Dr. Smith's ECG Blog

APRIL 18, 2024

Emergent cath lab activation is also named after this test (code STEMI), so patients whose ECGs don’t meet STEMI criteria don’t get emergent angiograms, despite guidelines. And because there was no Code STEMI, the discharge diagnosis was “non-STEMI”, so this case will not be flagged as an opportunity for improvement. But only 6.4%

EKG/ECG 119

EKG/ECG Documentation/Coding Fractures Emergency Department 119

RebelEM

DECEMBER 23, 2024

There has been ongoing study about the clinical significance of these effects, as well as whether and for whom LR might provide meaningfully better clinical outcomes ( Myburgh 2013 , Self 2018 , Semler 2018 , Self 2020 ).

Fluid Resuscitation 82

Fluid Resuscitation Resuscitation Documentation/Coding Outcomes 82

EMDocs

SEPTEMBER 26, 2024

An unknown EP reviews the report, determines that there is no reason to notify the patient, and documents nothing. It wasn’t, so you weren’t called, nor did the doc need to document anything. This patient’s history was either poorly taken or poorly documented. J Am Coll Rad 15:4;639-647, April 1, 2018.

Radiology 75

Radiology Radiology EKG/ECG Documentation/Coding 75

The Trauma Pro

MAY 10, 2024

This fills in the code on the second tab which will be added to TraumaBase. 2018 May;84(5):718-726. If you use a different registry, contact your vendor for assistance. The spreadsheets consist of three tabs/pages. On the first, enter the specific field names from your TraumaBase implementation. J Trauma Acute Care Surg.

Blood Transfusions 113

Blood Transfusions Documentation/Coding Radiology Radiology 113

Don't Forget the Bubbles

DECEMBER 2, 2024

The interventions were based on GINA guidelines 2018 and performed over a 5-month period. This study relied on coding, and if the patient had not been coded as asthma, for example, and coded as pneumonia instead, these patients would not have been included in the study set. During the preintervention period , 52.2%

Documentation/Coding 98

Documentation/Coding Pediatrics Emergency Department Fractures 98

Dr. Wes

OCTOBER 12, 2020

According to a Medscape survey of US internists in 2018, their average salary was $230,000.That

Documentation/Coding 52

Documentation/Coding 52

Pediatric EM Morsels

MAY 5, 2023

2018 Dec 20;11(1):5. Baroni L, Goggi S, Battaglino R, Berveglieri M, Fasan I, Filippin D, Griffith P, Rizzo G, Tomasini C, Tosatti MA, Battino MA. Vegan Nutrition for Mothers and Children: Practical Tools for Healthcare Providers. doi: 10.3390/nu11010005. PMID: 30577451; PMCID: PMC6356233.

Pediatrics 130

Pediatrics Documentation/Coding EMS 130

The Skeptics' Guide to EM

MAY 11, 2019

JAMA Surgery 2018 Guest Skeptic: Dr. Robert Leeper is an assistant professor of surgery at Western University and the London Health Sciences Centre. J AMA Surgery 2018 Guest Skeptic: Dr. Robert Leeper is an assistant professor of surgery at Western University and the London Health Sciences Centre.

Documentation/Coding 40

Documentation/Coding Operations Academics Ultrasounds 40

Emergency Medicine Journal

JULY 22, 2024

The rate of violent events in Mexico, especially in hospital settings, has increased since 2006, but has become more evident in 2018. Guanajuato State, located in central Mexico, is among the states most affected by the wave of violence, especially active shooter events. The year 2019 had the highest number of incidents.

Emergency Department 52

Emergency Department Documentation/Coding Hospitals 52

Sensible Medicine

SEPTEMBER 26, 2023

As background, a 2018 article in Health Affairs tried to look at the issue of how to best communicate with patients after a problem or adverse event; the paper studied what happened before and after a new communications program was implemented at 4 Massachusetts hospitals. Not so, unfortunately.

Research 122

Research Hospitals Documentation/Coding Outcomes 122

The Skeptics' Guide to EM

FEBRUARY 23, 2019

JAMA 2018 Guest Skeptics: Jay Loosley is the Superintendent of Education at Middlesex-London Paramedic Service. JAMA 2018 Guest Skeptics: Jay Loosley is the Superintendent of Education at Middlesex-London Paramedic Service. This was updated in 2018 with the 3-hour and 6-hour bundles combined into a single 1-hour bundle.

Sepsis 52

Sepsis Administration Documentation/Coding Hospitals 52

Don't Forget the Bubbles

NOVEMBER 20, 2023

Document the size, consistency and location in the notes to compare if they represent. They may grow again with subsequent upper respiratory tract infections. This waxing and waning course is normal, and families should be reassured and given red flag features that necessitate further assessment. Dermatopathology. Physician Assistant Clinics.

Pediatrics 124

Pediatrics Documentation/Coding Emergency Department Ultrasounds 124

Sensible Medicine

AUGUST 7, 2024

Research by Collett et al (2018) shows that, despite some improvement in PP by 18 months, the deformations persist beyond 36 months. In the resulting document , the working group changed the ages at which children can be expected to reach developmental milestones.

