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Utilization of computed tomography (CT) scans has increased markedly in the past decades. It is estimated that more than 75 million scans are performed annually in the United States, compared to only 3 million in 1980.
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Although lower extremity fractures are much less common than upper extremity fractures in children, the correct diagnosis and management of this type of injury is critical. In the second part of this series the authors review common lower extremity fractures, fractures common in abused children and the diagnosis and treatment of radial head subluxation. Children are much more likely to sustain fractures rather than ligamentous injuries and identification of injuries and timely management will maximize an optimal outcome. Awareness of certain unique pediatric fractures such as the triplane juvenile fracture and the juvenile Tillaux fracture will allow for prompt treatment and referral. The authors also provide a table encompassing guidelines for ED management and treatment of common pediatric orthopedic injuries.
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[Editor's note: This is the third in a three-part series on reducing violence in the ED. In the first article, our experts discussed the importance of a "zero tolerance" policy. In last month's article, we outlined key steps recommended by government agencies for reducing violence and discussed the importance of having clear procedures when it comes to dealing with patients and their families. This month we examine the Sentinel Event Alert recently published by The Joint Commission, which discusses why the ED is particularly susceptible to episodes of violence, outlines leading causal factors, and provides additional guidance for violence prevention.]
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Your ED patient's bad outcome might have nothing to do with the fact that he or she was held in the hallway while awaiting an inpatient bed. However, it could impact the outcome of subsequent litigation against the ED.
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[This quarterly column on coding in the ED is written by Caral Edelberg, CPC, CCS-P, CHC, president of Edelberg Compliance Associates, Baton Rouge, LA. If there are coding issues you would like to see addressed in this column, contact Edelberg at phone: (225) 454-0154. E-fax: (225) 612-6904. E-mail:
[email protected].]
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Representatives at Emerus Emergency Hospitals, a licensed emergency specialty hospital company based in The Woodlands, TX, have been telling patients at several of its "24-hour EDs" for months now that if they are not seen by a physician within 15 minutes, the hospital will pay for their $1,000 visit. So far, the new policy is working quite well, say Emerus representatives.
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[Editor's note: This is the second in a two-part series on placing pharmacists in the ED. In our last installation, we examined the performance improvements that the University of Rochester (NY) Medical Center achieved as the result of placing a pharmacist inside the ED. In addition, we discuss how a pharmacist's recommendations to dispense a medication orally instead of using an IV enabled the ED to save a considerable amount of money while at the same time improving patient safety. In this issue, we look at additional benefits these pharmacists offer, from the perspective of ED nurses and physicians.]
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The Joint Commission is hoping that its suspension of a policy that triggers an "automatic" adverse decision if an organization fails to complete an acceptable root cause analysis in response to a sentinel event or its related measure of success within a specified time frame will encourage more self-reporting and advance root cause analysis activities.
