MAY 2015 UCCOP Has a Watchful Eye
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™ MAY 2015 VOLUME 9, NUMBER 8 THE JOURNAL OF URGENT CARE MEDICINE® www.jucm.com The Official Publication of the UCAOA and UCCOP PUBLICATION BRAVEHEART A has a watchful eye. a 4FFGPSZPVSTFMG WJTJUOITJODDPN nhsinc.com The Art of the Right Fit™ LETTER FROM THE EDITOR-IN-CHIEF “Why Are You Calling Me?” How to Fix Relationships with Emergency Departments n my last column I covered the 3 main understood, mutual goal-setting and prioritization can com- Icauses of poor communication in transfer- mence, and it is invariably productive and helpful. ring patients from urgent care centers to emergency departments (EDs). I discussed Step 3: Policy and Procedure Development how poor communication creates risk, dis- Once the two parties are aligned, policy and procedure can be rupts work flow, and erodes professional sat- developed to help guide the clinical teams in both settings. The isfaction. Poor interprofessional relationships and inadequate goals of this exercise should be to facilitate transfers, keep com- planning and structure are creating an environment ripe for these munication focused and relevant, reduce interruptions, and breakdowns. Reversing the trend requires a focus on rehabilitat- eradicate judgmental or insulting commentary. Each medical ing relationships, initiating outreach, and developing coordinated director should commit to clearly communicating the new poli- policies and procedures for transfers and communication. cies and procedures to all of their physicians and, importantly, to all members of the nursing staff. A culture of mutual under- Step 1: Breaking the Ice standing and respect should be expected and clearly communi- As with all functional relationships, getting to know the people cated to everyone involved. and faces in area emergency departments is a critical first step. In Use of hospital transfer centers, where available, can dramati- the heat of a busy and frustrating shift, it is easy to demonize cally facilitate this process. These serve as air traffic control for faceless names on the other end of the phone line. They are transfers to and from the hospital and can even assist with easy targets. Likewise, getting to know your colleagues offers a degree urgent referrals to specialists. In this case, all policies and procedures of protection against confrontation. That is just human nature. should be coordinated with the transfer center, and urgent care Scheduling a meeting with the ED medical director is an impor- leaders should educate and communicate accordingly. tant first step, one that will almost always bear fruit. Step 4: Follow-Up and Reassessment Step 2: Mutual Goal-Setting and Prioritization Once an action plan and policies and procedures are in place, During this meeting, you and your counterpart have an oppor- both parties should commit to a scheduled follow-up when tunity to share your own unique situational challenges. Mutual feedback from both sides should be reviewed. Incidents should understanding around limitations and needs is crucial. We be examined and collaborative performance-improvement make assumptions that our colleagues appreciate our circum- plans can be initiated. stances and that they are simply just being insulting or obstruc- tionist when they give us a hard time about transfers. This is a Conclusion false assumption. In my experience, most ED physicians do not fully With a collegial and organized approach, urgent care leaders understand the urgent care model, its limitations, or its purpose can eliminate confrontation with their ED colleagues. The effort within health care. Once they do, most are far more collegial. is sure to improve the mood and productivity of staff members while The ED itself has no shortage of challenges, and this meeting reducing the risk of liability and bad outcomes. ■ can help the urgent care physician better appreciate how those might be affecting the efficiency of transfers. Risk and liability issues should be a high priority for both parties. Nothing is more dangerous than discrediting your peers in front of patients regarding anything that can be interpreted as poor perform- ance or poor decision-making. This is behavior that must be Lee A. Resnick, MD, FAAFP eliminated. Once each party’s challenges are more clearly Editor-in-Chief, JUCM, The Journal of Urgent Care Medicine www.jucm.com JUCM The Journal of Urgent Care Medicine | May 2015 1 ™ The Official Publication of the UCAOA and UCCOP May 2015 VOLUME 9, NUMBER 8 CLINICAL 8 Upper Gastrointestinal Disorders in Urgent Care, Part 2: Biliary Tract and Pancreatic Disease Biliary tract disease and pancreatic disease present as upper abdominal pain. Learn how to narrow the differential diagnosis. Tracey Q. Davidoff, MD Illustration showing gallstones blocking the bile ducts. PRACTICE MANAGEMENT IN THE NEXT ISSUE OF JUCM What can myocardial infarction, aortic dissection, 19 Six Elements of a and a ruptured ectopic pregnancy have in common? Winning Patient Experience Shoulder pain. To thrive, your urgent care center needs loyal patients. If you focus on the components