Sensible Medicine

MAY 15, 2024

At the same time, I struggle to see how such a person could run codes and work in trauma surgery. In this week’s Sensible Medicine podcast, I asked why students have an entire lecture with prolonged discussion of whether a patient coming to the hospital from prison should be called a prisoner. I fault the administrators.

Administration 119

Administration Documentation/Coding Hospitals Wellness 119

Emergency Medicine Journal

NOVEMBER 28, 2023

Accordingly, this pilot study aimed to test whether clinician-assigned ED discharge diagnosis coding could be implemented in an Irish ED, and whether coded data would be of sufficient quality to support operational needs and the proposed model of activity-based funding (ABF). 67% of available codes were used.

Documentation/Coding 40

Documentation/Coding Emergency Department Operations Administration 40

The Trauma Pro

OCTOBER 31, 2023

If you believe that harm will occur, here are your options, from least to most damaging to your professional status at the hospital: Contact another consultant in the same or overlapping specialty (if there is one). Contact the trauma medical director, service chief, or hospital administrator and see if they can intervene.

Risk Management 113

Risk Management Fractures Documentation/Coding Hospitals 113

RebelEM

JUNE 8, 2023

The retrospective design of this study omitted assessment of ventricular dysrhythmias related to push dose pressor administration, as they were reliant on information in the EMR. Assessed clinical practice, outcome, length of stay, safety, and efficacy of both phenylephrine and epinephrine peripherally administered through a push dose.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

RebelEM

JULY 3, 2023

What They Did: Researchers conducted a multicenter, retrospective cohort study in three community hospitals and two freestanding emergency departments. The study was dependent on EMR documentation which is prone to error. Critical information such as HR, SBP, drug administration times were occasionally missing. received CaCl 89.3%

Administration 96

Administration Outcomes Documentation/Coding Emergency Department 96

ACEP Now

DECEMBER 6, 2024

Repeat ECG following return of spontaneous circulation after administration of intravenous nitroglycerin. The decision was made to communicate directly with the on-call interventional cardiologist with specific and direct intent to discuss the administration of intravenous (IV) NTG. and at Naples Community Hospital in Naples, Fla.

Resuscitation 98

Resuscitation EKG/ECG Documentation/Coding COPD 98

RebelEM

AUGUST 22, 2024

Administration of intravenous tissue plasminogen activator (IV tPA) within 4.5 Administration of intravenous tissue plasminogen activator (IV tPA) within 4.5 Moreover, there are multiple operational and patient-specific barriers rendering timely thrombolytic administration difficult. Timely recognition of RAO is challenging.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

EMDocs

JUNE 9, 2023

How do we manage the agitated child in the pre-hospital environment? After listening to this episode you will be able to: Identify unique aspects of the pre-hospital environment that impact assessment and treatment of agitated children Describe the role of EMS personnel and EMS director in the care of agitated children. mg/kg IN; 0.1-0.15

EMS 97

EMS Documentation/Coding Pediatrics Psychiatric 97

Sensible Medicine

AUGUST 21, 2023

Administrative data sets are often collected for the purpose of billing, or costing, or administrative organization, and thus are extremely vulnerable to up coding or intentional or accidental omissions. This means that the data on which the observations are based, independently of how they are analyzed, are not reliable.

Administration 98

Administration Outcomes Research COPD 98

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). The primary outcome was hospital admission rates. The primary comparison was between administration of ICS in addition to systemic corticosteroids (SCS) and to SCS alone. Lung function poorly reported.

Outcomes 105

Outcomes Academics Documentation/Coding Emergency Department 105

American Medical Compliance

AUGUST 7, 2024

OSHA (Occupational Safety and Health Administration) Adhering to OSHA (Occupational Safety and Health Administration) regulations is vital for ensuring safe and healthy working conditions for healthcare workers. For example, CMS requires accurate and timely documentation of patient care to ensure proper billing and reimbursement.

Hazardous Materials 105

Hazardous Materials Documentation/Coding Legal Issues Patient Safety 105

ACEP Now

OCTOBER 10, 2024

McCormick earned his Master of Business Administration from National University and medical degree from Morehouse School of Medicine in Atlanta. He completed residency in emergency medicine through Emory while training at Grady Hospital in Atlanta. Most recently, Dr. McCormick served as an emergency physician at Northside Hospital.

Telemedicine 105

Telemedicine Critical Access Hospitals Emergency Department 105

PulmCCM

APRIL 29, 2024

government proposed adding VAP to its “hospital-acquired conditions” list—the ones that it won’t pay for. Hospital administrators put VAP on the kill list. And maybe, noticing all the fuss, some clinicians might have started coding for VAP slightly less often in equivocal cases. In 2008, the U.S.

