The author, JC Gerancher MD discusses the principals that add value to an electronic (EHR) or paper regional anesthesia note. See also:
http://www.raadvantages.com/wp-content/uploads/Helping-Patients-Understand.pdf
Primary care clinics-managing physician patient panelsAlexander Kolker
OUTLINE
• Traditional scheduling and the advanced
access at a primary care clinic
• Uncertainties that should be considered when
patients are scheduled
• Decisions that need to be made for designing an
appointment system
• Practice on using the panel size calculator
•Emerging Trends in Primary Care:
Local anesthetics work by blocking sodium channels in nerve fibers, preventing the generation of action potentials and conduction of nerve impulses. They typically contain a hydrophilic amine group, hydrophobic aromatic moiety, and intermediate ester or amide linkage. Esters are metabolized rapidly by plasma esterases while amides are metabolized more slowly by the liver. Common uses of local anesthetics include minor surgery, dental procedures, nerve blocks, epidurals and caudals. Adverse effects can include central nervous system toxicity, cardiac issues like arrhythmias or hypotension, and allergic reactions. Chloroprocaine and lidocaine are examples of commonly used local anesthetic agents.
Local anesthetics work by blocking sodium ion channels, preventing nerve impulse propagation. Early agents included cocaine, while modern ones like lidocaine are further classified as esters or amides. Administration can be via local infiltration, nerve block, or regional techniques like epidural or spinal anesthesia. Toxicities include allergic reactions and central nervous system or cardiovascular issues if too much is absorbed systemically. Proper dosage and addition of vasoconstrictors can maximize efficacy and safety.
Thought Leadership - Industry Focused MagazineTim Beisner
1) Anesthesia trends in ASCs include a growing demand for dedicated anesthesiologists or CRNAs to administer propofol sedation for endoscopic procedures, and more ASCs performing complex spine, orthopedic, and pain management cases.
2) ASCs face challenges with anesthesia services like competing for anesthesiologists' time between facilities, billing disputes causing issues with payors and referrals, and ensuring compliance with changing regulations.
3) Anesthesiologists can improve ASC efficiency by streamlining pre-op processes, managing intraoperative care to allow rapid recovery, and taking a leading role in scheduling as owners/partners invested in the facility's success.
The document discusses "core measures", which are evidence-based guidelines established by CMS and the Joint Commission for treating patients with certain diagnoses. The core measure patient groups include CHF, pneumonia, AMI, surgical care improvement, psychiatry, and patient satisfaction. Hospitals must follow specific treatment protocols for these patients and are audited to ensure compliance. Identifying core measure patients early and using established protocols and tools is key to improving outcomes and quality measures.
July-August 2013 • Vol. 22/No. 4246
Kimberly Foisy, MSN, RN, CMSRN, is Clinical Educator/Administrative Nursing Supervisor,
Orthopedic-Neurological Medical/Surgical Unit, North Shore Medical Center (NSMC), Salem
Hospital, an affiliate of Partners Healthcare System Inc.; and Assistant Professor, Massachusetts
College of Pharmacy and Health Sciences, School of Nursing, Boston, MA.
Acknowledgment: The author gratefully acknowledges Kathy Clune, MSN, RN, Nurse Manager,
Phippen 6 and 7; and Taryn Bailey, MSN, RN-BC, Executive Director, Professional Practice and
Patient Education Services, for their advice and guidance in the development of this article.
Thou Shalt Not Fall! Decreasing Falls
In the Postoperative Orthopedic
Patient with a Femoral Nerve Block
N
orth Shore Medical Center
(NSMC), Salem Hospital, an
affiliate of Partners Health -
care System Inc., is a 250-bed acute
care teaching hospital located in
Salem, MA, near Boston. The hospital
serves a diverse patient population
with 12,000 inpatient admissions per
year. The hospital’s 32-bed orthope-
dic-neurologic inpatient unit, which
is split between the 6th and 7th
floors of the Phippen Building, has
an average daily census of 30
patients. Unit leadership includes a
nurse manager, clinical educator,
unit coordinator, and one day-shift
charge nurse assigned to both floors.
Average daily staffing consists of
three nurses, two nursing assistants,
and a service associate for each 16-
bed unit; staff can be assigned to
either floor.
Improvement Needs
Decreasing patient falls is a
patient safety priority for direct-care
nurses. Many regulatory and govern-
mental agencies, such as the Centers
for Medicare & Medicaid Services
(CMS), have set standards and pay-
ment incentives to reduce or elimi-
nate falls in the health care setting.
