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There is a significant amount of research that demonstrates ED crowding due to boarding is responsible for poor outcomes, says Tom Scaletta, MD, president of Emergency Excellence, a Chicago-based organization that improves patient care and efficiency in the ED while controlling costs. He also is medical director of a high-volume community hospital in a Chicago suburb.
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Although a recent study at the University of Rochester (NY) seems to indicate that telemedicine could eliminate many pediatric ED visits, a pediatric ED physician with extensive experience with telemedicine believes that its applications are not broad enough to have a significant impact on ED overcrowding.
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Telemedicine has long been recognized for improving access to care as well as access to specialist expertise, particularly in rural facilities.
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In its second year, the clinical documentation program at Jupiter (FL) Medical Center was able to increase DRG reimbursement by 75% over the previous year.
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When the clinical nurse specialists and case managers at Akron, OH-based Summa Health analyzed the reasons patients were being readmitted within 31 days, they determined that mobility issues, self-care deficits, pain control, and failure of discharge planning were key factors.
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After Summa Health System began a series of initiatives to provide a seamless transition as patients move between levels of care, the rate of hospital readmissions within 31 days dropped from 26% to 24%.
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Sharon Spencer, RN, was working around the house on a Saturday evening when she got word that Columbus (IN) Regional Hospital, where she is employed as a case manager, was being evacuated because of a flash flood.
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An emergency physician is managing an acute myocardial infarction, arranging for a patient transfer, sewing up a laceration, and putting in a chest tube, with 20 people still waiting to be seen in the waiting room.
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"When I conduct an initial review of the chart, I read it from the beginning, like a story starting with the emergency department notes, through the history and physical and start building a story from a clinical standpoint.
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Regular audits and continuing education are the keys to a successful documentation assurance program, says Liz Youngblood, RN, MBA, vice president, patient care support services at Baylor Health Care System in Dallas.