Writing with purpose. Make IT real and simple. On the Medicine Wards for Medical Students, Interns, and Residents
|
|
|
- Coral Harrington
- 5 years ago
- Views:
Transcription
1 Writing with purpose Make IT real and simple On the Medicine Wards for Medical Students, Interns, and Residents Omar S. Darwish, MS, DO Health Science Assistant Professor Coordinator of the M&M Dept of Med Hospitalist University of California, Irvine
2 Objectives History and Physical Medicine Admission Note Progress Note Discharge Note 2 Department of Medicine
3 Objectives (I) For the H/P notes In the history section, focus your documentation on the elements of the complaint in addition to providing a comprehensive exam, also documenting pertinent positives and negatives in your exam providing a problem lists that reflects the active issues and the stability of the comorbidities and providing an active plan 3 Department of Medicine
4 Writing notes Tell us how you really feel Tiresome, Monotonous, Boring Time Consuming No one reads it anyway Gets in the way of patient care 4 Department of Medicine
5 Problem Failure to Communicate Active Plans of the Day Failure to Keep up with the Note Failure to Reflect The Amount of Work Done Barriers High Turnover High Census Academic commitments and too many necessary/unnecessary Interruptions 5 Department of Medicine
6 Change of attitude READ MY NOTES 6 Department of Medicine I WANT TO SHOW OFF MY KNOWLEDGE & ACTIVITY
7 History Section of the H/P and Progress Note H&P Document (Comprehensive History) Progress Note (Detailed History) Focus on the Elements of the Chief Complaint or the reason for admission. (Stop Writing the List of Past Medical Problems) PMH Connection Are there prior Hospitalization 10 System ROS: A few needs to be documented, but then the statement all other systems are negative needs to follow. PMH/Surgical History, Family History (CANNOT WRITE NONCONTRIBUTORY), Social History Daily assessment of how their chief complaint is doing. Great place to ask the patient if they are in pain (rate it, where is it, associated symptoms) and are pain meds helping ROS: At least 2 are needed Detailed Hx: 4 HPI elements or the status of 3 chronic medical problems + 2 ROS Comprehensive Hx: Same as above except + 10 ROS + Complete PFSH 7 Department of Medicine
8 EXAM Section of the H/P and Progress Note H&P Document (Comprehensive Exam) 1 bullet from each of the organ systems (8 pts) Example: Vitals: BP 120/80, HR 60, RR 23, T 98.6 General: NAD, alert and oriented x 3 Constitutional System 1 bullet for vital signs, 1 bullet for general appearance Progress Note (Detailed Exam) 5 bullets from any organ system Progress Note (Expanded Problem Focused Exam) 2-4 bullets from any organ system Vital signs: 120/80, P 67, RR 18, T 38 (constitutional +1) Gen: NAD (psycho +1) and A&O x 3 (neuro + 1) Heart: RRR no m (cardio + 1) Lungs: CTAB (pulm + 1) 8 Department of Medicine
9 Imaging and EKG Cutting and Pasting Imaging Findings & Impressions are Discouraged. Best thing to write is your interpretation, then if you are in agreement or question radiologist impression Why? Clutters the progress notes & for Discharge Summaries abnormalities listed maybe become a LIABILITY Example: CXR: my interpretation R large pleural effusion consistent with radiology impression 9 Department of Medicine
10 Assessment/Plans By far the most difficult section to write 10 Department of Medicine
11 Medical Decision Making (MDM) Overall MDM Problem Points Data Points Risks Straightforward 1 1 Minimal Low 2 2 Low Moderate 3 3 Moderate High 4 4 High For High MDM; Requires 2 out of the 3 of the following 1) Four Problem Points 2) Four Data Points 3) High Risk 11 Department of Medicine
12 Problem Points Problems Points Self-limited or minor 1 Established problem, stable or improving 1 Established problem, worsening 2 New problem, with no additional workup- planned 3 New problem, with additional workup planned 4 Example: 1. Atrial Fibrillation with RVR- etiology from HTN, hemodynamically stable, new diagnosis 2. Type 2 Diabetes with peripheral neuropathy stable, at hospitalized blood sugar goal on Lantus 30 U/day and Neurontin 300 bid. 3. Hypertension with cardiac disease- controlled on Norvasc 5 mg qday 4. Moderate Risk for DVT on Lovenox 40 SQ day. 6 pts Overall Plan/ For new Atrial Fibrillation, start Metoprolol 25 bid, check thyroid panel, obtain echocardiogram, start NOAC 12 Department of Medicine
13 Data Points 13 Department of Medicine Data Reviewed Points Review or order clinical lab tests 1 Review or order radiology test (except heart cath or echo) 1 Review or order medicine test (PFTs, EKG, cardiac echo or cath) 1 Discuss test with performing physician 1 Independent review of image, tracing or specimen 2 Decision to obtain old records 1 Review and summation of old records 2 Example: 1. Atrial Fibrillation with RVR- etiology from HTN, hemodynamically stable, new diagnosis 2. Type 2 Diabetes with peripheral neuropathy stable, at hospitalized blood sugar goal on Lantus 30 U/day and Neurontin 300 bid. 3. Hypertension with cardiac disease- controlled on Norvasc 5 mg qday. 2 pts 4. Moderate Risk for DVT on Lovenox 40 SQ day Overall Plan/ For new Atrial Fibrillation, start Metoprolol 25 bid, check thyroid panel, obtain echocardiogram, start NOAC
