Sensible Medicine

AUGUST 3, 2024

These participants received a gift card code in this email so they could purchase a 50-pack of masks at their local pharmacy. To reiterate, the intervention was an email with instructions and a gift code. What was the outcome? The outcome was not illness. The control group was explicitly instructed not to wear masks.

Documentation/Coding 135

Documentation/Coding Outcomes Research 135

The Trauma Pro

JULY 5, 2024

The emergency physician should be sure to convey their concerns very clearly, tell the specialist that the conversation will be documented carefully, and then do so. Be sure to fill out a consent as soon as practical, and document any attempts that were made to obtain it. Make sure all is documented well on the consent or in the EHR.

Documentation/Coding 113

Documentation/Coding Fractures Emergency Department Wellness 113

RebelEM

JUNE 29, 2023

Diagnostic yield, safety, and outcomes of Head-to-pelvis sudden death CT imaging in post arrest care: The CT FIRST cohort study. The CT FIRST Trial: Should We Pan-CT After ROSC?, REBEL EM Blog, June 1, 2023. Available at: HERE Branch KHR et al. Resus 2023.

CPR 145

CPR EMS Documentation/Coding Outcomes 145

Dr. Smith's ECG Blog

MARCH 14, 2024

Written by Jesse McLaren Three patients presented with acute chest pain and ECGs that were labeled by the computer as completely normal, and which was confirmed by the final cardiology interpretation (which is blinded to patient outcome) also as completely normal. The reliability of these ECGs should be based on patient outcome.

EKG/ECG 116

EKG/ECG Documentation/Coding Patient Safety Outcomes 116

The Trauma Pro

MAY 3, 2024

They separated all patients with acetabular and pelvic ring fractures using ICD-10 codes. Various hospital outcomes were tabulated, including hospital charges, mortality, and discharge location. AE and PPP have equivalent outcomes. You can feel comfortable that outcomes will be the same as AE.

Fractures 113

Fractures Documentation/Coding Radiology Radiology 113

PulmCCM

SEPTEMBER 17, 2023

The Centers for Disease Control and Prevention formally called on hospitals to develop robust sepsis care programs to systematically identify and treat sepsis, track outcomes, and improve care delivery.

CDC 98

CDC Sepsis Hospitals Documentation/Coding 98

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

Dr. Smith's ECG Blog

OCTOBER 18, 2023

1-3] But these studies were very short duration and used cardiology interpretation of ECGs or emergent angiography rather than patient outcomes. 4,5] We have now formally studied this question: Emergency department Code STEMI patients with initial electrocardiogram labeled ‘normal’ by computer interpretation: a 7-year retrospective review.[6]

EKG/ECG 123

EKG/ECG Documentation/Coding Emergency Department Outcomes 123

Dr. Smith's ECG Blog

JUNE 7, 2024

What was the outcome and final diagnosis? The discharge diagnosis was STEMI based on the STEMI positive ECG and code STEMI activation, with culprit lesion on angiography. Despite this clinical reality — all too many clinicians still fail to document the presence and relative severity of CP at the time each serial ECG is recorded.

EKG/ECG 105

EKG/ECG Documentation/Coding EMS Outcomes 105

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 88

Documentation/Coding Best Practices Operations Outcomes 88

EMDocs

MAY 4, 2024

. #1: Emergent Cath Lab Activations with “Normal” Computer ECG Interpretations Spoon Feed A significant minority of code STEMI patients have an initial normal computer ECG interpretation. The current analysis showed that EVT was superior in functional outcomes across a variety of ischemic severities and penumbra profiles on imaging.

Documentation/Coding 78

Documentation/Coding Stroke Emergency Department Pediatrics 78

RebelEM

JUNE 22, 2023

Population: Adults aged 30-85 years of age with BMI > 25 ( > 23 in those identifying as Asian or Latino) who had COVID-19 symptoms for fewer than 7 days and a documented SARS-CoV-2 positive PCR or antigen test within 3 days of enrollment without prior SARS-CoV-2 infection. Prior vaccination was not an exclusion criteria.

Outcomes 145

Outcomes Research Documentation/Coding Wellness 145

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 74

Documentation/Coding Pediatrics Research Outcomes 74

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

Don't Forget the Bubbles

DECEMBER 2, 2024

This study relied on coding, and if the patient had not been coded as asthma, for example, and coded as pneumonia instead, these patients would not have been included in the study set. Most QIs focus on the care process; however, there is a lack of QIs that assess clinical outcomes. and 16.7% , respectively.

