Stop and Think

JANUARY 1, 2024

Well, that can be a problem. Sometimes things we do are well grounded in evidence. Things like reading ECGs, echocardiograms, as well as learning to do procedures. Well, do you know the actual trials underpinning this evidence? They sit in a Google document. It will be a working document.

Documentation/Coding 75

Documentation/Coding Wellness EKG/ECG Hospitals 75

Dr. Smith's ECG Blog

MARCH 4, 2024

I have often written about how an ECG interpreted as "normal" by a conventional algorithm may well be manifesting OMI, or even long QT or hyperkalemia. link] Or use the QR code: 10 Cases: Case 1 Do you want to be interrupted to view what the computer calls normal or nonspecific ECGs? 2 cases at once! You can use it an unlimited amount.

EKG/ECG 98

EKG/ECG Documentation/Coding Wellness Resuscitation 98

Sensible Medicine

DECEMBER 18, 2023

Now let’s compare the two documents. That is my conclusion as well, and I favor large, pragmatic randomized trials in adults and kids with staggered starting times (adults first — to protect kids from harms we may not yet know). From their document. The AAP champions surgery and medications. Better food?

Pediatrics 141

Pediatrics Documentation/Coding Burns Academics 141

American Medical Compliance

FEBRUARY 2, 2024

Use of the ATD Standard Cal/OSHA requires employers covered by the Aerosol Transmissible Disease (ATD) Standard (California Code of Regulations, Title 8, Section 5199) to protect employees from airborne infectious disease such as COVID-19 and pathogens transmitted by aerosols. Employees who are working from home. 8, § 5199) (section 5199).

Infectious Diseases 52

Infectious Diseases Documentation/Coding PPE Wellness 52

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 Wellness EKG/ECG 52

Dr. Smith's ECG Blog

OCTOBER 18, 2023

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] have published a number of warnings about the previous reassuring studies.[4,5] Am J Emerg Med. 2022 ; 55 : 180 - 182 6.

EKG/ECG 111

EKG/ECG Documentation/Coding Emergency Department Outcomes 111

Sensible Medicine

MAY 15, 2024

At the same time, I struggle to see how such a person could run codes and work in trauma surgery. There are so many things students are not learning instead — like how to read a paper or how to take care of heart failure (well). I am a firm believer that someone who is paralyzed can be an oncologist (my job) or psychiatrist.

Administration 108

Administration Documentation/Coding Hospitals Wellness 108

American Medical Compliance

FEBRUARY 17, 2024

Ensuring the safety and well-being of both patients and staff is paramount. Maintain Comprehensive Recordkeeping Document workplace injuries and illnesses.

Best Practices 105

Best Practices PPE Infectious Diseases Documentation/Coding 105

Pediatric EM Morsels

FEBRUARY 2, 2024

In one ED study, ALL cases of missed travel-related illness did not have a documented travel history in their ED note , whereas 90% of the identified travel-related illnesses had a provider documented travel history (Greenky 2022) Those who are visiting friends and relatives (VFR) are typically at highest risk.

Infectious Diseases 161

Infectious Diseases Pediatrics Sepsis Documentation/Coding 161

EMDocs

OCTOBER 3, 2023

This is also where keeping up with documentation starts to slip. You’ll need to put the following tasks in a rank order list: new patient evaluations, dispositions, managing critical or potentially critical patients, results review, team huddle, running the board, calling consults, doing procedures, and documentation. It’s up to you.

Documentation/Coding 95

Documentation/Coding EMS Operations Emergency Department 95

EMDocs

DECEMBER 4, 2023

The Wells’ Criteria for DVT can help risk stratify [2,3]. If the patient’s Wells score is ≤ 0, DVT is nearly clinically excluded and no further immediate lab or ultrasound is necessary. In patients with a Wells’ score of 1-2 (moderate risk), DVT can be ruled out with a negative d-dimer rather than an US. mg/kg for 24 hours.

Ultrasounds 69

Ultrasounds Wellness Documentation/Coding EMS 69

American Medical Compliance

APRIL 29, 2024

A Framework Against Abuse and Neglect in Nursing Homes Federal Code has established regulations to safeguard nursing home residents from abuse and neglect. It is crucial for caregivers to remain vigilant to ensure the well-being of nursing home residents. To become certified, please visit us at: American Medical Compliance (AMC).