14 Risk: Requires ONE element in ANY of the following three categories 1. Type of Presenting Problem (MODERATE: e.g. mild COPD exacerbation; HIGH: acute hypoxic hypercapnic respiratory failure due to COPD) 2. Type of Diagnostic Procedure (MODERATE: EGD without risk factors; HIGH: EGD with risk factors) 3. Type of Management Options (MODERATE: Prescriptions; HIGH: Prescriptions requiring close monitoring 14 Department of Medicine
15 So How Should We Write the Note? An integrated problem lists with or without a line plan Adding a Discussion paragraph maybe needed to explain a complicated case Ending with an overall plan that shows current activity for that day 15 Department of Medicine
16 Example 1: of a Note on Day Department of Medicine
17 Example 1 of a Note Day Department of Medicine
18 Example 1: Apply the New Way of Writing 18 Department of Medicine
19 Example 2 19 Department of Medicine
20 Example 2 20 Department of Medicine
21 Example 3. How To Apply from Day to Day 21 Department of Medicine
22 Assessment of Common Medical Conditions (Degree, Complications). Be Specific (Location Matters) Do NOT Write Please Write (e.g.) DM2 or DM HTN Anemia Malnutrition Hypokalemia CHF Cellulitis Type 2 diabetes with peripheral neuropathy Hypertension with heart disease and CKD stage III Microcytic Anemia with blood loss Severe Protein Calorie Malnutrition (MCC*) Severe Hyperkalemia due to urine loss Acute on Chronic Systolic Heart Failure (MCC*) R foot cellulitis *MCC: Major complication or comorbidity; others include Acute Renal Failure, Acute Respiratory Failure, Acute CHF, hyponatremia, functional quadriplegia Protein Calorie Malnutrition 22 Department of Medicine
23 Use Non-Definitive Words Apply words like Presumed, Probable, or Possible when treating conditions you are not sure about. Example: Presumed Gram negative and MRSA Pneumonia on Vancomycin and Zosyn. The following day you could say Pneumonia Ruled Out stop antibiotics 23 Department of Medicine
24 Choose the Diagnosis that Best Reflects Severity A. Cellulitis B. Sepsis C. Septic Shock Answer: Sepsis Sepsis due Cellulitis 24 Department of Medicine
25 Choose the Diagnosis that Best Reflects Severity A. Pneumonia B. Severe Sepsis C. Acute Hypoxic Respiratory Failure Answer: Acute Hypoxic Respiratory Failure due to Severe Sepsis from presumed Gram Neg. Pneumonia 25 Department of Medicine
26 Choose the Diagnosis that Best Reflects Severity A. Diabetes B. Type 2 Diabetes C. Type 2 Diabetes with peripheral neuropathy D. Type 2 Diabetes with CKD stage III and peripheral neuropathy, retinopathy, and history of R toe amputation Answer: D Make connections 26 Department of Medicine
27 Change of attitude READ MY NOTES 27 Department of Medicine I WANT TO SHOW OFF MY KNOWLEDGE & ACTIVITY
28 Assessment/Plans Reflect your knowledge Reflect your activity for that day Overall show that you are committed in providing the best care 28 Department of Medicine
2
1 2 3 4 5 Elements: Location, Timing, Associated Sign and Symptom, Duration Type of History HPI Problem Focused (99201, 99213) Brief (1-3) Expanded Focused (99202, 99213 Brief (1-3) Detailed (99203, 99214)
10/17/2013. Billing and Coding in Long Term Care: Keeping the Wolves at Bay. Disclosure
Billing and Coding in Long Term Care: Keeping the Wolves at Bay Maine Medical Directors Association Annual Conference October 11, 2013 Alva S Baker, MD, CMD-R Disclosure Dr. Baker has indicated that he
"No FUNDS Left Behind": Maximizing Inpatient Revenue Capture Through Better Understanding and Use of Documentation and Coding Guidelines
"No FUNDS Left Behind": Maximizing Inpatient Revenue Capture Through Better Understanding and Use of Documentation and Coding Guidelines Workshop A01: SGIM 31 st Annual National Meeting Thursday April
How to Code Correctly for E/M Services (1997 Guidelines)
How to Code Correctly for E/M Services (1997 Guidelines) Phillip Ward, DPM CPT Editorial Board Advisor for Foot and Ankle Former CPT Assistant Editorial Board Member Past President, APMA General Principles
Documenting in the World of ICD-10 Capturing all your CCs and MCCs Crystal Coen, RN, MSN, FNP-BC NPSS Asheville, NC
Documenting in the World of ICD-10 Capturing all your CCs and MCCs Crystal Coen, RN, MSN, FNP-BC 2017 NPSS Asheville, NC Objectives Understand the importance of documenting to the highest specificity Understand
Learning Objectives. Clinical Validation. Ultimate Test for Queries:
1 Ultimate Test for Queries Cesar M. Limjoco, MD Kelli A. Estes, RN, CCDS Learning Objectives At the completion of this educational activity, the learner will be able to: Understand the true mission of
Ritecode.com Physician Coding Audit Report - Summary Statistics
Clinic Name: 1111 Manager: 1111 OB/GYN Physician: 1111 Encounters Correct (%): 80.00% Medical Decision Making Correct (%): 80.00% Exam Correct (%): 80.00% History Correct (%): 100.00% Documentation Needs
For The Critters Present
For The Critters Present Be sure to Sepsis Sepsis secondary to UTI Bacteremia SIRS secondary to infection For More Info-Contact Your Documentation Specialist Pat Spadaro, R.N. 6796 Rosanne Garofano, R.N.