For example, CMS (2011) no longer
reimburses for hospitalization if a
patient has an injury as a result of an
inpatient fall. Some health care
providers suggest falls cannot be
avoided (Muraskin, Conrad, Zheng,
Morey, & Enneking, 2007). However,
staff members for the involved units
at NSMC were determined to count-
er this view by taking action to
address a recent increase in patient
falls on the unit.
Phippen 6 and 7 house postoper-
ative orthopedic and neurological
surgical patients. Each floor has 16
private beds. A group of multidisci-
plinary professionals and unlicensed
staff from the two units convened to
form a team under the Transitioning
Care at the Bedside (TCAB) model
(Rutherford, Moen, & Taylor, 2009).
The team set a goal to eliminate falls
on the unit and started analyzing
falls data to determine the rate and
cause of falls that were occurring.
Data revealed as many as three falls
per month associated with femoral
nerve blocks (FNBs), with two
patients sustaining injury from
January to July 2009. The unit had a
fall rate of 5.2 per 1,000 patient days,
compared with a fall rate of 3.43 per
1,000 patient days for the facility.
Further data anal ...
Milestone Scientific Inc. is a leading developer of computerized drug delivery instruments that provide painless injections. They have entered the large worldwide dental market and believe their pressure force feedback and pulse wave technologies will help improve healthcare outcomes at lower costs across multiple medical areas. Recent studies showed their CompuFlo epidural instrument can save over $500 per hospital stay on average. New CompuWave and CathCheck features allow verification of epidural and catheter placement in real time, saving significant time and costs compared to traditional techniques. Milestone sees opportunities in peripheral nerve blocks, thoracic catheters, intra-articular injections and more, supported by their expanding patent portfolio.
Primary care clinics-managing physician patient panelsAlexander Kolker
OUTLINE
• Traditional scheduling and the advanced
access at a primary care clinic
• Uncertainties that should be considered when
patients are scheduled
• Decisions that need to be made for designing an
appointment system
• Practice on using the panel size calculator
•Emerging Trends in Primary Care:
Local anesthetics work by blocking sodium channels in nerve fibers, preventing the generation of action potentials and conduction of nerve impulses. They typically contain a hydrophilic amine group, hydrophobic aromatic moiety, and intermediate ester or amide linkage. Esters are metabolized rapidly by plasma esterases while amides are metabolized more slowly by the liver. Common uses of local anesthetics include minor surgery, dental procedures, nerve blocks, epidurals and caudals. Adverse effects can include central nervous system toxicity, cardiac issues like arrhythmias or hypotension, and allergic reactions. Chloroprocaine and lidocaine are examples of commonly used local anesthetic agents.
Local anesthetics work by blocking sodium ion channels, preventing nerve impulse propagation. Early agents included cocaine, while modern ones like lidocaine are further classified as esters or amides. Administration can be via local infiltration, nerve block, or regional techniques like epidural or spinal anesthesia. Toxicities include allergic reactions and central nervous system or cardiovascular issues if too much is absorbed systemically. Proper dosage and addition of vasoconstrictors can maximize efficacy and safety.
Thought Leadership - Industry Focused MagazineTim Beisner
1) Anesthesia trends in ASCs include a growing demand for dedicated anesthesiologists or CRNAs to administer propofol sedation for endoscopic procedures, and more ASCs performing complex spine, orthopedic, and pain management cases.
2) ASCs face challenges with anesthesia services like competing for anesthesiologists' time between facilities, billing disputes causing issues with payors and referrals, and ensuring compliance with changing regulations.
3) Anesthesiologists can improve ASC efficiency by streamlining pre-op processes, managing intraoperative care to allow rapid recovery, and taking a leading role in scheduling as owners/partners invested in the facility's success.
The document discusses "core measures", which are evidence-based guidelines established by CMS and the Joint Commission for treating patients with certain diagnoses. The core measure patient groups include CHF, pneumonia, AMI, surgical care improvement, psychiatry, and patient satisfaction. Hospitals must follow specific treatment protocols for these patients and are audited to ensure compliance. Identifying core measure patients early and using established protocols and tools is key to improving outcomes and quality measures.
July-August 2013 • Vol. 22/No. 4246
Kimberly Foisy, MSN, RN, CMSRN, is Clinical Educator/Administrative Nursing Supervisor,
Orthopedic-Neurological Medical/Surgical Unit, North Shore Medical Center (NSMC), Salem
Hospital, an affiliate of Partners Healthcare System Inc.; and Assistant Professor, Massachusetts
College of Pharmacy and Health Sciences, School of Nursing, Boston, MA.
