Practice Management
A 35-year-old woman presents with a history of 1 day of pain in her right eye, photophobia, and decreased vision. There is no history of trauma. One day earlier, she was seen at an urgent care center, where the diagnosis was a corneal abrasion, and she was treated with topical trimethoprim-polymyxin. Her symptoms have worsened, so she has returned for further evaluation. View the image taken (Figure 1) and consider what your diagnosis would be.
Read More
Urgent message: Because pain in the lower abdomen is a symptom that can indicate many diseases, including acute appendicitis and acute diverticulitis, it is easy to misdiagnose epiploic appendagitis (EA). Thus, it is important that urgent care practitioners be able to distinguish EA from many other entities, especially because surgery presents the risk of complications. MAY MOHTY, MD, FAAP, FAAUCM, and ANDREW WANG, MS-3 An epiploic appendage is a fat-filled sac (1–2 cm thick and …
Read MoreJOHN SHUFELDT, MD, JD, MBA, FACEP Recap of the Facts Johnny Dalton presented to the emergency department (ED) at St. Jacob’s Hospital after ingesting liquid methadone, a long-acting opioid. Responsive Emergency Medicine and Dr. Beth Ange evaluated and monitored Johnny for nearly 12 hours and discharged him home. Johnny was found dead by his family approximately 20 hours after discharge. Case name: John and Cathy Dalton v. Dr. Beth Ange and Responsive Emergency Medicine Decedent: …
Read MoreLee A. Resnick, MD, FAAFP In my last column I covered the 3 main causes of poor communication in transferring patients from urgent care centers to emergency departments (EDs). I discussed how poor communication creates risk, disrupts work flow, and erodes professional satisfaction. Poor interprofessional relationships and inadequate planning and structure are creating an environment ripe for these breakdowns. Reversing the trend requires a focus on rehabilitating relationships, initiating outreach, and developing coordinated policies and …
Read More
Urgent message: Upper abdominal pain is a common presentation in urgent care practice. Narrowing the differential diagnosis is sometimes difficult. Understanding the pathophysiology of each disease is the key to making the correct diagnosis and providing the proper treatment. TRACEY Q. DAVIDOFF, MD Part 1 of this series focused on disorders of the stomach—gastritis and peptic ulcer disease—on the left side of the upper abdomen. This article focuses on the right side and center of …
Read MoreData from the 2014 Urgent Care Chart Survey of 1,778,075 blinded patient visits to more than 800 different urgent care clinics, conducted by the Journal of Urgent Care Medicine, show that the top 3 conditions that patients reported at presentation were cough (10.9% of visits), sore throat (10.4% of visits), and pain of some kind (7.7% of visits). The survey’s methodology and data abstraction forms were initially designed in 2008 by researcher Robin M. Weinick, …
Read MoreQ. What code do we use now to bill for closed treatment of a rib fracture? A. In 2015, Current Procedural Terminology (CPT) deleted codes 21800, “Closed treatment of rib fracture, uncomplicated, each,” and 21810, “Treatment of rib fracture requiring external fixation (flail chest),” because of lack of use. You are now to report closed treatment of an uncomplicated rib fracture using an appropriate evaluation and management (E/M) code. Q. We perform many joint injections …
Read More
Urgent message: Successful urgent care centers depend on repeat visits from loyal patients, but if patients do not like the experience provided, do not value it, or do not think it meets their needs, they will not come back. Cultivating a loyal following entails understanding and building a service offering around the factors that attract patients and keep them coming back. ALAN A. AYERS, MBA, MAcc, Experity Urgent care is differentiated from other medical practices …
Read MoreThe Case The patient presented with an upper respiratory infection after vertebroplasty. A chest x-ray was ordered to rule out pneumonia. View the image taken (Figure 1) and consider what your diagnosis would be.
Read More