Documentation/Coding 52

Documentation/Coding Academics Administration Research 52

Northwestern EM Blog

OCTOBER 31, 2022

Written by: Mike Tandlich, MD (NUEM ‘24) Edited by: David Feiger, MD (NUEM ‘22) Expert Commentary by : Michael Schmidt, MD Expert Commentary While EMTALA was first enacted to address issues with “patient dumping”, it has had broad influence on how patients are treated, dispositioned, and transferred in emergency department and hospital settings.

Emergency Department 52

Emergency Department Administration Documentation/Coding Hospitals 52

Mind The Bleep

APRIL 10, 2025

They can be fine tuned to respond to prompts and perform specific tasks such as finishing code, generating essays or textual responses to users. AI can book appointments and perform other administrative tasks, for instance, retrieving medical information and billing. One of the most famous LLMs is ChatGPT.

Documentation/Coding 52

Documentation/Coding Research Outcomes Administration 52

PulmCCM

FEBRUARY 5, 2024

You can read the document here. Depends On the Patient, and Who You Ask The Centers for Disease Control and Prevention defines a fever (for general hospitalized patients) as >38°C. Read the original document here. to enforce compliance with an administrative policy). What’s a Fever? °C (100.9°F).

Best Practices 111

Best Practices Ultrasounds Infectious Diseases Sepsis 111

The Skeptics' Guide to EM

FEBRUARY 23, 2019

Association Between Early Intravenous Fluids Provided by Paramedics and Subsequent In-Hospital Mortality Among Patients With Sepsis. Association Between Early Intravenous Fluids Provided by Paramedics and Subsequent In-Hospital Mortality Among Patients With Sepsis. Date: February 22nd, 2019 Reference: Lane et al. Reference: Lane et al.

Sepsis 52

Sepsis Administration Documentation/Coding Hospitals 52

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. Software attacks crippled operations in large hospital chains, and physical assaults on ED staff continued unabated. Patient volume losses in 2020 reversed in 2021.

Emergency Department 52

Emergency Department Documentation/Coding Operations EMS 52

ACEP Now

JUNE 7, 2023

Another proposed application for LLMs involves transcription and summarization services to reduce administrative overhead. The example provided illustrates both the potential and current limitations of the technology, presently requiring careful review to ensure spurious extrapolations have not been inserted into the medical documentation.

Documentation/Coding 78

Documentation/Coding Wellness Administration Research 78

Taming the SRU

JUNE 3, 2024

Myth: Some patients are “too sick to transport” Myth Part B: The receiving hospital gets to decide if a patient is too sick to transport. What drives the concern? Relative to inactions, actions receive more attention, elicit stronger emotional reactions, trigger higher regret, and are often perceived as more consequential.

Shock 92

Shock Seizures Airway Management Stroke 92

EMDocs

JUNE 2, 2023

Route of administration If the patient is cooperative, offer oral medications first. Document what you gave and why, as well as the impact. You should always follow your local practice guidelines and recommendations as well as adhere to approved medications in your facility. If a patient has a PRN on their med list do that!

Psychiatric 91

Psychiatric Pediatrics Emergency Department Administration 91

Mind The Bleep

SEPTEMBER 1, 2024

A clinical attachment is a short period of time (can be anywhere from a month up to a year) where a qualified medical graduate, i.e., having sat their PLAB 2 and in the process of getting GMC registered, is attached to a trust hospital in the NHS with the primary purpose of gaining NHS experience. Is it a requirement to work in the NHS?

Hospitals 52

Hospitals Documentation/Coding Administration Wellness 52

ACEP Now

JUNE 14, 2024

Transferring patients from one ED to another hospital is an established part of emergency medicine practice. Patients who need inpatient services do not match the index hospitals’ capabilities, or the patient requests such a transfer, or the hospital has no available inpatient space. Click to enlarge. Click to enlarge.

Emergency Department 52

Emergency Department Operations Hospitals Leadership 52

ACEP Now

AUGUST 1, 2023

Our Indiana ACEP colleagues have helped us all as emergency physicians in championing the passage of state legislation mandating a physician leading a hospital’s emergency department to be physically present in that hospital.

Emergency Department 98

Emergency Department EMS Critical Access Hospitals 98

ACEP Now

JUNE 14, 2024

The ED Accreditation program is designed to recognize hospitals that adhere to policies and practice standards that meet key criteria and provide the best patient care possible. Open applications will be coming soon, but you can find out more and get on the interest list today at acep.org/EDap.

Sexual Assault 52

Sexual Assault Seizures Documentation/Coding EMS 52

Greater Sydney Area HEMS

AUGUST 1, 2023

In contrast to hospital life, we work in relative isolation in HEMS. Again, stark contrast to the hospital environment, where we are so often blitzed with service provision to the point where it’s a challenge to schedule emptying your bladder! – The re-design of C+C documentation process was launched. Why is C+C important?

