ACEP Now

MAY 5, 2023

What is your role as the emergency physician? Introduction Law enforcement officers frequently accompany emergency department (ED) trauma patients or patients who are under arrest or require assistance. Law enforcement gathering in the emergency department: Legal and ethical background and practical approaches.

Emergency Department 52

Emergency Department Documentation/Coding 52

EMDocs

AUGUST 22, 2024

12 How do we address these disparities in the emergency department? 13 Interventions may include: Ascertaining a patient’s preferred language early in the clinical encounter (during registration, for instance), and clearly documenting this preference in a place that is visible to all providers.

Documentation/Coding 82

Documentation/Coding Emergency Department Federal Emergency Management Agency Best Practices 82

RebelEM

NOVEMBER 6, 2024

2023 Aug 4. 2023 Nov 5. Elbow Dislocations in the Emergency Department: A Review of Reduction Techniques. J Emerg Med. Multiple Concomitant Injuries in One Upper Extremity: A Case Report. Am J Case Rep. 2016 Jan 6;17:6-11. doi: 10.12659/ajcr.894984. PMID: 26732673 Akhondi H, Varacallo M. In: StatPearls [Internet].

Dislocations 109

Dislocations Fractures Soft Tissue Injuries Outcomes 109

ACEP Now

DECEMBER 17, 2024

In spring 2023, nearly 95 percent of house staff voted to unionize with the Committee of Interns and Residents (CIR), a branch of the Service Employees International Union (SEIU) and the largest and oldest house staff union in the country. Contract negotiations began in fall 2023, but progress was slow. link] Published May 24, 2023.

Burns 105

Burns Hospitals Documentation/Coding Emergency Department 105

EMDocs

JUNE 13, 2024

We just don’t document it. If we don’t use printed instructions, document our verbal instructions regarding the most common side effects of the drug(s) being prescribed. Documenting our warnings should be standard care. State regulations and codes may place that responsibility on our shoulders. Updated: Jun 7, 2023.

Documentation/Coding 77

Documentation/Coding Patient Safety Emergency Department Hospitals 77

ACEP Now

OCTOBER 26, 2023

Using Maryland state law as a guide, the American College of Emergency Physicians (ACEP) and the Emergency Department Practice Management Association (EDPMA) lobbied for passage of federal protections beginning in the mid-1990s. There were multiple interpretative letters issued by the HCFA (now CMS) to interpret BBA ’97.

Documentation/Coding 124

Documentation/Coding Hospitals Administration Emergency Department 124

ACEP Now

AUGUST 1, 2023

In late June, ACEP organized a congressional briefing with the Emergency Nurses Association (ENA) and the National Alliance on Mental Illness (NAMI) to express strong concerns to legislators about the impact of emergency department boarding on our health care safety net. Read more at acep.org/boarding-briefing.

Documentation/Coding 52

Documentation/Coding Emergency Department Emergency Nursing Research 52

EM Literature of Note

OCTOBER 9, 2024

This exploration of LLMs in the emergency department is a bit unique in its conceptualization. emergency departments are general cesspools of aggressive empiric antibiotic coverage, driven by CMS regulations – so it may in fact be the LLM displaying astute clinical judgement, here. For what its worth, of course, U.S.

Radiology 86

Radiology Radiology Emergency Department Documentation/Coding 86

PEMBlog

JUNE 14, 2023

Thousands of children and adolescents spend days at time in Emergency Departments waiting for definitive mental health disposition. Alice Kuo and Ilene Claudius Podcast EIIC: Safe Control of the Agitated Patient Webinar Series with Dr. Zima; Follow-up After Pediatric Mental Health Emergency Visits. West J Emerg Med.

Psychiatric 98

Psychiatric Emergency Department Pediatrics Best Practices 98

Dr. Smith's ECG Blog

JUNE 17, 2024

Written by Bobby Nicholson, MD 67 year old male with history of hypertension and hyperlipidemia presented to the Emergency Department via ambulance with midsternal nonradiating chest pain and dyspnea on exertion. I refer to My Comment in the March 4, 2023 post — in which I included a Table with ECG Findings of Acute PE.