Mortality Risk Adjustment and HCCs: Is This the New 'Sweet Spot' for Physician Buy In?
Mortality Risk Adjustment and HCCs: Is This the New 'Sweet Spot' for Physician Buy In? Kyra Brown, RHIA, CCS, CCDS Clinical Documentation Manager/Educator Erlanger Chattanooga, TN 1 Learning Objectives
Sepsis Combine experience and Evidence. Eran Segal, MD Director General ICU, Sheba Medical Center, Israel
Sepsis Combine experience and Evidence Eran Segal, MD Director General ICU, Sheba Medical Center, Israel The Science of Sepsis A complex and diverse clinical entity Outcome is affected by: Infecting organism
61 yo M w/heart disease presenting in decompensated HF. 1/24/13 Jess Hwang
61 yo M w/heart disease presenting in decompensated HF 1/24/13 Jess Hwang HPI 3 weeks worsening orthopnea, PND, DOE Referred to UCMC for transplant evaluation Found to have 100% afib burden 1 month prior
Compare and Contrast health data and information. List Factors that lead to improvement in patient care healthcare quality and outcomes
Developing World Class Health Information What Are the Factors That Lead To Improvement in Patient Care, Healthcare Quality and Outcomes? The Role of Electronic Health Records, Teamwork and Coordination
Update in Hospital Medicine. Update in Hospital Medicine 2009
2009 Bradley A. Sharpe, MD UCSF Division of Hospital Medicine PE in Acute COPD Exacerbations Question: What is the prevalence of PE in patients with COPD who need hospitalization? Design: Systematic review,
Charting Smarter, not Longer: Basic Concepts in Outpatient Coding
Charting Smarter, not Longer: Basic Concepts in Outpatient Coding Workshop WA01 SGIM 29 th Annual Meeting April 27, 2006 Sponsored by the SGIM Clinical Practice Task Force (CPTF) Faculty: Jeannine Engel,
Supporting Documents Case Studies
Supporting Documents Case Studies ONA Presentation/Case Studies 1 CASE STUDY #1 CC: Right Breast Lump History of Present Illness: 41 yr old G3P0 with an LMP of 08/01/2017 who presents today to discuss
POCUS is the future of the physical exam
Diagnostic Point of Care Ultrasound For Hospitalists Nima Afshar MD Associate Professor Trevor Jensen MD MS Assistant Professor Department of Medicine, UCSF Oct 2018 POCUS is the future of the physical
John Sanchez, D.O. August 18, 2013
John Sanchez, D.O. August 18, 2013 Ø Coding Caps Ø Relevance to Clinical Practice Ø Current Guidelines 1995 (organ systems) 1997 (bullets) Ø Definitions ICD- 9 CPT E/M ( 99 _ ) Ø Who Should Determine the
Case #1. 73 y/o man with h/o HTN and CHF admitted with dizziness and SOB Treated for CHF exacerbation with Lasix Now HR 136
Tachycardias Case #1 73 y/o man with h/o HTN and CHF admitted with dizziness and SOB Treated for CHF exacerbation with Lasix Now HR 136 Initial Assessment Check Telemetry screen if pt on tele Telemetry
Morbidity & Mortality Grand Rounds Hospitalist Program
Morbidity & Mortality Grand Rounds Hospitalist Program September 11, 2017 Ashkan Etemadian, MD Health Science Assistant Professor Hospitalist Program University of California, Irvine Upcoming M&M Dates
Point-of-Care Ultrasound Closer look at the Inferior Vena Cavae &
Point-of-Care Ultrasound Closer look at the Inferior Vena Cavae & Brief Introduction to Gross Systolic Function Omar S. Darwish, MS, DO Certified in Point-of-Care Ultrasound Hospitalist University of California,
TEE in Non-Cardiac Surgery. Govind Rajan MBBS Professor, Director of Clinical affairs Chief of Surgical Liaison Corp. UCI Health, Irvine, California
TEE in Non-Cardiac Surgery Govind Rajan MBBS Professor, Director of Clinical affairs Chief of Surgical Liaison Corp. UCI Health, Irvine, California Disclaimer MADgic Airway MADgic Wand 2 Talking Points..
