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.

Emergency Department 52

Emergency Department Fractures Best Practices Documentation/Coding 52

RebelEM

MARCH 27, 2023

Over the past few years, there has been an increase in emergency department (ED) volumes and lengths of stay. The effect of emergency department crowding on lung-protective ventilation utilization for critically ill patients. Unfortunately, its not clear whether the documentation came from RTs or ED providers.

Emergency Department 52

Emergency Department Operations Documentation/Coding Academics 52

The Trauma Pro

JULY 5, 2024

Improper care during an emergency This situation can occur in the emergency department when the emergency physician calls a specialist to assist with management. Specialists, make sure you understand the emergency physician’s concerns and clearly explain why you think you don’t need to see the patient in person.

Documentation/Coding 113

Documentation/Coding Fractures Emergency Department Wellness 113

Emergency Medicine Journal

JUNE 20, 2024

Emergency departments (ED) represent a promising setting to address preventive health measures like CRC screening. We evaluated feasibility of identification, provided preliminary effect size estimates and documented participant acceptability.

Emergency Department 40

Emergency Department Documentation/Coding Outcomes 40

AENJ: Current Issue

SEPTEMBER 30, 2023

The overuse of computed tomographic (CT) scans for patients who present to the emergency department (ED) after mild traumatic brain injury (mTBI) has been well-documented. The Canadian Computed Tomography Head Rule (CCHR) is a validated tool to guide ED providers in determining the need for emergent CT of mTBI patients.

Emergency Department 52

Emergency Department Documentation/Coding Outcomes Wellness 52

PEMBlog

NOVEMBER 21, 2024

Michael “Fish” Fishman, MD, PEM – Fellow, Boston Children’s Utilizing Co-regulated Evaluations (CORE) to Optimize Feedback and Evaluations Explored success in implementing and maintaining a co-regulated evaluation system in the Emergency Department.

Documentation/Coding 52

Documentation/Coding Pediatrics Emergency Department 52

Emergency Medicine Journal

NOVEMBER 28, 2023

Patients assessed by an Emergency Department (ED) based Frailty Intervention Team (FIT) are routinely asked ‘What Matters To You’ (WMTY). Age, Gender, Clinical Frailty Score (CFS) and documentation of ‘WMTY’ was analysed. 468 (79%) patients had documentation of WMTY. Five themes emerged – 1.

Emergency Department 40

Emergency Department Documentation/Coding Administration Hospitals 40

Emergency Medicine Journal

JULY 24, 2023

Introduction Pain is the most common presenting feature within the ED, yet undertreatment of pain in the ED is a well-documented problem worldwide. Despite the development of interventions to address this problem, there is still limited understanding of how pain management can be improved within the ED.

Emergency Department 74

Emergency Department Documentation/Coding Research Wellness 74

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 84

Radiology Radiology Emergency Department Documentation/Coding 84

The Trauma Pro

OCTOBER 18, 2024

To take some of the variability out of the decision-making process for admitting service, two surgical groups on Long Island created a scoring system that incorporated several parameters described in the ACS Optimal Resource Document (Orange book). The only gray zone is the score of 4 or 5.

Documentation/Coding 147

Documentation/Coding Emergency Department Hospitals 147

The Trauma Pro

AUGUST 15, 2023

MTP logistics include details such as who will be delivering the blood, what actually goes in each cooler, what ratios should be used, limitations imposed by the use of frozen plasma, and documentation. Documentation is critically important, both in the trauma bay and the blood bank. And there are plenty around all the time!

Documentation/Coding 130

Documentation/Coding Best Practices Resuscitation Administration 130

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. Too much weight was given to the EKG, CXR, and labs.

Radiology 75

Radiology Radiology EKG/ECG Documentation/Coding 75

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. 45:446-458. Taira B, et al.

Documentation/Coding 82

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

EMDocs

JULY 25, 2024

The nurse completes the Columbia-Suicide Severity Rating Scale (C-SSRS) and documents that the patient’s recent thoughts of killing himself and his detailed plan makes him “High Risk” for suicide. There is no documented handoff to the on-coming emergency physician (EP) who assumes care. ” (See reference #1 below.)

Documentation/Coding 82

Documentation/Coding Hospitals Patient Safety Emergency Department 82

EM Updates

JUNE 15, 2021

Maimonides Medical Center (MMC) is Brooklyn’s largest hospital, an academic quaternary care center with, in normal times, 711 total beds, 66 intensive care beds, and an Emergency Department that treats approximately 120,000 patients per year. On March 9, the first patient with a novel coronavirus infection was admitted to MMC.

Emergency Department 52

Emergency Department Hospitals Outcomes Wellness 52

PEMBlog

JUNE 14, 2023

Thousands of children and adolescents spend days at time in Emergency Departments waiting for definitive mental health disposition. West J Emerg Med. Mental Health Revisits at US Pediatric Emergency Departments. Prolonged emergency department length of stay for US pediatric mental health visits (2005-2015).

Psychiatric 98

Psychiatric Emergency Department Pediatrics Best Practices 98

EMergucate

MAY 25, 2016

Information Systems (Computerised Vs Manual) Manual systems Pros Cheap Easy Convenient Cons Failed documentation – notes, timing, summaries, legibility Difficult … Continue reading →

Emergency Department 40

Emergency Department EMS Documentation/Coding 40

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. Giving written instructions about a drug is the pharmacist’s job. Vashi A, Rhodes K. EM, April 2011.