EKG/ECG 135

EKG/ECG Emergency Department Ultrasounds Shock 135

Dr. Smith's ECG Blog

APRIL 18, 2024

Written by Jesse McLaren A 70 year old with prior MIs and stents to LAD and RCA presented to the emergency department with 2 weeks of increasing exertional chest pain radiating to the left arm, associated with nausea. But only 6.4% of such ‘high risk Non-STEMI’ patients get angiography within 2 hours.[2] Take away 1.

EKG/ECG 116

EKG/ECG Documentation/Coding Fractures Emergency Department 116

PEMBlog

OCTOBER 18, 2024

Duchenne Muscular Dystrophy (DMD) is a complex and progressive disease requiring highly specialized care, especially in emergency situations. When patients with DMD present in the Emergency Department (ED), an understanding of the nuanced aspects of their care is essential for optimal management. Updated 2023 Jul 10].

Emergency Department 52

Emergency Department Fractures Best Practices Documentation/Coding 52

EB Medicine

JANUARY 3, 2023

2) 2023 E/M coding guidelines are in effect. 2) 2023 E/M coding guidelines are in effect. Announcements: 1) The interactive Clinical Pathways have launched and they are available for free!

Shock 52

Shock Pediatrics Airway Management Sepsis 52

PulmCCM

JUNE 12, 2023

Temperature management (or fever avoidance) should begin immediately after cardiac arrest (ideally in the emergency department, for out-of-hospital arrests) and continued for at least 72 hours. Read in Nature Don’t forget to register for the Hospitalist and Resuscitationist 2023 conference Sepetmber 27-30 in Montreal.

Hyperthermia / Hypothermia 105

Hyperthermia / Hypothermia Academics Documentation/Coding Outcomes 105

EMDocs

SEPTEMBER 30, 2024

Inhaled Corticosteroids Rarely Prescribed at Emergency Department Discharge Despite Low Rates of Follow-Up Care. J Emerg Med. 2023 May;64(5):555-563. Among patients with a primary provider documented in the chart, 30-day outpatient follow-up rate was 21.3% (n = 313).

Outcomes 83

Outcomes Documentation/Coding Academics Administration 83

Dr. Smith's ECG Blog

JANUARY 20, 2024

Written by Pendell Meyers A man in his late 30s with history of hypertension, tobacco use, and obesity presented to the Emergency Department for acute chest pain which started approximately 3 hours prior to arrival, in the setting of a very stressful situation. The pain radiated down both arms, 10/10 in severity.

EKG/ECG 111

EKG/ECG Documentation/Coding Emergency Department Hospitals 111

ALiEM

JANUARY 22, 2024

A 40-year-old male, tailor by occupation, was brought to the Emergency Department with complaints of high-grade fever for the past 11 days. Fever was documented to be 102°F and was not associated with any chills or rigors. Epub 2011 Sep 12. PMID: 21911554; PMCID: PMC3193135.

Documentation/Coding 64

Documentation/Coding Academics Emergency Department Hospitals 64

EMDocs

JUNE 9, 2023

We’re defining “protocol” here as a written document that provides oversight from the medical director about how to assess and treat patients. Reassessment and Documentation After any type of restraint is instituted, careful assessment, re-assessment, and documentation is required. Was the documentation complete?

