Urgent Care I. Rationale



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Urgent Care
I. Rationale
Urgent Care Medicine is the provision of immediate medical service offering outpatient care for the treatment of acute and exacerbation of chronic illness and injury. The Urgent Care elective provides services to adult patients with a wide range of acute and chronic medical conditions. A comprehensive fund of knowledge and skills are required to provide such care. Urgent Care providers are often the first to diagnose acute and chronic medical conditions. In addition, Urgent care providers begin management, obtain appropriate consults and make necessary referrals for effective patient care.
II. Goals
The goal of the Urgent Care rotation is to teach family medicine residents the Urgent Care model of practice which is to evaluate an acute complaint. Emphasis is placed on appropriate evaluation of signs and symptoms to make accurate diagnosis to guide appropriate triage and treatment decisions. Skills focus on case presentations centered on the acute complaint, recognizing high risk conditions, efficiency, rationing of resources, utilization and interpretation of laboratory data, appropriateness of referrals and consultations.
III. Objectives
By the end of the Urgent Care rotation, each resident will demonstrate the following under each competency category:
Medical Knowledge


  1. Properly evaluate signs and symptoms for accurate diagnosis.

  2. Recognize high risk conditions and triage appropriately.

  3. Utilize and interpret available laboratory and imaging resources in an effective manner.

  4. Recognize indications for urgent consultation.

  5. Recognize indications for referral.

  6. Perform common clinic procedures such as: tonometry, fundoscopy, flourescein corneal exam,

arthrocentesis, soft tissue injections, I&D, suture, removal, splinting, anoscopy, pelvic exam


Learning Activities




Attending Rounds




Research Conference

X

Outpatient Clinics




Multidisciplinary Rounds




Ethics/Comm Conference

X

Direct Patient care




Grand Rounds




Specialty Conference




Resident Seminar




Sub-Specialty Conference




Noon Conference




Journal Club




Morning Report

X

Faculty Supervision

X

Readings




Didactics




Procedures










Other




Evaluation Methods

X

Attending Evaluation

X

Directly Supervised Procedures




Morning Report




Program Dir

Review





In-Training Exam

X

Faculty Supervision and Feedback




360 ᵒ evaluation




Videotape Review

X

Quarterly Review




Other



Patient Care


  1. Provide an effective, focused, problem based case presentation.

  2. Create appropriate assessments and make therapeutic decisions based on correct interpretation

of data, use of resources and recognition of high vs low risk conditions.

  1. Demonstrate sound judgment, insight and prioritization skills in order to make appropriate clinical

choices.

  1. Safely and proficiently perform medical procedures that minimizes patient’s discomfort and maintains

sterile precautions.

  1. Demonstrate efficiency and improve time management skills.

  2. Be able to manage the following common urgent medical problems:

1. Neurology and Psychiatry

a. Headache

b. Vertigo

c. Dizziness

d. Depression/Anxiety

e. Syncope

f. Insomnia

2. Ophthalmology

a. Eye Pain

b. Red Eye

c. Eye Trauma

d. Visual Change

3. ENT

a. Ear pain



b. Tinnitus and Hearing Loss

c. Allergic Rhinitis

d. Epistaxis

4. Oral and Dental

a. Dental pain

b. Mucocele

c. Oral Candidiasis

d. Oral HSV

e. Sialolithiasis

f. TMJ


5. Cardiology

a. Chest Pain (Typical vs Atypical)

b. Palpitations

c. HTN (Newly dx, chronic, urgency/emergency)

