ACEP Now

OCTOBER 29, 2024

Our nurse did not study Paul Ekman’s Facial Action Coding System for Action Units to code “fear” in the patient’s face. 4 However, emergency physicians rely on gestalt to predict outcomes well. Thiruganasambandamoorthy V, Kwong K, Wells GA, et al. Ann Emerg Med. 2024;84(3):246-258. 2016;188(12):E289-E298.

Emergency Department 59

Emergency Department Mass Casualty Incidents Documentation/Coding Sepsis 59

The Trauma Pro

JULY 5, 2024

But under-prescribing can create problems as well. Uncontrolled pain is a huge patient dissatisfier, and can lead to unwelcome complications as well (think pneumonia after rib fractures). Be sure to fill out a consent as soon as practical, and document any attempts that were made to obtain it.

Documentation/Coding 113

Documentation/Coding Fractures Emergency Department Wellness 113

Ken Grauer, MD

FEBRUARY 28, 2023

Figure-2: I've color-coded P waves from Figure-1 according to P wave morphology ( See text ). NOTE: For clarity — I've color-coded P waves in the long lead II rhythm strip according to morphology. Remember — 12 leads are better than one! Microvascular dysfunction — cardiac vasculitis — intravascular thrombosis.

EKG/ECG 195

EKG/ECG Documentation/Coding Sepsis COPD 195

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. It is well known that NOMI usually has a normal ECG or nonspecific ECG.

EKG/ECG 119

EKG/ECG Documentation/Coding Patient Safety Outcomes 119

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. Well-meaning providers who are not highly fluent may contribute to miscommunication and diagnostic errors.

Documentation/Coding 105

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

American Medical Compliance

MARCH 11, 2024

These are recordkeeping and documentation. While the primary focus in dentistry is patient health and well-being, carefully keeping records is equally needed. Informed Consent Documentation Before initiating any treatment, informed consent must be obtained from the patient or their legal guardian.

Documentation/Coding 105

Documentation/Coding Best Practices Operations Outcomes 105

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? and 9 hours of symptom onset; stroke symptoms that started during sleep were assumed to have started halfway between the actual last known well and the time of wake-up. to 53.54, p=0.053).

Stroke 98

Stroke Administration Documentation/Coding Outcomes 98

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 119

EKG/ECG Documentation/Coding Emergency Department Outcomes 119

Don't Forget the Bubbles

MAY 31, 2023

The DIMPLES study by PERUKI sought to investigate the incidence of new-onset diabetes in the paediatric population across the UK and Ireland, as well as the characteristics of these ED presentations, and to determine if SARS-CoV2 infection was involved. What outcomes did they look at? Which patients were involved?

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

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. 1,2 Intra-arterial (IA) tPA has also shown benefit but is less well studied. Patients whose last known well (LKW) time was within 24 hours of presentation. 1 week after treatment.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

American Medical Compliance

SEPTEMBER 9, 2024

Skin health is not only a matter of comfort and well-being but also a key indicator of a resident’s overall health status. Recognize and reward teamwork in addressing skin issues. Monitor and Measure Outcomes Regularly monitor the outcomes of skin care interventions.

Teamwork 105

Teamwork Best Practices Outcomes Wellness 105

Sensible Medicine

AUGUST 21, 2023

Administrative data sets are often collected for the purpose of billing, or costing, or administrative organization, and thus are extremely vulnerable to up coding or intentional or accidental omissions. ” For example, mortality is a patient outcome—provided it can be reliably ascertained. It is our goal.

Administration 97

Administration Outcomes Research COPD 97

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

Sensible Medicine

JUNE 11, 2024

This interface shortens the time required for human-to-computer interaction by transforming an input given through natural language into almost any form, from text to images to computer code. This responsibility extends to patients as well, ensuring that their voices and needs are central to the innovation process.

Documentation/Coding 88

Documentation/Coding Wellness Outcomes Research 88

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 121

EKG/ECG EMS Documentation/Coding Shock 121

Don't Forget the Bubbles

JUNE 19, 2024

Well-designed multicentre large studies in children were warranted; cue Leonard et al. 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?

CPR 124

CPR Research Documentation/Coding Outcomes 124

RebelEM

JULY 3, 2023

Currently, the infusion of IV calcium before diltiazem is not well understood, and more studies have focused on administering IV calcium prior to verapamil than diltiazem. Secondary outcome All secondary outcomes were found to be similar (Not statistically significant) between groups (See table above). Article: Rossi N et al.

Administration 96

Administration Outcomes Documentation/Coding Emergency Department 96

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

American Medical Compliance

AUGUST 7, 2024

It protects the health and well-being of staff. For example, CMS requires accurate and timely documentation of patient care to ensure proper billing and reimbursement. This plan should clearly define your policies and procedures regarding patient privacy, billing, documentation, and safety.

Hazardous Materials 105

Hazardous Materials Documentation/Coding Legal Issues Patient Safety 105

Mind The Bleep

OCTOBER 29, 2024

Alkali burns result in liquefaction necrosis, allowing for deeper tissue injury as well as vascular injury that can lead to both local and systemic toxicity [1]. These systemic effects can include central nervous system (agitation, seizures , and coma), as well as cardiac ( hypotension and dysrhythmias) [10, 11].