EMS 77

EMS Documentation/Coding Pediatrics Psychiatric 77

Taming the SRU

NOVEMBER 14, 2023

Chief complaints involving the ear are a common occurrence in Emergency Departments across the US and include presenting symptoms such as ear pain or fullness, hearing loss, redness, trauma, vertigo, and foreign bodies. A retrospective analysis of the Nationwide Emergency Department Sample (NEDS) from 2009 through 2011 identified 8.6

Emergency Department 92

Emergency Department Pediatrics Wellness Fractures 92

ALiEM

JANUARY 10, 2025

A 3-month-old male with no past medical history was brought to the emergency department for evaluation of newly asymmetric pupils. Other documented pharmacological causes of anisocoria include nebulized ipratropium bromide and scopolamine (14-19). Anisocoria. Int Ophthalmol Clin. 2019;59(3):125-39. Payne WN, Blair K, Barrett MJ.

Pediatrics 64

Pediatrics Documentation/Coding Academics Administration 64

Don't Forget the Bubbles

OCTOBER 10, 2024

2023 Mar 30;110(4):432-438. Exploring communication preferences and risk thresholds of clinicians and parents of febrile infants under 90 days presenting to the emergency department: a qualitative study. 2024 Jul 10:archdischild-2023-326727. doi: 10.1136/archdischild-2023-326727. Arch Dis Child. Arch Dis Child.

Emergency Department 75

Emergency Department Outcomes Research Operations 75

EMDocs

JULY 9, 2024

The emergency department takes care of some of the highest risk patients with the worst access to health care and social services Over the past 20 years, many researchers have created and validated social needs screeners Some examples: iHELP, WE CARE, SEEK, USDA 2-item food insecurity questionnaire Does screening make a difference?

Pediatrics 55

Pediatrics Emergency Department Research Burns 55

EMDocs

JUNE 2, 2023

Document what you gave and why, as well as the impact. Best Practices for Evaluation and Treatment of Agitated Children and Adolescents (BETA) in the Emergency Department: Consensus Statement of the American Association for Emergency Psychiatry. 2023 Mar 21:S1876-2859(23)00091-8. PMID: 30881565; PMCID: PMC6404720.

Psychiatric 66

Psychiatric Pediatrics Emergency Department Administration 66

RebelEM

JULY 3, 2023

Impact of intravenous calcium with diltiazem for atrial fibrillation/flutter in the emergency department. Am J Emerg Med. What They Did: Researchers conducted a multicenter, retrospective cohort study in three community hospitals and two freestanding emergency departments. Article: Rossi N et al.

Administration 93

Administration Outcomes Documentation/Coding Emergency Department 93

EMDocs

MAY 26, 2023

Emerg Med Clin North Am. Structured team approach to the agitated patient in the emergency department. Emerg Med Australas. Use and avoidance of seclusion and restraint: consensus statement of the american association for emergency psychiatry project Beta seclusion and restraint workgroup. doi: 10.1016/j.emc.2009.07.003.

Pediatrics 76

Pediatrics Emergency Department Psychiatric Documentation/Coding 76

ALiEM

MARCH 11, 2024

In July 2022, a 32-year-old male with a past medical history of HIV (on antiretroviral therapy, CD4 390, viral load undetectable) presented to the emergency department with constitutional symptoms and a rash for 4-5 days. There is limited literature documenting eye involvement and pictographic examples of its presentation.

Documentation/Coding 56

Documentation/Coding Academics Emergency Department Hospitals 56

ACEP Now

NOVEMBER 7, 2023

3 These regulations have led to widespread practices of EHI, such as test results and clinical documentation, being shared with patients in real time. In turn, concerns have arisen regarding when information blocking is appropriate and what ethical issues emergency department (ED) physicians must consider prior to information blocking.

Documentation/Coding 52

Documentation/Coding Best Practices Ethical Issues Academics 52

ACEP Now

NOVEMBER 7, 2024

Elizabeth Wharff was the director of emergency psychiatry at Boston’s Children’s Hospital in the late 1990s when she became concerned about what was, then, a new problem. Boarding of mentally ill patients in emergency departments: American Psychiatric Association resource document. West J Emerg Med. Pediatrics.