6. Pulmonary

a. Cough


b. Dyspnea/SOB

c. Hemoptysis

7. GI

a. GERD/Dyspepsia/PUD



b. Vomiting/Diarrhea

c. Abdominal pain

d. Rectal bleeding/pain

e. Hemorrhoids

f. Dysphagia

g. Jaundice

h. Cirrhosis/ascites

i. Hepatitis/Transaminitis

8. Urology

a. Hematuria

b. Nephrolithiasis

c. Scrotal pain

d. Dysuria

e. Urinary Retention

f. Urinary incontinence

9. Gynecology/Women’s Health

a. Pelvic Pain

b. Vaginal Bleeding/Menorrhagia

c. Vaginal discharge

d. Breast Pain/Discharge/Mass

e. Galactorrhea

10. Musculoskeletal

a. Neck pain

b. Shoulder pain

c. Wrist/Hand pain

d. Back pain

e. Hip pain

f. Knee pain

g. Ankle/foot pain

h. RA


i. OA

j. Gout


k. Fractures-Closed simple

11. Soft Tissue

a. Animal Bites

b. Foreign body/Puncture wounds

c. Paronychia

d. Ingrown toenail

e. Ulcers-DM, Venostasis

12. Dermatology

a. Dermatitis (Contact, Eczema)

b. Herpes Zoster

c. Burns

d. Scabies

e. Tinea

f. Warts


g. Psoriasis

h. Drug eruptions

i. Rosacea

13. Endocrine

a. Diabetes (New onset, chronic, DKA)

b. Hyperthyroid/Hypothyroid/Thyroiditis

c. Thyroid nodules

14. ID


a. Tooth abscess

b. URI


c. Sinustitis/Otitis

d. Pharyngitis/Tonsillitis/Peritonsillar abscess

e. PNA/Bronchitis

f. Gastroenteritis

g. Diverticulitis

h. Pyelonephritis

i. UTI

j. Prostatitis



k. STDs

l. Cellulitis/Abscess

15. Renal

a. Renal failure (Acute, chronic)

b. Fluid and Electrolyte imbalance


Learning Activities




Attending Rounds




Research Conference

X

Outpatient Clinics




Multidisciplinary Rounds




Ethics/Comm Conference

X

Direct Patient care




Grand Rounds




Specialty Conference




Resident Seminar




Sub-Specialty Conference




Noon Conference




Journal Club




Morning Report

X

Faculty Supervision

X

Readings




Didactics




Procedures










Other




Evaluation Methods

X

Attending Evaluation

X

Directly Supervised Procedures




Morning Report




Program Dir

Review





In-Training Exam

X

Faculty Supervision and Feedback




360 ᵒ evaluation




Videotape Review

X

Quarterly Review




Other



Interpersonal and Communication Skills


  1. Demonstrate effective listening, narrative and nonverbal skills for effective patient care.

  2. Perform an effective, well organized case presentation with a focus on the acute complaint.

  3. Communicate and counsel patients and their families effectively regarding working diagnosis, work-up and treatment.

  4. Demonstrate respectful and collaborative relationships with colleagues and other clinic employees.

  5. Document care appropriately in the medical record.



Learning Activities




Attending Rounds




Research Conference

X

Outpatient Clinics




Multidisciplinary Rounds




Ethics/Comm Conference

X

Direct Patient care




Grand Rounds




Specialty Conference




Resident Seminar




Sub-Specialty Conference




Noon Conference




Journal Club




Morning Report

X

Faculty Supervision




Readings




Didactics




Procedures










Other




Evaluation Methods

X

Attending Evaluation

X

Directly Supervised Procedures




Morning Report




Program Dir

Review





In-Training Exam

X

Faculty Supervision and Feedback




360 ᵒ evaluation




Videotape Review

X

Quarterly Review




Other


Professionalism


  1. Demonstrate respect, compassion, integrity and honesty.

  2. Role model responsible and ethical behavior, including acknowledgment of errors.

  3. Consider the needs of patients, families, colleagues and other clinic staff; including sensitivity to different cultural/socioeconomic backgrounds, and avoiding judgmental behaviors.




Learning Activities




Attending Rounds




Research Conference

X

Outpatient Clinics




Multidisciplinary Rounds




Ethics/Comm Conference

X

Direct Patient care




Grand Rounds




Specialty Conference




Resident Seminar




Sub-Specialty Conference




Noon Conference




Journal Club




Morning Report

X

Faculty Supervision

X

Readings




Didactics




Procedures










Other




Evaluation Methods

X

Attending Evaluation

X

Directly Supervised Procedures




Morning Report




Program Dir

Review





In-Training Exam

X

Faculty Supervision and Feedback




360 ᵒ evaluation




Videotape Review

X

Quarterly Review




Other



Practice-Based Learning


  1. Demonstrate a commitment to self-assessment and improvement by listening and incorporating

provided feedback.

