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

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 107

EKG/ECG Documentation/Coding Patient Safety Outcomes 107

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

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 81

Documentation/Coding Emergency Department Best Practices Federal Emergency Management Agency 81

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

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 Teamwork CPR 52

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 100

Teamwork Best Practices Outcomes Wellness 100

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 117

EKG/ECG Documentation/Coding Emergency Department Outcomes 117

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 78

Stroke Administration Documentation/Coding Outcomes 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

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 73

Documentation/Coding Wellness Outcomes Research 73

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

Mind The Bleep

NOVEMBER 21, 2023

” Yes, I have seen clerking look like this and I can confirm, it does not go down well. Unless you’re documenting something hilarious, please keep it brief and to the point. History of Presenting Complaint In this section use SOCRATES to document the pain.

Documentation/Coding 52

Documentation/Coding COPD EKG/ECG Wellness 52

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 116

EKG/ECG EMS Documentation/Coding Shock 116

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

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 98

Administration Outcomes Documentation/Coding Emergency Department 98

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 84

Administration Outcomes Research COPD 84

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

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

AENJ: Current Issue

SEPTEMBER 30, 2023

The overuse of computed tomographic (CT) scans for patients who present to the emergency department (ED) after mild traumatic brain injury (mTBI) has been well-documented. The outcomes measured were the number of CT scans ordered, ED length of stay, and the cost of avoidable CT scans. Cost of care was also estimated.

Emergency Department 52

Emergency Department Documentation/Coding Outcomes Wellness 52

Don't Forget the Bubbles

OCTOBER 10, 2024

Reviewed by: Isabella Davenport Article 2: Does it improve outcomes if you replace the nail in nail bed repair? Children with nail bed injuries were randomly assigned to nail replacement or discarding , with the primary outcomes being secondary infection in 7 days and cosmetic outcome in four months.

Emergency Department 75

Emergency Department Outcomes Research Operations 75

RebelEM

MARCH 13, 2024

This was not a Code 3 respiratory distress, fentanyl overdose with minimal response to Narcan or even an unconscious stroke patient with the blood pressure of a giraffe. Would they ever be well enough to be extubated? If we tried to wait it out, could he pull through on BiPAP alone? How would the hemodynamics respond to RSI?

Documentation/Coding 59

Documentation/Coding Outcomes EMS Stroke 59

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 88

Hazardous Materials Documentation/Coding Legal Issues Patient Safety 88

Greater Sydney Area HEMS

AUGUST 1, 2023

Why does it work so well? When I found it, I felt the documentation (if done at all) largely tended to be the bare minimum, and certainly not reflective of the beautiful learning conversations happening in the room. It also dovetails with our governance process. M+M, airway audit etc) to ensure they haven’t been missed.

Documentation/Coding 52

Documentation/Coding Outcomes Hospitals Administration 52

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

American Medical Compliance

APRIL 29, 2024

Our Continuing Medical Education (CME) program is committed to enhancing the knowledge, skills, and professional performance of healthcare providers to improve healthcare outcomes. A Framework Against Abuse and Neglect in Nursing Homes Federal Code has established regulations to safeguard nursing home residents from abuse and neglect.

Elder Abuse 52

Elder Abuse Documentation/Coding Administration Outcomes 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

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 Outcomes Documentation/Coding 124

Taming the SRU

APRIL 22, 2023

If untreated, atrial fibrillation can increase clot formation and lead to an increased risk for heart attack and stroke as well as development of congestive heart failure. There were similar lengths of say overall and no significant difference in safety outcomes. The diltiazem group had greater reduction in HR at 30 and 60 minutes.

Outcomes 52

Outcomes Stroke Documentation/Coding Fractures 52

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 Outcomes Pediatrics Documentation/Coding 75

ACEP Now

NOVEMBER 7, 2024

Wound management in the ED is only a starting point, and appropriate referral and follow-up are key to an improved outcome. Conclusion Poorly healing wounds pose a significant burden on health care systems and personal well-being, and their presence as a harbinger of severe morbidity and mortality must be appreciated.

Burns 52

Burns Documentation/Coding Outcomes Emergency Department 52

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 52

Documentation/Coding Operations Academics Ultrasounds 52

Taming the SRU

SEPTEMBER 1, 2023

for detecting major injuries Abnormal CXR Rapid deceleration mechanism Presence of a distracting injury Chest wall tenderness Sternal/thoracic spine/scapular tenderness There are limited decision-making rules for thoracic spine imaging Yet a study (Inaba et al., 2015) reported a sensitivity of 98.9%

Sepsis 95

Sepsis Documentation/Coding Administration Fractures 95

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

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 Outcomes Dehydration 98

The Skeptics' Guide to EM

MAY 8, 2021

He is an EMS medical director with Lexington Fire/EMS as well as the AMR/NASCAR […] The post SGEM#329: Will Corticosteroids Help if…I Will Survive a Cardiac Arrest? He is an EMS medical director with Lexington Fire/EMS as well as the AMR/NASCAR Safety Team. first appeared on The Skeptics Guide to Emergency Medicine.

CPR 52

CPR Hyperthermia / Hypothermia EMS Documentation/Coding 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 105

CDC Documentation/Coding Research Pediatrics 105