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Instant Care

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A sudden injury or painful symptoms is scary. But knowing what to do, where to go, and what to expect can ease the stress.

GO TO: Northwest Health Index

Let’s say it’s Sunday afternoon, and you’ve just taken a spill on an icy walkway and think your leg might be broken. Or your knife slipped while you were chopping vegetables, causing a deep, bloody gash. Or you have a sharp pain on your right side and are worried it’s appendicitis.

Having a sudden injury or painful symptoms is scary, but knowing what to do, where to go, and what to expect if your destination is a Group Health Urgent Care Center can make the experience a little easier. To find out what you should know, we talked to Group Health staff and members familiar with our Urgent Care Centers. Here’s what we learned.

ALSO SEE: Online Medical Records Set Group Health Apart

Unsure what to do? Call our Consulting Nurse Service

“If you wonder whether you need immediate care, a nurse can help you decide what to do and where to go to get the fastest and most appropriate care,” says Kate Wreford-Brown, RN, manager of the Consulting Nurse Service.

One option the nurse will consider is our Urgent Care Centers in Bellevue, Everett, Olympia, Seattle, Silverdale, and Tacoma. All members can use these facilities, even if they don’t regularly receive care at a Group Health medical center.

“If our facilities are too far away or not open when you need them, a consulting nurse may direct you to your local emergency department or hospital,” says Wreford-Brown.

What happens when you arrive at one of our Urgent Care Centers?

First, check in at the front desk. (If you aren’t the patient, ask for assistance if you need help getting the person out of your vehicle.) You may be asked to wear a mask if you have flu symptoms or a contagious illness. Then you’ll probably be directed to take a seat in the waiting area.

Next, a nurse will talk to you about why you came. This might be done in a space located just off the waiting area. Your heart rate, blood pressure, and temperature will be measured, and the urgency of your medical condition will be evaluated.

It’s important to fully answer the nurse’s questions and clearly describe your symptoms and level of pain. Patients with the most serious problems are seen first, so your treatment might start right away. Or if your symptoms are less severe, you’ll probably be asked to wait until your name is called.

If you start feeling better or worse while you’re waiting, let the check-in person know right away. “The waiting area is watched by nursing staff at all times so that patients with worsening symptoms are seen sooner, if appropriate,” says Debbie Hall, RN, director of Urgent Care Services.

 

How long will you wait?

It’s hard to predict wait times because things can change quickly in an Urgent Care Center. For example, ambulances may arrive with patients who need care right away. Typically, it’s less than an hour before a nurse will escort you to an exam room and you’ll see a doctor. On busy days it can be two hours, and on the busiest days, it might be longer.

The length of time you’ll spend receiving care depends on many factors, such as the complexity of your exam, the need for tests and the time required to get the results, and the type of treatment you get.

When member Ginny Fairbairn took a fall in May, she arrived at our Urgent Care Center in Bellevue at a quiet time and only waited half an hour before seeing a doctor. It turned out her leg was broken. But when she went to an Urgent Care Center in 2005, she waited four hours before receiving a few stitches. “There were people walking in continuously with injuries more serious than mine,” she says.

“We expect Urgent Care Centers to be like McDonald’s, where you get served right away,” says member Elisabeth Fredericksen, who recently spent about nine hours in an Urgent Care Center with severe intestinal symptoms. “Like everyone else, I’d like that to be the reality. But it’s not. Getting tests and having results evaluated takes time. Once I realized that good care isn’t necessarily fast care, waiting became easier. And it helped when nurses came in frequently to update me on what we were waiting for.”

What happens after your visit to an Urgent Care Center?

Many patients can go straight home after they’ve been evaluated and treated in one of our Urgent Care Centers. “Before you leave, a nurse will talk to you about how to take care of yourself at home,” says John Vandergrift, MD, urgent care physician at Tacoma Medical Center. “You’ll also get an after-visit summary, with written instructions, along with any needed prescriptions. Try to raise any concerns and questions at this point.”

If you receive your primary care at a Group Health medical center, your after-visit summary is available online. (You must register for MyGroupHealth for Members on this site, log in, and follow the instructions to upgrade your account.) In addition, your personal physician will be updated via your electronic medical record.

If you need to be admitted to a hospital or other care setting after your visit, we’ll coordinate that transition. Some people drive themselves to the facility, while others go by ambulance, depending on their condition. You’ll be registered there and asked to sign all the required forms.

At Bellevue Medical Center and Capitol Hill Campus in Seattle, there’s another option when you leave the Urgent Care Center. If you need additional observation or treatment — to get a few doses of intravenous antibiotics, for example, or a rehydration treatment — an urgent care physician may admit you to our extended observation unit for up to 24 hours. “You’ll get the extra care you need without hospital admission and the risks of exposure to hospital germs,” says Hall.


New Concussion Guidelines

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New Guideline For Managing Concussion

19 Mar 2013

The American Academy of Neurology has released its guideline for evaluating and managing athletes with concussion. The AAN says that over one million sportsmen and sportswomen in the USA experience a concussion annually. This is the first concussion update in 15 years.

