Emergency Medicine Journal

DECEMBER 30, 2024

Background Calls to emergency departments (EDs) from ambulances to alert them to a critical case being transported to that facility that requires a special response (‘pre-alerts’) have been shown to improve outcomes for patients requiring immediate time-critical treatment (eg, stroke).

Emergency Department 52

Emergency Department Stroke Documentation/Coding Outcomes 52

American Medical Compliance

MARCH 11, 2024

These are recordkeeping and documentation. In a survey , dental providers agree that careful and precise recordkeeping is indispensable, emphasizing the importance of documenting elements such as patient histories, examination results, diagnoses, radiographs, treatment plans, consent forms, and clinic notes.

Documentation/Coding 105

Documentation/Coding Best Practices Operations Outcomes 105

PulmCCM

JANUARY 15, 2025

Draft Guidance Document Wong et al. Clinical Outcomes Associated With Overestimation of Oxygen Saturation by Pulse Oximetry in Patients Hospitalized With COVID-19. Analysis of Discrepancies Between Pulse Oximetry and Arterial Oxygen Saturation Measurements by Race and Ethnicity and Association With Organ Dysfunction and Mortality.

Academics 81

Academics Documentation/Coding Administration Research 81

Pediatric EM Morsels

JULY 28, 2023

A critical MORSEL is that every child you treat for DKA needs to have an initial thorough neuro exam including cranial nerves and then frequent neuro reassessments … and document it ( so your colleagues who take over care for the kid can know if there has been a change )! Is your patient hyperglycemic, acidotic, with ketonuria?

Fluid Resuscitation 246

Fluid Resuscitation Pediatrics Resuscitation Research 246

EMDocs

MAY 9, 2024

Exam documents that he is alert and oriented but “tired appearing” and “not appearing post-ictal.” Defense : The EP did address the seizure when he documented “not post-ictal.” There is no negligence, as the documentation supports reasonable judgment. The triage nurse records the event as a “seizure” lasting 7 minutes.

Seizures 105

Seizures Dehydration Documentation/Coding Infectious Diseases 105

American Medical Compliance

JUNE 21, 2024

Here are key areas where they can make a significant impact. Accurate Documentation and Coding Accurate documentation and coding are fundamental in preventing fraud, waste, and abuse. Providers must ensure that patient records accurately reflect the services provided and that coding accurately represents these services.

Documentation/Coding 105

Documentation/Coding Leadership Best Practices Outcomes 105

EMDocs

AUGUST 22, 2024

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. Utilizing certified interpreters and documenting their use. Educating patients on their rights.

Documentation/Coding 105

Documentation/Coding Emergency Department Federal Emergency Management Agency Best Practices 105

The Skeptics' Guide to EM

JULY 27, 2024

It is a medical emergency that requires prompt recognition and treatment to improve patient outcomes. The primary outcome reported was no statistical difference in mortality at 28 days (8% in both groups) despite giving antibiotics 96 minutes earlier [2].

Sepsis 99

Sepsis Outcomes Documentation/Coding Hospitals 99

Sensible Medicine

OCTOBER 19, 2023

We wrote this letter and submitted it to the journal, documenting that the trial violated ethical codes. Kids are a vulnerable population— subject to teasing and bullying— and frankly the dogs were not that good at sniffing COVID19. Lots of false positives and negatives. Yet the journal refuses to print it.

Documentation/Coding 129

Documentation/Coding Pediatrics Research Outcomes 129

EMDocs

SEPTEMBER 26, 2024

This story, while unlikely to reflect the standards of most readers, has a somewhat surprising outcome. 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.

Radiology 98

Radiology Radiology EKG/ECG Documentation/Coding 98

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 98

Stroke Administration Documentation/Coding Outcomes 98

The Trauma Pro

MAY 9, 2023

” This concept served as the basis of the [poorly documented] “Golden Hour” and for decades has directed our efforts at getting patients to a center with an immediately available OR as quickly as possible. The Pennsylvania Trauma Outcomes Study database contains a huge amount of data.