Acknowledgment: The author gratefully acknowledges Kathy Clune, MSN, RN, Nurse Manager,
Phippen 6 and 7; and Taryn Bailey, MSN, RN-BC, Executive Director, Professional Practice and
Patient Education Services, for their advice and guidance in the development of this article.
Thou Shalt Not Fall! Decreasing Falls
In the Postoperative Orthopedic
Patient with a Femoral Nerve Block
N
orth Shore Medical Center
(NSMC), Salem Hospital, an
affiliate of Partners Health -
care System Inc., is a 250-bed acute
care teaching hospital located in
Salem, MA, near Boston. The hospital
serves a diverse patient population
with 12,000 inpatient admissions per
year. The hospital’s 32-bed orthope-
dic-neurologic inpatient unit, which
is split between the 6th and 7th
floors of the Phippen Building, has
an average daily census of 30
patients. Unit leadership includes a
nurse manager, clinical educator,
unit coordinator, and one day-shift
charge nurse assigned to both floors.
Average daily staffing consists of
three nurses, two nursing assistants,
and a service associate for each 16-
bed unit; staff can be assigned to
either floor.
Improvement Needs
Decreasing patient falls is a
patient safety priority for direct-care
nurses. Many regulatory and govern-
mental agencies, such as the Centers
for Medicare & Medicaid Services
(CMS), have set standards and pay-
ment incentives to reduce or elimi-
nate falls in the health care setting.
For example, CMS (2011) no longer
reimburses for hospitalization if a
patient has an injury as a result of an
inpatient fall. Some health care
providers suggest falls cannot be
avoided (Muraskin, Conrad, Zheng,
Morey, & Enneking, 2007). However,
staff members for the involved units
at NSMC were determined to count-
er this view by taking action to
address a recent increase in patient
falls on the unit.
Phippen 6 and 7 house postoper-
ative orthopedic and neurological
surgical patients. Each floor has 16
private beds. A group of multidisci-
plinary professionals and unlicensed
staff from the two units convened to
form a team under the Transitioning
Care at the Bedside (TCAB) model
(Rutherford, Moen, & Taylor, 2009).
The team set a goal to eliminate falls
on the unit and started analyzing
falls data to determine the rate and
cause of falls that were occurring.
Data revealed as many as three falls
per month associated with femoral
nerve blocks (FNBs), with two
patients sustaining injury from
January to July 2009. The unit had a
fall rate of 5.2 per 1,000 patient days,
compared with a fall rate of 3.43 per
1,000 patient days for the facility.
Further data anal ...
Milestone Scientific Inc. is a leading developer of computerized drug delivery instruments that provide painless injections. They have entered the large worldwide dental market and believe their pressure force feedback and pulse wave technologies will help improve healthcare outcomes at lower costs across multiple medical areas. Recent studies showed their CompuFlo epidural instrument can save over $500 per hospital stay on average. New CompuWave and CathCheck features allow verification of epidural and catheter placement in real time, saving significant time and costs compared to traditional techniques. Milestone sees opportunities in peripheral nerve blocks, thoracic catheters, intra-articular injections and more, supported by their expanding patent portfolio.
This document provides biographical information about the editors of the book "Anesthesia in Day Care Surgery". M.M. Begani has over 40 years of experience as a surgeon in Mumbai, India. He helped pioneer the use of local anesthesia for day surgeries. Dheeraj V. Mulchandani is a consultant surgeon in Mumbai with extensive experience in general and laparoscopic surgery. Shagufta Choudhary is a consultant anesthesiologist who has dedicated her career to advancing ambulatory anesthesia and minimizing hospitalization time for day surgeries. The introduction emphasizes how this handbook aims to enable day surgeries across many specialties using various anesthesia techniques, which could help
Paul D. White was a pioneering American cardiologist who helped establish the Framingham Heart Study and served in leadership roles at the American Red Cross and National Institutes of Health. He died in 1973 at age 87 following a second stroke. The United States Postal Service honored him with a postage stamp in 1986. White was influential in identifying risk factors for coronary artery disease through his work on the Framingham Heart Study.
Communiqué features articles focusing on the latest hot topics for anesthesiologists, nurse anesthetists, pain management specialists and anesthesia practice administrators.
Communique is created by Anesthesia Business Consultants (ABC), the largest physician billing and practice management company specializing exclusively in the practice of anesthesia and pain management.