UBMD Internal Medicine
UBMD Internal Medicine Clinical Documentation Example Established Outpatient Visit - 99215 Pat Kisiel-Neunder, Compliance Administrator Email: pkisieln@buffalo.edu Regulations The following information
Documentation- Overview. Coding for Emergency Department Services. Documentation Guidelines
Documentation- Overview Coding for Emergency Department Services Sarah Todt, RN, CPC, CPMA, CEDC Documentation Guidelines CMS 1995 CMS 1997 May choose guidelines that are most favorable to the provider
Pneumonia Community-Acquired Healthcare-Associated
Pneumonia Community-Acquired Healthcare-Associated Edwin Yu Clin Infect Dis 2007;44(S2):27-72 Am J Respir Crit Care Med 2005; 171:388-416 IDSA / ATS Guidelines Microbiology Principles and Practice of Infectious
Patient Management Conference. John M. Lasala MD PhD Professor of Medicine and Surgery Washington University
Patient Management Conference John M. Lasala MD PhD Professor of Medicine and Surgery Washington University Disclosures None Case Patient SK 63 y/o man with history of: Atrial fibrillation with RVR, on
CODING and RVU s: What AHLTA Can Do For You (and what it can t)! Edited 2015 from USAFP Conference March 2007 Mark Stackle, MD
CODING and RVU s: What AHLTA Can Do For You (and what it can t)! Edited 2015 from USAFP Conference March 2007 Mark Stackle, MD Coding Basics The Dry Stuff Evaluation and Management Coding 2/3 areas for
UPDATE IN HOSPITAL MEDICINE
UPDATE IN HOSPITAL MEDICINE FLORIDA CHAPTER ACP MEETING 2016 Himangi Kaushal, M.D., F.A.C.P. Program Director Memorial Healthcare System Internal Medicine Residency DISCLOSURES None OBJECTIVES Review some
Vitals HR 90 BP 125/58 Tmax 98.7F O2 Sat 97% on NC 2L/min BMP SCr 1.78 K 3.9 Gluc 194 A1c 7.5 Cardiac LVEF 55% NTproBNP 9,200 Troponin 0.
ALDOSTERONE ANTAGONIST IN HEART FAILURE WITH PRESERVED EJECTION FRACTION ABBREVIATIONS BMP: basic metabolic panel HPI: history of present illness CAD: coronary artery disease HR: heart rate PINHUI (JUDY)
Coding Hints 2 nd Edition
Coding Hints 2 nd Edition Medicare s guidelines state, Code all documented conditions which co-exist at the time of the visit that require or affect patient care or treatment. Beyond the Basics Incomplete
The Cat Story : Building the Cardiac Patient Relationship from Admission to Rehabilitation
The Cat Story : Building the Cardiac Patient Relationship from Admission to Rehabilitation Nina Swan, MSN, RN, CMSRN, CNL 2015 Cardiovascular Forum Statesville Civic Center April 29, 2015 Disclosure: I
Mayo Clinic Physician Assistant Board Review
PHARMACOLOGY CONTENT Mayo Clinic Physician Assistant Board Review Select presentations will contain pharmacology content as noted in the program. Identified presentations represent approximately 11.75
Best Practices in Acute Care Precepting at the Sharp Chula Vista Medical Center Medicine Rotation
Best Practices in Acute Care Precepting at the Sharp Chula Vista Medical Center Medicine Rotation Pratima Patel, PharmD Clinical Pharmacist Medicine Rotation Preceptor Sharp Chula Vista Medical Center
Diagnosis Coding. Tips, Guidelines & Common Errors. Amy Jack, Risk Adjustment Coding Auditor, RHIT, CCA, CRC
Diagnosis Coding Tips, Guidelines & Common Errors Amy Jack, Risk Adjustment Coding Auditor, RHIT, CCA, CRC Medical Coding Why is Diagnosis Coding Important? Protect Patient Health Ensure Quality Patient
2015 Behavioral Medicine Resident Chart Documentation. Laura Sullivan, MSW, CPC Compliance Auditor
2015 Behavioral Medicine Resident Chart Documentation Laura Sullivan, MSW, CPC Compliance Auditor 1 Legal Stuff The information provided here is being provided by a nonlawyer and should not be construed
2016 Behavioral Medicine Resident Chart Documentation. Laura Sullivan, MSW, CPC Compliance Auditor
2016 Behavioral Medicine Resident Chart Documentation Laura Sullivan, MSW, CPC Compliance Auditor 1 Legal Stuff The information provided here is being provided by a nonlawyer and should not be construed
Evaluation and Management Services
Advanced E/M Auditing Evaluation and Management Services Disclaimer area Evaluation and Management Services History Exam Medical Decision Making Select the E/M Code Subjective portion of the visit where
9/15/2017. Joyce Turner RN Director of Clinical Program Development
