Practice Management
This month, we will discuss Question III: What is the incidence of deaths in patients recently discharged from the ED? In May 2007, Sklar et al performed a very interesting study concerning deaths that occurred within seven days of ED discharge. A similar study had been done in 1994 by Kefer et al, looking at medical examiner cases. Sklar’s study, however, is more likely to have captured all unanticipated deaths because it was performed at …
Read MoreNEJM Article Blames CT-Related Radiation for Up to 2% of Cancers in U.S. Key point: The growth of medical CT utilization may be re- sponsible for 1.5% to 2% of cancer cases in the U.S. Citation: Brenner DJ, Hall EJ. N Engl J Med. 2007;357:2277- 2284. A New England Journal of Medicine review article published recently targets the cancer risks of CT at the same time that hundreds of scientific presentations and new products at …
Read MoreThe patient is a 26-year-old male who slipped and twisted his left ankle. He is unable to bear weight on the ankle and there is marked local swelling circumferentially around the ankle. Oth erwise, he is generally healthy. View the x-ray taken (Figure 1) and consider what your diag- nosis and next steps would be. Resolution of the case is described on the next page.
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Urgent message: In the absence of controlled outpatient trials, the author proposes urgent-care specific guidelines for treatment of community-acquired MRSA, informed by clinical experience and local and regional case reports. Michael Dickey, MD The goal of any treatment is to maximize the chance of a positive outcome for a patient. The purpose of a treatment guideline is to maximize the chance of positive outcomes in groups of patients that present with a similar disease states. …
Read MoreLee A. Resnick, MD, FAAFP Have you ever wondered how many urgent care centers there are in the U.S.? So did UCA. Partnering with researchers at Harvard University and Massachusetts General Hospital, UCA has completed the first-ever sampling frame of urgent care centers across the country. Our goal was to produce an objective, scientifically valid assessment of the size of the urgent care industry. Estimates have flown around the industry for years, but until now …
Read MoreThe patient is a 10-year-old boy who received a blow to the forearm when he fell at home. He presented with local swelling and tenderness on exam, complaining of severe pain in his wrist. View the x-rays taken (Figure 1 and Figure 2) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
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Urgent message: Atypical chest pain in a young male offers a challenge solved by ordering—and assessment—of the appropriate imaging. Shannon Dowler, MD The patient is a 20-year-old white male who presented to urgent care with a two-week history of mild dyspnea, with the onset of chest pain in the prior 24 hours. He denied wheezing, vomiting, and recent trauma, and reported that he has tried no medications for his symptoms. Further discussion with the patient …
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Urgent message: The ability to evaluate children presenting with a limp—and to recognize red flags that help distinguish those to treat from those requiring immediate referral—should be within the purview of the urgent care clinician. Raymond W. Liu, MD, Hadeel Abaza, MD, and Allison Gilmore, MD A limping child without a clear traumatic history or diagnosis is a common presentation to an urgent care center. The broad differential diagnosis can be daunting, with causes that …
Read MoreYou thought you were alone on an island trying to navigate through the trials of urgent care. You thought you were the only one faced with the clinical and financial challenges. Hopefully, you have discovered the Urgent Care Association (UCA), attended one of the conferences, and shared in the delight of collaborating with colleagues who share your questions, your challenges, and your desire to make a difference one patient at a time. Hopefully, you recognize …
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