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| PetrackConsulting.com | ||
 Fall, 2008 Volume 6, Issue 4
New: Dr. Petrack quoted in recent Business Network article on appreciative inquiry in emergency medicine.
For free articles, abstracts, Emergency Care Briefs, and more, visit our Resource Center at PetrackConsulting.com...
New, revised CalmerKids Training Module! Get a new low price, plus become CalmerKids Certified when training is complete. Show me... |
Consultant's Corner Emory Petrack, MD, FAAP, FACEP
Do you find, as I do, that you need to review medical records quite frequently? Like many of you, our ED receives the occasional patient complaint, which means we need to review the ED record. I also review charts from a wide cross-section of emergency departments across the country as part of my medical-legal consulting work.
While the quality of documentation varies tremendously from institution to institution and among physician and nursing staff, I've noticed two common threads: 1) documentation is frequently less than optimal, and 2) many departments still use handwritten charts. Both of these issues are problematic on many levels; both are the topics of discussion for today.
Feature Article Charting for Trouble
Medical records are critically important for several reasons. First and foremost, they are essential for good patient care. You've likely experienced a return patient visit within days of an initial ED visit. The physician and nurses caring for the patient at the initial visit may not be present. Aside from the patient's current history, the chart provides a link to what really happened during that first encounter. If the patient is alone and has an altered level of consciousness, the chart may be the only link we have.
Second, the medical record is also essential from a quality improvement perspective. Having identified a potential clinical concern, we may want to retrospectively review charts to improve care in the department. Handling patient complaints well requires clear documentation of events and times; medical-legal issues require similar, excellent documentation. Unfortunately, critical and basic elements of the medical record are often missing: like what happened, who was involved, and times of consults and tests.
Unless we want to be charting for trouble, we simply must do better in the area of documentation. We owe it to ourselves, to our organizations and to our patients. Consider these suggestions for your department or center:
In the News
Quote of the Month
New Articles/Abstracts
Brief summary of recent new articles and abstracts from http://www.PetrackConsulting.com/articles.html
The number of ED visits has increased 28% between 1992 and 2005, and the current trend continues upward. These investigators looked at several parameters from 1996 to 2004, using the national Community Tracking Study Household Surveys. The proportion of adult ED visits by persons without insurance was stable over the study period, ranging from 14.5% to 16.1%.The proportion of visits by persons with family income greater than 400% of the federal poverty level increased from 21.9% to 29% (p=.002). The proportion of visits by those whose usual source of care was a physician’s office increased from 52.4% to 59% (p=.002). They conclude that the increase in ED visits cannot be primarily attributed to the uninsured, and that a major contribution to the increase is from ED use by nonpoor persons and those whose usual source of care is a physician’s office.
These authors conducted a PubMed search to identify research related to ED crowding, grading the methodology for each study. 93 articles met their inclusion criteria, which focused on crowding causes, effects and solutions. The methods and results for each high quality study are summarized. This is an excellent reference article for those interested in addressing the issues and challenges surrounding overcrowding in EDs.
Upcoming Meetings
Oct 11-14, 2008, American Academy of Pediatrics, Annual Meeting, Boston, MA
Oct 27-30, 2008, American College of Emergency Physicians, Annual Meeting, Chicago, IL
March 4-9, 2009, Emergency Nurses Association, Leadership Conference, Reno, NV About Our Organization
Created in 2003, Petrack Consulting is dedicated to helping physician and hospital
leadership bring excellence to emergency services. We work collaboratively to
fully understand our client's needs, and then address programmatic initiatives
with measurable outcomes. Our unique background in emergency medicine, administrative
medicine, and organization development allows us to create uniquely effective solutions
for enhancing emergency services.
Website: http://www.PetrackConsulting.com |
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