Joyce Turner RN Director of Clinical Program Development A toxic response to an infection that spirals out of control attacking the body s own organs and tissues. The infection can be bacterial, viral
Augmented Renal Clearance: Let s Get the Discussion Flowing
Augmented Renal Clearance: Let s Get the Discussion Flowing Terry Makhoul, PharmD PGY-2 Emergency Medicine Pharmacy Resident University of Rochester Medical Center Strong Memorial Hospital Disclosures
3 rd Year Tips. Adam and Mandy Gleason
3 rd Year Tips Adam and Mandy Gleason Typical Day on the Floor Pre-Rounding When starting a rotation, give yourself at least 45 min - 1 hour per patient, before the start of rounding adjust time as needed
Medical Treatment for acute Decompensated Heart Failure. Vlasis Ninios Cardiologist St. Luke s s Hospital Thessaloniki 2011
Medical Treatment for acute Decompensated Heart Failure Vlasis Ninios Cardiologist St. Luke s s Hospital Thessaloniki 2011 2010 HFSA guidelines for ADHF 2009 focused update of the 2005 American College
Just Clear Them The Approach to Medical Clearance
Just Clear Them The Approach to Medical Clearance Dr. Nalin Ahluwalia MD CCFP(EM) Associate Chief of Staff Emergency Physician Oakville Trafalgar Memorial Hospital My Disclosures None! Exemplary patient
Atrial Fibrillation is Common. The (S)Low-down on Rapid Afib Resuscitation Step ED Dx - Rx 4/4/2017. There Are 5 Causes of Atrial Fibrillation
The (S)Low-down on Rapid Afib Resuscitation 2017 Corey M. Slovis, M.D. Vanderbilt University Medical Center Metro Nashville Fire Department Nashville International Airport Nashville, TN Atrial Fibrillation
PLANNING/IMPLEMENTATION/EVALUATION Pt. Room: 2A (Include a RUBRIC for each)
PLANNING/IMPLEMENTATION/EVALUATION Pt. Room: 2A (Include a RUBRIC for each) Nursing Diagnosis Risk for decreased cardiac output r/t altered stroke volume secondary to sepsis. Long Term Goal Pt. will maintain
When is Limb Edema Not Heart Failure
When is Limb Edema Not Heart Failure An Approach to the Swollen Leg Greg Harding M.D. Vascular Surgeon Faculty/Presenter Disclosure Faculty: Greg Harding M.D. Relationships with commercial interests: None
58 Year-old Male with Alcoholic Cirrhosis Presents with Hyponatremia. Jess Hwang 11/8/12
58 Year-old Male with Alcoholic Cirrhosis Presents with Hyponatremia Jess Hwang 11/8/12 HPI Fluid leaking from umbilical hernia secondary to his ascites Went to OR for drain placement which was complicated
Topic: Chronic Heart Failure Cases for Monday s March 21th lecture.
1 Phar6122: CV section Date: 3/10/05 Topic: Chronic Heart Failure Cases for Monday s March 21th lecture. Directions: This handout includes three chronic heart failure cases of increasing difficulty. In
Who Needs Admission and Who can go home?
Who Needs Admission and Who can go home? Where is the presentation (clinic or ER)? Time of onset/duration Can symptoms be relieved? Stroke risk reduction Can adequate heart rate control be achieved? Is
PRE-OP H&P S: WHAT REALLY MATTERS
1 2 PRE-OP H&P S: WHAT REALLY MATTERS Jenikka Soyring, DNP Why Pre-op Assessments Reduce risk for cardiac, pulmonary and infectious complications Not meant to clear for surgery It is to evaluate and implement
ACOFP 55th Annual Convention & Scientific Seminars. How Complicated is Your Panel? Effective Risk Coding in Primary Care. Alison Mancuso, DO, FACOFP
8 ACOFP 55th Annual Convention & Scientific Seminars How Complicated is Your Panel? Effective Risk Coding in Primary Care Alison Mancuso, DO, FACOFP How Complicated is Your Panel?: Effective Risk Coding
Atrial fibrillation in the ICU
Atrial fibrillation in the ICU Atrial fibrillation Preexisting or incident (new onset) among nearly one in three critically ill patients Formation of arrhythogenic substrate usually fibrosis (CHF, hypertension,
CODING REVIEW FOR ACCESS2MD PROVIDERS
CODING REVIEW FOR ACCESS2MD PROVIDERS May 27, 2015 Tricia Stanley, DNP, RN, ANP-BC, FNP-BC TYPES OF CODES CPT What was done during the visit Two Types CPT Evaluation and Management ICD Why it was done
ICD-10 Physician Education. Palliative Care SIP
ICD-10 Physician Education Palliative Care SIP 1 Training Objectives ICD-9 to ICD-10 Comparison Documentation Tips Additional Educational Opportunities Questions 2 ICD-9 to ICD-10 Comparison Code Structure
NITROGLYCERIN A NEW LOOK FOR AN OLD FRIEND. Casey Patrick MD Jordan Anderson LP, CCP-C Texas EMS November 19, 2018