Documentation/Coding 78

Documentation/Coding Patient Safety Emergency Department Hospitals 78

Emergency Medicine Journal

NOVEMBER 28, 2023

Measures of time taken (mins : secs), number information technology (IT) support calls, quality of documentation (using a visual analogue scale), and cognitive load (NASA Task Load Index) were recorded and analysed. Quality of documentation improved with OSLER 4.3 ± 0.3 vs 2.7 ± 0.9 (p p < 0.001). 95% CI 2.3 – 3.5

Documentation/Coding 40

Documentation/Coding Emergency Department 40

EB Medicine

SEPTEMBER 1, 2022

In this episode, Sam Ashoo, MD interviews Lela Bachrach, MD, MS, Larissa Truschel, MD, MPH, and Makini Chisolm-Straker, MD, MPH - the authors of the July 2022 PEMP article on Human Trafficking of Children and Adolescents: Recognition and Response in the Emergency Department. Do you find this dissuades patients form reporting?

Emergency Department 52

Emergency Department Documentation/Coding EMS Best Practices 52

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

Pediatric EM Morsels

FEBRUARY 2, 2024

In one ED study, ALL cases of missed travel-related illness did not have a documented travel history in their ED note , whereas 90% of the identified travel-related illnesses had a provider documented travel history (Greenky 2022) Those who are visiting friends and relatives (VFR) are typically at highest risk. Pediatr Emerg Care.

Infectious Diseases 161

Infectious Diseases Pediatrics Sepsis Documentation/Coding 161

EM Literature of Note

OCTOBER 1, 2023

” This brief report in Annals describes a retrospective experiment in which 30 written case summaries lifted from the electronic documentation system were fed to either clinician teams or ChatGPT. “ ChatGPT and Generating a Differential Diagnosis Early in an Emergency Department Presentation “ Tweet

Documentation/Coding 86

Documentation/Coding Operations Emergency Department Wellness 86

The Skeptics' Guide to EM

SEPTEMBER 14, 2024

Full dose challenge of moderate, severe and unknown beta-lactam allergies in the emergency department. Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. Case: It’s another day, another dollar in the emergency department (ED). AEM August 2024.

Anaphylaxis 54

Anaphylaxis Emergency Department Documentation/Coding Hospitals 54

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

EMDocs

OCTOBER 3, 2023

Emergency Physician and founder of Orman Physician Coaching Host of the Stimulus Podcast Learn more at roborman.com If you want to hear the coaching session where Brit and Rob deconstructed his shift and came up with this strategy, it’s here. Episode 87: Conquering Mid-Shift Overwhelm Mid-shift in an emergency department is a special beast.

Documentation/Coding 98

Documentation/Coding EMS Operations Emergency Department 98

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

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. Another COVID casualty: The emergency department transfer process.

Emergency Department 52

Emergency Department Operations Hospitals Leadership 52

Don't Forget the Bubbles

OCTOBER 10, 2024

Exploring communication preferences and risk thresholds of clinicians and parents of febrile infants under 90 days presenting to the emergency department: a qualitative study. Wilson K, Umana E, McCleary D, Waterfield T, Woolfall K. Arch Dis Child. 2024 Jul 10:archdischild-2023-326727. doi: 10.1136/archdischild-2023-326727.

Emergency Department 73

Emergency Department Outcomes Research Operations 73

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. Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage. What do you think?

EKG/ECG 137

EKG/ECG Emergency Department Shock Ultrasounds 137

The Skeptics' Guide to EM

OCTOBER 1, 2022

Disparities in the emergency department management of pediatric migraine by race, ethnicity, and language preference. Guest Skeptic: Dr. Lauren Westafer is an Assistant Professor in the Department of Emergency Medicine at the University of Massachusetts Medical School – Baystate. AEM September 2022. AEM September 2022.

Pediatrics 52

Pediatrics Emergency Department Documentation/Coding Research 52

Dr. Smith's ECG Blog

OCTOBER 12, 2024

A man in his 90s with a history of HTN, CKD, COPD, and OSA presented to the emergency department after being found unresponsive at home. Vital signs were within normal limits on arrival to the Emergency Department. Written by Bobby Nicholson What do you think of this “STEMI”? Blood glucose was not low at 162 mg/dL.

EKG/ECG 101

EKG/ECG Documentation/Coding Emergency Department COPD 101

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.

Documentation/Coding 64

Documentation/Coding Academics Emergency Department Hospitals 64

EMDocs

SEPTEMBER 30, 2024

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

Outcomes 83

Outcomes Documentation/Coding Academics Administration 83

ACEP Now

JULY 8, 2024

Recently published experiments with LLMs in the emergency department fall into a handful of primary areas of interest. In a similar vein, another study evaluated the ability of an LLM to assess “clinical acuity” in the emergency department. J Am Coll Emerg Physicians Open. 2024;26(1):40-46. JAMA Netw Open.

Emergency Department 52

Emergency Department Operations Documentation/Coding EKG/ECG 52

Dr. Smith's ECG Blog

OCTOBER 18, 2023

If you were working in a busy emergency department, would you like to be interrupted to interpret these ECGs or can these patients safely wait to be seen because of the normal computer interpretation? Emergent cardiac outcomes in patients with normal electrocardiograms in the emergency department. Am J Emerg Med.

EKG/ECG 118

EKG/ECG Documentation/Coding Emergency Department Outcomes 118

RebelEM

JUNE 8, 2023

If pre-made syringes are not financially feasible then the creation of these medications should be done by a dedicated emergency department pharmacist. Clinical Bottom Line: Acute hypotension must be treated emergently in order to decrease morbidity and mortality. J Med Toxicol. Epub 2019 Jul 3. Intensive Care Med.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98