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Emergency Department Boarding

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https://www.readbyqxmd.com/read/28433453/attending-documentation-contribution-to-billing-at-an-academic-emergency-department-with-an-electronic-health-record
#1
Brian J Yun, Stephen C Dorner, Brian M Baccari, John Brennan, Karen Smith, Ali S Raja, Benjamin A White
INTRODUCTION: In emergency medicine (EM), patient care documentation serves many functions, including supporting reimbursement. In addition, many electronic health record systems facilitate automatically populating certain data fields. As a result, in the academic model, the attending's note may now more often recapitulate many of the same elements found in the resident's or physician assistant's (PA) note. We sought to determine the value of additional attending documentation, and how often the attending documentation prevented a downcoding event...
April 14, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28431334/one-hundred-injured-patients-a-day-multicenter-emergency-room-surveillance-of-trauma-in-pakistan
#2
A A Hyder, S He, W Zafar, M U Mir, J A Razzak
OBJECTIVES: Injuries increasingly contribute to the global burden of disease in low- and middle-income countries. This study presents results from a large-scale surveillance study on injury from several urban emergency departments (EDs) in Pakistan. The objective is to document the burden of injuries that present to the healthcare system in Pakistan and to test the feasibility of an ED-based injury and trauma surveillance system. STUDY DESIGN: Cross-sectional study conducted using active surveillance approach...
April 18, 2017: Public Health
https://www.readbyqxmd.com/read/28398941/the-season-of-hoverboards-a-case-series-of-fractures
#3
Chester J Donnally, Charles M Lawrie, Augustus J Rush, Avi C Baitner
OBJECTIVE: The aim of this study was to identify the types of pediatric orthopedic extremity fractures that are sustained as a result of hoverboard (self-balancing, self-propelling, 2-wheeled boards) use. METHODS: We performed a retrospective review of all orthopedic consultations from the emergency department at our institution from December 1 to 31, 2015. Data was collected on the injury mechanism, fracture location, management, and patient characteristics including sex, age, and hand dominance...
April 11, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28382611/parkinsonism-or-other-movement-disorders-presenting-as-stroke-mimics
#4
Cheng-Yang Hsieh, Chih-Hung Chen, Sheng-Feng Sung, Wen-Juh Hwang
PURPOSE: Patients with parkinsonism or other movement disorders may visit the emergency department due to acute deterioration of neurological status or consciousness disturbance. Under such circumstances, patients may be misdiagnosed as having a hyperacute stroke, i.e. stroke mimic. The purpose of the present study was to explore the clinical features and consequences of patients with parkinsonism or other movement disorders presenting as stroke mimics with activation of a stroke code...
December 15, 2016: Acta Neurologica Taiwanica
https://www.readbyqxmd.com/read/28375955/using-lean-management-to-reduce-emergency-department-length-of-stay-for-medicine-admissions
#5
Nazima Allaudeen, Anita Vashi, Julia S Breckenridge, Farnoosh Haji-Sheikhi, Sarah Wagner, Keith A Posley, Steven M Asch
BACKGROUND: The practice of boarding admitted patients in the emergency department (ED) carries negative operational, clinical, and patient satisfaction consequences. Lean tools have been used to improve ED workflow. Interventions focused on reducing ED length of stay (LOS) for admitted patients are less explored. OBJECTIVE: To evaluate a Lean-based initiative to reduce ED LOS for medicine admissions. DESIGN, SETTING, PATIENTS: Prospective quality improvement initiative performed at a single university-affiliated Department of Veterans Affairs (VA) medical center from February 2013 to February 2016...
April 2017: Quality Management in Health Care
https://www.readbyqxmd.com/read/28357505/identification-of-left-ventricle-failure-on-pulmonary-artery-cta-diagnostic-significance-of-decreased-aortic-left-ventricle-enhancement
#6
Abhishek Chaturvedi, Joel P Thompson, Katherine Kaproth-Joslin, Susan K Hobbs, Karl Q Schwarz, Vijay K Krishnamoorthy, Apeksha Chaturvedi, Timothy Baran
PURPOSE: This study aimed to identify findings on non-ECG-gated CT pulmonary angiography (CTPA) indicating decreased left ventricle (LV) systolic function, later confirmed by echocardiogram. METHODS: After obtaining institutional review board approval, review was performed of emergency department (ED) patients who had CTPA and follow-up echocardiogram within 48 h, over 18 months. Patients with pulmonary embolus, suboptimal CTPA, arrhythmias or pericardial tamponade were excluded...