NITROGLYCERIN A NEW LOOK FOR AN OLD FRIEND Casey Patrick MD Jordan Anderson LP, CCP-C Texas EMS November 19, 2018 OBJECTIVES Review pathophysiology of CHF Differentiate between acute pulmonary edema (APE),
By Kevin Solinsky, CPC, CPC-I, CEDC, CEMC
By Kevin Solinsky, CPC, CPC-I, CEDC, CEMC Learn components of the ED E&M Medical Necessity vs MDM Critical Care coding Procedure coding Orthopedic coding Emergency Room Services 99281 99285 Critical Care
Acute Valve Regurgitation Catherine M. Otto, MD J. Ward Kennedy-Hamilton Endowed Chair in Cardiology University of Washington, Seattle
Acute Valve Regurgitation Catherine M. Otto, MD J. Ward Kennedy-Hamilton Endowed Chair in Cardiology University of Washington, Seattle No conflicts of interest Acute Aortic Regurgitation Causes aortic
Use of Anticoagulants in Geriatrics: Current Evidence and Special Considerations
Use of Anticoagulants in Geriatrics: Current Evidence and Special Considerations Aryn You, PharmD Assistant Professor, Pharmacy Practice The Daniel K. Inouye College of Pharmacy Aida Wen, MD Associate
What is sepsis? RECOGNITION. Sepsis I Know It When I See It 9/21/2017
Sepsis I Know It When I See It September 15, 2017 Matthew Exline, MD MPH Medical Director, Medical ICU What is sepsis? I shall not today attempt further to define the kinds of material [b]ut I know it
Coding Chronic Conditions
Coding Chronic Conditions Presented by Brenda Edwards, CPC, CPB, CPMA, CPC-I, CEMC, CRC Copyright 2016 AAPC Fair Warning! 1 Objectives To learn and have fun To share your knowledge To communicate effectively
ICD-10CM, HCC and Risk Adjustment Factor
ICD-10CM, HCC and Risk Adjustment Factor Not everyone is aware of what CMs calls the risk adjustment model. It was developed under the Patient Protection and Affordable Care Act (also known as the PACA)
8:30-10:30 WS #4: Cardiology :00-13:00 WS #11: Cardiology 101 (Repeated)
Professor Ralph Stewart Cardiologist Auckland City Hospital Green Lane Cardiovascular Research Unit Auckland Heart Group Fiona Stewart Cardiologist Green Lane Hospital National Women's Hospital Professor
Nuts for Neuro and why I hate EMR
Nuts for Neuro and why I hate EMR Roberta S Rose, DO private practice in General neurology Staff physician: IRMC and SRMC I have no disclosures, I m just a working stiff Stroke overview: 2018 Guidelines
Coding Chronic Conditions
Coding Chronic Conditions Presented by Brenda Edwards, CPC, CPB, CPMA, CPC-I, CEMC, CRC Senior Consulting Manager of Risk Adjustment Disclaimer The speaker has no financial relationship to any products
Family Centered Pediatric Emergency Department Sickle Cell Assessment of Needs and Strengths (FC-Peds-ED-SCANS) Overall Algorithm
Family Centered Pediatric Emergency Department Sickle Cell Assessment of Needs and Strengths (FC-Peds-ED-SCANS) Overall Algorithm Decision 1: Triage Decision 2: Analgesic Management Decision 3: Diagnostic
5AB Dysrhythmia Interpretation and Management 2016
5AB Dysrhythmia Interpretation and Management 2016 How to complete your biennial ECG review: A website has been created that contains the basic review information. Use this as a reference during your review.
TACO CASE STUDIES RTC JUNE Kerry Dowling Blood Transfusion Laboratory Manager Jonathan Ricks Blood Transfusion Nurse Practitioner
TACO CASE STUDIES RTC JUNE 2017 Kerry Dowling Blood Transfusion Laboratory Manager Jonathan Ricks Blood Transfusion Nurse Practitioner RISK FACTORS - TACO Age over 70 years although also seen in younger
InterQual Acute Criteria: Demonstration of Condition Specific Subsets
InterQual Acute Criteria: Demonstration of Condition Specific Subsets February 24, 2011 Today s Presenters Lollie Dubiel, RN, BSN Sr. Product Manager McKesson Laura McIntire, RN, BSN, MA Clinical Lead
76 year-old female presents with muscle cramps. Jess Hwang 12/6/12
76 year-old female presents with muscle cramps Jess Hwang 12/6/12 HPI Worked up for outpatient hypercalcemia Calcium had been 10.3-11.1, PTH ~120 No h/o osteoporosis, CKD, kidney stones Not taking calcium
Severe β-lactam allergy. Alternative (use for mild-moderate β-lactam allergy) therapy
Recommended Empirical Antibiotic Regimens for MICU Patients Notes: The antibiotic regimens shown are general guidelines and should not replace clinical judgment. Always assess for antibiotic allergies.