According to the AAN (American Academy of Neurology), which published the new guideline in Neurology (March 18th, 2013 issue), Americans now have an objective, evidence-based review of the literature by a committee of experts from various fields.

The Academy added that its guideline has been endorsed by a wide range of sports, medical and patient groups, including: The National Association of Emergency Medical Service Physicians, the Neurocritical Care Society, the American Football Coaches Association, the National Football League Players Association, the Child Neurology Society, the National Academy of Neuropsychology, the National Association of School Psychologists, and the National Athletic Trainers Association.

If you suspect concussion, remove the athlete from play immediately

Co-lead guideline author, Christopher C. Giza, MD, with the David Geffen School of Medicine and Mattel Children’s Hospital at UCLA, explained that it is imperative that any athlete who is suspected of experiencing concussion be removed from play straight away.

Dr. Giza said:

“We’ve moved away from the concussion grading systems we first established in 1997 and are now recommending concussion and return to play be assessed in each athlete individually. There is no set timeline for safe return to play.”

The updated guideline recommends:

  • Immediate action – any athlete with suspected concussion must be taken out of the game immediately
  • See a specialist – that athlete should not be allowed to return until an examination has been carried out by a licensed health care professional trained in concussion
  • A gradual return to play – return to play should be done slowly, and only after acute symptoms have completely disappeared
  • Children and teenagers – athletes up to high school age with a concussion “should be managed more conservatively” regarding when they be allowed to come back to the game. According to available evidence, this age group takes longer to recover than older sports people

The authors of the guideline gathered and examined all available evidence that was published in academic journals up to the end of June 2012.

The author panel included a broad range of expertise, the AAN informed. They spent “thousands of work hours” locating and examining scientific studies. They excluded studies that did not provide compelling evidence to make recommendations, such as expert opinions or anecdotal accounts. Each study was independently analyzed and graded by two or more authors.

The guideline says that:

  • The sports with the greatest risk of concussion are football and rugby, and then hockey and soccer, among males
  • Among females, soccer and basketball have the greatest risk of concussion
  • A sportsman or sportswoman who has already experienced at least one concussion is more likely to be diagnosed with another, compared to athletes with no history of concussion
  • After being diagnosed with concussion, the patient is at greatest risk of being diagnosed with another concussion during the following ten days
  • The authors found no compelling evidence that demonstrated that one type of football helmet is better than another at protecting the athlete against concussion.
  • Doctors who are trained in treating concussion should look for ongoing symptoms, particularly fogginess and headache, a history of concussions, and younger age in the athlete. These factors have been individually associated with longer recovery after a concussion.
  • Athletes with a prior concussion, long exposure to a sport, and those that have the ApoE4 gene have a higher risk of experiencing chronic neurobehavioral impairment.

The AAN emphasized that “Concussion is a clinical diagnosis. Symptom checklists, the Standardized Assessment of Concussion (SAC), neuropsychological testing (paper-and-pencil and computerized) and the Balance Error Scoring System may be helpful tools in diagnosing and managing concussions but should not be used alone for making a diagnosis.”

What are the signs and symptoms of concussion?

  • Headache
  • Sensitivity to light
  • Sensitivity to sound
  • Changes to reaction time
  • Changes in judgment
  • Changes in speech
  • Changes in sleep
  • Loss of consciousness, or a ” blackout” (occurs in less than 10% of concussions)

Jeffrey S. Kutcher, MD, with the University of Michigan Medical School in Ann Arbor and a member of the AAN, said:

“If in doubt, sit it out. Being seen by a trained professional is extremely important after a concussion. If headaches or other symptoms return with the start of exercise, stop the activity and consult a doctor. You only get one brain; treat it well.”

Should there be absolute rest after a concussion? – the guideline states that there is insufficient compelling evidence to support absolute rest after concussion, but the athlete should be immediately removed from play.

Part of concussion management may include activities known not to worsen symptoms and which are not linked to a risk of repeat concussion.

Sports Concussion Tool Kit – American Academy of Neurology

The AAN has also launched an app called “Concussion Quick Check” which is available for iPad, Android, IOS (Apple) and some other mobile devices. It is aimed at helping coaches, trainers, parents and other athletes rapidly decide whether somebody is experiencing concussion and needs to see a doctor.

References:
American Academy of Neurology

“Summary of evidence-based guideline update: Evaluation and management of concussion in sports”
Report of the Guideline Development Subcommittee of the American Academy of Neurology

Christopher C. Giza, MD, Jeffrey S. Kutcher, MD, Stephen Ashwal, MD, FAAN, Jeffrey Barth, PhD, Thomas S.D. Getchius, Gerard A. Gioia, PhD, Gary S. Gronseth, MD, FAAN, Kevin Guskiewicz, PhD, ATC, Steven Mandel, MD, FAAN, Geoffrey Manley, MD, PhD, Douglas B. McKeag, MD, MS, David J. Thurman, MD, FAAN and Ross Zafonte, DO

Christian Nordqvist. “New Guideline For Managing Concussion.” Medical News Today. MediLexicon, Intl., 19 Mar. 2013. Web.
19 Mar. 2013. <http://www.medicalnewstoday.com/articles/257811.php>

Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care
professional.


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