Journal of Urgent Care Medicine

EHR Interoperability: A Bridge to Nowhere

Lee A. Resnick, MD, FAAFP In the beginning, interoperability and health information exchange (HIE) were key selling points for physicians considering adoption of and investment in electronic health records (EHRs), but today most are left feeling misled, stranded on a bridge that leads nowhere. The Healthcare Information and Management Systems Society (HIMMS) defines EHR interoperability as “the ability of different information technology systems and software applications to communicate, exchange data, and use the information that …

Maintenance of Certification: A Punch in the Gut

In an era of plummeting leverage and influence over health care and the well-being of our practices and patients, physicians desperately need representation. Our collective voice has been muzzled and utterly dismissed when it comes to health-care delivery and economics. We have essentially been relegated to serving as the voice of public health and clinical best practice, nothing more. How did we get here, and what are our representatives in our professional organizations doing to …

“Why Are You Calling Me?” How to Fix Relationships with Emergency Departments

Lee 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 …

“Why Are You Calling Me?” The Problem with Patient Transfers in Urgent Care

Lee A. Resnick, MD, FAAFP According to the 2012 Benchmarking Survey from the Urgent Care Association of America, about 4% of urgent care patients are referred to an emergency department (ED) for ongoing care. Some get there by personal vehicle, and others are transferred by emergency services, private ambulance, or other critical-care transportation. Given an average patient volume of 40 patients per day for a single urgent care center, that is 1.5 ED transfers per …

Evaluating Chest Pain in Urgent Care— “Catch 22 and the Three Bears”: Part 2

Lee A. Resnick, MD, FAAFP In my last column, I introduced a framework for evaluating chest pain in urgent care. In this month’s column I discuss a risk and probability stratification that can assist in disposition decision-making. The following discussion considers existing evidence, but there is no formal guideline for this process in the outpatient setting. Our goal is to make a risky scenario into something we can live with. This model is for risk-stratification …

Evaluating Chest Pain in Urgent Care— “Catch 22 and the Three Bears”: Part 1

Lee A. Resnick, MD, FAAFP What can Joseph Heller and Goldilocks teach us about managing no-win situations in urgent care? As it turns out, if you look under the covers of Baby Bear’s bed, you might find something meaningful, perhaps even something that’s “just right.” Take the classic no-win situation when patients present to urgent care with chest pain. Without a definitive and reliable test to guide our decision making, we are stuck with the …

The ‘Control’ Paradox

Lee A. Resnick, MD, FAAFP Influenza is off to a fast start this year and volumes are ballooning. ‘Tis the season to be swamped in urgent care, and without a good approach, urgent care clinicians can quickly become overwhelmed, burned out, and irritable. Pile on the stress of the holidays and the demands of family and loved ones and you’ve got a recipe for disaster. Work-life balance is important for all of us, yet feels …

The Role of Urgent Care in Reducing Hospital Readmissions

Lee A. Resnick, MD, FAAFP Early outpatient follow-up after hospital admission has been documented to be an important factor in reducing hospital readmission rates. Readmissions are also well known to cost billions of dollars annually. The problem with readmissions spans all socioeconomic classes and impacts all payors, public and private. As of 2013, the CMS began penalizing hospitals for readmissions, thus efforts are being made to limit these rates as much as possible. Numerous studies …

A Rational Approach to ‘Suspected’ Ebola Virus Disease in Urgent Care

Lee A. Resnick, MD, FAAFP Fear and anxiety are high in the wake of the first Ebola Virus Disease (EVD) cases on American soil. As with any new, deadly, and transmissible infectious disease, confusion and missteps rule the day. The U.S. public health and disease control entities are certainly not perfect, but the reasonable clinician will see that the ability of these entities to prevent an outbreak is actually quite high. The Disease EVD causes …

The Power of Innocence in Medicine

Lee A. Resnick, MD, FAAFP Medicine, from time to time, calls for reflection. The hangover from arduous shifts, the mind-numbing regulatory “whack-a-mole,” the technology treadmill and the career second-guessing, all contribute to an epidemic of lost perspective in our profession. In an effort to manage an avalanche of competing interests, physicians often sacrifice themselves to the point of burnout and self-destructive behavior. Without perspective, these burdens soon overwhelm even the hardiest among us. We become …