message: Acute injuries to the midfoot and hind foot require immediate treatment or emergent referral. Close attention to the location and mechanism of injury at the urgent care site may facilitate efficient care and prevent long-term disability. Phillip H. Disraeli MD, FAAFP In keeping with the tone of part 1 of this two-part series (JUCM, December 2008), this article will discuss the urgent care clinician’s approach to foot fractures …

Crisis in the ER: Quantifying the Impact of Urgent Care

Much has been written lately on the growing crisis in emergency services: diversions, overcrowding, uncompensated care, lack of hospital beds, and the high cost of care in emergency department settings. Much has also been written of late about the growing crisis in primary care: poor reimbursement, declining numbers of primary care physicians and trainees, and declining access to primary care as a result. This has caused increased wait times and limited same-day availability. All of …

Clinical Challenge: January, 2009

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 R 5th finger PIP hyperextension and DIP hyperflexion (swan neck deformity). Her PIP flexion limited to about 20°, while her contralateral PIP joint shows about 100 degrees of flexion. No sensory or motor deficits noted. View the x-rays taken (Figure 1 and 2) and consider what your diagnosis and …

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