Documentation/Coding 52

Documentation/Coding Outcomes Hospitals Administration 52

ACEP Now

OCTOBER 26, 2023

The parents only have a copy of the discharge instructions, and your hospital and Children’s General do not share electronic health records. And, when alerted of a bounce-back to another hospital, it’s in everyone’s best interest to know about and help rectify any possible previous mistakes as soon as possible.

Infectious Diseases 52

Infectious Diseases Documentation/Coding Hospitals Emergency Department 52

PulmCCM

OCTOBER 16, 2023

hospitals, between roughly one and four central line-associated bloodstream infections (CLABSI) occur per 1,000 days with a central line in place (catheter-days). Central line infections result in excess mortality, hospital stays, and cost (although the magnitude of all three are debated). How Often Do Central Lines Become Infected?

CDC 52

CDC Hospitals Ultrasounds Documentation/Coding 52

ACEP Now

JULY 6, 2023

Now, many PID patients are treated and released after ED administration of appropriate antibiotics to eradicate possible infection by Neisseria gonorrhea and Chlamydia trachomatis , often with added treatment for anaerobic microbes. Warfarin pills are inexpensive, but the associated hospital care is not.

Head Injuries 52

Head Injuries Emergency Department Research Pediatrics 52

Dr. Smith's ECG Blog

SEPTEMBER 10, 2023

Ongoing pain noted throughout all documentation, but after nitro drip and prn morphine, "pain improved to 2/10." In the first year since discharge, he has been hospitalized 3 times with CHF. Repeat ECG: New developing Q waves in V2 and V3, further confirming evolving OMI. CT aorta negative for dissection. Repeat trop 150 ng/L.

EKG/ECG 77

EKG/ECG Outcomes Academics Documentation/Coding 77

Dr. Smith's ECG Blog

NOVEMBER 30, 2019

Hospital admission had been recommended, but she left that ED against medical advice. IV administration of potassium is indicated when arrhythmias are present or hypokalemia is severe (potassium level of less than 2.5 Administration of potassium may be empirical in emergent conditions. "If mEq/L and a creatinine 1.5

Shock 40

Shock EKG/ECG Resuscitation Ultrasounds 40

EB Medicine

AUGUST 6, 2019

Interestingly, one retrospective study found limited agreement between EMS records and hospital documentation on current DOAC usage. Make sure to get the name, dose, and time of last administration of any DOAC. This strategy reduces hospital days and costs with otherwise similar outcomes - total win all around.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

PulmCCM

JANUARY 15, 2025

Draft Guidance for Industry and Food and Drug Administration Staff. Draft Guidance Document Wong et al. Clinical Outcomes Associated With Overestimation of Oxygen Saturation by Pulse Oximetry in Patients Hospitalized With COVID-19. January 2025. Fingertip oxygen sensors can fail on dark skin — now a physician is suing.

Academics 81

Academics Documentation/Coding Administration Research 81

RebelEM

NOVEMBER 30, 2023

For those with sepsis, the administration of intravenous fluids (IVF) at the volumes recommended in the Surviving Sepsis Campaign (SSC) requires careful consideration of an individual’s chronic medical conditions and subsequent sensitivity to IVF. Studies without a clear timeframe for fluid administration. 2.89, p = 0.01.

Sepsis 121

Sepsis Fluid Resuscitation Resuscitation Administration 121

EMDocs

NOVEMBER 16, 2024

Posterior – Shortened, adducted, internally rotated 5,6 Anterior – Shortened, abducted, externally rotated 5,6 As with all dislocations, perform and document distal neurovascular exam before and after management. 8 Perform and document distal neurovascular exam. Hospitals, 2018. 5 CT if concern for occult fracture.

EMS 97

EMS Dislocations Fractures Operations 97

Don't Forget the Bubbles

JULY 3, 2023

This time we have our first group of colleagues from Birmingham Children’s Hospital Emergency Department. This study supports existing evidence that the use of intranasal fentanyl improves the time to administration of analgesia for those with SCD-VOE. Why does it matter? Opioids are the mainstay of treatment. Why does it matter?

Emergency Department 105

Emergency Department Hospitals Domestic Violence Pediatrics 105

ACEP Now

APRIL 9, 2025

When I was an inpatient pharmacy manager in 2013, my hospital was visited by the California Department of Public Health (CDPH), concerned about droperidol and ECG monitoring, or rather, lack thereof. CDPH still insists that following the Food and Drug Administrations (FDA) package insert is the gold standard when it comes to medical practice.

Emergency Department 52

Emergency Department Administration EKG/ECG Resuscitation 52