PEDIATRIC RESPIRATORY ILLNESS MADE SIMPLE
Copyright 2012 Joel Berezow, MD and The Pediatrics for Emergency Physicians Network All rights reserved. Duplication in whole or in part, or electronic transmission in any form, is prohibited THE PEDIATRICS
Dilemmas in Septic Shock
Dilemmas in Septic Shock William Janssen, M.D. Assistant Professor of Medicine National Jewish Health University of Colorado Denver Health Sciences Center A 62 year-old female presents to the ED with fever,
Observation Medicine The Inpatient Fast Track Kirk Jensen, MD, MBA, FACEP Jody Crane, MD, MBA, FACEP
These presenters have nothing to disclose Observation Medicine The Inpatient Fast Track Kirk Jensen, MD, MBA, FACEP Jody Crane, MD, MBA, FACEP April 29, 2015 Cambridge, MA Session Objectives 2 After this
Case Study #2. Case Study #1 cont 9/28/2011. CAPA 2011 Christy Wilson PA C. LH is 78 yowf with PMHx of metz breast CA presents
Case Study #1 CAPA 2011 Christy Wilson PA C 46 yo female presents with community acquired PNA (CAP). Her condition worsened and she was transferred to the ICU and placed on mechanical ventilation. Describe
Charles Krasner, M.D. University of NV, Reno School of Medicine Sierra NV Veterans Affairs Medical Center
Charles Krasner, M.D. University of NV, Reno School of Medicine Sierra NV Veterans Affairs Medical Center Kathy Peters is a 63 y.o. patient that presents to your urgent care office today with a history
Learning Objectives. Guidance Hierarchy. AHA Coding Clinic Update
1 AHA Coding Clinic Update Nelly Leon Chisen, RHIA Director, Coding and Classification Executive Editor, Coding Clinic American Hospital Association Chicago, IL Learning Objectives At the completion of
Update in Hospital Medicine. Disclosures 10/30/2017. none Oregon Chapter ACP Scientific Meeting
Update in Hospital Medicine 2017 Oregon Chapter ACP Scientific Meeting DATE: November 4, 2017 PRESENTED BY: Joel Papak, MD FACP Disclosures none 1 How well do you think you keep up with the medical literature?
2015 HCPro, a division of BLR. All rights reserved. These materials may not be duplicated without express written permission.
Diagnostic Criteria 101: Criteria to Diagnose 15 Common Hospital Medicine Diagnoses Timothy N. Brundage, MD, CCDS Medical Director Brundage Medical Group, LLC Redington Beach, Florida 2 Learning Objectives
Case Discussion. 18 th Annual UCSD Heart Failure Symposium
Case Discussion 18 th Annual UCSD Heart Failure Symposium In your office today is a returning patient and an eager-to-please 3 rd year medical student. You review HF s history as the student is in the
Hand-Carried Ultrasound Performed by a Hospitalist to Assist with Clinical Decisions in Medicine Inpatients: a Case Series
Hand-Carried Ultrasound Performed by a Hospitalist to Assist with Clinical Decisions in Medicine Inpatients: a Case Series Stefan Tchernodrinski, MD Cook County Hospital Chicago, Illinois Introduction
SECTION I: ACTIVE DIAGNOSES. Active Diagnoses in the Last 7 Days
SECTION I: ACTIVE DIAGNOSES Intent: The items in this section are intended to code diseases that have a relationship to the resident s current functional status, cognitive status, mood or behavior status,
Core Content In Urgent Care Medicine Release Date: December 1, 2009 Review Date: January 31, 2011 Expiration Date: November 30, 2014
Posttest and CME Instructions To receive a statement of credit for CME you must: 1. Print out the handouts and posttest files prior to reviewing the presentations. You can find the handouts by clicking
HIP ATTACK Trial: Can we improve outcomes after a hip fracture with accelerated surgery? PJ Devereaux, MD, PhD
HIP ATTACK Trial: Can we improve outcomes after a hip fracture with accelerated surgery? PJ Devereaux, MD, PhD Disclosure Member of research group with policy of not accepting honorariums or other payments
How did I decide on the topics?