March 29, 2017: Emergency Radiology
https://www.readbyqxmd.com/read/28336507/planking-or-the-lying-down-game-two-case-reports
#7
Stefania Barbieri, Paolo Feltracco, Luca Omizzolo, Rossella Snenghi, Rafi El Mazloum, Gianna Vettore, Mauro Bergamini, Armando Stefanati, Daniele Donato, Cecilia Ferronato, Francesco Maria Avato, Alberto Tredese, Rosa Maria Gaudio
BACKGROUND: The monitoring and management of risks regarding children and young people admitted to the emergency department as a result of dangerous behaviors distributed via the Internet should be based on clinical reasoning and knowledge about these social media-related phenomena. Here we examine 2 cases of teenagers who reported severe injuries while performing the "planking" craze, a challenge that consists in lying face-down stiffly like a board on any kind of surface. OBJECTIVE: Our objective is to examine and describe the Internet craze called planking, also known as the "lying-down game," through 2 case reports from our experience, enriching this study with information gained through discussions with secondary school teenagers...
March 23, 2017: Interactive Journal of Medical Research
https://www.readbyqxmd.com/read/28328652/delayed-second-dose-antibiotics-for-patients-admitted-from-the-emergency-department-with-sepsis-prevalence-risk-factors-and-outcomes
#8
Daniel Leisman, Victor Huang, Qiuping Zhou, Jeanie Gribben, Andrea Bianculli, Michelle Bernshteyn, Mary Frances Ward, Sandra M Schneider
OBJECTIVE: 1) Determine frequency and magnitude of delays in second antibiotic administration among patients admitted with sepsis; 2) Identify risk factors for these delays; and 3) Exploratory: determine association between delays and patient-centered outcomes (mortality and mechanical ventilation after second dose). DESIGN: Retrospective, consecutive sample sepsis cohort over 10 months. SETTING: Single, tertiary, academic medical center. PATIENTS: All patients admitted from the emergency department with sepsis or septic shock (defined: infection, ≥ 2 systemic inflammatory response syndrome criteria, hypoperfusion/organ dysfunction) identified by a prospective quality initiative...
March 21, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28325207/using-a-systematic-framework-of-interventions-to-improve-early-discharges
#9
Hemali Patel, Sasha Morduchowicz, Michelle Mourad
BACKGROUND: Late-afternoon hospital discharges can lead to admission bottlenecks and negatively affect the flow of patients needing hospital admission. Delays in discharge are a prevalent health care problem and have been linked to increased length of stay, lower patient satisfaction scores, and adverse outcomes. As a result, hospitals are placing a renewed emphasis on early discharge as a way to reduce admission delays and achieve optimal patient flow. This study shows that the Model for Improvement (MFI) is an effective approach for complex improvement efforts...
April 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28301779/detection-of-bone-marrow-edema-in-nondisplaced-hip-fractures-utility-of-a-virtual-unenhanced-dual-energy-ct-application
#10
Trenton T Kellock, Savvas Nicolaou, Sandra S Y Kim, Sultan Al-Busaidi, Luck J Louis, Tim W O'Connell, Hugue A Ouellette, Patrick D McLaughlin
Purpose To quantify the sensitivity and specificity of dual-energy computed tomographic (CT) virtual noncalcium images in the detection of nondisplaced hip fractures and to assess whether obtaining these images as a complement to bone reconstructions alters sensitivity, specificity, or diagnostic confidence. Materials and Methods The clinical research ethics board approved chart review, and the requirement to obtain informed consent was waived. The authors retrospectively identified 118 patients who presented to a level 1 trauma center emergency department and who underwent dual-energy CT for suspicion of a nondisplaced traumatic hip fracture...
