Journal of Urgent Care Medicine

Evaluating Febrile Patients with Rash

Urgent message: The broad differential diagnoses in patients presenting with rash and fever range from minor conditions to life threatening illnesses, requiring the urgent care provider to make prompt but valid assessment with minimal diagnostic tools. Kosta G. Skandamis, MD The combination of fever and rash is so common that it may sometimes seem to be a daily occurrence in the urgent care setting. Nonetheless, the extensive differential diagnosis requires the provider to be vigilant …

A 9-year-old Boy with Respiratory Symptoms

Urgent message: ‘Fresh eyes’ may be needed to reconsider an initial diagnosis or re-evaluate treatment in patients who present with unresolved symptoms. Joseph Toscano, MD The Case A 9-year-old boy presented to an urgent care clinic with a several-day history of dry cough and intermittently noisy and difficult breathing, especially at night. He had no fever or chest pain, no nasal discharge or headache, and no rash or pruritis. His past medical history included no …

Case Report: Gout vs. Cellulitis

Urgent message: Sometimes, cellulitis can be confused with gout – especially when it involves the area around a joint. A detailed history and physical exam, along with diagnostic testing, will help you reach definite diagnosis. Introduction Gout is a metabolic disease characterized by recurrent episodes of acute arthritis. It is a type of monoarticular arthritis caused by deposition of monosodium urate crystals in and around the joint. Hyperuricemia (serum uric acid level >6.5 mg/dL) seems …

Urgent Care Clinic Evaluation: A Case Study

By Julie Wright, MBA, CMPE Introduction The steady growth of new urgent care centers (UCC) has garnered publicity and caught the eyes of entrepreneurial thinkers across the country. As medical groups have become more responsive to patient needs, and as patients have become independent, urgent care centers have found their niche in the market. UCCs are an important addition to our healthcare system and have been growing in popularity for both patient and practitioner for …

Treatment of Pediatric Community-acquired Pneumonia in an Urgent Care Center

Urgent message: Although diagnosis of pediatric community-acquired pneumonia is not always straightforward, most cases can be diagnosed adequately by non-pediatricians and treated in the urgent care center, thereby reducing hospitalization for this condition. By Deena R. Zimmerman, MD, MPH, IBCLC, Scott Fields, MD, Nahum Kovalski, BSc, MDCM Introduction Pediatric community-acquired pneumonia (CAP) is a common illness. Estimates are that the annual incidence of pneumonia per 1,000 children in North America ranges from 30 to 45 cases …

Valuation of an Urgent Care Clinic

Urgent message: Despite the fact that underlying principles are the same as for other settings, it behooves the urgent care operator to consider factors unique to the urgent care arena when determining the value of the practice. By Keith Borglum, CHBC How much is your practice worth? This is a simple question with a complex answer. There are many books on the topic—and a fair amount of debate—and the answer differs depending on the particular situation …

Managing Employee Performance: A Path to Clinical and Business Excellence

By Marty Martin, PsyD, MPH, MA Imagine a patient who walks into an urgent-care center feeling as many patients do – sick, tired, and irritable. But as soon as the patient arrives, the receptionist greets him warmly and with respect. As the patient sits down in the waiting room, the receptionist lets him know how long the wait might be. When the receptionist invites the man back to the treatment area, he is greeted warmly …

Galeazzi Fracture–Dislocation of the Wrist or Isolated Distal Radius Fracture?

Urgent message: Fractures of the distal radius are a common presentation in the urgent care setting. Nonetheless, a high index of suspicion is required for the diagnosis of a Galeazzi fracture–dislocation.By Heather L Hinshelwood, MD and David Caro, MD IntroductionThe anatomic structure of the forearm typically maintains the integrity of the distal radioulnar joint when the radius is fractured. However, in certain situations this joint may be compromised with certain rotational forces. CaseA 14-year-old African-American male …

Outpatient Management of Opioid Dependence in Urgent Care

Urgent message: Urgent care physicians may be well positioned to play a role in stemming the national epidemic of opioid dependence, providing much needed care for patients and adding a new facet to their own clinical practice. By Paolo T. Coppola, MD, FACEP and Matthew I. Salzberg Introduction The DSM-IV-TR defines dependence as “a cluster of cognitive, behavioral, and physiologic symptoms that indicate a person has impaired control of psychoactive substance use and continues use of …