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. Executive Summary of ED Operations in 2022 Volume was up from 2021.

Emergency Department 52

Emergency Department Documentation/Coding Operations EMS 52

ACEP Now

NOVEMBER 14, 2023

In 1901, UVA opened its first hospital with 25 beds and three operating rooms. The emergency department (ED) at UVA was rebuilt in 2019 and the department had not fully optimized its operations when COVID-19 hit. They also developed standard work documents for each role.

Academics 52

Academics Emergency Department Leadership Operations 52

ACEP Now

MARCH 13, 2024

Consequences of this are well documented and include delayed treatment, exposure to error, increased length of stay, and increased mortality. 1 Hospital boarding is the main driver of ED crowding, with patients nearly always awaiting transfer to inpatient beds and now more commonly, to other hospitals.

Ethical Issues 52

Ethical Issues Emergency Department Operations Hospitals 52

Resus Review

SEPTEMBER 28, 2015

Inappropriate delay of establishing a surgical definitive airway with a cricothyrotomy has been documented in field and hospital operations 1,2. J Spec Oper Med. This can be attributed to many factors including: Failure to recognize Can’t Intubate-Can’t Ventilate scenario. 2012; 12:17.

Operations 52

Operations Documentation/Coding Hospitals 52

RebelEM

AUGUST 22, 2024

Moreover, there are multiple operational and patient-specific barriers rendering timely thrombolytic administration difficult. Finally, most hospitals lack the necessary protocols and processes to coordinate the complex interdisciplinary care patients with RAO may require. Documented at the following time points: Before treatment.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

Medagadget

MAY 23, 2023

This task can be complex and very time-consuming.Resource utilization: treating transplant rejection may need hospitalization, additional diagnostic tests, etc. These multimodal data and rules are necessary to provide a precise diagnostic, which considers all the biological operating processes, grades, and types of rejection.

Research 83

Research Hospitals Documentation/Coding Operations 83

Don't Forget the Bubbles

OCTOBER 10, 2024

This time the team from Bristol Royal Children’s Hospital ED tell us what is new in the world of paediatric literature… Led by Dr John Coveney a Paediatric Emergency Medicine Trainee in Bristol who has revived The Journal Club at Bristol Royal Children’s Hospital ED on a monthly basis. 2023 Mar 30;110(4):432-438.

Emergency Department 75

Emergency Department Outcomes Research Operations 75

RebelEM

MARCH 27, 2023

2 Finally the settings initiated early in a patient’s care are often carried forward unchanged into their hospital and ICU stay. There may have very well been a policy where only RTs can make changes to a ventilator after an order was placed to ensure accurate documentation. J Crit Care.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

The Skeptics' Guide to EM

NOVEMBER 21, 2020

Your hospital has asked you to consider adding some advanced practice providers (APPs) instead of physician hours. The American College of Emergency Physicians ( ACEP ) has a number of documents discussing APPs in the ED. Case: You are the medical director of a medium sized urban emergency department (ED). Reference: Pines et al.

Emergency Department 52

Emergency Department Telemedicine Academics Outcomes 52

RebelEM

SEPTEMBER 11, 2023

Similarly, surgeons might hesitate to operate on older patients with multiple comorbidities due to higher associated risks. Moreover, surgeons may seek “official” documentation in a patient’s chart before surgery. Rezaie, MD (Twitter/X: @srrezaie ) The post POCUS in the ED: Is Confirmatory RUQ US Still Necessary?

Ultrasounds 68

Ultrasounds Radiology Radiology Emergency Department 68

Mind The Bleep

MARCH 22, 2023

What time did the injury happen?

Fractures 59

Fractures Documentation/Coding Operations Hospitals 59

RebelEM

MARCH 9, 2023

Assess for head and neck trauma : A 2014 study out of NYU/Bellevue Hospital found that 39% of patients who frequented the emergency department with acute alcohol intoxication had a moderate to severe brain injury over a three-year period. As always, document clinical sobriety before discharge. Annals of Emergency Medicine.

Psychiatric 52

Psychiatric Emergency Department Fractures Documentation/Coding 52

ACEP Now

JULY 8, 2024

In this case, the LLM lacks specific domain training on the CTAS score, and the predictions do not have the appropriate foundational training to operate accurately. As a mechanism for augmenting clinical operations, this approach may show value in passively collecting and feeding information into other systems.

Emergency Department 52

Emergency Department Operations Documentation/Coding EKG/ECG 52

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. Training opportunities for documentation best practices should be employed. Dr. Bissmeyer is a senior resident at Orange Park Hospital in Jacksonville, Fla.

