Q. Will you please help me understand initial visit, subsequent visit, and sequelae related to fracture care? If the patient is treated elsewhere for a fracture and the provider just stabilizes the fracture and instructs the patient to then come to my office for reduction, is this a subsequent visit or an initial visit? A. International Classification of Diseases 10th Revision, ClinicalModification (ICD-10-CM) guidelines state that a seventh character, A, is used for the initial …
Read MoreFinger Pain After Jamming During a Basketball Game
A 19-year-old college student presents to an urgent care center with pain at the distal interphalangeal (DIP) joint of the middle finger of his right hand. He reports that the pain started suddenly the previous evening when the finger was jammed while he was playing basketball. The pain is worse through the range of motion, but there is no numbness and no pain at the proximal interphalangeal (PIP) joint.
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Wrist Pain in an Adult After a Fall
A 62-year-old woman presents with left wrist pain that began after she fell onto her outstretched left hand earlier in the morning while walking her dog. She has wrist pain throughout the range of motion, as well as some pain in her hand. She sustained no injuries to her head or neck, and she has no head pain, neck pain, chest pain, or shortness of breath.
Read MoreAbstracts in Urgent Care – May 2016
SEAN M. McNEELEY, MD Results Unavailable for 71% of Trials Key point: Many research findings are not easily available to clinicians. Citation: Chen Ruijun, Desai NR, Ross JS, et al. Publication and reporting of clinical trial results: cross sectional analyis across academic medical centers BMJ. 2016;352:i637. Researchers investigated the amount of clinical trial findings at academic medical centers that are not published and thus not easily available to clinicians. In a cross-sectional analysis of academic …
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Pelvic Pain, Dysuria, and Back Pain in an Adolescent Female
Urgent message: Adolescent patients present to urgent care facilities with unique needs and diagnoses. It is imperative that those who care for them be familiar with some of these diagnoses and keep in mind the importance of obtaining a full and accurate medical history and performing a thorough physical examination. Introduction Adolescent patients can represent unique challenges for health-care providers. In caring for them, providers must work from a broad differential, including diagnoses common to …
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Open-Book Management: Using Transparency and Gamification to Engage and Empower Frontline Staff
Alan A. Ayers, MBA, MAcc Practice Velocity Urgent care requires dedicated, engaged, and focused frontline staff members to deliver the types of patient experiences that spur repeat visits and positive word of mouth. Yet a Gallup poll conducted in 2014 showed that a paltry 32% of U.S. workers are truly engaged in their jobs.1 That means that more than two-thirds of America’s workforce is simply going through the motions—which engagement experts have clearly demonstrated has a …
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Diverticulitis in the Urgent Care Setting
Urgent message: Abdominal pain due to acute diverticulitis is commonlyseen in the urgent care setting. This is a clinical update on the management and treatment of acute diverticulitis. Abdominal pain commonly presents in the ambulatory setting, in anywhere from 1.5% to 8% of patients.1,2 With diverticulitis being a common diagnosis in the presence of abdominal pain, the clinical challenge in a nurgent care setting is determining uncomplicated from complicated diverticulitis. Diverticulosis French pathologist Jean Cruveilhier …
Read MoreThe Secret of Success: Caring Is Believing
Dr. James Gore, an old friend and an urgent care pioneer, shared those words of wisdom with me during a recent conversation. We were discussing the current state of health care and the challenges we face in urgent care with the rabid market activity we are seeing. We chatted a bit about the new faces and the outside interests entering the industry, and we laughed about all the mistakes being made by people looking for …
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Despite Cost Complaints, Patients Don’t Use Price Transparency Tools
Patient advocates and regulators at every level decry that a lack of price transparency often leads to patients getting bigger bills than they expected after leaving a doctor’s office. However, a new study published in Health Affairs calls the actual value of price transparency tools into question—if for no other reason than it’s unclear how often patients would actually use such a tool. Researchers looked at how a population of Aetna members fared using that …
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New Patient Satisfaction Data Highlight Need for Timely Care
Most patients who gave their healthcare providers low scores after an encounter did so because of perceived bad service, not poor medical care, according to a new study published in the Journal of Medical Practice Management. In fact, 96% of complaints in an analysis of 35,000 online reviews were related mainly to communication and wait times. Just 1 in 25 patients who gave their provider one or two stars (on a five-star scale) said they …
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