Head Injuries 130

Head Injuries Operations Documentation/Coding Outcomes 130

American Medical Compliance

APRIL 16, 2024

Our Continuing Medical Education (CME) program is committed to enhancing the knowledge, skills, and professional performance of healthcare providers to improve healthcare outcomes. Furthermore, advance directives are legal documents that provide instructions for medical care and only go into effect if you cannot communicate your wishes.

Documentation/Coding 100

Documentation/Coding Research Outcomes 100

ACEP Now

OCTOBER 3, 2023

This document is an update of guidelines first published in 2000, and then updated in 2007. These guidelines present the best available evidence to support clinical decision making in the prehospital setting when TBI care may have the most significant impact on outcomes; they also establish a research agenda for future investigations.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation EMS 98

American Medical Compliance

JUNE 28, 2024

Our Continuing Medical Education (CME) program is committed to enhancing the knowledge, skills, and professional performance of healthcare providers to improve patient care outcomes. Languages: American English Key features: Audio narration, learning activity, and post-assessment.

Teamwork 96

Teamwork Documentation/Coding Outcomes 96

RebelEM

JULY 3, 2023

Pregnant or incarcerated patients Documentation for systolic BP is incomplete Intervention: Administration of IV calcium within 60 min prior to or 30 min after IV diltiazem administration in patients with AF/AFL with RVR. Limitations: The primary and secondary outcomes were nearly all disease oriented and not patient oriented.

Administration 96

Administration Outcomes Documentation/Coding Emergency Department 96

EMDocs

OCTOBER 10, 2024

Exam is normal except for tenderness as documented in the diagram. She never had a documented abdominal exam. I just failed to document it. The EP documented seeing the patient and agreed with the ARNP’s plan. Takeaways : There are more questions than answers in this case, but: This is a common outcome.

Documentation/Coding 98

Documentation/Coding Hospitals Sepsis Infectious Diseases 98

RebelEM

JANUARY 29, 2024

in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 to 4.0mg/hr typically given in EKOS therapy (See Below).

Stroke 136

Stroke Outcomes Hospitals Administration 136

EMDocs

SEPTEMBER 30, 2024

Primary outcome: Prescription of ICS on ED discharge from the index visit Secondary outcomes: ICS prescription rates in high-risk subgroups Rates of outpatient follow-up within 30 days of an ED visit for asthma Variation in ICS prescription rates among attending ED physicians. The primary outcome was hospital admission rates.

Outcomes 105

Outcomes Academics Documentation/Coding Emergency Department 105

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

RebelEM

NOVEMBER 30, 2023

Outcomes: Primary Outcome: In-hospital mortality. Secondary Outcomes: Delayed hypotension, increased ICU stay, and other relevant outcomes. There was no specified time-frame for the primary outcome, potentially affecting the precision of the findings. Mayo Clin Proc Innov Qual Outcomes. 2.89, p = 0.01.

Sepsis 122

Sepsis Fluid Resuscitation Resuscitation Administration 122

American Medical Compliance

MARCH 6, 2025

Our Continuing Medical Education (CME) program is committed to enhancing the knowledge, skills, and professional performance of healthcare providers to improve patient care outcomes. Positive Outcomes of Accountability: Employees thrive in environments where accountability is not just linked to negative consequences.

Documentation/Coding 52

Documentation/Coding Patient Safety Leadership Outcomes 52

PulmCCM

JANUARY 29, 2024

Read the document for all the details (it’s not long). No strong evidence exists to suggest that detecting and treating nonconvulsive seizures improves neurologic outcomes after arrest, but there’s a compelling pathophysiologic rationale to prevent further brain injury. Here’s PulmCCM’s take on the new changes.

Seizures 115

Seizures CPR Documentation/Coding Hyperthermia / Hypothermia 115

PulmCCM

JANUARY 6, 2025

A cluster randomized trial using all-cause mortality as an outcome was always needed to determine whether EMR alerts improve outcomes for suspected severe infection. This led the authors to speculate that qSOFA parameters were being documented more diligently on the wards randomized to screening.

Sepsis 45

Sepsis Documentation/Coding Hospitals Outcomes 45

Ken Grauer, MD

FEBRUARY 28, 2023

Although acute Myocarditis is often suspected as the cause of troponin elevation in Covid-positive patients — documented viral myocarditis caused by Covid appears to be much less common than initially thought ( Up-to-Date — Caforio et al — Jan, 2023 ). Microvascular dysfunction — cardiac vasculitis — intravascular thrombosis.

