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 120

Administration Documentation/Coding Hospitals Wellness 120

ACEP Now

JANUARY 11, 2024

The wave of increasing hospital closures and service line cutbacks continues to sweep the United States. A recent article documents 56 additional U.S. hospitals that are closing clinical departments or ending or reducing services. 2 Of these 56 additional hospitals, many are not rural; thus, this specter is expanding.

Hospitals 52

Hospitals Administration Documentation/Coding Research 52

EMDocs

OCTOBER 10, 2024

Exam is normal except for tenderness as documented in the diagram. Hospital Inpatient : R thigh is indurated and blistered but abdomen is all but ignored. On the 2nd hospital day, she becomes obtunded and is intubated. She only gets worse, and by the 4th hospital day she is unresponsive. I just failed to document it.

Documentation/Coding 93

Documentation/Coding Hospitals Sepsis Infectious Diseases 93

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

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

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 91

Administration Outcomes Documentation/Coding Emergency Department 91

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

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

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 95

EMS Documentation/Coding Pediatrics Psychiatric 95

EMDocs

JUNE 8, 2023

and 9 hours after onset of symptoms, with non-infarcted brain tissue, does the administration of alteplase improve functional outcome at 90 days? Subsequently reduced enrollment to 310 patients because no patients had been lost to follow-up or had insufficient data documented. Intervention: Alteplase 0.9 in alteplase group versus 0.9%

Stroke 95

Stroke Administration Documentation/Coding Outcomes 95

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

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 101

Outcomes Academics Documentation/Coding Emergency Department 101

RebelEM

JANUARY 29, 2024

PMID: 37188358 Clinical Question: What is the efficacy and safety of low-dose (25mg) prolonged administration (over 6hrs) of alteplase in patients with massive PE? Reduced-Dose Systemic Fibrinolysis in Massive Pulmonary Embolism: A Pilot Study. Clin Exp Emerg Med 2023. in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47

Stroke 133

Stroke Outcomes Hospitals Administration 133

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

ACEP Now

OCTOBER 3, 2023

This document is an update of guidelines first published in 2000, and then updated in 2007. Confounders to the GCS such as seizure and post-ictal phase, ingestions and drug overdose, as well as medications administered in the prehospital setting that impact GCS score should be documented.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation EMS 98

Taming the SRU

MAY 11, 2024

3% HTS appears to be safe for peripheral IV administration and does not require a central line. The available data does not support any benefit of administration of hyperosmolar therapy in the setting of a TBI. Guidelines also support not administering HTS in the pre-hospital setting, yet the available data is weak.

Administration 92

Administration Resuscitation Fluid Resuscitation Research 92

Downeast Emergency Medicine

DECEMBER 1, 2021

329 participants were enrolled at an urban teaching hospital over a period of four years. Rosenberg and colleagues took a qualitative approach when investigating barriers and facilitators to successful implementation of ED-initiated buprenorphine programs in critical access hospital EDs across Maine.

Emergency Department 52

Emergency Department Documentation/Coding Leadership Administration 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

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

RebelEM

OCTOBER 5, 2023

The treating physicians and research personnel were all unaware of the treatment arm, reducing the potential for bias in treatment administration and outcome assessment. 2022) involving 586 ICU-admitted patients with severe community-acquired pneumonia (CAP), no benefit was observed from methylprednisolone administration.

Research 94

Research Outcomes Administration Shock 94

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 91

Shock Seizures Airway Management Stroke 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

RebelEM

AUGUST 12, 2024

PMID: 36038001 Clinical Question: In patients undergoing cardiac surgery with cardiopulmonary bypass, does the administration of intravenous amino acid therapy lead to lower occurrence of postoperative AKI when compared to placebo? The PROTECTION trial. Contemp Clin Trials. Epub 2022 Aug 28.

Outcomes 81

Outcomes Hospitals Operations Shock 81

Downeast Emergency Medicine

APRIL 26, 2021

2][3] If earlier treatment with TXA is better, would there be benefit in its administration in the prehospital setting? Association between prehospital tranexamic acid administration and outcomes of severe traumatic brain injury. If so, could this be done safely? These questions are asked in the first paper that we reviewed.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

Dr. Smith's ECG Blog

JULY 21, 2024

The patient was extubated on Day-3 of the hospital stay. The patient improved, and on Day-11 of the hospital stay — he was off inotropes and on a small dose of a ß-blocker. In both tracings — an exceedingly fast PMVT is documented. Administration of Procainamide is 10-17 mg/kg at 20 mg/min.

EKG/ECG 132

EKG/ECG Shock Hospitals Sepsis 132

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 85

Psychiatric Pediatrics Emergency Department Administration 85

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

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

Don't Forget the Bubbles

DECEMBER 16, 2024

Depending on the individuals circumstances, this may involve either the administration of the MMR vaccine within 72 hours of exposure or intravenous immunoglobulin within six days. JOINT committee on vaccination and immunisation code of practice June. European Centre for Disease Prevention and Control. Measles facts [Internet].

Infectious Diseases 59

Infectious Diseases Documentation/Coding Pediatrics CDC 59

Emergency Medicine Journal

NOVEMBER 28, 2023

Introduction Directing care goals according to the individual values of our patients is a key element of Institute for Health Improvement Age-Friendly hospital systems. Data was routinely collected from Comprehensive Geriatric Assessments, and entered prospectively onto Excel by a trained administrator. Mean (SD) age was 83 (6.9)

Emergency Department 40

Emergency Department Documentation/Coding Administration Hospitals 40

ACEP Now

APRIL 2, 2024

4 The association between ackee ingestion and the illness was initially recognized in 1875 and officially documented in 1904. 5 Despite being endemic to Jamaica, cases of THS have been reported across the world, with the first case in the United States documented in 1993. Food and Drug Administration website. Clin Toxicol.

Poisoning 40

Poisoning Administration Documentation/Coding Urgent Care 40