JOHN SHUFELDT, MD, JD, MBA, FACEP I was an emergency medicine resident on the south side of Chicago in the mid-1980s and, truth be known, I sometimes played inappropriate practical jokes on residents at other area trauma centers. One of my favorites was calling over the “patch phone” with a report that a patient whose penis was “Lorena Bobbitted” by a pit bull was en route; the paramedics were bringing in both the patient and …
Read MoreWhat, When, Who, and How to Offer ‘Freebies’
Historically, marketing occupational health services has often meant producing various commodities with your clinic’s name on it: pens, hats, mini-flashlights, refrigerator magnets, note pads, even t-shirts. Cute, perhaps—but these trinkets cost money, took time to distribute, and quickly faded from the recipient’s mind, if not their possession. Should your clinic’s outreach strategy include “freebies?” If so, what should they be, how should they be distributed, and who should receive them?
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The Search for the Urgent Care Center
Urgent message: Efforts to define and accurately count urgent care centers in the U.S.—which may be crucial to the industry’s continued growth—are ongoing, and will require the commitment of trade organizations and individual urgent care owners alike. Robin M. Weinick, PhD, Steffanie J. Bristol, BS, Jessica E. Marder, and Catherine M. DesRoches, DrPH Our quest to provide accurate, scientifically rigorous benchmarking data for urgent care centers began with the decision to conduct a survey. Before …
Read MoreDetermining New vs. Established Patients for E/M Coding
Q.We are in the process of adding urgent care services to our occupational medicine clinic. How do we determine when to use a new or established E/M code for the patients who are seen for urgent care services? A.I continue to receive questions regarding the “when to code new or established patient E&M codes” conundrum, so let’s try to simplify the issue. The official CPT definition of new patient is: A patient who has not …
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A 25-Year-Old Male Presenting with Tetanus
Urgent message: Unusual as the diagnosis may be in 2009, patients with symptoms of what is later confirmed to be tetanus may be more likely to present to urgent care than to other practice settings. Curtis G. Kommer, MD, Latha Shankar, MD, and Mario Kapetsonis, MD Tetanus, a toxin-mediated infection of gram-positive bacteria Clostridium tetani, is a rare presentation in the 21st century. Since 2000, there have been fewer than 50 cases per year reported …
Read MoreAbstracts in Urgent Care: January 2009
Who Needs a Blood Culture in the ED? Key point: Use of a prediction rule might reduce use of cultures in low-risk patients. Citation: Shapiro NI, Wolfe RE, Wright SB, et al. Who needs a blood culture? A prospectively derived and validated prediction rule. J Emerg Med. 2008; 35(3): 255-264. Although blood cultures often are obtained for patients in the emergency department, little evidence is available to guide patient selection for such testing. Currently, general …
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Managing Foot Fractures in Urgent Care
Second in a Two-part Series Urgent message: Acute injuries to the midfoot and hind foot require immediate treatment or emergent referral. Close attention to the location and mechanism of injury at the urgent care site may facilitate efficient care and prevent long-term disability. Phillip H. Disraeli MD, FAAFP In keeping with the tone of part 1 of this two-part series (JUCM, December 2008), this article will discuss the urgent care clinician’s approach to foot fractures …
Read MoreCrisis in the ER: Quantifying the Impact of Urgent Care
Much has been written lately on the growing crisis in emergency services: diversions, overcrowding, uncompensated care, lack of hospital beds, and the high cost of care in emergency department settings. Much has also been written of late about the growing crisis in primary care: poor reimbursement, declining numbers of primary care physicians and trainees, and declining access to primary care as a result. This has caused increased wait times and limited same-day availability. All of …
Read MoreClinical Challenge: January, 2009
The patient is a 35-year-old female who got her finger caught in a metal staircase banister one day prior to presentation. Physical examination is significant for R 5th finger PIP hyperextension and DIP hyperflexion (swan neck deformity). Her PIP flexion limited to about 20°, while her contralateral PIP joint shows about 100 degrees of flexion. No sensory or motor deficits noted. View the x-rays taken (Figure 1 and 2) and consider what your diagnosis and …
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35-year-old female with worsening neck pain
The patient is a 35-year-old Caucasian female who presented with dysphagia and progressively worsening neck pain. No history of injury was reported. Neurovascular exam was normal. View the images taken and consider what your diagnosis and next steps would be.
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