RCEM Learning

MAY 20, 2022

Author: Govind Oliver / Code: / Published: 06/02/2020 In December 2019 the NIHR announced a themed call for applications in urgent and emergency care, injuries and accidents. The NIHR Academy fellowship scheme is included in this themed call.

Documentation/Coding 52

Documentation/Coding 52

Emergency Medicine Journal

MARCH 21, 2024

Background In 2019, the emergency medical services (EMS) covering the western Norway Regional Health Authority area implemented its version of the prehospital clinical criteria G-FAST (Gaze deviation, Facial palsy, Arm weakness, Visual loss, Speech disturbance) to detect acute ischaemic stroke (AIS) with large vessel occlusion (LVO).

Stroke 52

Stroke Documentation/Coding EMS Hospitals 52

Dr. Smith's ECG Blog

OCTOBER 18, 2023

4,5] We have now formally studied this question: Emergency department Code STEMI patients with initial electrocardiogram labeled ‘normal’ by computer interpretation: a 7-year retrospective review.[6] 2019 ; 54 : 79 - 81. have published a number of warnings about the previous reassuring studies.[4,5] J Electrocardiol. Am J Emerg Med.

EKG/ECG 118

EKG/ECG Documentation/Coding Emergency Department Outcomes 118

EMDocs

OCTOBER 11, 2023

.” The tech cleans the wound and documents it as 2cm long and “ dirty.” The ED physician documents suturing a 3 cm laceration in a single layer, omitting any reference to any wound exploration, cleansing or debridement. I thought they were incidental “ bone islands” so I didn ’ t document them. Negligence was present.

Documentation/Coding 69

Documentation/Coding Radiology Radiology Patient Safety 69

Pediatric EM Morsels

OCTOBER 6, 2023

(Forster, 2021) Transmission is by Fecal-Oral route (Chiodini 2018) Incubation period 6-30 days after exposure (Chiodini 2018) Salmonella typhi produces an endotoxin although its clinical significance is not yet well understood (Gibani 2019) Two typhoid vaccines are available for those > 6 m/o and are 50-80% effective. Lancet Infect Dis.

Pediatrics 161

Pediatrics CDC Seizures Documentation/Coding 161

Pediatric EM Morsels

MAY 5, 2023

2019 Oct;26(7):442-450. Epub 2019 Oct 12. Vegan diet in children and adolescents. Recommendations from the French-speaking Pediatric Hepatology, Gastroenterology and Nutrition Group (GFHGNP). Arch Pediatr. doi: 10.1016/j.arcped.2019.09.001. 2019.09.001. PMID: 31615715.

Pediatrics 130

Pediatrics Documentation/Coding EMS 130

SheMD

MAY 11, 2023

Transcripts were coded to sort data into “leadership occurrences” or “unrelated to leadership” as well as critical treatment decisions. CPR-related performance items were coded by the second as present or absent. 2019; 47(1): e8- e13. How they measured things: Data was studied through video recordings collected for analysis.

Leadership 52

Leadership Documentation/Coding Teamwork CPR 52

Don't Forget the Bubbles

AUGUST 23, 2023

2016) “Implementation of a Post-Code Pause: Extending Post-Event Debriefing to Include Silence”. 2012) “Implementation of a Rapid Post-Code Debrief Quality Improvement Project in a Community Emergency Department Setting”. Please watch this video for a beautiful explanation from Jonathan Bartels of this initiative. & Liska, H.

Emergency Department 98

Emergency Department Resuscitation Documentation/Coding Best Practices 98

Dr. Smith's ECG Blog

MARCH 4, 2024

link] Or use the QR code: 10 Cases: Case 1 Do you want to be interrupted to view what the computer calls normal or nonspecific ECGs? For my clarifying Figure illustrating T-QRS-D ( 2nd bullet ) — See My Comment at the bottom of the page in Dr. Smith’s November 14, 2019 post. = 2 cases at once! You can use it an unlimited amount.