ABC serves several thousand anesthesiologists and CRNAs nationwide with anesthesia billing software solutions.
Please send your email address to info [at] anesthesiallc [dot] com if you would like to join the Communique mailing list!
Visit www.anesthesiallc.com for more information!
A multi-disciplinary team is essential for effective home mechanical ventilation programs. The document discusses recommendations from Dr. Chan Yeow on setting up such a program in Singapore. Key points include:
- A home ventilation program should consist of an ICU-trained nurse, a technical provider, a family physician, and a respiratory therapist as a minimum.
- Initial ventilator settings are determined based on the patient's condition and disease progression, aiming to balance adequate ventilation with encouraging compliance.
- Challenges include managing changes in patient and caregiver situations long-term and supporting end-of-life decisions.
- Home care is more cost-effective than hospitalization, with costs in Singapore being around SGD
This document discusses several topics related to improving healthcare quality including data transparency, evidence-based medicine, pay for performance programs, and using these strategies together as a new engine for healthcare quality improvement. It provides examples of how public reporting of outcomes data has driven quality improvement. It also outlines 10 challenges healthcare organizations must address to be ready for ongoing quality and payment reform.
Milestone Scientific Inc. (MLSS) is a biomedical technology research and development company that patents, designs, develops and commercializes innovative diagnostic and therapeutic injection technologies and instruments for medical and dental applications. Milestone's computer-controlled systems are designed to make injections precise, efficient, virtually painless, and less expensive. Milestone’s proprietary DPS® Dynamic Pressure Sensing technology® platform advances the development of next-generation devices, regulating flow rate and monitoring pressure from the tip of the needle, through platform extensions for local anesthesia for subcutaneous drug delivery, with specific applications for epidural space identification in regional anesthesia procedures.
Jehovah's Witnesses believe they must abstain from blood transfusions based on biblical references. They will accept alternatives to transfusions like autologous blood transfusions and volume expanders. The patient is a Jehovah's Witness with a hematocrit below 25 who refuses a blood transfusion. Non-blood alternatives and strategies to aid recovery without a transfusion should be considered.
Top ten facts about acute pain management Claudia Gomez
1. The document provides 10 facts about acute pain management, including that treatment of acute pain is fundamental, patient variables influence pain response, and multimodal analgesic techniques should be offered.
2. It discusses recommended elements for pain assessment, such as onset, location, and intensity, and validated pain scales like FLACC and PAINAD.
3. Future pain assessment may rely on technology to provide objective measurements, such as analyzing heart rate variability, skin conductance, or pupillometry when patients cannot communicate their pain levels.
This document discusses anesthesia considerations for intraoperative neurophysiological monitoring. It notes that anesthesia aims to induce unconsciousness, provide analgesia, and relax muscles. Various types of anesthesia are described, including inhalational agents like halothane and intravenous agents like opioids, barbiturates, benzodiazepines, ketamine, etomidate, and propofol. Muscle relaxants are also discussed. The effects of different anesthetic agents on monitoring motor and sensory systems are then reviewed, noting the importance of avoiding paralysis and reducing halogenated agents and nitrous oxide when monitoring evoked potentials. Special anesthesia regimens may be needed for motor evoked potential monitoring.
While individually prescribed exercise programs are often the bread and butter of a physical therapy plan of care, there is no denying that technological advances in physical therapy tools have a place in the clinic also.
This document outlines constraints for an Enhanced Recovery After Surgery (ERAS) program at John Doe Hospital aimed at optimizing patient outcomes and reducing costs for hip and knee replacement surgeries. Constraints are established based on average lengths of stay, operating room times, costs, and variable costs for 461 prior cases. The constraints define acceptable ranges for factors like length of stay being between 1-2 days, total operating room time between 1.5-3 hours, and total costs between $15,630-$22,600. Measuring patient outcomes is difficult without access to outcomes data, but collecting additional clinical data over time could help refine the program and constraints.
This presentation is an introduction to WALANT and the reimbursement issues related to WALANT procedures and the Office-Based Surgical Suite (OBSS). I am not a clinician, I am a reimbursement expert so this focuses on the business issues.
DOCUMENTATION DEFICIENCY FEEDBACK is an integral component of ensuring that you are
not losing critical revenue dollars. Here are some tips on decreasing most common documentation
deficiencies in the emergency department.
Coronary artery bypass grafting (CABG) surgery is performed to treat coronary artery disease by creating bypasses around blockages in the coronary arteries to improve blood flow to the heart. The document provides details on:
1) What coronary artery disease and CABG surgery are
2) How CABG surgery is performed
3) Post-operative recovery, including returning to normal activities and long-term precautions like controlling risk factors
A publication dedicated to bringing articles and advice, specific to the anesthesia and pain management community, that are practical and tangible.
