Use of Health Information Technology to Manage Frequently Presenting Emergency Department Patients

From Medscape (free subscription required):

Objective: To determine if the effective use of Health Information Technologies (HIT) and the Electronic Medical Record (EMR) affects emergency department (ED) usage in a complicated frequently presenting patient population.
Methods: A retrospective, observational study of 45 patients enrolled in our Frequent User Program called Community Resources for Emergency Department Overuse (CREDO) between June 2005 and July 2007. The study was conducted at an urban hospital with greater than 95,000 annual visits. Patients served as their own historical controls. In this pre-post study, the pre-intervention control period was determined by the number of months the patient had been enrolled in the program. The pre- and post-intervention time periods were the same for each patient but varied between patients. The intervention included using HIT to identify the most frequently presenting patients and creating individualized care plans for those patients. The care plans were made available through the EMR to all healthcare providers. Study variables in this study intervention included ED charges, lab studies ordered, number of ED visits, length of stay (LOS), and Total Emergency Department Contact Time (TEDCT), which is the product of the number of visits and the LOS. We analyzed these variables using paired T-tests. This study was approved by the institutional review board.
Results: Forty-five patients were enrolled, but nine were excluded for no post enrollment visits; thus, statistical analysis was conducted with n=36. The ED charges decreased by 24% from $64,721 to $49,208 (p=0.049). The number of lab studies ordered decreased by 28% from 1847 to 1328 (p=0.04). The average number of ED visits/patient decreased by 25% from 67.4 to 50.5 (p=0.046). The TEDCT decreased by 39% from 443.7 hours to 270.6 hours (p=0.003).
Conclusion: In this pre-post analysis of an intervention targeting ED frequent users, the use of HIT and the EMR to identify patients and store easily accessible care plans significantly reduced ED charges, labs ordered, number of ED visits, and the TEDCT.

Medical necessity, not patient convenience, should drive inpatient stay, CMS warns

From Fierce Healthcare:

The perennial issue of medical necessity makes a grand appearance in recent CMS guidance you may have missed.

The agency sends a clear message: A patient’s convenience or personal needs should not factor into a decision to admit him or her for an inpatient stay. It’s a mistake that your friendly Recovery Audit Contractor will be on the lookout for – and which could earn you a retrospective payment denial.

Bulgarian Doctor Fired for Confusing Stroke with Flu

From Novinite:

A Bulgarian doctor from the Sofia emergency room is going to be fired one day after he confused symptoms of stroke and flu.

The Head of the Emergency Care Unit at the Bulgarian Health Ministry, Dr. Georgi Gelev, has conducted a probe in the case, after being alarmed by Darik radio.

Dr. Georgi Hadzhinedelchev will be terminated on the grounds of being reckless when fulfilling his duties.

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