Documentation/Coding 52

Documentation/Coding Best Practices Ethical Issues Academics 52

ACEP Now

FEBRUARY 11, 2024

The ultrasound system should be placed so that the operator is able to visualize the point of needle entry, as well as the ultrasound screen in the same line of sight. 8 For all ultrasound-guided nerve blocks, we recommend placing documentation both in the EHR and as a small skin marking with a surgical pen on the patient.

Ultrasounds 52

Ultrasounds Fractures Emergency Department Hospitals 52

Taming the SRU

OCTOBER 14, 2024

Tissue cultures obtained in the operating room grew nonspecific gram positive cocci in chains and pairs and gram positive bacilli. The patient was transitioned to a 10 day course of cefpodoxime and was discharged on hospital day 3 with ENT and ophthalmology follow up.

Ultrasounds 52

Ultrasounds Urgent Care Emergency Department Documentation/Coding 52

Taming the SRU

AUGUST 4, 2024

The largest retrospective cohort study to date (Beyde et al.) shows that most will improve with empiric antibiotics.

Dislocations 85

Dislocations Emergency Department Documentation/Coding Burns 85

Pediatric Education

NOVEMBER 12, 2023

No specific documentation regarding the duration of the car seat testing could be identified in the medical records. It is recommended to be performed within 1-2 days of hospital discharge. Pierre-Robin Sequence) and post-operative congenital heart disease. The pertinent physical exam showed the patient was now 3.34 Pediatrics.

Pediatrics 40

Pediatrics Poisoning Hospitals Documentation/Coding 40

Advanced Emergency Nursing from AENJ

NOVEMBER 20, 2014

It is critically important to document the physical findings in a plain-seeing, plain-speaking, non-judgmental manner that will not color or taint future investigations. Accurate time entries are important to document. BULLETIN-HOSPITAL FOR JOINT DISEASES NEW YORK, 64(3/4), 139. Tejwani, N. C., & Egol, K. Cristante, A.

Military 40

Military Forensics Documentation/Coding Emergency Nursing 40

Northwestern EM Blog

APRIL 25, 2022

Definitive treatment is joint wash out in the Operating Room. Ideally your exploration should be in a bloodless, painless field and documented as such. Matthew Levine, MD Associate Professor Department of Emergency Medicine Northwestern Memorial Hospital How To Cite This Post: [Peer-Reviewed, Web Publication] Kermani, P.

Soft Tissue Injuries 52

Soft Tissue Injuries Fractures Sepsis Documentation/Coding 52

EMDocs

NOVEMBER 16, 2024

4 Pain is the most common reason for presentation in the early post operative period. 5 Highest risk of dislocation early in the post operative course due to laxity of the soft tissue after surgery. 6 Hip flexion or adduction in the early post-operative period can cause atraumatic dislocations (typically avoided for 6 weeks post-op).

EMS 97

EMS Dislocations Fractures Operations 97

Dr. Smith's ECG Blog

JUNE 13, 2024

Her first set of vitals were documented: BP 116/57 Pulse 94bpm Respiratory rate 24/min O2 sat 90% on room air Temp 97F She had been cleaning a Jeep in the sun, and was sunburned. The physician documented “normal sinus rhythm”. The physician documented that she was “improved” and the patient was discharged. CK MB was 1.9

EKG/ECG 92

EKG/ECG Documentation/Coding EMS Burns 92

PulmCCM

SEPTEMBER 13, 2024

Nyckoletta Martin, a former employee of Kentucky Organ Donor Affiliates, sent a letter to the subcommittee alleging that KODA pressured her and other staff to retrieve organs from an awake patient who later left the hospital alive. Transplant hospitals generally pay OPOs for each organ they transplant.

Operations 124

Operations Administration Leadership Hospitals 124

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

En route to the hospital the patient experienced multiple short-lasting episodes, with cramping and loss of consciousness. I therefore feel it relevant to document ( in your dictation/on the medical chart ) when significant artifact potentially impairs the accuracy of your interpretation. One episode was of longer duration.

Seizures 113

Seizures EKG/ECG EMS Stroke 113

RebelEM

AUGUST 12, 2024

What They Did: Double-blind, randomized, placebo controlled trial that ran from October 2019 through January 2024 Multinational study conducted at 22 centers in three European countries 3512 patients were enrolled and before surgery eligible patients were randomly assigned to one of the following two groups Amino Acid Group: 10% Isopuramin at a dose (..)

Outcomes 81

Outcomes Hospitals Operations Shock 81

The Skeptics' Guide to EM

MAY 11, 2019

Background: The first documented appendectomy was done by Claudius Amyand in 1735. This is an example of why things in evidence-based medicine can be “complicated” ( SGEM#115 and SGEM#180 Clinical Question: Operative treatment or non-operative treatment of acute Grade 1 (uncomplicated) appendicitis? Reference: Sceats et al.

