The role of urgent care centers in headache management: a quality improvement project

Table 5 Protocol for Treating Headaches and Migraines at Urgent Care Locations Provided

Question	N
Is it regular practice for providers (any) at your urgent care to do pain checks?	N = 10
Yes	80% (8)
Pain assessments used in evaluating and managing patients presenting with headache to the urgent care(s)	N = 8
VAS	50% (4)
Wong-Baker FACES Pain Rating Scale	12.5% (1)
Pain assessment screener	12.5% (1)
Pain scale/numeric rating scale	25% (2)
Diagnostic test(s) performed onsite for patients with headache disorders (multiple selections)	N = 8
X-Ray	25% (2)
MRI	25% (2)
CT Scan	37.5% (3)
Labs (bloodwork)	52.5% (5)
Physical Exam only	12.5% (1)
Other (EKG, Sleep Study, Neuroimage)	37.5% (3)
Clinical diagnostic tool used	N = 10
ICHD3	10% (1)
EPIC screening tools	10% (1)
Are there any policies in place to ensure follow-up with a patient’s PCP, neurologist, or headache specialist?	N = 10
Yes^a	40% (4)
What percentage of patients that present with headache have a disposition to the emergency department?^b	N = 10
> 1%	20% (2)
What type of providers do you refer to? (multiple selections allowed)	N = 10
Primary Care Physician (PCP)	70% (7)
Neurologist	70% (7)
Headache Specialist	60% (6)
Pain Specialist	40% (4)
Other Healthcare provider^c	30% (3)
Are there home UC locations in your area?	N = 10
Yes	20% (2)
Does the home UC treat migraine/headache?	N = 10
Yes^d	20% (2)

^aReferrals sent to Headache Clinic if it is a chronic issue (or 2x visits in 1 year), PCP is always cc-ed on chart and patient is instructed to follow up with PCP or return to urgent care in 2–4 business days or go to ED (discourage ED use); Most often in our practices, patients are referred from their provider to these units. Follow-ups are scheduled or ensured on discharge; Started to schedule patients consultation with a neurologist or headache specialist in the moment of the patient delivery from ED; See all patients back in 4 weeks until significant improvements in headache burden are made. Patients come in more frequently if needed for urgent care
^bEight respondents left question blank
^cIncludes ophthalmologists, sleep centers, physical therapists, hormone specialists, endocrine, weight management, ENT, cardiologist
^dNewly established local Urgent Care (about 1 year) uses typical medication for headache care; excludes IV treatments and opioids; offers telemedicine and consultations with MD/DO; remedy room established to treat patients with migraine/tension headache/hangover headaches
ICHD3 International Classification of Headache Disorders-3

ISSN: 1472-6963