CDC 105

CDC Documentation/Coding Research Pediatrics 105

EMDocs

JANUARY 25, 2024

The patient’s last INR should be documented, and one obtained if not recent. For patients on warfarin, documenting a reason for not checking an INR is a worthwhile practice. 2018 Mar; 7(1): 55–61. Drug-drug and drug-food interactions should be considered. This is a classic case of “anchoring bias” (i.e., J Korean Neurosurg Soc.

Poisoning 73

Poisoning Documentation/Coding Patient Safety Hospitals 73

Emergency Medicine Journal

JANUARY 22, 2024

This is an Institutional Review Board-exempt retrospective review of de-identified ED data available for the state of Maryland through the Healthcare Cost and Utilization Project (HCUP) database from 2016 to 2018.

Outcomes 40

Outcomes Emergency Department Poisoning Documentation/Coding 40

ACEP Now

NOVEMBER 13, 2023

1,2 In a 2018 study by ACEP, nearly half of emergency physicians polled reported a physical assault while at work. 5 Hospitals commonly activate a “code” in response to agitated patients, alerting security personnel to the location of that patient. References Workplace Violence in Healthcare, 2018. Published 2018.

Emergency Department 52

Emergency Department Documentation/Coding Psychiatric Best Practices 52

EMDocs

JUNE 8, 2023

Pre-enrollment calculations estimated that 400 enrollments would be necessary to provide the trial with 80% power to detect a 15% difference in the primary outcome, allowing for up to 90 patients to be lost to follow-up or to have insufficient data documented. Intervention: Alteplase 0.9 in alteplase group versus 0.9% to 53.54, p=0.053).

Stroke 79

Stroke Administration Documentation/Coding Outcomes 79

RebelEM

AUGUST 22, 2024

Documented at the following time points: Before treatment. Time from Presentation to Treatment: The duration from when the patient arrived at the ED and the stroke code was called to the administration of tPA. 2020;51(7):2018-2025. Within 24 hours after treatment. 1 week after treatment. 1 month after treatment.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

EMDocs

JULY 9, 2024

Insurance companies paying more attention to addressing social needs Medicaid: 1115 Demonstration Waivers, CalAIM in California ICD-10 code modifiers to acknowledge – and compensate—for the added complexity of social needs Additional resources/further reading: Liberman DB, Pham PK, Semple-Hess JE. Epub 2018 Nov 22. Epub 2018 May 23.

Pediatrics 55

Pediatrics Emergency Department Research Burns 55

ACEP Now

JUNE 7, 2023

ED leaders worked to develop new physician documentation and coding guidelines that needed to be implemented at the beginning of 2023. The overall length of stay for all ED patients increased to 199 minutes in 2022, up from 182 minutes in 2018 (see graph above). This necessarily increased ED walkaway rates.

Emergency Department 52

Emergency Department Documentation/Coding Operations EMS 52

PulmCCM

MARCH 11, 2024

About 544,000 99292 codes were billed to CMS in 2021, according to ACCP , reportedly stable at about 10% of the total bills. Each hospital’s Medical Executive Committee approved the protocol, and data was collected 2016-2018. How your employer considers the billed-but-unpaid 99292s in your RVUs is a separate question.)

Hospice 52

Hospice Documentation/Coding Administration Hospitals 52

The Skeptics' Guide to EM

JULY 30, 2022

CT is generally the first choice of imaging, the “abdominal series” of plain X-rays have been demonstrated to have poor predictive value, but a 2018 meta-analysis found 92.4% AEM July 2022 * Population: Patients with ICD-10 coding “intestinal obstruction” from 2018 National Hospital Ambulatory Medical Care Survey.

Ultrasounds 52

Ultrasounds Operations Documentation/Coding Outcomes 52

Total Medical ComplianceHIPAA

NOVEMBER 8, 2024

This marks OCR’s fourth ransomware-related settlement, as ransomware incidents in healthcare have increased by 264% since 2018. OCR emphasizes the importance of documenting and routinely reviewing mitigation strategies to counteract risks before they lead to a breach, supporting a more resilient cybersecurity framework.

Risk Management 59

Risk Management Best Practices Documentation/Coding 59

RebelEM

JANUARY 29, 2024

JACC Cardiovasc Interv 2018. A Randomized Trial of the Optimum Duration of Acoustic Pulse Thrombolysis Procedure in Acute Intermediate-Reisk Pulmonary Embolism: The OPTALYSE PE Trial. PMID: 30025734 Sharifi M et al. Moderate Pulmonary Embolism Treated with thrombolysis (from the “MOPETT” Trial). Am J Cardiol 2013.

Stroke 136

Stroke Outcomes Hospitals Administration 136

Sensible Medicine

MAY 25, 2023

“The Centers for Medicare and Medicaid Services should make establishing payment codes for products involving women’s heart disease a priority to prompt private insurers to cover new service lines.” One of them, the coronary artery calcium score (CAC) was reviewed in 2018 by the U.S.