Psychiatric 59

Psychiatric Pediatrics Hospitals Emergency Department 59

The Skeptics' Guide to EM

MARCH 31, 2023

Date: March 28, 2023 Reference: Fowler et al. Objective assessment of sleep and fatigue risk in emergency medicine physicians. You find her at […] The post SGEM#399: I’m So Tired – Emergency Medicine and Fatigue first appeared on The Skeptics Guide to Emergency Medicine. Date: March 28, 2023 Reference: Fowler et al.

Academics 52

Academics Documentation/Coding Emergency Department Outcomes 52

Don't Forget the Bubbles

MAY 6, 2024

of patients with follow-up documentation, 70.8% (95% CI 62.9–77.9) Factors that impact second attempt success for neonatal intubation following first attempt failure: a report from the National Emergency Airway Registry for Neonates. 2024 Feb 28:fetalneonatal-2023-326501. doi: 10.1136/archdischild-2023-326501.

Sepsis 75

Sepsis Outcomes Pediatrics Documentation/Coding 75

ACEP Now

JUNE 14, 2024

1 As fresh challenges of the pandemic and hospital operations changed emergency medicine practice, one of the more challenging areas was the movement of admitted patients out of the first emergency department (ED). emergency departments. in 2023 will be reported at around 160 million patients. percent).

Emergency Department 52

Emergency Department Operations Hospitals Leadership 52

EMDocs

DECEMBER 4, 2023

Johnson, MD ( Community EM, Salina Regional Health Center) // Reviewed by: Joshua Lowe, MD (EM Attending Physician, USAF); Marina Boushra, MD (Cleveland Clinic Foundation, EM-CCM); Brit Long, MD (@long_brit) Case A 40-year-old woman presents to a rural emergency department (ED) with left leg pain and swelling for the past 5 days.

Ultrasounds 71

Ultrasounds Documentation/Coding Wellness EMS 71

ACEP Now

MAY 6, 2023

Case A 35-year-old male is brought to the emergency department (ED) following a single-motor-vehicle collision in which two people were ejected and pronounced dead at the scene. Updated January 20, 2023. Accessed April 3, 2023. He is completely amnestic to the events of the accident. Discussion There were over 2.1

Forensics 52

Forensics Documentation/Coding Fractures Head Injuries 52

Dr. Smith's ECG Blog

JANUARY 27, 2024

, tells us that we physicians do not need to even look at this ECG until the patient is placed in a room because the computer says it is normal: Validity of Computer-interpreted “Normal” and “Otherwise Normal” ECG in Emergency Department Triage Patients I reviewed this article for a different journal and recommended rejection and it was rejected.

EKG/ECG 98

EKG/ECG Emergency Department Outcomes Documentation/Coding 98

ACEP Now

DECEMBER 10, 2023

In January 2023, the state of Maryland launched the first-ever government-based emergency medicine alternative payment model. Broad categories of diagnoses in the 2023 model are listed on the related chart. 2 More than 600 emergency department (ED) clinicians in the state are participating in the program.

Emergency Department 52

Emergency Department Hospitals Documentation/Coding 52

Dr. Smith's ECG Blog

SEPTEMBER 5, 2023

(including Pendell and Smith) just published this article: Emergency department Code STEMI patients with initial ECG labeled ‘normal’ by computer interpretation: a 7-year retrospective review Among 394 True positive cath lab activations, 16 (4.1%) had computer "normal" ECGs. == MY Comment , by K EN G RAUER, MD ( 9/5 /2023 ): == When I first saw today’s (..)

EKG/ECG 76

EKG/ECG Documentation/Coding Emergency Department 76

EMDocs

JUNE 16, 2023

And now we’re here at our destination, the place we know and love, the emergency room to talk about what we should be doing for the growing volume of children with mental health problems boarding in the emergency department. McEnany, Olutosin Ojugbele, Julie R. Doherty, Jennifer L. McLaren, JoAnna K. 10.1542/peds.2020-1174

Psychiatric 52

Psychiatric Pediatrics Emergency Department Best Practices 52