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

ACEP Now

JULY 7, 2024

You are well prepared for this. Lead your room well. If the resuscitation does not go as well as you wanted, learn from it and move on. If you have a difficult outcome, it is helpful to know what risk management support you have at your hospital. I am wishing them well and reminding myself of how I felt in their shoes.

Resuscitation 98

Resuscitation Risk Management Hospitals Critical Access 98

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

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

SheMD

MAY 11, 2023

In medical emergencies, provider qualities which lead to greater performance and patient outcomes include leadership and teamwork. Transcripts were coded to sort data into “leadership occurrences” or “unrelated to leadership” as well as critical treatment decisions. [link] ,Why is this article important? Crit Care Med.

Leadership 52

Leadership Documentation/Coding CPR Teamwork 52

Sensible Medicine

AUGUST 7, 2024

There is evidence that, for children and adults, elevated cortisol levels and chronic stress can lead to behavioral, mental-health, and mood issues, as well as changes in inflammation and immunity. In the resulting document , the working group changed the ages at which children can be expected to reach developmental milestones.

CDC 114

CDC Documentation/Coding Research Pediatrics 114

ACEP Now

OCTOBER 30, 2023

One case report highlighted an unfortunate outcome from aspiration pneumonia, later found to be due to crayons rather than the expected culprits such as food, secretions, or beverages. This makes documentation and communication of the utmost importance for these patients for their health and safety.

Sexual Assault 98

Sexual Assault Teamwork Dehydration Outcomes 98

Downeast Emergency Medicine

DECEMBER 1, 2021

The primary outcome was enrollment in and receiving addiction treatment at 30-days post-randomization. Additional outcomes included self-reported days of illicit opioid use, urine testing for illicit opioids, HIV risk, and use of addiction treatment services. Annals of Emergency Medicine. 2021; 78(3): 434-442.[

Emergency Department 52

Emergency Department Documentation/Coding Leadership Administration 52

Sensible Medicine

JUNE 16, 2023

This can happen while watching my daughter’s track meet; during a swim; even while documenting another patient’s visit. I may be unaware of bad outcomes, and, like most doctors, without this knowledge I assume good outcomes rather than bad. A patient joins the ghost-patient panel when I realize I no longer see them.

Documentation/Coding 95

Documentation/Coding Outcomes Wellness 95

Dr. Smith's ECG Blog

JUNE 15, 2023

I sent this ECG to the Queen of Hearts (PMcardio OMI), and here is the verdict: You can subscribe for news and early access (via participating in our studies) to the Queen of Hearts here: [link] queen-form Then I learned that a Code STEMI was activated for concern of anterior "STEMI" in V1-V2. High sensitivity troponin I was 23 ng/L.

EKG/ECG 98

EKG/ECG Documentation/Coding Outcomes Hospitals 98

American Medical Compliance

JULY 2, 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. Document observations consistently to identify patterns and trends over time.

Patient Safety 97

Patient Safety Documentation/Coding Outcomes Wellness 97

PulmCCM

FEBRUARY 5, 2024

You can read the document here. Also, many patients with infection won’t have fevers, and those that don’t may be at the highest risk for poor outcomes. Read the original document here. Ultrasound is well-suited for identifying most serious biliary system abnormalities. What’s a Fever?

Best Practices 111

Best Practices Ultrasounds Infectious Diseases Sepsis 111

Dr. Smith's ECG Blog

AUGUST 9, 2024

He had no previously documented medical problems except polysubstance use. The LCx and OM vessels are not as well visualized. Opioids associate with worse outcomes in myocardial infarction , probably because they eliminate the pain signal that informs the clinician of the urgency of revascularization. Do not treat AIVR.

EKG/ECG 107

EKG/ECG EMS Emergency Department Wellness 107

Dr. Smith's ECG Blog

JANUARY 27, 2024

Smith : Old inferior MI with persistent ST Elevation ("inferior aneurysm") has well-formed Q-waves. Fortunately they spontaneously reperfused, or else they could have had a worse outcome, but deferring all ‘normal’ ECGs will perpetuate delayed diagnosis and reperfusion for STEMI(-)OMI. Does this change your interpretation?

EKG/ECG 117

EKG/ECG Emergency Department Outcomes Documentation/Coding 117

PulmCCM

JULY 31, 2023

severe hypoxemia not doing well or on a bad trajectory while receiving conventional care). To make that leap, I for one would need to see improved outcomes with caloric restriction in patients with less-severe shock. Extracorporeal membrane oxygenation (ECMO) was encouraged, based largely on the EOLIA trial.

Shock 98

Shock Documentation/Coding Outcomes Wellness 98

Sensible Medicine

APRIL 12, 2024

For probably the twelfth time on Sensible Medicine, I’ll reference Lisa Rosenbaum’s essay, Being Well while Doing Well — Distinguishing Necessary from Unnecessary Discomfort in Training which brought some of the current inter-generational angst to the fore. What could possibly go wrong?

Radiology 83

Radiology Radiology Hospitals Documentation/Coding 83

The Skeptics' Guide to EM

MAY 11, 2019

Background: The first documented appendectomy was done by Claudius Amyand in 1735. Exclusion: Patients with co-occurring diagnosis or procedure codes consistent with complicated appendicitis and patients lacking appendectomy codes. Omar et al (2008) showed just how safe laparoscopic appendectomies have become.

Documentation/Coding 40

Documentation/Coding Operations Academics Ultrasounds 40