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Most of us dread the chief complaint of weakness. This nonspecific symptom engenders a differential that ranges from malingering to fatal, from psychiatric to cancer. The finding of demonstrable muscle weakness helps, but then leads to a confusing set of relatively rare diagnoses.
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Faced with an increasing number of patients in observation status, Brandon (FL) Regional Hospital began an observation management process that resulted in a 16% decrease in observation patients and a 27% drop in observation length of stay in just one year.
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The Centers for Medicare & Medicaid Services (CMS) has proposed significant expansion in hospital quality reporting requirements, including adding 46 new quality measures for which hospitals must submit data over the next two years, and increasing the number of hospital-acquired conditions for which Medicare won't reimburse.
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Gilbert (AZ) Hospital has one of the busiest emergency departments in the area and an average ED waiting time of less than 12 minutes.
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An elderly woman tells ED triage nurses she's had an excruciating, unrelenting headache for the past two days. She has a steady gait.
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If you assume that patients complaining of headache are nontherapeutic medication seekers or chronic complainers, you risk undertriaging these patients, warns Rebekah Child, RN, MSN, CEN, CNIV, an ED nurse at Cedars-Sinai Medical Center in Los Angeles.
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Deciding whether patients should be in observation or inpatient status always has been a challenge for hospitals and now that the Centers for Medicare & Medicaid Services (CMS) has embarked on a nationwide program to audit for overpayment, placing patients in the correct status is more critical than ever.
