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It will be several years before the Centers for Medi-care & Medicaid Services (CMS) will require hospitals to use the Continuity Assessment Record and Evaluation (CARE) tool, but hospital case managers can start now to prepare for its implementation and to give CMS feedback on the tool and its use in various settings.
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In its proposed rule for the Outpatient Prospective Payment System, issued July 3, 2008, the Centers for Medicare & Medicaid Services (CMS) continued its efforts to tie reimbursement to quality of services, adding four new outpatient quality measures that hospitals must report on and asking for public comments on an additional 18 measures being considered for future years.
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Faced with an increase in emergency department visits and a rising inpatient census, the chief executive officers at Massachusetts General Hospital in Boston made ED overcrowding a major quality and safety initiative of the hospital starting in 2006 and took a systemwide approach to addressing the problem.
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An outpatient surgery patient shows up with-out an escort to drive him home. Despite the nurse's insistence, the patient indicates he doesn't have anyone who can escort him. There is no cab or public transportation available. Reluctantly, the case continues, and the patient drives himself home.
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Once a patient with violence-related traumatic injuries is stable and about to be discharged, you have to consider something equally important: Will he or she be safe after leaving your ED?
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A patient assessment tool being tested in a Medicare demonstration project is intended to standardize the information providers share as patients transition from one level of care to another.
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A collaborative effort between Boston's Massachusetts General Hospital emergency department staff and the health system's post-acute facilities and home care agency moves patients out of the ED and directly into post-acute care, freeing up beds and improving patient throughput.
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As part of its patient throughput initiative, Spartanburg (SC) Regional Health System set a goal of discharging 80% of patients by 2 p.m. and is conducting a series of Lean Six Sigma projects in an effort to reach that goal.
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Two cases from the Canadian Medical Protective Association, a mutual defense organization for 95% of Canadian physicians, illustrate the danger of patients driving home after ambulatory surgery:
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A simple fall in a healthy person shouldn't result in multiple facial injuries, except if the patient was intoxicated, says Regina Curry, RN, an ED nurse at Thomas Jefferson University Hospital in Philadelphia. Instead, patients might break their wrist or skin their knees and hands from trying to break the fall, she says.
