Practice Management
The patient is a 35-year-old male with a soft tissue mass in the mid index finger of his right hand. He reports that he noticed it only recently, and denies any other symptoms. View the x-ray taken and consider what your diagnosis and next steps would be.
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The scourge of the COVID-19 pandemic has affected urgent care practices deeply, beyond what you already know firsthand. In addition to fluctuations in patient visits, efforts to keep staff safe, and reorganizing locations to meet whatever need was greatest at a given moment, the “typical” urgent care staffing model evolved at an accelerated pace between 2019 and today. The proportion of centers in which physician assistants and nurse practitioners treat patients with only remote …
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Urgent message: Psoas (or iliopsoas) abscess, although rare, is a cause of back pain associated with high morbidity and mortality. Proper diagnosis requires the physician to recognize signs in the history and physical examination that are suggestive of a potentially serious spinal condition prompting further workup. Fabrizia Faustinella, MD, PhD and L. Alexandre Frigini, MD Citation: Faustinella F, Frigini LA. A common compliant with an unlikely diagnosis: psoas abscess in the urgent care center. J …
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Urgent message: Often, patients that could safely be treated for lacerations in the urgent care center are referred to the emergency room due to the quest for expediency, or even providers being out of practice with treating such wounds on site during the COVID-19 pandemic. However, doing so contributes to the degradation of acuity in urgent care while delaying care and raising costs. Anesthesia for wound repair can be achieved in many ways, typically with …
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Urgent message: Utilization of validated scoring systems and clinical decision-making tools can enable the urgent care provider to manage many patients presenting with symptoms of deep-vein thrombosis in the urgent care center, reducing the need for costly referral to the emergency room. Daniel Eisner, DMSc, PA-C ABSTRACT Management of venous thromboembolism accounts for $10 billion in medical spending annually, with much of the cost attributable to emergency room visits. Conversely, managing VTE patients in the …
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Ivan Koay MBChB, MRCS, FRNZCUC, MD Kinesiology Taping for Shoulder and Chest Wall Injuries Take-home point: Kinesiologytaping (KT) combined with standard care appears to be more effective for acute pain reduction in patients with uncomplicated traumatic injury of the shoulder or chest wall. Citation: Bakker M, Bon V, Hubrechts B, et al. Kinesiotaping for acute pain due to uncomplicated traumatic injury of the shoulder or chest wall. Am J Emerg Med. 2022;58:197-202. Relevance: KT offers …
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Ivan Koay MBChB, MRCS, FRNZCUC, MD Applying the Ottawa Ankle Rule to Pediatric Patients Take-home point: Application of the Ottawa Ankle Rule (OAR) limits unnecessary imaging in children without missing clinically relevant fractures. Citation: de Almeida S, Rios J, Lima S, et al. Applying the Ottawa Ankle Rule in a pediatric emergency department. Pediatr Emerg Care. 2022;38(3):e1123-e1126. Relevance: Ankles fractures in children are common.Use of the OAR, a simple clinical decision rule, by UC providers …
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Urgent message: X-ray is an essential component of urgent care operations. Amid rising costs and staffing shortages, limited-scope x-ray techs may be a viable alternative to licensed radiology techs to perform imaging in the clinic. Alan A. Ayers, MBA, MAcc One of the unexpected changes we’ve seen come out of the COVID-19 pandemic is the difficulty urgent care centers face in hiring licensed radiologic technologists (RTs). Even hospitals struggle to hire, offering sign-on bonuses of …
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Urgent message: Founded by emergency medicine doctors on a mission to keep nonemergent patients out of the ED, urgent care has been forced by changes in reimbursement policies to emphasize high productivity and labor cost savings—ultimately leading to overall fewer procedures and thus a lower acuity level for urgent care centers. Benjamin Barlow, MD; Monte Sandler; Alan Ayers, MBA, MAcc The urgent care community has faced many challenges over the past several years. The largest …
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Urgent message: Approximately one quarter of pediatric ambulatory visits result in antibiotic prescriptions, with over one third of those exceeding guideline-recommended durations. Factors that influence urgent care providers toward longer durations have not been studied previously. Megan Hamner, MD; Amanda Nedved, MD; Holly Austin, MD; Donna Wyly, RN, MSN, CPNP-AC, PPCNP-BC; Alaina Burns, PharmD, BCPPS; Brian Lee, PhD, MPH; and Rana E. El Feghaly MD, MSCI Citation: Hamner M, Nedved A, Austin H, Wyly D, …
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