This edition covers the following topics:
• Using Big Data for Big Research: MPOG, NACOR and other Anesthesia Registries
• Another Year of Changes Lies Ahead for Anesthesiologists
• Disruptive Change, Anesthesiologists, and ASCs
• Performing High Acuity Cases in ASCs: The Anesthesiologist’s Role
• Endoscopy: Revisited
• Reporting Postoperative Pain Management in 2014
• 2014 CPT Coding and Key Reimbursement Changes
1. Chronic spinal pain is difficult to diagnose due to its multifactorial nature and lack of universally accepted diagnostic standards. Accurate diagnosis is important to determine appropriate treatment.
2. Controlled diagnostic injection techniques, including facet joint injections, sacroiliac joint injections, and discography, allow accurate diagnosis in 85% of patients compared to 15% with standard clinical evaluation alone.
3. Consistency in patient response to injections using anesthetics with different durations of action helps validate the accuracy of these diagnostic techniques by ruling out false positives. Controlled diagnostic injections remain the best available tool to identify specific spinal structures causing pain.
As the preeminent provider of outsourced anesthesia billing and management services in America, we are always interested in how anesthesia providers are modifying their practices to take advantage of new pain management modalities and changing patient expectations. Anesthesia is not just focused on the operating room and the delivery suite. It is increasingly concerned with the entire perioperative episode. That includes the diagnosis and treatment of the patient's post-operative pain.
The transshipment or posterolateral spinal approach is indicated for broad, ventral squeezing etiologies of the thoracic spinal cord, discitis with extradural abscess, calcified or non-calcified regressive disk disease, metastatic epidural spinal cord compression, nerve sheath tumors,tumour traumatic burst fractures, and less commonly, primary bone tumors.
This document provides guidance on setting up a regional anesthesia practice at a hospital. It discusses the importance of hiring anesthesiologists with good regional training, investing in anatomy education, focusing on patient outcomes and satisfaction, using pharmacology evidence-basedly, gaining surgeon buy-in, and establishing proper infrastructure and billing practices to support the regional anesthesia program. The overall message is that regional anesthesia can enhance surgical recovery when implemented through a thoughtful, multidisciplinary approach.
In a world where medical software is systemically plagued by complexity, OMS is helping cardiologists take back control. Created by and for cardiologists, allow us to restore your faith in what's possible.
This document discusses challenges and opportunities in teaching regional anesthesia. It notes obstacles like surgical culture which prefers general anesthesia and time constraints. Regional anesthesia education requires preparation, continuity of care, and appropriate sedation. Minimum requirements for regional blocks in academic programs are often not met due to long surgeries and sick patients. The document advocates for improving outcomes through regional techniques and emphasizes functional recovery, operating room efficiency, cost, and patient satisfaction as important new paradigms. It provides examples of improved outcomes with regional anesthesia and strategies for growing successful regional anesthesia programs.
This presentation described features of a custom OR information system used to ensure timely administration of the correct antibiotics prior to surgery. The custom software (John Galt Systems) has since been replaced by an off-the-shelf product (Epic).
More Related Content
Similar to Building a Better Regional Anesthesia Note (on paper or in an EHR)
This document provides biographical information about the editors of the book "Anesthesia in Day Care Surgery". M.M. Begani has over 40 years of experience as a surgeon in Mumbai, India. He helped pioneer the use of local anesthesia for day surgeries. Dheeraj V. Mulchandani is a consultant surgeon in Mumbai with extensive experience in general and laparoscopic surgery. Shagufta Choudhary is a consultant anesthesiologist who has dedicated her career to advancing ambulatory anesthesia and minimizing hospitalization time for day surgeries. The introduction emphasizes how this handbook aims to enable day surgeries across many specialties using various anesthesia techniques, which could help
Paul D. White was a pioneering American cardiologist who helped establish the Framingham Heart Study and served in leadership roles at the American Red Cross and National Institutes of Health. He died in 1973 at age 87 following a second stroke. The United States Postal Service honored him with a postage stamp in 1986. White was influential in identifying risk factors for coronary artery disease through his work on the Framingham Heart Study.
Communiqué features articles focusing on the latest hot topics for anesthesiologists, nurse anesthetists, pain management specialists and anesthesia practice administrators.