EKG/ECG 195

EKG/ECG Documentation/Coding Sepsis COPD 195

American Medical Compliance

JULY 9, 2024

Our Continuing Medical Education (CME) program is committed to enhancing the knowledge, skills, and professional performance of healthcare providers to improve patient care outcomes. Furthermore, documenting and monitoring any new findings enables timely intervention and treatment.

Documentation/Coding 98

Documentation/Coding Outcomes 98

American Medical Compliance

SEPTEMBER 9, 2024

By enrolling in this training, you will enhance your facility’s capacity to maintain optimal skin health, improve overall resident outcomes, and minimize the risk of complications associated with common skin issues among the elderly. Addressing these issues promptly and effectively is crucial for maintaining the quality of life for residents.

Teamwork 105

Teamwork Best Practices Outcomes Wellness 105

American Medical Compliance

AUGUST 7, 2024

For example, CMS requires accurate and timely documentation of patient care to ensure proper billing and reimbursement. By following these guidelines, healthcare providers secure the necessary funding, improve patient outcomes, and foster trust within the healthcare system, ultimately enhancing the overall quality and efficiency of care.

Hazardous Materials 105

Hazardous Materials Documentation/Coding Legal Issues Patient Safety 105

RebelEM

JUNE 8, 2023

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

1 Relatively little literature on the clinical characteristics and outcomes of out-of-hospital cardiac arrest (OHCA) patients complicated by coronary vasospasm exists beyond anecdotal reports, however. Cardiac arrest secondary to myocardial ischemia from coronary vasospasm is well documented.

Resuscitation 98

Resuscitation EKG/ECG Documentation/Coding COPD 98

Total Medical ComplianceHIPAA

APRIL 14, 2023

On April 11, 2023, the HHS published a notice on upcoming new rules to add greater protection to reproductive health care because of new state laws passed due to the outcome of the Supreme Court ruling on Roe v. You can even call and talk to your patient and document this. New HIPAA rules proposed by Health and Human Services (HHS).

Documentation/Coding 83

Documentation/Coding Outcomes Wellness 83

Don't Forget the Bubbles

JUNE 19, 2024

A proportion of the patients who were initially missed using the CDR were found to actually have risk factors documented in EMS reports or the medical record. Were the predictor variables and the outcome evaluated in a blinded fashion? Were the predictor variables and the outcome evaluated in the initial sample?

CPR 124

CPR Research Documentation/Coding Outcomes 124

Dr. Smith's ECG Blog

JUNE 7, 2024

What was the outcome and final diagnosis? Bizarrely, the STEMI/Non-STEMI films are named not after how they end (the patient outcome) but how they begin (whether ECGs meet STEMI criteria, or whether code STEMI is activated), with STEMI(-)OMI still called ‘non-STEMI’ regardless of outcome.

EKG/ECG 112

EKG/ECG Documentation/Coding EMS Outcomes 112

Taming the SRU

JULY 25, 2024

More efficacious than parenteral opioids alone Safer than opioids Decreased delirium Patients have been shown to have improved functional outcomes at 30 days Early pain control matters! Currently EVT for large core is being looked at and so far the outcomes seem to be favorable

Stroke 98

Stroke Fractures Operations Outcomes 98

Sensible Medicine

OCTOBER 19, 2023

We wrote this letter and submitted it to the journal, documenting that the trial violated ethical codes. Kids are a vulnerable population— subject to teasing and bullying— and frankly the dogs were not that good at sniffing COVID19. Lots of false positives and negatives. Yet the journal refuses to print it.

Documentation/Coding 90

Documentation/Coding Pediatrics Research Outcomes 90

Don't Forget the Bubbles

MAY 6, 2024

Outcomes included clinical status when urine culture was available, subsequent antibiotic treatment within seven days and subsequent UTI within 30 days. of patients with follow-up documentation, 70.8% (95% CI 62.9–77.9) The primary outcome was the successful intubation on the second attempt. Of the 74.9% Why does it matter?

Sepsis 75

Sepsis Pediatrics Outcomes Documentation/Coding 75

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