Elder Abuse 52

Elder Abuse Documentation/Coding Administration Outcomes 52

ACEP Now

JUNE 7, 2023

Whereas previous versions of GPT were unable to pass the medical examinations, GPT-4 demonstrated scores of approximately 85 percent correct on each Step of USMLE, well above the passing threshold. Future versions are likely to have greater accuracy and error-checking abilities, as well as improved domain-specific generative abilities.

Documentation/Coding 78

Documentation/Coding Wellness Administration Research 78

EM Literature of Note

OCTOBER 1, 2023

” This brief report in Annals describes a retrospective experiment in which 30 written case summaries lifted from the electronic documentation system were fed to either clinician teams or ChatGPT. Each case was tested both solely on the recorded narrative, as well as with laboratory results added.

Documentation/Coding 97

Documentation/Coding Operations Emergency Department Wellness 97

Don't Forget the Bubbles

AUGUST 23, 2023

Definitive emotional support is critical to our emotional and psychological well-being. 2016) “Implementation of a Post-Code Pause: Extending Post-Event Debriefing to Include Silence”. 2012) “Implementation of a Rapid Post-Code Debrief Quality Improvement Project in a Community Emergency Department Setting”. & Liska, H.

Emergency Department 98

Emergency Department Resuscitation Documentation/Coding Best Practices 98

Stop and Think

NOVEMBER 19, 2023

Also well known—from old data—was that myocarditis is a cause of cardiac arrest during sport. This was a 20-year survey in which the authors used 4 independent databases to document the incidence and causes of sudden cardiac death in NCAA athletes. Young males had the highest risk of this adverse effect. But it was real.

Documentation/Coding 119

Documentation/Coding Wellness Resuscitation 119

Downeast Emergency Medicine

DECEMBER 1, 2021

They conducted semi-structured interviews (n = 11) with ED directors across Maine using an interview guide designed to elicit responses around the reasons for starting or not starting and ED-buprenorphine program as well as barriers and facilitators to ED-based buprenorphine.

Emergency Department 52

Emergency Department Documentation/Coding Leadership Hospitals 52

ACEP Now

OCTOBER 9, 2023

percent) do not speak English as a primary language, and 25 million of those speak English less than well (known as “limited English proficiency” or LEP); many indicators show this number will only continue to grow. Physicians should document the interpreter’s name and identification number if available in the patient’s chart.

Emergency Department 64

Emergency Department Documentation/Coding EMS Wellness 64

Mind The Bleep

JULY 26, 2023

Good Medical Practice is the GMC’s core guidance document (a new version is out this year) and there are supporting documents covering important areas like consent , confidentiality , prescribing and treating children. Take care to document these discussions in the records. Most employers will have a chaperones policy too.

Documentation/Coding 52

Documentation/Coding Patient Safety Wellness Hospitals 52

The Trauma Pro

DECEMBER 26, 2023

Screening looks at patient factors such as age, obesity, and previous VTE, as well as injury risk factors like spine and pelvic fractures and decreased mobility. But the key fact is that every compression device manufacturer includes existing DVT as a contraindication in their product documentation.

Documentation/Coding 162

Documentation/Coding Fractures Hospitals Research 162

ACEP Now

OCTOBER 26, 2023

One of the HCFA letters, written by then Medicaid Director Tim Westmoreland (the Westmoreland Letter) specifically cited that the CPT 9928X codes should be reimbursed under federal PLP unless the Medicaid plan believed there were program integrity issues with the claim.

Documentation/Coding 124

Documentation/Coding Hospitals Administration Emergency Department 124

Dr. Smith's ECG Blog

JANUARY 5, 2024

The documentation does not describe any additional details of the history. They also documented "Reproducible chest tenderness." The proximal LAD has mild disease, but the distal LAD and diagonal branches are not well evaluated in this view. The distal LCx is seen, and the OM is not well visualized here.

EKG/ECG 95

EKG/ECG Burns Urgent Care Documentation/Coding 95

Emergency Medicine Journal

JULY 24, 2023

Introduction Pain is the most common presenting feature within the ED, yet undertreatment of pain in the ED is a well-documented problem worldwide. Despite the development of interventions to address this problem, there is still limited understanding of how pain management can be improved within the ED.

Emergency Department 74

Emergency Department Documentation/Coding Research Wellness 74

Taming the SRU

FEBRUARY 22, 2024

M&M - Arterial Lines - Fat Embolism Syndrome - CPC Morbidity & Mortality WITH Dr. Finney Case 1: MVC AMA, especially in pediatrics, is a high-risk disposition that requires thorough discussion and documentation Approach pediatric blunt abdominal trauma with a thorough physical exam and consider decision making tools when applicable Case 2 & (..)