March 16, 2017: Radiology
https://www.readbyqxmd.com/read/28284460/the-impact-of-prolonged-waiting-time-for-coronary-care-unit-admission-on-patients-with-non-st-elevation-acute-coronary-syndrome
#11
Chien-Chih Chen, I-Min Chiu, Fu-Jen Cheng, Kuan-Han Wu, Chao-Jui Li
BACKGROUND: The boarding of patients in the emergency department consumes nursing and physician resources, and may delay the evaluation of new patients. It may also contribute to poor cardiovascular outcomes in patients with acute coronary syndrome (ACS). This study analyzed the relationship between the delay in coronary care unit (CCU) admission and the clinical outcomes of patients with ACS with non-ST-segment elevation (NSTE-ACS). METHODS: Patients were divided into 2 groups according to the CCU waiting time (<12h and >12h)...
February 28, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28197843/copeptin-for-risk-stratification-in-non-traumatic-headache-in-the-emergency-setting-a-prospective-multicenter-observational-cohort-study
#12
MULTICENTER STUDY
Claudine Angela Blum, Bettina Winzeler, Nicole Nigro, Philipp Schuetz, Silke Biethahn, Timo Kahles, Cornelia Mueller, Katharina Timper, Katharina Haaf, Janina Tepperberg, Margareth Amort, Andreas Huber, Roland Bingisser, Peter Stephan Sándor, Krassen Nedeltchev, Beat Müller, Mira Katan, Mirjam Christ-Crain
BACKGROUND: In the emergency setting, non-traumatic headache is a benign symptom in 80% of cases, but serious underlying conditions need to be ruled out. Copeptin improves risk stratification in several acute diseases. Herein, we investigated the value of copeptin to discriminate between serious secondary headache and benign headache forms in the emergency setting. METHODS: Patients presenting with acute non-traumatic headache were prospectively enrolled into an observational cohort study...
December 2017: Journal of Headache and Pain
https://www.readbyqxmd.com/read/28188202/progressive-prediction-of-hospitalisation-in-the-emergency-department-uncovering-hidden-patterns-to-improve-patient-flow
#13
Yuval Barak-Corren, Shlomo Hanan Israelit, Ben Y Reis
INTRODUCTION: One of the factors contributing to ED crowding is the lengthy delay in transferring an admitted patient from the ED to an inpatient department (ie, boarding time). An earlier start of the admission process using an automatic hospitalisation prediction model could potentially shorten these delays and reduce crowding. METHODS: Clinical, operational and demographic data were retrospectively collected on 80 880 visits to the ED of Rambam Health Care Campus in Haifa, Israel, from January 2011 to January 2012...
February 10, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28141672/conducting-community-health-needs-assessments-in-the-local-public-health-department-a-comparison-of-random-digit-dialing-and-the-community-assessment-for-public-health-emergency-response
#14
Kahler Stone, Allison Sierocki, Vaidehi Shah, Kelly R Ylitalo, Jennifer A Horney
CONTEXT: Community health needs assessments (CHNAs) are now required by the Affordable Care Act (ACA) for nonprofit hospitals and the Public Health Accreditation Board (PHAB) for local health departments that seek accreditation. Currently, various primary data collection methods exist that meet the ACA and PHAB requirements. OBJECTIVE: To compare 2 CHNA data collection methods implemented in the same geographical area from a local health department perspective. DESIGN AND SETTING: Two community surveys, one door-to-door and one telephone, in the 76706 zip code area of McLennan County, Texas...
January 30, 2017: Journal of Public Health Management and Practice: JPHMP
https://www.readbyqxmd.com/read/28125568/cluster-of-an-unusual-amnestic-syndrome-massachusetts-2012-2016
#15
Jed A Barash, Nick Somerville, Alfred DeMaria
In November 2015, a neurologist in the Boston, Massachusetts, area reported four cases of an uncommon amnestic syndrome involving acute and complete ischemia of both hippocampi, as identified by magnetic resonance imaging (MRI), to the Massachusetts Department of Public Health (MDPH) (1). A subsequent e-mail alert, generated by the Massachusetts Board of Registration in Medicine and sent to relevant medical specialists (including neurologists, neuroradiologists, and emergency physicians), resulted in the identification of 10 additional cases that had occurred during 2012-2016...