Documentation/Coding 57

Documentation/Coding Academics Wellness 57

Emergency Medicine Journal

FEBRUARY 20, 2024

Incident cases of AAS were identified between 2003 and 2018 using a validated algorithm based on ICD codes and death. Methods A population-based retrospective cohort study of anonymously linked data for residents of Ontario, Canada, was carried out. These preliminary analyses were unadjusted for clustering or any covariates.

Documentation/Coding 40

Documentation/Coding Hospitals Outcomes 40

Don't Forget the Bubbles

JULY 26, 2023

Paediatric survivors of out-of hospital VF: etiologies and outcomes, Silka et al, Heart Rhythm 2018 : Survival rates for paediatric out of hospital arrest are 12-29%, however, in cases where there was a sustained return of circulation, more than 80% had an underlying cardiac aetiology identified.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

Cook County EM Blog

MAY 15, 2023

A code STEMI was activated, and the patient was given sublingual nitroglycerin and morphine for his pain. Fourth Universal Definition of Myocardial Infarction (2018). A posterior EKG was immediately obtained showing very mild ST elevation in V7 and V8. Unfortunately, this EKG was not recorded in the EMR. Neth Heart J. Alpert, Allan S.

EKG/ECG 52

EKG/ECG Documentation/Coding Wellness 52

Dr. Smith's ECG Blog

JULY 26, 2023

2 prior ECGs were found in his medical record — the latest of which was done circa 2018 ( which would be ~8 years after his inferior MI — and ~5 years before ECG #1 ). To facilitate comparison in Figure-1 — I put this 2018 prior tracing ( = ECG #3 ) — together with ECG #1.

EKG/ECG 52

EKG/ECG Documentation/Coding Wellness 52

EMDocs

NOVEMBER 6, 2024

tetani infection is also indicated.

Poisoning 79

Poisoning Airway Management Dislocations Forensics 79

Sensible Medicine

MARCH 27, 2024

The 2018 American guidelines recommend an LDL-C level <100 mg/dl for primary prevention. I have long aimed for LDL-C and apoB levels/non HDL levels <60 in my patients with documented ASCVD (either by CAC, CCTA or ASCVD events). For patients with established ASCVD (secondary prevention) they recommend LDL-C <70.

Research 93

Research Documentation/Coding Wellness 93

Pediatric Emergency Playbook

AUGUST 1, 2018

0.34) Documented temperature >38° or >38.5°C 2018 Feb;90(2):105-108. 2018 Mar 19;12(3):e0006335. Use this new post-test probability to help in your decision Your patient has palatal petechiae, which confers a positive likelihood ratio (LR+) of 2.7 7.62) 0.94 (0.90-0.97) 0.97) 0.08 (0.05-0.14) 0.14) 0.98 (0.95-0.99)

Pediatrics 52

Pediatrics Documentation/Coding 52

EMDocs

DECEMBER 4, 2023

Document a risk and benefit discussion with the patient regarding empiric anticoagulation, perhaps even including the HAS-BLED score in the documentation [10]. Give the first dose of enoxaparin in the ED: 1 mg/kg subcutaneously for 12 hours or 1.5 mg/kg for 24 hours. Ultrasound. 2020;28(1):23-29. Circulation. 2018;137(14):1505-1515.

Ultrasounds 71

Ultrasounds Documentation/Coding Wellness EMS 71

PEMBlog

OCTOBER 18, 2024

These documents should be reviewed promptly upon presentation, as they often contain critical information about the patient’s DNR status, preferred ventilation strategies, and other key management instructions. 2018 Oct;142(Suppl 2):S72-S81. 2018-0333I. Cardiac Management of the Patient With Duchenne Muscular Dystrophy.

Emergency Department 52

Emergency Department Fractures Best Practices Documentation/Coding 52

American Medical Compliance

OCTOBER 17, 2023

To ensure that any hazards requiring preventive control will be greatly mitigated or averted and to help ensure that the food is not tainted, preventive controls that must be documented must be put into action. Languages: American English Key features: Audio narration, learning activity, and post-assessment.

Documentation/Coding 52

Documentation/Coding Wellness 52

Taming the SRU

FEBRUARY 5, 2024

1) However, it wasn’t until the 1890s that purposeful, successful, and safe attempts to access this fluid were documented (2). 2018) Epidemiology of lumbar punctures in hospitalized patients in the United States. A., & Koehler, P. The first lumbar puncture. Journal of the history of the neurosciences, 6(2), 147–153.

Infectious Diseases 96

Infectious Diseases Seizures Ultrasounds Sepsis 96

PEMBlog

MAY 11, 2023

These were used by two independent reviewers to determine Neonatal Facial Coding System with pain scores. The primary outcome was the difference between the Neonatal Faces Coding Scale (NFCS) before the procedure and during LP needle insertion. 2018 Mar;25(3):310-316. for the lidocaine group and 4.8 (0.5) Acad Emerg Med.

Documentation/Coding 52

Documentation/Coding Pediatrics Emergency Department Academics 52