Disclosures None How did I decide on the topics? Important papers within 1 year vs topics of importance or innovation/aha moments Sepsis Atrial Fibrillation Pneumonia Procalcitonin Objectives By the end
Community Acquired Pneumonia. Abdullah Alharbi, MD, FCCP
Community Acquired Pneumonia Abdullah Alharbi, MD, FCCP A 68 y/ male presented to the ED with SOB and productive coughing for 2 days. Reports poor oral intake since onset due to nausea and intermittent
Frank Sebat, MD - June 29, 2006
Types of Shock Hypovolemic Shock Low blood volume decreasing cardiac output. AN INTEGRATED SYSTEM OF CARE FOR PATIENTS AT RISK SHOCK TEAM and RAPID RESPONSE TEAM Septic or Distributive Shock Decrease in
CAP, HCAP, HAP, VAP. 1. In 1898, William Osler described community-acquired pneumonia as:
1. In 1898, William Osler described community-acquired pneumonia as: Brad Sharpe, M.D. Professor of Clinical Medicine Department of Medicine UCSF sharpeb@medicine.ucsf.edu I have no relevant financial
Intro to Observation Medicine
Philip A. Lewalski, M.D., F.A.C.E.P. Director of Observation Services Assistant Professor Department of Emergency Medicine Wayne State University School of Medicine Detroit Receiving Hospital Unique Perspective
Aspiration pneumonia in older people
Aspiration pneumonia in older people Ayman Morish, M.D. Internal medicine, Critical care Medicine and Geriatrics Fellow. Contents Epidemiology Causes of aspiration pneumonia Issues of older age Management
Objectives. Let s start at the beginning 10/28/2014. What is Heart Failure? Understanding Heart Failure with Preserved LV Systolic Function
Understanding Heart Failure with Preserved LV Systolic Function Eric Ernst, MD Medical Director C.O.R.E. Clinic Objectives Clarify the terminology surrounding right heart failure and diastolic heart failure
CONSULTATION REFRESHER
060310 BLAST CONSULTATION REFRESHER We have had many requests from clients recently asking how to correctly code Medicare consultations utilizing the new CMS requirements. Attached is a mini refresher
Sepsis in primary care. Sarah Bailey, Emma Evans, Nicola Shoebridge, Fiona Wells
Sepsis in primary care Sarah Bailey, Emma Evans, Nicola Shoebridge, Fiona Wells sepsisnurses@uhcw.nhs.uk Quiz!! OR Hands on your heads Hands on your hips Definition. The Third International Consensus Definition
Case 1: 24 yo pregnant female presenting with abnormal TFTs and tachycardia RAJESH JAIN ENDORAMA 3/16/2017
Case 1: 24 yo pregnant female presenting with abnormal TFTs and tachycardia RAJESH JAIN ENDORAMA 3/16/2017 Chief Complaint The ER calls about a 24 year old, 12 weeks pregnant. She presented with tachycardia
Case Presentation: Mr. S
Case Presentation: Mr. S History Seen as inpatient in May, but has significant prior history and is a poor historian 53 y.o. Male no PMH, has been out of contact with medicine for years aside from hernia
RESPIRATORY FAILURE - CAUSES, CLINICAL INFORMATION, TREATMENT AND CODING CONVENTIONS
RESPIRATORY FAILURE - CAUSES, CLINICAL INFORMATION, TREATMENT AND CODING CONVENTIONS QUIZ REVIEW The correct answer is in bold font. 1. Hypoxic respiratory failure involves: a. Low oxygen b. High oxygen
CAN T MISS ECG FINDINGS L. THOMAS RICHARDS, MD ASSISTANT PROFESSOR OF EMERGENCY MEDICINE
Topics in Emergency Medicine 2010 CAN T MISS ECG FINDINGS L. THOMAS RICHARDS, MD ASSISTANT PROFESSOR OF EMERGENCY MEDICINE OBJECTIVES Examine three common presentations to the ED which compel the EM provider
Atrial Fibrillation and the NOAC s. John Raymond MS, PA-C, MHP February 10, 2018
Atrial Fibrillation and the NOAC s John Raymond MS, PA-C, MHP February 10, 2018 Pathogenesis EPIDEMIOLOGY Arrhythmia-related hospitalisations in the US Ventricular fibrillation 2% Atrial fibrillation 34%
Kohlman Evaluation of Living Skills (KELS) of the Hospitalized Patient. Family Medicine Residency Program at Wesley. Objectives
Kohlman Evaluation of Living Skills (KELS) of the Hospitalized Patient Jonathan Baalman, MD Family Medicine Residency Program at Wesley 1 Objectives Identify the use of KELS Explain the elements evaluated
It is for this reason that we have upgraded our HPI button for the review of chronic conditions.
Chronic Conditions The chronic condition review has changed. On the Master GP template the chronic conditions are listed in the first column. Beside the list of Chronic Conditions there are a number of
A walk through a STEMI
A walk through a STEMI M.M. s Story Kim Robison Ashley Corcoran Situation M.M. is an 82 year old male brought in by private vehicle on 10/22/17 to the Emergency Department Pt. c/o left arm numbness, pain
ALL BLEEDING STOPS EVENTUALLY! PATRICK C. CULLINAN, DO FCCM, FACOI, FACOEP SAN ANTONIO, TX
ALL BLEEDING STOPS EVENTUALLY! PATRICK C. CULLINAN, DO FCCM, FACOI, FACOEP SAN ANTONIO, TX NO DISCLOSURES! OBJECTIVES Discuss different types of DOACs Discuss the pharmacokinetics of the DOACs Discuss