discussed here, your patients will keep returning. DEPARTMENTS Alan A. Ayers, MBA, MAcc 7 From the UCAOA CEO 29 Insights in Images 31 Health Law CASE REPORT 34 Abstracts in Urgent Care 25 Epiploic Appendagitis 36 Coding Q&A Because pain in the lower abdomen is a 40 Developing Data symptom that can indicate many diseases, it is easy to misdiagnose epiploic appendagitis. CLASSIFIEDS May Mohty, MD, FAAP, FAAUCM, and Andrew Wang, MS-3 38 Career Opportunities www.jucm.com JUCM The Journal of Urgent Care Medicine | May 2015 3 JUCM EDITOR-IN-CHIEF Joseph Toscano, MD Lee A. Resnick, MD, FAAFP San Ramon (CA) Regional Medical Center Chief Medical and Operating Officer Urgent Care Center, Palo Alto (CA) Medical WellStreet Urgent Care Foundation President, Institute of Urgent Care Janet Williams, MD, FACEP EDITOR-IN-CHIEF Medicine Rochester Immediate Care Lee A. Resnick, MD Assistant Clinical Professor, Case Western [email protected] Mark D. Wright, MD Reserve University MANAGING EDITOR Department of Family Medicine University of Arizona Medical Center Katharine O’Moore-Klopf, ELS [email protected] JUCM JUCM ADVISORY BOARD ASSOCIATE EDITOR, PRACTICE MANAGEMENT EDITORIAL BOARD Alan A. Ayers, MBA, MAcc Alan A. Ayers, MBA, MAcc Michelle H. Biros, MD, MS CONTRIBUTING EDITORS Concentra Urgent Care University of Minnesota Sean M. McNeeley, MD Tom Charland Kenneth V. Iserson, MD, MBA, FACEP, John Shufeldt, MD, JD, MBA, FACEP Merchant Medicine LLC FAAEM David Stern, MD, CPC The University of Arizona MANAGER, DIGITAL CONTENT Richard Colgan, MD Brandon Napolitano University of Maryland School of Medicine Gary M. Klein, MD, MPH, MBA, CHS-V, [email protected] Jeffrey P. Collins, MD, MA FAADM ART DIRECTOR Harvard Medical School mEDhealth advisors Tom DePrenda Massachusetts General Hospital Benson S. Munger, PhD [email protected] Tracey Quail Davidoff, MD The University of Arizona Accelcare Medical Urgent Care Emory Petrack, MD, FAAP Kent Erickson, MD, PhD, DABFM Petrack Consulting, Inc.; Unlimited Patient Care Center, PLLC Fairview Hospital 120 N. Central Avenue, Ste 1N Ramsey, NJ 07446 Thomas E. Gibbons, MD, MBA, FACEP Hillcrest Hospital Doctors Care Cleveland, OH PUBLISHERS William Gluckman, DO, MBA, FACEP, Peter Rosen, MD Peter Murphy [email protected] • (201) 529-4020 CPE, CPC Harvard Medical School FastER Urgent Care Stuart Williams David Rosenberg, MD, MPH [email protected] • (201) 529-4004 David Gollogly, MBChB, FCUCP University Hospitals Medical Practices CLASSIFIED AND RECRUITMENT ADVERTISING (New Zealand) Case Western Reserve University [email protected] College of Urgent Care Physicians School of Medicine Pete Murphy - (201) 529-4020 • Stu Williams - (201) 529-4004 Wendy Graae, MD, FAAP Martin A. Samuels, MD, DSc (hon), Mission Statement PM Pediatrics FAAN, MACP JUCM The Journal of Urgent Care Medicine supports the evolution of urgent care medicine by creating content that addresses both the clinical practice of urgent care medicine Nahum Kovalski, BSc, MDCM Harvard Medical School and the practice management challenges of keeping pace with an ever-changing healthcare Terem Emergency Medical Centers marketplace. As the Official Publication of the Urgent Care Association of America and Kurt C. Stange, MD, PhD the Urgent Care College of Physicians, JUCM seeks to provide a forum for the exchange Peter Lamelas, MD, MBA, FACEP, Case Western Reserve University of ideas and to expand on the core competencies of urgent care medicine as they apply FAAEP to physicians, physician assistants, and nurse practitioners. Robin M. Weinick, PhD MD Now Urgent Care Medical Centers, Inc. Affiliations RAND JUCM The Journal of Urgent Care Medicine (www.jucm.com) is published through a partnership Melvin Lee, MD, CCFP, RMC between Braveheart Group, LLC (www.braveheart-group.com) and the Urgent Care Asso- FastMed North Carolina ciation of America (www.ucaoa.org). UCAOA BOARD OF DIRECTORS Disclaimer Sean M. McNeeley, MD JUCM The Journal of Urgent Care Medicine (JUCM) makes every effort to select authors Network Medical Director Nathan “Nate” P. Newman, MD, FAAFP, who are knowledgeable in their fields. However, JUCM does not warrant the expertise of any author in a particular field, nor is it responsible for any statements by such authors. University Hospitals of Cleveland President The opinions expressed in the articles and columns are those of the authors, do not imply endorsement of advertised products, and do not necessarily reflect the opinions Patrice Pash, RN, BSN Laurel Stoimenoff, Vice President or recommendations of Braveheart Publishing or the editors and staff of JUCM. Any pro- Urgent Care Integrated Consultants cedures, medications, or other courses of diagnosis or treatment discussed or suggested Steve P. Sellars, MBA, Secretary by authors should not be used by clinicians without evaluation of their patients’ conditions Marc E. Rogers, MD and possible contraindications or dangers in use, review of any applicable manufacturer’s Robert R. Kimball, MD, FCFP, Treasurer West Virginia University product information, and comparison with the recommendations of other authorities. Marc R. Salzberg, MD, FACEP, Advertising Mark R.