EKG/ECG 113

EKG/ECG Documentation/Coding Wellness Resuscitation 113

Emergency Medicine Journal

MAY 23, 2023

We investigated the association between bystander CPR and the likelihood of ventricular fibrillation (VF) or ventricular tachycardia (VT) as the first documented cardiac rhythm. The first documented cardiac rhythm was compared between patients who received bystander CPR and those who did not, using a 1:2 propensity score-matched analysis.

Resuscitation 40

Resuscitation CPR Hospitals Documentation/Coding 40

ACEP Now

NOVEMBER 13, 2023

5 Hospitals commonly activate a “code” in response to agitated patients, alerting security personnel to the location of that patient. From the law enforcement perspective, hospital policies regarding behavioral codes were “vague” and the same patients are often seen multiple times with similar behavioral crises, he noted in an interview.

Emergency Department 52

Emergency Department Documentation/Coding Psychiatric Best Practices 52

The Skeptics' Guide to EM

MAY 11, 2019

Date: May 6th, 2019 Reference: Sceats et al. Date: May 6th, 2019 Reference: Sceats et al. Background: The first documented appendectomy was done by Claudius Amyand in 1735. Exclusion: Patients with co-occurring diagnosis or procedure codes consistent with complicated appendicitis and patients lacking appendectomy codes.

Documentation/Coding 52

Documentation/Coding Operations Academics Ultrasounds 52

RCEM Learning

MAY 20, 2022

Author: Rick Body / Editor: Govind Oliver / Code: / Published: 06/02/2020 In 2017 the National Institute for Health Research (NIHR) published its Training Review. The Royal College of Emergency Medicine (RCEM) successfully applied to set up an NIHR Incubator for Emergency Care, which was launched at Octavia House in June 2019.

Academics 52

Academics Documentation/Coding Research Hospitals 52

Stop and Think

DECEMBER 10, 2023

This massive 156-page document updates the 2019 guidelines. (It’s The old 2019 recommendation to do AF ablation in the presence of heart failure was a 2b, which is the lowest level. I include the links at the end of this post. It’s open access.) Stop and Think is a reader-supported publication.

Documentation/Coding 40

Documentation/Coding 40

EMDocs

SEPTEMBER 30, 2024

Among patients with a primary provider documented in the chart, 30-day outpatient follow-up rate was 21.3% (n = 313). Guidelines – Global Initiative for Asthma (GINA) 2023 The 2019 Global Initiative for Asthma (GINA) guidelines recommend that all patients with asthma be prescribed ICS.

Outcomes 83

Outcomes Documentation/Coding Academics Administration 83

PEMBlog

JUNE 14, 2023

Boarding of Mentally Ill Patients in Emergency Departments: American Psychiatric Association Resource Document. 2019 Jul 22;20(5):690-695. Pediatrics March 2023; 151 (3): e2022057383. 10.1542/peds.2022-057383 2022-057383 Nordstrom K, Berlin JS, Nash SS, Shah SB, Schmelzer NA, Worley LLM. West J Emerg Med. doi: 10.5811/westjem.2019.6.42422.

Psychiatric 98

Psychiatric Emergency Department Pediatrics Best Practices 98

The Skeptics' Guide to EM

MAY 2, 2020

July 2019 Guest Skeptic: Dr. Robert Edmonds is an emergency physician in the US Air Force in Virginia. July 2019 Guest Skeptic: Dr. Robert Edmonds is an emergency physician in the US Air Force in Virginia. The crew then asks if you want them to transport your father Code 3 with full lights and sirens.

Documentation/Coding 40

Documentation/Coding EMS EKG/ECG Outcomes 40

Emergency Medicine Journal

NOVEMBER 28, 2023

The pathway was implemented in January 2023 and comparisons made with 4 weekly average data taken from June to December 2019. All DTS scans had documented senior review at radiology request to ensure governance. The pathway has reduced average waiting times for MRI scan in hours by 46% and in OOH period by 58%.There to 6.5%.