Communique is created by Anesthesia Business Consultants (ABC), the largest physician billing and practice management company specializing exclusively in the practice of anesthesia and pain management.
ABC serves several thousand anesthesiologists and CRNAs nationwide with anesthesia billing software solutions.
Please send your email address to info [at] anesthesiallc [dot] com if you would like to join the Communique mailing list!
Visit www.anesthesiallc.com for more information!
A multi-disciplinary team is essential for effective home mechanical ventilation programs. The document discusses recommendations from Dr. Chan Yeow on setting up such a program in Singapore. Key points include:
- A home ventilation program should consist of an ICU-trained nurse, a technical provider, a family physician, and a respiratory therapist as a minimum.
- Initial ventilator settings are determined based on the patient's condition and disease progression, aiming to balance adequate ventilation with encouraging compliance.
- Challenges include managing changes in patient and caregiver situations long-term and supporting end-of-life decisions.
- Home care is more cost-effective than hospitalization, with costs in Singapore being around SGD
This document discusses several topics related to improving healthcare quality including data transparency, evidence-based medicine, pay for performance programs, and using these strategies together as a new engine for healthcare quality improvement. It provides examples of how public reporting of outcomes data has driven quality improvement. It also outlines 10 challenges healthcare organizations must address to be ready for ongoing quality and payment reform.
Milestone Scientific Inc. (MLSS) is a biomedical technology research and development company that patents, designs, develops and commercializes innovative diagnostic and therapeutic injection technologies and instruments for medical and dental applications. Milestone's computer-controlled systems are designed to make injections precise, efficient, virtually painless, and less expensive. Milestone’s proprietary DPS® Dynamic Pressure Sensing technology® platform advances the development of next-generation devices, regulating flow rate and monitoring pressure from the tip of the needle, through platform extensions for local anesthesia for subcutaneous drug delivery, with specific applications for epidural space identification in regional anesthesia procedures.
Jehovah's Witnesses believe they must abstain from blood transfusions based on biblical references. They will accept alternatives to transfusions like autologous blood transfusions and volume expanders. The patient is a Jehovah's Witness with a hematocrit below 25 who refuses a blood transfusion. Non-blood alternatives and strategies to aid recovery without a transfusion should be considered.
Top ten facts about acute pain management Claudia Gomez
1. The document provides 10 facts about acute pain management, including that treatment of acute pain is fundamental, patient variables influence pain response, and multimodal analgesic techniques should be offered.
2. It discusses recommended elements for pain assessment, such as onset, location, and intensity, and validated pain scales like FLACC and PAINAD.
3. Future pain assessment may rely on technology to provide objective measurements, such as analyzing heart rate variability, skin conductance, or pupillometry when patients cannot communicate their pain levels.
This document discusses anesthesia considerations for intraoperative neurophysiological monitoring. It notes that anesthesia aims to induce unconsciousness, provide analgesia, and relax muscles. Various types of anesthesia are described, including inhalational agents like halothane and intravenous agents like opioids, barbiturates, benzodiazepines, ketamine, etomidate, and propofol. Muscle relaxants are also discussed. The effects of different anesthetic agents on monitoring motor and sensory systems are then reviewed, noting the importance of avoiding paralysis and reducing halogenated agents and nitrous oxide when monitoring evoked potentials. Special anesthesia regimens may be needed for motor evoked potential monitoring.
While individually prescribed exercise programs are often the bread and butter of a physical therapy plan of care, there is no denying that technological advances in physical therapy tools have a place in the clinic also.
This document outlines constraints for an Enhanced Recovery After Surgery (ERAS) program at John Doe Hospital aimed at optimizing patient outcomes and reducing costs for hip and knee replacement surgeries. Constraints are established based on average lengths of stay, operating room times, costs, and variable costs for 461 prior cases. The constraints define acceptable ranges for factors like length of stay being between 1-2 days, total operating room time between 1.5-3 hours, and total costs between $15,630-$22,600. Measuring patient outcomes is difficult without access to outcomes data, but collecting additional clinical data over time could help refine the program and constraints.
This presentation is an introduction to WALANT and the reimbursement issues related to WALANT procedures and the Office-Based Surgical Suite (OBSS). I am not a clinician, I am a reimbursement expert so this focuses on the business issues.
DOCUMENTATION DEFICIENCY FEEDBACK is an integral component of ensuring that you are
not losing critical revenue dollars. Here are some tips on decreasing most common documentation
deficiencies in the emergency department.
