The patient, a 60-year-old woman, presented with swelling in her right arm after a fall and blow to her right elbow. She was in severe pain. View the image taken (Figure 1) and consider what your diagnosis would be.
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November 2012
Productivity Without Peril: Painfree Steps for Efficient Encounters
Lee A. Resnick, MD, FAAFP Managing flow in the urgent care center can be daunting. Volume and acuity are variable, staff is inconsistently engaged, and our patients can create more unpredictable challenges than a “Wipeout” obstacle course. Those who master the chaos move through the day with the effortless grace of a Kung Fu master. Those who don’t resemble something closer to a “Pinball Wizard.” So, what’s the secret sauce? Can efficiency be trained, or …
Read MoreDeveloping Data: November, 2012
These data from the 2010 Urgent Care Benchmarking Survey are based on responses of 1,691 US urgent care centers; 32% were UCAOA members. The survey was limited to “full-fledged urgent care centers” accepting walk-ins during all hours of operation; having a licensed provider and x-ray and lab equipment onsite; the ability to administer IV fluids and perform minor procedures; and having minimal business hours of seven days per week, four hours per day. In this …
Read MoreFracture Care, Laceration Kits, Reimbursement for Extended Hours
DAVID STERN, MD (Practice Velocity) Q. When is it appropriate to use fracture codes without manipulation? If a patient comes in with pain in a finger after a fall and an E/M is performed, x-rays are taken to confirm a fracture, the finger is splinted and the patient is referred to an orthopedist, would that treatment constitute billing for initial care? If not, what must we do to be able to bill these? A. CPT …
Read MoreWhat You Don’t Know
JOHN SHUFELDT, MD, JD, MBA, FACEP In the late 1970s I read a book by Samuel Shem called The House of God. The book is about an intern in a New York hospital during his first year of residency. His senior resident, “The Fat Man,” coins a number of laws about surviving residency. One of them—“If you don’t take a temperature you can’t find a fever”—can be extrapolated to all sorts of questions, tests, and …
Read MoreAbstracts in Urgent Care: November, 2012
Acute Heart Failure: Hospitalize or Discharge? Key point: A new tool for estimating prognosis could facilitate rapid risk assessment. Citation: Lee DS, Stitt A, Austin PC, et al. Prediction of heart failure mortality in emergent care: A cohort study. Ann Intern Med. 2012; 156(11): 767-775. The decision to hospitalize or discharge a patient with acute heart failure (HF) is often difficult to make. To develop a prognostic model for acute HF suitable for use in …
Read MoreClinical Challenge: November, 2012
The patient, a 9-month-old male, suffered a blow to his left shoulder. View the image taken (Figure 1) and consider what your diagnosis would be. Resolution of the case is described on the next page.
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Ludwig’s Angina
Urgent message: Thoroughly evaluate patients who complain of dental or oral pain. CHRISTOPHER MCKENNA and JOHN SHUFELDT, MD, JD, MBA, FACEP Ludwig’s angina is a serious and potentially life-threatening connective tissue infection found on the floor of the mouth and in the deep neck spaces. More specifically, it is a bilateral infection of the submandibular space. The two compartments affected are the sublingual space and the submylohyoid space.1 This condition usually presents in individuals who …
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Wear Your Brand: Increasing Awareness of Your Urgent Care Center
Urgent message: An urgent care entrepreneur is the “product” and must become skilled at promoting him/herself. When you “wear your brand,” you call attention to what you have to offer, generating awareness of an interest in your urgent care center. ALAN A. AYERS, MBA, MAcc, ExperityOn a recent visit to a popular bakery-café, I noticed a young woman on the sofa working on her laptop. For passersby, there was no question about which candidate would …
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