Radiology 40

Radiology Radiology Documentation/Coding Hospitals 40

PulmCCM

JUNE 12, 2023

Elsevier boasted a 40% profit margin in 2019. Use code PULMCCM15 and get 15% off when you register online. Elsevier explained that their fees are justified to maintain open access (i.e. no paywalls) and because other publishers do it. Read in the Guardian Getting sued: not if but when?

Hyperthermia / Hypothermia 98

Hyperthermia / Hypothermia Academics Documentation/Coding Outcomes 98

Total Medical ComplianceHIPAA

OCTOBER 15, 2022

The HHS Office for Civil Rights (OCR) recently settled three more investigations in the Right of Access Initiative it started in 2019. If a patient emails a request for their records, it is considered sufficient documentation for the practice to provide those records once the practice confirms the email address belongs to the patient.

Documentation/Coding 52

Documentation/Coding Administration Wellness 52

Don't Forget the Bubbles

MAY 10, 2023

Then you hear the words coming out of the speaker, “ Paediatric code black. Paediatric code black ”. You’ve heard the phrase code black before – it’s a traumatic cardiac arrest. You know a paediatric code black means paediatric traumatic cardiac arrest. You’re just about aware of the tannoy in the background. Emerg Med J.

Emergency Department 91

Emergency Department Resuscitation Documentation/Coding Teamwork 91

ACEP Now

DECEMBER 11, 2023

A recent article documents 56 additional U.S. Published November 24, 2019. The wave of increasing hospital closures and service line cutbacks continues to sweep the U.S. hospitals that are closing clinical departments or ending or reducing services. Published January 19, 2023. Accessed December 8, 2023. Forbes website.

Hospitals 98

Hospitals Administration Documentation/Coding Research 98

Pediatric EM Morsels

AUGUST 18, 2023

None of the patients were documented to have joint disease at follow up. Etminan 2019) In Belgium between 2010 – 2013, of the 262 children treated with fluroquinolones while hospitalized, only 17% were used for labelled indications. There were 2523 children included. 451 pediatric patients were included. Clin Pediatr. 55(2):107-10.

Pediatrics 130

Pediatrics Infectious Diseases Seizures Hospitals 130

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. 2019; 380:1795-1803. Reference: Ma H, Campbell BC, Parsons MW, et al.

Stroke 78

Stroke Administration Documentation/Coding Outcomes 78

Dr. Smith's ECG Blog

JULY 7, 2024

But because Code STEMI was cancelled on arrival and the patient had delayed angiography, the discharge diagnosis was 'non-STEMI' despite having the exact same pathology. The patient also had a 100% proximal LAD occlusion, with a peak troponin of 100,000 ng/L.

EKG/ECG 66

EKG/ECG Documentation/Coding EMS Wellness 66

Dr. Smith's ECG Blog

OCTOBER 12, 2024

The providers documented concern for ST elevation in the precordial and lateral leads as well as a concern for hyperkalemic T waves in the setting of succinylcholine administration. Preliminary findings documented in the cath lab were “Anterior STEMI and no significant coronary artery disease.” (!!!) Potassium resulted as 4.9,

EKG/ECG 101

EKG/ECG Documentation/Coding Emergency Department COPD 101

Mind The Bleep

OCTOBER 29, 2024

Provide detailed documentation of the initial assessment, treatment provided, and the patient’s response to interventions. 2019 Nov;34(4):276-281. Epub 2019 Nov 29. Preparation for Transfer Ensure the patient is hemodynamically stable before transfer. J Med Toxicol. 2015 Jun;11(2):227-31. doi: 10.1007/s13181-014-0440-1.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

Don't Forget the Bubbles

MARCH 19, 2024

In 2019, 14% of all child and adolescent mental health patients were treated in approved adult hospitals. Acknowledging the challenges associated with paediatric social admissions begins with documenting social issues and assessing their social history with the same level of detail as their medical history. What can clinicians do?