Documentation/Coding 94

Documentation/Coding Pediatrics Emergency Department Fractures 94

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 82

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

Don't Forget the Bubbles

MAY 31, 2023

What outcomes did they look at? Was the outcome accurately measured to minimise bias? The inability to test for SARS-CoV-2 antibodies may have led to an underestimation of the impact of the virus on the reported outcomes. All ED visits that met the criteria for ‘new onset diabetes’ or DKA (‘decompensation’) were included.

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

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 98

Administration Outcomes Documentation/Coding Emergency Department 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

Emergency Medicine Journal

JANUARY 22, 2024

1–3 However, the literature is sparse surrounding the characteristics, treatment, outcomes, costs, disposition and resource utilisation of people who co-use compared with those who use opioids alone. Many overdose deaths are associated with patient co-use of opioids and other substances, such as benzodiazepines.

Outcomes 40

Outcomes Emergency Department Poisoning Documentation/Coding 40

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 82

Seizures Dehydration Documentation/Coding Infectious Diseases 82

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

PulmCCM

JUNE 12, 2023

TTM2 found no improvement in survival or neurologic outcome among patients randomized to cooling to a target of 33 °C, as compared to controls receiving fever prevention (e.g. Use code PULMCCM15 and get 15% off when you register online.

Hyperthermia / Hypothermia 105

Hyperthermia / Hypothermia Academics Documentation/Coding Outcomes 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 94

EKG/ECG Documentation/Coding EMS Burns 94

Dr. Smith's ECG Blog

SEPTEMBER 12, 2024

The paramedic called the EM physician ahead of arrival and discussed the case and ECGs, and both agreed upon activating "Code STEMI" (even though of course it is not STEMI by definition), so that the acute LAD occlusion could be treated as fast as possible. Long term outcome is unavailable. So the cath lab was activated.

EKG/ECG 123

EKG/ECG EMS Documentation/Coding Shock 123

RebelEM

AUGUST 22, 2024

hours of symptom onset appears to be the most promising approach for improving visual outcomes, supported by multiple studies and meta-analyses. Outcomes: Primary Outcome: Visual Acuity (VA) Improvement Measured using logarithm of the minimum angle of resolution (logMAR). Within 24 hours after treatment. 1 week after treatment.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

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

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 121

Sepsis Fluid Resuscitation Resuscitation Administration 121

Sensible Medicine

NOVEMBER 4, 2024

The glucagon-like peptide-1 receptor agonists (GLP1a) improve hard clinical outcomes in patients with diabetes and obesity. The study team also measured numerous other qualitative outcomes which generally favored semaglutide. Sensible Medicine is a reader-supported publication. The primary endpoints were positive.

Outcomes 128

Outcomes Documentation/Coding 128

The Skeptics' Guide to EM

AUGUST 10, 2024

A code stroke is activated, and a CT head shows a left basal ganglia hemorrhage with no vascular lesions on CT angiography. INTERACT-2 demonstrated that in patients with ICH, intensive lowering of blood pressure did not result in a significant reduction in the rate of the primary outcome of death or severe disability (SGEM#73).

Stroke 69

Stroke Airway Management Outcomes Documentation/Coding 69

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 78

Stroke Administration Outcomes Documentation/Coding 78

PulmCCM

JUNE 5, 2023

There was no significant difference in survival with a favorable neurologic outcome at 30 days (20% vs 16% nominally favoring the ECMO group, P=0.52) or at 6 months. Check out the preliminary program , and use code PULMCCM15 to get 15% off the attendance fees. In the U.S., Patients with secondary pneumothoraces (e.g.,

Advances Cardiac Life Support (ACLS) 96

Advances Cardiac Life Support (ACLS) Documentation/Coding CPR Shock 96

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 74

Radiology Radiology EKG/ECG Documentation/Coding 74

American Medical Compliance

APRIL 17, 2024

Our Continuing Medical Education (CME) program is committed to enhancing the knowledge, skills, and professional performance of healthcare providers to improve healthcare outcomes. American Medical Compliance is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing education to physicians.

Documentation/Coding 52

Documentation/Coding Best Practices Operations Outcomes 52

American Medical Compliance

NOVEMBER 8, 2024

Proper injury reporting protects patients, supports a safe workplace, and shields healthcare providers from potential legal issues that may arise due to negligence or lack of documentation. Scenario-based training adds real-world relevance.

Documentation/Coding 85

Documentation/Coding Legal Issues Operations Incident Reporting 85

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

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 73

Sepsis Outcomes Documentation/Coding Hospitals 73