Coronary artery bypass grafting (CABG) surgery is performed to treat coronary artery disease by creating bypasses around blockages in the coronary arteries to improve blood flow to the heart. The document provides details on:
1) What coronary artery disease and CABG surgery are
2) How CABG surgery is performed
3) Post-operative recovery, including returning to normal activities and long-term precautions like controlling risk factors
A publication dedicated to bringing articles and advice, specific to the anesthesia and pain management community, that are practical and tangible.
This edition covers the following topics:
• Using Big Data for Big Research: MPOG, NACOR and other Anesthesia Registries
• Another Year of Changes Lies Ahead for Anesthesiologists
• Disruptive Change, Anesthesiologists, and ASCs
• Performing High Acuity Cases in ASCs: The Anesthesiologist’s Role
• Endoscopy: Revisited
• Reporting Postoperative Pain Management in 2014
• 2014 CPT Coding and Key Reimbursement Changes
1. Chronic spinal pain is difficult to diagnose due to its multifactorial nature and lack of universally accepted diagnostic standards. Accurate diagnosis is important to determine appropriate treatment.
2. Controlled diagnostic injection techniques, including facet joint injections, sacroiliac joint injections, and discography, allow accurate diagnosis in 85% of patients compared to 15% with standard clinical evaluation alone.
3. Consistency in patient response to injections using anesthetics with different durations of action helps validate the accuracy of these diagnostic techniques by ruling out false positives. Controlled diagnostic injections remain the best available tool to identify specific spinal structures causing pain.
As the preeminent provider of outsourced anesthesia billing and management services in America, we are always interested in how anesthesia providers are modifying their practices to take advantage of new pain management modalities and changing patient expectations. Anesthesia is not just focused on the operating room and the delivery suite. It is increasingly concerned with the entire perioperative episode. That includes the diagnosis and treatment of the patient's post-operative pain.
The transshipment or posterolateral spinal approach is indicated for broad, ventral squeezing etiologies of the thoracic spinal cord, discitis with extradural abscess, calcified or non-calcified regressive disk disease, metastatic epidural spinal cord compression, nerve sheath tumors,tumour traumatic burst fractures, and less commonly, primary bone tumors.
This document provides guidance on setting up a regional anesthesia practice at a hospital. It discusses the importance of hiring anesthesiologists with good regional training, investing in anatomy education, focusing on patient outcomes and satisfaction, using pharmacology evidence-basedly, gaining surgeon buy-in, and establishing proper infrastructure and billing practices to support the regional anesthesia program. The overall message is that regional anesthesia can enhance surgical recovery when implemented through a thoughtful, multidisciplinary approach.
In a world where medical software is systemically plagued by complexity, OMS is helping cardiologists take back control. Created by and for cardiologists, allow us to restore your faith in what's possible.
Similar to Building a Better Regional Anesthesia Note (on paper or in an EHR) (20)
This document discusses challenges and opportunities in teaching regional anesthesia. It notes obstacles like surgical culture which prefers general anesthesia and time constraints. Regional anesthesia education requires preparation, continuity of care, and appropriate sedation. Minimum requirements for regional blocks in academic programs are often not met due to long surgeries and sick patients. The document advocates for improving outcomes through regional techniques and emphasizes functional recovery, operating room efficiency, cost, and patient satisfaction as important new paradigms. It provides examples of improved outcomes with regional anesthesia and strategies for growing successful regional anesthesia programs.
This presentation described features of a custom OR information system used to ensure timely administration of the correct antibiotics prior to surgery. The custom software (John Galt Systems) has since been replaced by an off-the-shelf product (Epic).
Cell Analog Blind Kid's Seventh Grade Project: A cell is like a krispy kreme ...John Gerancher
This is the powerpoint presentation my son completed for a cell analogy school project. Classmates help play act the organelles and doughnuts were provided to all as yummy "proteins."
John Charles Gerancher has held medical licenses in Washington, California, and North Carolina. Furthermore, JC Gerancher recently served as a professor of anesthesiology at the Wake Forest University School of Medicine.
Residency Training in Anesthesiology at Wake Forest University John Gerancher
A former professor of anesthesiology at the Wake Forest University School of Medicine, Dr. John Charles Gerancher served the school for more than a decade. Between 1999 and 2011, Dr. John Gerancher created and introduced a regional anesthesia program to the University's Baptist Medical Center that includes clinical care as well as a teaching curriculum.
