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

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

Taming the SRU

SEPTEMBER 1, 2023

to divert the plane). Lane & Mcdonough Definition of an immediate whole body CT (iWBCT) scan Shortly after patient arrival.

Sepsis 95

Sepsis Fractures Documentation/Coding Administration 95

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

PulmCCM

MARCH 11, 2024

You probably don’t ever see this–you bill as usual, but CMS reportedly doesn’t pay your hospital for any of your 99292s until billed time goes over 104 minutes. About 544,000 99292 codes were billed to CMS in 2021, according to ACCP , reportedly stable at about 10% of the total bills.

Hospice 52

Hospice Documentation/Coding Administration Hospitals 52

Don't Forget the Bubbles

JUNE 19, 2024

Children in the validation cohort were admitted to the intensive care unit or operating room less frequently than those in the derivation cohort. This may limit the generalisability of the results in regional/community hospital settings. What were the limitations of the study?

CPR 124

CPR Research Outcomes Documentation/Coding 124

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

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

Taming the SRU

MAY 11, 2024

Guidelines also support not administering HTS in the pre-hospital setting, yet the available data is weak. Usually presents consistent with failure of that organ. For mid-shaft femur fractures, traction appears to may reduce blood loss and pulmonary complications, but the available data is very scarce. What do we do at UC?

Administration 91

Administration Resuscitation Fluid Resuscitation Research 91

RebelEM

JUNE 8, 2023

The relationship between ICU hypotension and in-hospital mortality and morbidity in septic patients. Emergency department hypotension predicts sudden unexpected in-hospital mortality: a prospective cohort study. PMID: 31270748 Maheshwari K, et al. Intensive Care Med. 2018;44(6):857–67. PMID: 29872882 Jones AE, et al. 2006;130(4):941–6.

Administration 97

Administration Emergency Department Outcomes Documentation/Coding 97

The Skeptics' Guide to EM

JULY 30, 2022

AEM July 2022 Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. AEM July 2022 Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. She is also the creator of all those wonderful Paper in a Pictures.

Ultrasounds 52

Ultrasounds Operations Documentation/Coding Outcomes 52

Don't Forget the Bubbles

JANUARY 1, 2024

The Bubble Wrap Plus is a monthly paediatric Journal Club reading list from Professor Jaan Toelen (University Hospitals Leuven) and Dr Anke Raaijmakers (Sydney Children’s Hospital). However, children who had an operation experienced improvements in behaviour, symptoms, and quality of life and had lower blood pressure.

Pediatrics 98

Pediatrics Ultrasounds Blood Transfusions Sepsis 98

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

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

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

SEPTEMBER 5, 2024

With elimination of CME funding in many of our hospitals and groups, it is crucial to continue to add value and communicate that value to residents before graduation. While some issues are handled locally, many issues cannot be solved in our emergency department or hospital. If ACEP is already doing this, why be a member?

Leadership 98

Leadership PPE EMS Wellness 98

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

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

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

Taming the SRU

OCTOBER 30, 2024

female patients; those with atypical symptoms that were not abrupt or did not include chest, back, or any pain; patients with an absence of pulse deficit or hypotension; or those who initially presented to a nontertiary care hospital. Debrief codes and odd encounters for yourself, your team, and your hospital system.

Hospitals 52

Hospitals Emergency Department EKG/ECG Documentation/Coding 52

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

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. 1033, section 4004.

Documentation/Coding 52

Documentation/Coding Best Practices Ethical Issues Academics 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

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

Taming the SRU

AUGUST 4, 2024

Know your audience, and tailor your presentation to them in terms of humor, pop culture references, and dress code Err on the side of making your presentation slightly shorter than the alloted time to allow room for questions. 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

PulmCCM

JANUARY 6, 2025

With financial penalties coming for noncompliance with the new rule, hospital administrators rapidly deployed the alerts to fire on all eligible inpatients. The SCREEN Trial SCREEN was a stepped-wedge cluster randomized trial of an EMR alert for organ failure, conducted at 45 wards of 5 hospitals in Saudi Arabia from 2019 to 2021.

Sepsis 45

Sepsis Documentation/Coding Hospitals Outcomes 45

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 Documentation/Coding Academics 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

Mind The Bleep

MARCH 22, 2023

What time did the injury happen?

Fractures 59

Fractures Documentation/Coding Operations Hospitals 59

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

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

Don't Forget the Bubbles

OCTOBER 14, 2024

Undocumented migrant: Someone who enters or stays in a country without the documents required under immigration regulations. MVI offers essential outreach services to refugee camps as well as operating a central clinic in Athens, providing undocumented migrants, refused asylum seekers, and the homeless with regular medical care.

Documentation/Coding 59

Documentation/Coding Hospitals Wellness Operations 59

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

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

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

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