Urgent care medicine

Urgent Care Medicine

The field of Urgent Care Medicine is emerging internationally to function in conjunction to our existing Emergency Medicine facilities and services. This domain of medicine addresses injuries and clinical illnesses of an acute nature, requiring urgent medical attention, but not necessitating immediate hospital admission or specialized investigations.

The discipline includes caring for the following ailments & injuries:

·      Acute minor illnesses: including conditions such as stable upper respiratory tract infections, gastrointestinal upset and conjunctivitis.

·      Acute injuries including simple, uncomplicated fractures and wounds suitable to management in primary care. The majority of urgent care clinics have access to X-ray imaging. Simple fractures can be immobilized at the clinic and many urgent care facilities offer a fracture clinic to facilitate Orthopaedic follow-up. Wound care follow-up is also available.

Urgent care medicine does not manage the following conditions:

·      Acute life-threatening medical emergencies including but not limited to myocardial infarction, pulmonary embolism, cerebrovascular accidents, diabetic emergencies and sepsis. These cases should present to the local emergency department or make use of local ambulance services for transport to hospital.

·      Chronic medical conditions such as hypertension, thyroid dysfunction, epilepsy and mental health conditions should not be treated at the urgent care clinic but rather by one’s own general practitioner.

·      Chronic skeletal pathologies such as osteoarthritis, degenerative back pain, osteoporosis and rheumatoid disease should not be treated in the acute setting of the urgent care clinic. Initial investigation via one’s GP would be the appropriate approach. The presence of acute neurological fallout in conjunction with spinal pathology should be attended to at an Emergency Department.

·      Minor surgical cases such as excision of skin lesions and avulsing an ingrown toenail are not performed in the urgent care clinic. These cases may be assessed in the clinic but will likely receive a referral to a minor procedures clinic or surgical consultant for definitive management.

·      Complex, specialized cases are not managed at the urgent care clinic including malignant disease, chronic metabolic & endocrine derangements, surgical cases as well as conditions usually observed and managed under specialist guidance. Follow-up with one’s specialist or consultant is advised and acute deterioration should prompt hospital attendance for the appropriate investigations & care.

·      Open & complicated fractures requiring manipulation under sedation or anaesthetic cannot be definitively managed at the urgent care clinic. These fractures are immobilized and referred to the Emergency Department for urgent Orthopaedic attention. This includes open, grossly displaced or deformed fractures as well as limbs with neurovascular compromise following fracture.

·      Large, deep and penetrating wounds should not be treated at the urgent care clinic. Deep, penetrating wounds may necessitate surgical washout and/or debridement. Wounds with evidence of nerve, vascular or tendinous injury should be referred to the Emergency Department.

As it becomes evident from the above, Urgent Care Medicine does well to fill the gap between chronic & sub-acute services via one’s GP and the emergency treatment provided at the local emergency departments. This service suits well to stable patients with an acute minor illness that are unable to secure a timely appointment with their GP as well as patients with uncomplicated acute injuries, fractures and wounds that require attention. Ideally, urgent care clinics reduce the volume of patients attending local emergency departments with minor illnesses and injuries, allowing for more efficient management of seriously ill or injured patients at the ED.

What are the requirements to become an urgent care physician in Ireland?

·      Medical degree from a recognized institution along with completion of one’s internship.

·      Experience working in Emergency Medicine & Primary Health Care

·      Working experience in Ireland: minimum 1 year; ideally in position of Emergency Medicine Registrar.

·      Active IMC registration.

·      Up to date BLS & ACLS.

·      Private indemnity insurance will be required, this is usually obtained with the instruction & assistance of your employer.

If you are interested in Urgent Care Medicine or want further information, feel free to reach out to me, Nicole Rabie, on LinkedIn.

Nicole Rabie

Urgent Care Physician

Limerick, Ireland