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Without Rationale in Chart, Defense of Discharge Claims Becomes Complicated, Experts Say

EPs who clearly and concisely document why a patient was discharged provide safety against potential litigation.

It’s Not Enough to Prove Standard of Care Was Breached

EPs are in the same boat as all others if a physician’s record on achieving quality metrics can be used as evidence in proving medical malpractice.

Osteoarthritis

MONOGRAPH: It's important to understand patients who come to the ED with undifferentiated symptoms, including joint pain.

TJC: HCOs need to be on alert for HIT problems related to sociotechnical factors, take steps to improve safety culture, process, and leadership

It’s no secret that for all of the efficiencies that health information technology (HIT) brings to the table, there are also immense challenges that go along with safely using tools that, in many cases, alter workflow, documentation, and the way providers interact with patients. Of particular concern is the potential for patient harm that can result when systems are poorly designed or implemented, raising the possibility that information will be miscommunicated or entered incorrectly.

Clean up coding practices to maximize revenue, minimize compliance issues, and be optimally prepared for ICD-10

ICD-10 implementation is priority No.1 for nearly every hospital.

Study: Emergency providers often lack consensus on what patients intend when end-of-life forms come into play

A new study suggests there is a lack of consensus or understanding about what patients intend when they fill out Physicians Orders for Life Sustaining Treatment forms, and that this likely leads to patients either receiving or not receiving treatment contrary to their wishes.

ED-based interventions to break cycle among patients presenting with violence-related injuries

Emergency providers have so much to do it is hard to justify adding one more task to their already full plates. However, when the right resources are in place, there is increasing evidence that EDs can play a pivotal role in preventing victims of violence from becoming enmeshed in a cycle that brings them or associates back to the ED with similar injuries again and again.

Corticosteroids in Severe Community-Acquired Pneumonia: The Controversy Continues

Treatment failure in hospitalized patients with severe community-acquired pneumonia (CAP) is associated with an excessive inflammatory response and worse outcomes. Torres and colleagues sought to determine the effect of corticosteroids in patients with severe CAP and a significant inflammatory response. In this multicenter, randomized, double-blind, placebo-controlled trial, 120 severe CAP patients with C-reactive protein (CRP) levels >150 mg/L were randomized to receive either an IV methylprednisolone bolus of 0.5 mg/kg every 12 hours or placebo. Treatment began within 36 hours of hospital admission and lasted for 5 days. Severe CAP was defined as two out of the three minor criteria independently associated with severity including PaO₂ /FiO₂ < 250, multilobar involvement, and systolic blood pressure < 90 mmHg, or one out of two major criteria, including a requirement for mechanical ventilation or septic shock.¹ Risk class V for the Pneumonia Severity Index was also considered severe CAP.² The primary outcome was early or late treatment failure. Early treatment failure was defined as the development of shock, need for mechanical ventilation not present at baseline, or death within 72 hours of treatment. Late treatment failure was defined as radiographic progression, persistence of severe respiratory failure, development of shock, need for invasive mechanical ventilation not present at baseline, or death between 72 hours and 120 hours after treatment.

Neuromuscular Blockade and Successful Endotracheal Intubation

Previous studies have shown the utility of neuromuscular blocking agents for endotracheal intubation in the operating room and emergency department. However, airway management in the ICU often involves unplanned, emergent intubations under suboptimal conditions. This study asked whether NMBAs improved first attempt success of intubations in the ICU. Additionally, these authors asked whether succinylcholine or rocuronium improved first attempt success and the effects of NMBA on intubations using video laryngoscopy.

Does Functional Ability Prior to an ICU Admission Influence Outcomes in Older Adults?

The impact of an older person’s functional status prior to experiencing hospitalization for a critical illness is difficult to determine. Given that ICU admission is generally an unplanned event, obtaining prospective evaluations of function prior to a critical illness or injury is almost impossible. Most evidence to date has utilized proxy reports for a patient’s functional status to determine what, if any, pre-ICU disability may have on an older adult’s outcomes after hospitalization for a critical illness or injury.

Emergency

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