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When a Swiss tourist came to a Tucson, AZ, ED with pneumonia, none of the ED nurses suspected that measles was the underlying cause. As a result, the patient wasn't isolated, and patients and health care workers in the ED were needlessly exposed.
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If a psychiatric patient came to your ED acting aggressively with pressured speech, you might conclude that the behavior was caused by failure to take antipsychotic medications.
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Psychiatric patients can leave your ED without warning or cause harm to themselves or someone else, says Nancy Bennett, RN, MSN, ED educator at The Hospital of Central Connecticut in New Britain.
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"This is one of my favorite problems to 'diagnose,'" says Joan Somes, PhD, MSN, RN, CEN, FAEN, ED educator at St. Joseph's Hospital in St. Paul, MN.
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Decreased renal and hepatic blood flow. Decreased glomerular filtration rate. Decreased total body water. Increased percentage of body fat.
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If someone told you that an ED had experienced a 60% increase in volume between 2000 and 2008, you wouldn't be surprised to learn that the average length of stay (LOS) for their patients also had increased dramatically.
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As part of its Outpatient Prospective Payment System (OPPS) payment rule for 2009, the Centers for Medicare & Medicaid Services (CMS) has established a multiple imaging composite methodology, which means it will provide a single composite ambulatory payment classification (APC) payment each time a hospital bills more than one procedure from an imaging "family" on a single date of service. The families are:
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Every year at about this time, the Centers for Medicare & Medicaid Services (CMS) publishes its final Out-patient Prospective Payment System (OPPS) payment rule for the following calendar year, and every year emergency medicine experts express their dissatisfaction with one aspect or another of what CMS has wrought. This year, however, might prove to be an exception.
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The establishment of a communitywide patient information sharing system by the Wisconsin Health Information Exchange (WHIE) was a collaborative effort from the start, says Kim Pemble, WHIE's executive director.
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