CHAPTER 39
Ensuring Patient Safety
John Shufeldt
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IF ALL ELSE FAILS, patient safety needs to be the one constant—the one common denominator—by which the urgent care industry is recognized. Assuming this focus on patient safety is so important, the follow-up question we must therefore ask is whether we, as an industry, are spending enough time, money, and resources to ensure that we meet this objective.
First, we must recognize that urgent care medicine is by nature a high-risk undertaking. Generally, patients who present for services are generally not well suited to select the treatment modality or location most appropriate for their particular complaint, and thus many conditions and injuries exceed the level of service and care available at a particular facility. This is not to say that the provider cannot diagnose the condition and effectively treat the patient. Rather, it simply points to the need for the available resources, both human and equipment, that are necessary for the patient’s immediate and ongoing care.
Urgent care medicine is more challenging than emergency medicine because it is akin to finding the proverbial needle in the haystack, and because emergency department (ED) providers generally have access to the resources to diagnose and treat the patient, as well as access to consultants and ancillary staff members to whom they can turn for assistance.
Moreover, in the ED, emergency physicians and their teams are trained to think “worst first,” where everyone walking in is assumed to have a life-threatening condition until it is proven otherwise. Because an urgent care provider can treat hundreds of minor illnesses before facing a patient who may be very, or even indeterminately, ill, the ED’s belief system does not carry over into the urgent care practice. This fact speaks to the need for maintaining a high level of awareness, even after hours of seeing patients, to ensure that the subtle spinal epidural abscess masquerading as mechanical musculoskeletal pain does not slip through undiagnosed.
Most patients with medical issues who end up in litigation or with adverse outcomes do not present screaming, “Look at me, I have XXXX,” but they pre sent exactly the way thousands of other patients with minor conditions present, perhaps save for one small nuanced laboratory test finding, historical nugget, or physical exam finding.
Other patient safety misadventures are always possible as well, including missed laboratory or imaging findings, inappropriate or absent informed consent, and acute care events that occur when staff members are untrained, poorly trained, or unaccustomed to caring for the critically ill.
The practice of urgent care medicine is difficult. Obtaining patients’ medical histories and performing thorough physical exams are only two absolutely crucial aspects of such practice. Without the typical benefits of long-term relationships, time, and unlimited diagnostics, our assessments and decisions must be made rapidly, relying on, and being comfortable with, imperfect and incomplete information gathered and synthesized just as quickly.