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The Centers for Medicare & Medicaid Services (CMS) has implemented the new $1 billion program for emergency health services furnished to undocumented aliens.
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It began with the Joint Commission on Accreditation of Healthcare Organizations issuing formal warnings about people posing as surveyors to gain access to health care facilities. However, they may have been only a small piece of the problem. ED Management has learned of more than a dozen such incidents several involving EDs in which individuals claiming to be Joint Commission surveyors, physicians, or members of government agencies presented themselves at hospitals and began asking probing questions about areas such as staffing and bed capacity.
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Among the more challenging issues facing ED managers are those where there are no universal rules governing policies and procedures at least none that are clearly spelled out by nationwide organizations such as the Joint Commission on Accreditation of Healthcare Organizations or the Centers for Medicare & Medicaid Services.
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I am a chairman in an ED, and this case recently occurred: A man came to the ED after cutting his flexor tendon at home. He had 100% flexor cut on his nondominant hand. He also was experiencing a loss of sensation around the ulnar aspect of the affected index finger.
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One of the most common manifestations of disease, fever in children remains controversial, misunderstood, and often is thought to be mysterious. The clinician always should realize that fever is not a disease itself, but a manifestation of a number of different disease processes. Because there are substantial differences in the cause and outcome of fever-generating illnesses in children of different ages, the discussion must consider age. Not surprisingly, there is a diversity of approaches to fever.
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As medical practitioners mature with experience, many discover that what was taught in medical school — History is the most important part of the patient encounter — is actually true. Yet, taking a history is a practiced skill even for the examiner who speaks the same language as the patient. The problems encountered with taking a history from a patient are compounded exponentially when the examiner and the patient are not skilled in speaking the same language. In this issue, the author explores numerous facets of caring for patients who speak a language other than the physician’s language.
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The emergency department physician is continually challenged to identify children who may have sustained an injury secondary to abuse. Reaching a balance between protecting a child from possible harm and putting a family through the ordeal of an unwarranted investigation is challenging. This article reviews the common patterns of injury that should raise concern for abuse.
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Acute renal failure, characterized by sudden loss of the ability of the kidneys to excrete waste, concentrate urine, conserve electrolytes, and maintain fluid balance, is a frequent clinical problem.
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In this study from Rush University Medical Center in Chicago, Duckro and colleagues carried out a careful molecular epidemiologic study of the transmission of vancomycin-resistant enterococci (VRE) to the hands of health care workers from both intact skin areas of VRE-colonizes patients and various environ mental surfaces in the patients vicinity.
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Leonard and colleagues reviewed all the sputum specimens obtained to test for tuberculosis for nearly 4 years in a large public teaching hospital. Sensitivities of first, second, and third acid-fast bacilli (AFB) smears were calculated overall and also separately for HIV-negative and HIV-positive patients.
