Abstracts

Report Pulmonary Illness Possibly Involving Vaping to State, Local Health Departments Key point: The CDC is working with state health departments to characterize severe pulmonary disease in patients who use e-cigarettes, also known as vaping. Citations: Centers for Disease Control and Prevention. CDC urges clinicians to report possible cases of unexplained vaping-associated pulmonary illness to their state/local health department. Available at: https://emergency.cdc.gov/newsletters/coca/081619.htm. Accessed September 6, 2019. Caporale A, Langham MC, Wensheng G, et al. Acute …

Practice of Urgent Care: Rude Patients May Do More than Ruin Your Mood Key point: Individual and team performance of clinicians suffer in both quality of diagnostic approach and procedural skills when dealing with rude patients. Citation: Riskin A, Erez A, Foulk TA, et al. The impact of rudeness on medical performance: a randomized trial. Pediatrics.2015;136(3):487-495. Patients in urgent care commonly have unrealistic demands and expectations. When they make disparaging remarks, it’s easy to feel …

Rush for Outpatient Stress Test Recommendation (Finally) Examined Key point: Rapid outpatient stress testing (ie, within 72 hours), which has long been recommended by the American Heart Association, did not decrease the short-term risk of major adverse cardiac events (MACE). Citation: Natsui S, Sun BC, Shen E, et al. Evaluation of outpatient cardiac stress testing after emergency department encounters for suspected acute coronary syndrome. Ann Emerg Med. April 5, 2019. [Epub ahead of print] The …

Practice of Urgent Care: The Illusion of Multitasking and the Cost of Interruptions Key point: True multitasking is not possible. Rather, when we attempt to multitask, our brains are actually rapidly switching focus. Task-switching and interruptions negatively impact our ability to complete tasks accurately and effectively. Minimizing task-switching reduces the likelihood of cognitive errors and, consequently, adverse patient outcomes. Citation: Skaugset LM, Farrell S, Carney M, et al. Can you multitask? Evidence and limitations of …

Mitigating Risk Through Shared Decisionmaking Key point: Shared decision-making appears to mitigate the risk to clinicians of patient complaints and lawsuits in the event of a bad outcome. Citation: Schoenfeld  EM, Mader S, Houghton C, et al. The effect of shared decisionmaking on patients’ likelihood of filing a complaint or lawsuit: a simulation study. Ann Emerg Med. January 3, 2019. [Epub ahead of print]   Missed and delayed diagnoses of dangerous conditions are unavoidable in …

Rethinking IV Antibiotics for Cellulitis Key point: Oral antibiotics are noninferior to parenteral antibiotics for uncomplicated cellulitis. Erythema of cellulitis commonly expands somewhat, even if treated with appropriate antibiotics, for the first 1-2 days after starting treatment. Citation: Aboltins CA, Hutchinson AF, Sinnappu RN, et al. Oral versus parenteral antimicrobials for the treatment of cellulitis: a randomized non-inferiority trial, J Antimicrob Chemother. 2015;70(2):581-586. Patients with cellulitis are often referred from urgent care to the emergency …

Practice of Urgent Care: More Patients, More Decisions, More Fatigue Key point: We should be aware, as clinicians, that as we progress through our shifts, decision fatigue mounts. One manifestation of decision fatigue is an incremental decline in antibiotic stewardship. It is also important to understand that taking breaks seems to combat the harmful effects of decision fatigue. Citations: Linder JA, Doctor JN, Friedberg MW, et al. Time of day and the decision to prescribe …