January 27, 2017: MMWR. Morbidity and Mortality Weekly Report
https://www.readbyqxmd.com/read/28110985/a-profile-of-indian-health-service-emergency-departments
#16
Kenneth Bernard, Kohei Hasegawa, Ashley Sullivan, Carlos Camargo
STUDY OBJECTIVE: The Indian Health Service provides health care to eligible American Indians and Alaskan Natives. No published data exist on emergency services offered by this unique health care system. We seek to determine the characteristics and capabilities of Indian Health Service emergency departments (EDs). METHODS: All Indian Health Service EDs were surveyed about demographics and operational characteristics for 2014 with the National Emergency Department Inventory survey (available at http://www...
January 19, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28063614/analysis-of-emergency-department-length-of-stay-for-mental-health-patients-at-ten-massachusetts-emergency-departments
#17
Mark D Pearlmutter, Kristin H Dwyer, Laura G Burke, Niels Rathlev, Louise Maranda, Greg Volturo
STUDY OBJECTIVE: Prolonged boarding times in the emergency department (ED) disproportionately affect mental health patients, resulting in patient and provider dissatisfaction and increased patient morbidity and mortality. Our objective is to quantify the burden of mental health boarding and to elucidate the effect of insurance together with demographic, social, and comorbid factors on length of stay. METHODS: We conducted a cross-sectional observational study of 871 consecutive patients requiring an ED mental health evaluation at one of 10 unaffiliated Massachusetts hospitals...
December 30, 2016: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28009394/eighty-years-of-cirm-a-journey-of-commitment-and-dedication-in-providing-maritime-medical-assistance
#18
Syed Sarosh Mahdi, Francesco Amenta
BACKGROUND: A review of activities of Centro Internazionale Radio Medico (International Radio Medical Centre, CIRM) from its foundation in 1935 until its 80th anniversary in 2015 was accomplished. CIRM was founded in 1935 to provide medical assistance via radio to ships with no doctor on board and other distant patients who cannot be reached by a doctor. In 1950 CIRM was established as a non-profit-making foundation and has benefited since 1957 from an annual contribution from the Italian government...
2016: International Maritime Health
https://www.readbyqxmd.com/read/27988200/dissecting-costs-of-ct-study-application-of-tdabc-time-driven-activity-based-costing-in-a-tertiary-academic-center
#19
Yoshimi Anzai, Marta E Heilbrun, Derek Haas, Luca Boi, Kirk Moshre, Satoshi Minoshima, Robert Kaplan, Vivian S Lee
RATIONALE AND OBJECTIVES: The lack of understanding of the real costs (not charge) of delivering healthcare services poses tremendous challenges in the containment of healthcare costs. In this study, we applied an established cost accounting method, the time-driven activity-based costing (TDABC), to assess the costs of performing an abdomen and pelvis computed tomography (AP CT) in an academic radiology department and identified opportunities for improved efficiency in the delivery of this service...
February 2017: Academic Radiology
https://www.readbyqxmd.com/read/27955985/quarterly-reporting-of-computed-tomography-ordering-history-reduces-the-use-of-imaging-in-an-emergency-department
#20
Richard Ehrlichman, Zachary Dezman, Joel Klein, Jean Jeudy, Daniel Lemkin
BACKGROUND: Computed tomography (CT) is a useful and necessary part of many emergency department (ED) assessments. However, the costs of imaging and the health risks associated with radiation exposure have sparked national efforts to reduce CT ordering in EDs. STUDY OBJECTIVE: We analyzed CT ordering habits prior to and following implementation of a feedback tool at a community hospital. METHODS: In this intervention study, we identified the CT-ordering habits of physicians and mid-level care providers (physician assistants and nurse practitioners) at baseline and after implementation of a system that sent quarterly feedback reports comparing their ordering habits with those of their peers...
December 9, 2016: Journal of Emergency Medicine
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