Hospitals 52

Hospitals Psychiatric Documentation/Coding Pediatrics 52

RebelEM

NOVEMBER 30, 2023

May 1, 2019 , A5999-A5999. It is crucial for physicians to exercise clinical judgment and discretion when administering crystalloid fluids, avoiding indiscriminate fluid administration based on these nuanced considerations. CRITICAL CARE: HARD TIMES – RESUSCITATING MY PATIENT: FLUID, BLOOD AND OTHER STRATEGIES. 2020;4(5):537-541.

Sepsis 122

Sepsis Fluid Resuscitation Resuscitation Administration 122

RebelEM

JUNE 8, 2023

Epub 2019 Jul 3. Am J Emerg Med. 2022 2022 Sep 5. PMID: 36108346 Cole JB, et al. Human Errors and Adverse Hemodynamic Events Related to “Push Dose Pressors” in the Emergency Department. J Med Toxicol. PMID: 31270748 Maheshwari K, et al. Intensive Care Med. 2018;44(6):857–67. Am J Emerg Med.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

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. 2019 May-Jun;19(4):378-385.

Pediatrics 72

Pediatrics Emergency Department Research Burns 72

The Skeptics' Guide to EM

NOVEMBER 16, 2019

Date: November 6th, 2019 Reference: Lascarrou et al. NEJM Oct 2019 Guest Skeptic: Dr. Laura Melville (@lmelville535) is an emergency physician in Brooklyn, New York, is a part of the New York ACEP Research Committee, ALL NYC EM, and is the NYP-Brooklyn Methodist Resident Research Director. Do you continue with the ICE Code?

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia EMS Research Documentation/Coding 40

EMDocs

JUNE 2, 2023

Document what you gave and why, as well as the impact. 2019 Mar;20(2):409-418. Epub 2019 Feb 19. 2019 May;20(3):537. 2019 Jul;20(4):688-689. Let’s look at management based on etiology: As always follow local procedures and recommendations. Summary All right, so that’s it for this episode. West J Emerg Med.

Psychiatric 67

Psychiatric Pediatrics Emergency Department Administration 67

Emergency Medicine Ireland

NOVEMBER 26, 2020

once conclusively shown to be a fungal infection heavyweights from the International Code of Nomenclature for algae, fungi, and plants (the ICNafp) weighed in and it became officially Jirovecii with “i”s at the end. 2019 Sep;33(9):e13587. Epub 2019 Jul 1. Clin Transplant. doi: 10.1111/ctr.13587. PMID: 31077616.

Infectious Diseases 40

Infectious Diseases Documentation/Coding Hospitals 40

The Skeptics' Guide to EM

FEBRUARY 23, 2019

Date: February 22nd, 2019 Reference: Lane et al. Date: February 22nd, 2019 Reference: Lane et al. JAMA 2018 * Population: Patients with sepsis identified using the international Statistical Classification of Disease and Related Health Problems, Tenth Revision (ICD-10CA) coding that was modified to be consisten.

Sepsis 52

Sepsis Administration Documentation/Coding Hospitals 52

Don't Forget the Bubbles

OCTOBER 14, 2024

Undocumented migrant: Someone who enters or stays in a country without the documents required under immigration regulations. Most patients lack medical records, so documentation of previous investigations, management, or surgery is limited to what they tell you. They usually have no recourse to public funds or governmental support.

Documentation/Coding 57

Documentation/Coding Hospitals Wellness Operations 57

ACEP Now

JANUARY 11, 2024

A recent article documents 56 additional U.S. Published November 24, 2019. The wave of increasing hospital closures and service line cutbacks continues to sweep the United States. hospitals that are closing clinical departments or ending or reducing services. Published January 19, 2023. Accessed December 8, 2023. Forbes website.

Hospitals 52

Hospitals Administration Documentation/Coding Research 52