Journal of Urgent Care Medicine

A Legal Quandary: Poor Care…or Malpractice?

Urgent message: Failure to consider subtleties and the context in which a patient presents can lead to insufficient differential diagnoses and, therefore, mis- or missed diagnoses that leave the patient at risk for poor outcomes and the provider at risk for litigation. Michael Weinstock, MD and Charles Pilcher, MD Back pain is usually back pain, whether it’s from a muscular strain or another self-limiting, non-serious cause. But there is potential danger lurking below the surface, …

A Novel Method for Blinding Reviewers to Gender of Proceduralists for the Purposes of Gender Bias Research

Urgent message Gender bias, whether overt or subconscious, may be to blame for disparities in hiring practices, salary, and advancement in medical schools, the urgent care setting, and any healthcare workplace. Recognizing the value of gender-neutral assessment may not only “even the playing field,” but increase the likelihood of identifying the best candidates for clinical positions. Michael Pallaci, DO; Jennifer Beck-Esmay, MD; Adam R. Aluisio, MD, MSc; Michael Weinstock, MD; Allen Frye, NP; Ashley See, …

Most Clinicians Are Still Not Comfortable Sending Chest Pain Patients Home with a Very Low Risk of 30-Day Major Adverse Cardiac Event (MACE)

Michael B. Weinstock, MD; Michael Pallaci, DO; Amal Mattu, MD; Cameron Berg, MD; Paul Jhun, MD; and Jeff Riddell, MD. Urgent message: Patients who present with chest pain but tests indicate there is little risk for a major event can leave providers uncertain as to what next steps are appropriate, and raise concerns for bad outcomes and litigation. Citation: Weinstock MB, Pallaci M, Mattu A, Berg C, Jhun P, Riddell J. Most Clinicians Are Still …

A Multicenter Study of the Rate of MACE in Chest Pain Patients with a Moderate HEART Risk Score Referred from Urgent Care for an Expedited Outpatient Cardiology Evaluation

ABSTRACT Background: The HEART Score is an effective method of risk-stratifying emergency department patients with chest pain. The rate of major adverse cardiovascular events (MACE) in patients with moderate HEART score referred from an urgent care center (UC) for an expedited outpatient cardiology evaluation is unknown. Purpose: The primary outcome of this study was to examine the rate of MACE when patients with moderate HEART score were referred for expedited outpatient cardiology follow-up after evaluation …

A 41-Year-Old Woman with Multiple Complaints

Urgent message: The risk in not “doing the math” with a patient’s risk factors is obvious for that patient. However, urgent care providers and operators also run significant legal risk when patients with multiple complaints present and there’s a bad outcome—even if the most pressing complaint is impossible to discern. Michael B. Weinstock, MD; David A. Farcy, MD FAAEM, FACEP, FCCM; and Ramin Vejdani, DO [This case was adapted from a chapter in the book Bouncebacks! …

Chest X-Ray Findings Among Urgent Care Patients with COVID-19 Are not Affected by Patient Age or Gender: A Retrospective Cohort Study of 636 Ambulatory Patients

Joshua Russell, MD, MSc, FACEP MD; Ana Echenique, MD, DABR; Steven R. Daugherty, PhD; and Michael Weinstock, MD Abstract Background/Objective A prior study of patients presenting to urgent care (UC) centers with COVID-191 showed that only a small proportion of these ambulatory patients demonstrated significant pathology on chest x-ray (CXR). In this secondary analysis of 636 ambulatory patients with confirmed COVID-19 from greater New York City (NYC), our primary objective was to determine whether the …

Chest X-Ray Findings in 636 Ambulatory Patients with COVID-19 Presenting to an Urgent Care Center: A Normal Chest X-Ray Is no Guarantee

Michael B. Weinstock, MD, Ana Echenique, MD, DABR, Joshua W. Russell, MD, MSc, FACEP, Ari Leib, MD, Jordan A. Miller, DO, David J. Cohen, MD, Stephen Waite, MD, Allen Frye, NP, and Frank A. Illuzzi, MD, FACEP Abstract Background/Objective Patients with COVID-19 commonly present to Urgent Care (UC) centers. Our primary objective was to determine what percentage of UC patients with confirmed COVID-19 had normal vs abnormal chest x-rays (CXR). Secondarily, we aim to describe …

A 5-Month-Old with Symptoms Beyond the Presenting Complaint

Urgent message: Treating preverbal children can be challenging under every-day circumstances for pediatricians who know the child and the family. Urgent care providers who may not have the benefit of that history must be especially vigilant for all available signs and symptoms to make diagnoses based on the full scope of the presentation. Michael Weinstock, MD Case Presentation (Please note: The Case Presentation is drawn directly from the treating physician’s notes, without editing or correction, …

A 16-Week-Old Infant with Bloody Vomitus

In Bouncebacks, we provide the documentation of an actual patient encounter, discuss patient safety and risk-management principles, and then reveal the patient’s bounceback diagnosis. This case is from the book Bouncebacks! Pediatrics, by Michael B. Weinstock, Kevin M. Klauer, Madeline Matar Joseph, and Gregory L. Henry, and is available at www.anadem.com and www.amazon.com. Introduction A 16-week-old infant was brought by her parents to the emergency department (ED) of a children’s hospital. Note: The following is the actual documentation by the provider. Visit …

Nonhealing Wounds, Part 2: Treatment in the Urgent Care Center

Urgent message: The etiology of nonhealing wounds is often multifactorial, with the likelihood of healing enhanced if all considerations are addressed, including evaluation and management of the blood supply in patients with peripheral arterial disease or diabetes mellitus, as well as local wound care. The diagnosis of a nonhealing wound is largely clinical, with diagnostic studies tailored to the suspected cause as well as to the underlying process. Part 1 of this article [see “Nonhealing Wounds, Part 1: Diagnosis in the Urgent Care …