Documentation/Coding 40

Documentation/Coding Operations Academics Ultrasounds 40

Northwestern EM Blog

MAY 16, 2022

were hospitalizations during f/u period; 26.4% were hospitalizations during f/u period; 26.4% There also were no significant differences in pain scores, hospitalizations, ED readmissions among the groups. Follow up CT should depend on the patient and ultrasound operator. vs. US 31.2% In this study, 40.7%

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

Don't Forget the Bubbles

JULY 26, 2023

This has been trialled (out of hospital) in known children with SVT. Upside-down position for the out of hospital management of children with SVT, Bronzetti et al, International Journal of Cardiology 2017 this showed that a modified position (upside down) improved cardioversion rates from 33% to 67%. www.cats.nhs.uk/wp-content/uploads/guideline-intubation.pdf

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

Northwestern EM Blog

SEPTEMBER 12, 2022

Written by: August Grace, MD (NUEM ‘24) Edited by: Andrew Rogers, MD, MBA (NUEM ‘22) Expert Commentary by : Andra Farcas, MD (NUEM ‘21) Introduction In the setting of trauma, most hospitals are adept at treating and managing patients with a variety of injuries. Time begins after the first patient arrives at the hospital [8].

Mass Casualty Incidents 52

Mass Casualty Incidents EMS Hospitals Hazardous Materials 52

ACEP Now

MARCH 14, 2024

In our case, the patient had a CT of the head, cervical spine, and chest, abdomen, and pelvis with intravenous contrast demonstrated a C2, C7 compression fracture with significant bowel edema (Figure 4), and was taken to the operating room for left arm disarticulation, left below knee amputation and right above knee amputation. Am J Cardiol.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

ACEP Now

JUNE 6, 2023

A medical student reports a murmur, not documented by either the emergency physician or the cardiologist. POCUS: Point-of-care ultrasound for AD is highly specific, but operator-dependent, and lacking in sensitivity—although late–model units can have sensitivity as high as 80-85 percent. Then what? He denies back pain.

EKG/ECG 85

EKG/ECG Stroke Documentation/Coding Operations 85

AED Leader

AUGUST 22, 2024

This blog post aims to demystify the operation, importance, and application of AED defibrillators for both healthcare professionals and laypersons alike. AEDs are designed for easy use, so even people without medical training can operate them effectively in critical situations. How does an AED Work?

CPR 52

CPR Shock Operations Outcomes 52

The Skeptics' Guide to EM

JANUARY 23, 2021

He wants to know if being seen by an APP alters his chance of diagnostic testing or hospital admission. That SGEMHOP episode asked how the productivity of APPs compare to emergency physicians and what is its impact on ED operations? Background: We covered the use of advanced practice providers (APPs) on the SGEM#308.

Poisoning 52

Poisoning Research Documentation/Coding Operations 52

Advanced Emergency Nursing from AENJ

MAY 3, 2014

Review of the Wellcome Library movies on YouTube (1945) [ links below in references ] is instructive as to resuscitative methods of the 1930s and 1940s: Manual methods; gas bag or bellows operated by hand or machine; an anesthesia gas machine; or iron lung. Evaluation: Manually Operated Resuscitators (1971) Emergency Care Research Institute.

Resuscitation 40

Resuscitation Military Operations Emergency Nursing 40

Advanced Emergency Nursing from AENJ

FEBRUARY 29, 2016

Still, except for the public hospital, other hospitals did little emergency work and would have unattended first aid or treatment room in which one could meet one's physician or have an intern provide care in the meanwhile. ." Rebuilding of EDs in proximity to Radiology, Blood Bank, OR, and ICU, becoming organic to the hospital.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

Advanced Emergency Nursing from AENJ

SEPTEMBER 4, 2014

It wrongly frightened some medical personnel as it was operated by a 50 psi wall source or from a step-down regulator from a tank (some thought the patient received wall 50 psi or 1500 psig from the tank directly to the lung. It was extremely well-liked by field personnel, but virtually unknown in hospitals. Grainge, C. Bogetz, M.

Resuscitation 40

Resuscitation CPR Documentation/Coding Military 40

Advanced Emergency Nursing from AENJ

MAY 27, 2014

This is a cased kit of a Sparklet Resuscitator (J size), with pressure chamber, regulator, tubing, reservoir bag, flow stopcock, and funnel mask, with associated documents. The Therapeutic Use of Carbon Dioxid After Anesthesia and Operation. ©Tom Trimble, RN CEN; object from Author’s Collection CLICK FOR LARGER IMAGE. Henderson , Y.,

Resuscitation 40

Resuscitation Poisoning Research Administration 40