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 93

Radiology Radiology EKG/ECG Documentation/Coding 93

Pediatric EM Morsels

AUGUST 18, 2023

None of the patients were documented to have joint disease at follow up. Wirth 2018) One study including 4.4 Meesters 2018) Resistance is growing (likely from inappropriate / overuse)! There were 2523 children included. 451 pediatric patients were included. 451 pediatric patients were included. BMC Infectious Disease.

Pediatrics 130

Pediatrics Infectious Diseases Seizures Hospitals 130

EMDocs

FEBRUARY 12, 2025

AAPM Medical Physics Practice Guideline 12.a: a: Fluoroscopy dose management. J Appl Clin Med Phys. 2022;23(3):e13526. doi:10.1002/acm2.13526 Writing Committee Members, Hirshfeld JW Jr, Ferrari VA, et al. Clin J Oncol Nurs. 2020;24(6):681-684. doi:10.1188/20.CJON.681-684 681-684 Radiation Emergency Medical Management. Cutaneous Radiation Syndrome.

Best Practices 54

Best Practices Documentation/Coding Radiology Radiology 54

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 122

EKG/ECG Documentation/Coding Fractures Emergency Department 122

Dr. Smith's ECG Blog

MARCH 10, 2025

Weve also published the largest study on this question: Emergency Department Code STEMI patients with initial electrocardiogram labeled normal by computer interpretation: a 7-year retrospective review. This underestimates computer false normal ECGs because we only included code STEMIs, not Non-STEMIs with OMI.

EKG/ECG 89

EKG/ECG Outcomes Documentation/Coding Emergency Department 89

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 Radiology Radiology Documentation/Coding 113

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

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

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 70

Pediatrics Emergency Department Research Burns 70

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

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 95

Stroke Administration Documentation/Coding Outcomes 95

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

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 90

Poisoning Documentation/Coding Patient Safety Hospitals 90

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 113

CDC Documentation/Coding Research Pediatrics 113

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 76

Documentation/Coding Academics Wellness 76

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

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

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

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

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 113

Research Documentation/Coding Wellness 113

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 90

Ultrasounds Documentation/Coding Wellness EMS 90

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

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

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

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 133

Stroke Outcomes Hospitals Administration 133

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

Dr. Smith's ECG Blog

DECEMBER 27, 2023

Cardiology consult note written around that time documents that "Pain improved with NTG, morphine in ED but still present." Smith comment: But the tests (ECG and troponin) are extremely specific and so the post test probability is nearly 100%. Repeat cTnI drawn at around 8 AM was 3.910 ng/mL. This patient was not one of the lucky 6.4%

EKG/ECG 132

EKG/ECG Documentation/Coding Wellness Emergency Department 132

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

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

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

Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

A b rief chart review revealed his most recent echo in 2018, with LV EF 67%, “very small” inferior wall motion abnormality. As I discussed and documented in Lesson 1 of My Comment at the bottom of the page in the April 2, 2022 post of Dr. Smith's ECG Blog — certain patients may remain in sustained VT not only for hours — but even for days!

EKG/ECG 140

EKG/ECG Shock Academics Documentation/Coding 140

Taming the SRU

NOVEMBER 14, 2023

Foreign body removal steps Assess hearing before and after the procedure and document any suspected damage/injury prior to removal attempts so that these will not later be attributed to the procedure (6). Elsevier; 2018. Updated 2018 Dec 16]. Roberts JR, Custalow CB, Thomsen TW, eds. Seventh edition. Krogmann RJ et al.

Emergency Department 94

Emergency Department Pediatrics Wellness Fractures 94

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

The Skeptics' Guide to EM

MARCH 4, 2018

[display_podcast] Date: February 27th, 2018 Reference: Moran et al. display_podcast] Date: February 27th, 2018 Reference: Moran et al. Exclusions: There were 26 exclusions in their supplemental documentation. JAMA May 2017.

Infectious Diseases 40

Infectious Diseases Documentation/Coding Ultrasounds Outcomes 40