Pediatrics 73

Pediatrics Documentation/Coding Wellness 73

The Trauma Pro

OCTOBER 31, 2023

Explain to the consultant that you truly believe that harm will occur, and you will have to document that fact in the medical record as well as their failure to respond. Contact the trauma medical director, service chief, or hospital administrator and see if they can intervene.

Risk Management 113

Risk Management Documentation/Coding Hospitals Fractures 113

ACEP Now

NOVEMBER 13, 2023

For the safety of staff as well as patients, interventions that interrupt escalations before they blossom into violence deserve further study. 5 Hospitals commonly activate a “code” in response to agitated patients, alerting security personnel to the location of that patient.

Emergency Department 52

Emergency Department Documentation/Coding Psychiatric Best Practices 52

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 74

Radiology Radiology Hospitals Documentation/Coding 74

ACEP Now

OCTOBER 3, 2023

This document is an update of guidelines first published in 2000, and then updated in 2007. Confounders to the GCS such as seizure and post-ictal phase, ingestions and drug overdose, as well as medications administered in the prehospital setting that impact GCS score should be documented. 2019;154(7):e191152.

Documentation/Coding 98

Documentation/Coding Fluid Resuscitation Resuscitation Pediatrics 98

EMDocs

JUNE 8, 2023

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. Subsequently reduced enrollment to 310 patients because no patients had been lost to follow-up or had insufficient data documented.

Stroke 76

Stroke Administration Outcomes Documentation/Coding 76

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 Canadian Computed Tomography Head Rule (CCHR) is a validated tool to guide ED providers in determining the need for emergent CT of mTBI patients.

Emergency Department 55

Emergency Department Documentation/Coding Outcomes Wellness 55

Total Medical ComplianceHIPAA

APRIL 14, 2023

You can be sure that your patient has been notified of the subpoena if you have a judge-signed subpoena, an authorization signed by the patient, or an attorney signed document that states this process has already happened. You can even call and talk to your patient and document this.

Documentation/Coding 83

Documentation/Coding Outcomes Wellness 83

PulmCCM

MARCH 4, 2024

About half of participants had had documented prior Covid infection. While not IQ tests per se , the tests (branded as Cognitron ) purport to correlate well with, and to be indexed to, formal IQ tests. Thanks to the large data set, however, other demographics were well-represented and analyzable. standard deviation).

Sepsis 52

Sepsis CDC Pediatrics Documentation/Coding 52

Total Medical ComplianceHIPAA

MARCH 15, 2023

This is causing concerns about the risk to the patient’s privacy as well as how to handle requests from the employers for more details. The HIPAA regulations are clear that an authorization document cannot include anything but another authorization. If the doctor believes this to be valid, they generate the letter.

Documentation/Coding 59

Documentation/Coding Wellness 59

EMDocs

FEBRUARY 12, 2024

ABG and VBG Correlation The correlation between venous and arterial blood gases is well-documented for standard differences (Table 1), and the data obtained from the VBG can be acted on as if it were an ABG (1, 3-6). While ABGs and VBGs usually correlate well, there are a few situations where this correlation is disturbed.

Emergency Department 93

Emergency Department Resuscitation COPD Shock 93

ALiEM

JANUARY 22, 2024

Fever was documented to be 102°F and was not associated with any chills or rigors. The patient also complained of shortness of breath for one week associated with a dry cough, as well as an altered sensorium for one day. The patient during his hospital stay developed ARDS and was on mechanical ventilation for 20 days.

Documentation/Coding 64

Documentation/Coding Academics Emergency Department Hospitals 64

Medical Law

JUNE 20, 2023

California Vehicle Code 21212 provides that all riders and passengers under the age of 18 are legally required to wear a helmet when using a bicycle, a non-motorized scooter, in-line roller skates, or a skateboard to travel along streets or bikeways, or on any other public bicycle path or trail.

Documentation/Coding 52

Documentation/Coding CDC Research Wellness 52

Dr. Smith's ECG Blog

OCTOBER 23, 2023

Macroscopic T-Wave Alternans: A Red Flag for Code Blue. This 1910 description by Lewis serves well to this day to remind us of the 2 principal clinical situations in which electrical alternans is most often encountered: i ) Supraventricular reentry tachycardias; and , ii ) Pericaradial tamponade. J Am Coll Cardiol. doi: 10.1016/j.jacc.2005.08.066.

EKG/ECG 108

EKG/ECG Documentation/Coding Psychiatric EMS 108