ED Management 2008-11-01

Measles patient ordered into isolation, but remains in the ED for 12 hours

This was the stuff of an ED manager's nightmare: A 36-year-old woman with measles, thought to be the source of an eventual outbreak of measles in February 2008, was kept in the ED of Northwest Medical Center in Tucson, AZ, for more than 12 hours after a physician had ordered that she be placed in isolation.

Revisit your process for infectious diseases

Recently, a patient at Northwest Medical Center in Tucson, AZ, was diagnosed with measles and ordered into isolation by her physician, but remained unisolated in the ED for more than 12 hours.

Experienced coders help ED create excellence

(Editor's note: This is the third in a three-part series on innovative approaches to documentation that can significantly enhance your department's revenues without making any changes in patient flow and throughput processes. This article discusses the use of experienced coders and improved documentation. In the previous two articles, we discussed effective documentation tools, proper staffing to optimize their use, and incentive programs for improved documentation.)

ED Coding Update: Coding for critical care: Timing is everything

[Editor's note: With this issue, we begin a quarterly column on coding in the ED by Caral Edelberg, president of Edelberg Compliance Associates. If there are coding issues you would like to see addressed in this column, contact: Caral Edelberg, CPC, CCS-P, CHC, Edelberg Compliance Associates, Baton Rouge, LA. Phone: (225) 454-0154. EFAX Number: (225) 612-6904.]

Emtala Q & A: New on-call options: CMS rejects EMTALA expansion

[Editor's note: This column addresses readers' questions about the Emergency Medical Treatment and Labor Act (EMTALA). If you have a question you'd like answered, contact Steve Lewis, Editor, ED Management, Atlanta. Phone: (770) 442-9805. Fax: (770) 664-8557. E-mail: [email protected].]

When can staff divulge patient's HIV status?

A man with chest pain tells your ED physician that he uses cocaine and is HIV-positive, then asks the physician not to tell his girlfriend who is about to enter the room.

Warn patients of specific risks

ED physicians should not disclose a patient's HIV status, except when there is a legal mandate to do so and even in this case, this is preferably done through a third party, such as a public health official, advises Matthew Rice, MD, JD, FACEP, an ED physician with Northwest Emergency Physicians of TEAMHealth in Federal Way, WA.

What if HIPAA conflicts with your state's law?

According to Jill M. Steinberg, a health care attorney with Baker Donelson in Memphis, TN, the Health Insurance Portability and Accountability Act (HIPAA) would prevent an ED physician from discussing a patient's HIV status with any other person, even if that person could be potentially exposed to an infectious disease.

Patients accessing records: Liability for the ED staff?

A growing number of hospitals are allowing patients to view their own medical records electronically. Does this increase liability risks for emergency staff?

When the patient disagrees with the ED record

What should be done if the ED patient disagrees with what is documented or perceives that the record is incomplete?

OIG says no problem with patient gift cards

If you want to give patients gift cards as a way to say "sorry" for that long wait in the ED or anything else that left them unhappy feel free. The government says you're not violating any prohibitions on improper remuneration.

ED Accreditation Update: The Joint Commission challenges facilities to improve staff flu immunization rates

Joint Commission Resources (JCR) has launched a "Flu Vaccination Challenge" to underscore the responsibility that hospitals have to help keep their employees and patients healthy this flu season and to increase flu vaccination rates among health care workers.

ED Accreditation Update: Convenience, accessibility boost vaccination rates

One way to get your staff flu vaccination rates higher is to make it as easy as possible for them to obtain a vaccination, says David Ross, DO, an emergency physician at Penrose Hospital in Colorado Springs, CO. Ross says his hospital's staff vaccination rate has risen from 63% to 73% in the past year.

ED Accreditation Update: Mandatory immunizations: Do they make any sense?

In light of the importance of having health care workers immunized against influenza, some facilities have instituted mandatory vaccination programs.

ED Accreditation Update: Newly OK'd test detects seasonal, novel flu viruses

The Food and Drug Administration has approved a new test to diagnose human flu infections, including the avian flu virus (H5N1), which scientists fear could cause a pandemic.

ED Accreditation Update: New scoring process: 'quality, not quantity'

The Joint Commission has released a statement that effective Jan. 1, 2009, there will be new simplified scoring and decision processes for all accreditation and certification programs that "better reflect an organization's performance regarding compliance with Joint Commission standards and elements of performance [EPs]."