  1. Effectively apply evidence based medicine by using information technology resources available. (e.g.

UptoDate, Visual Dx)



Learning Activities




Attending Rounds




Research Conference

X

Outpatient Clinics




Multidisciplinary Rounds




Ethics/Comm Conference

X

Direct Patient care




Grand Rounds




Specialty Conference




Resident Seminar




Sub-Specialty Conference




Noon Conference




Journal Club




Morning Report

X

Faculty Supervision

X

Readings




Didactics




Procedures










Other




Evaluation Methods

X

Attending Evaluation

X

Directly Supervised Procedures




Morning Report




Program Dir

Review





In-Training Exam

X

Faculty Supervision and Feedback




360 ᵒ evaluation




Videotape Review

X

Quarterly Review




Other


Systems-Based Practice


  1. Effectively access hospital, clinic and ancillary resources as well as consults and referrals.

  2. Appropriately use practice guidelines.

  3. Effectively use a systematic approach to improve patient care in clinic.

  4. Comply with all documentation requirements. (e.g. ATEMM procedures, date/time/sign all notes, iMed, Consent, write legibly and avoid use of unapproved abbreviations)




Learning Activities




Attending Rounds




Research Conference

X

Outpatient Clinics




Multidisciplinary Rounds




Ethics/Comm Conference

X

Direct Patient care




Grand Rounds




Specialty Conference




Resident Seminar




Sub-Specialty Conference




Noon Conference




Journal Club




Morning Report

X

Faculty Supervision

X

Readings




Didactics




Procedures










Other




Evaluation Methods

X

Attending Evaluation

X

Directly Supervised Procedures




Morning Report




Program Dir

Review





In-Training Exam

X

Faculty Supervision and Feedback




360 ᵒ evaluation




Videotape Review

X

Quarterly Review




Other



IV. Instructional Strategies (see above)

This is a four-week rotation and should be attended by the resident for a minimum of 5-6 half days per week. The other 4-5 half days per week will be spent in the resident’s continuity clinic and in didactics. Readings can be obtained from Section VII and should also be solicited from the Urgent Care attending.



V. Evaluation Strategies (see above)





  1. Observation of the resident by the Urgent Care attending.

  2. Procedure/diagnosis documentation by the resident.

  3. End of rotation evaluation.

  4. AFP Monographs (see below) Pre and Post Tests



VI. Implementation Methods

The rotation is offered as a PGY3 elective. The Urgent Care rotation is an outpatient experience. The resident will further his/her rotational experience by continuing to see his/her continuity clinic patients 3-4 half days per week and by attending Family Practice didactics on one half day per week.


Location: Lynnette Sells, MD

3720 Holcomb Bridge Road

Norcross, GA 30092

770-263-1000 ofc

440-263-7770 fax
Nick Beaulieu, MD

920 Ponce de Leon Avenue

Atlanta, GA 30306

404-815-1957 ofc

404-815-1954 fax
James Yost, MD

Physician’s Immediate Medicine

2575 Peachtree Parkway

Cumming, GA 30041-2407

770-205-9777 ofc

770-888-8779 fax


Family Practice Center: 5 ½ days per week in the Family Medicine Clinic, 4 ½ days in the Urgent Care Clinic.
Call/Vacation: Call will be with the FMS @ Emory University Midtown Hospital. Vacation is permitted.
Supervision: Residents will be supervised by preceptor. Residents should document all procedures in their residency passport.
Conferences: The resident is expected to attend Family Medicine Didactics Conferences.

VII. Required Readings
AFP Monographs: Adult Office Urgencies (FP Essentials #289)

Childhood Office Emergencies (FP Essentials #338)



Last updated March 7, 2013


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