NC Organization Supports Parents with Visually Impaired ChildrenJohn Gerancher
Physician John Charles Gerancher is an active contributor to the community in which he lives and works. Dr. JC Gerancher maintains affiliation with the North Carolina Association for Parents of Children with Visual Impairment (NC-APVI). Affiliated with the National Association for Parents of Children with Visual Impairments, the NC-APVI provides education, resources, and emotional support to families with children who are visually impaired or blind.
Gerancher: Informed Consent, DNR, and EMR issues in AnesthesiaJohn Gerancher
Originally presented in 2011, this talk gives an overview of informed consent, do not resuscitate, and electronic medical record issues for anesthesia providers. This talk may be interesting for doctors and nurses that work in the operating room as well as hospital administrators and those working in health care informatics .
this presentation reviews basic information on adjuncts to local anesthetics and peripheral nerve blockade. it was last undated and used for anesthesiology resident education in 2011. hope you find this information helpful. John Gerancher JC Gerancher MD
Different types of anesthesia by john gerancherJohn Gerancher
Dr. John Gerancher was a pioneer in the field of anesthesiology. He was responsible for developing the clinical care area, teaching program, and regional anesthesia section at Wake Forest Baptist Medical Center. Dr. Gerancher also designed and implemented a computer information system for the operating room called the John Galt. He was licensed to practice medicine in Washington, North Carolina, and California. The document then provides descriptions of the different types of anesthesia administered to patients: general, local, and regional.
Wake forest professor john gerancher developed school’s anesthesiologyJohn Gerancher
Located in Winston-Salem, North Carolina, the Wake Forest University School of Medicine was founded in 1902 and its Department of Anesthesiology has received national recognition for excellence in research, teaching, and patient care.
Comprehensive Rainy Season Advisory: Safety and Preparedness Tips.pdfDr Rachana Gujar
The "Comprehensive Rainy Season Advisory: Safety and Preparedness Tips" offers essential guidance for navigating rainy weather conditions. It covers strategies for staying safe during storms, flood prevention measures, and advice on preparing for inclement weather. This advisory aims to ensure individuals are equipped with the knowledge and resources to handle the challenges of the rainy season effectively, emphasizing safety, preparedness, and resilience.
At Malayali Kerala Spa Ajman, Full Service includes individualized care for every client. We specifically design each massage session for the individual needs of the client. Our therapists are always willing to adjust the treatments based on the client's instruction and feedback. This guarantees that every client receives the treatment they expect.
By offering a variety of massage services, our Ajman Spa Massage Center can tackle physical, mental, and emotional illnesses. In addition, efficient identification of specific health conditions and designing treatment plans accordingly can significantly enhance the quality of massaging.
At Malayali Kerala Spa Ajman, we firmly believe that everyone should have the option to experience top-quality massage services regularly. To achieve that goal we offer cheap massage services in Ajman.
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Michigan HealthTech Market Map 2024. Includes 7 categories: Policy Makers, Academic Innovation Centers, Digital Health Providers, Healthcare Providers, Payers / Insurance, Device Companies, Life Science Companies, Innovation Accelerators. Developed by the Michigan-Israel Business Accelerator
2024 HIPAA Compliance Training Guide to the Compliance OfficersConference Panel
Join us for a comprehensive 90-minute lesson designed specifically for Compliance Officers and Practice/Business Managers. This 2024 HIPAA Training session will guide you through the critical steps needed to ensure your practice is fully prepared for upcoming audits. Key updates and significant changes under the Omnibus Rule will be covered, along with the latest applicable updates for 2024.
Key Areas Covered:
Texting and Email Communication: Understand the compliance requirements for electronic communication.
Encryption Standards: Learn what is necessary and what is overhyped.
Medical Messaging and Voice Data: Ensure secure handling of sensitive information.
IT Risk Factors: Identify and mitigate risks related to your IT infrastructure.
Why Attend:
Expert Instructor: Brian Tuttle, with over 20 years in Health IT and Compliance Consulting, brings invaluable experience and knowledge, including insights from over 1000 risk assessments and direct dealings with Office of Civil Rights HIPAA auditors.
Actionable Insights: Receive practical advice on preparing for audits and avoiding common mistakes.
Clarity on Compliance: Clear up misconceptions and understand the reality of HIPAA regulations.
Ensure your compliance strategy is up-to-date and effective. Enroll now and be prepared for the 2024 HIPAA audits.
Enroll Now to secure your spot in this crucial training session and ensure your HIPAA compliance is robust and audit-ready.
https://conferencepanel.com/conference/hipaa-training-for-the-compliance-officer-2024-updates
Let's Talk About It: Breast Cancer (What is Mindset and Does it Really Matter?)bkling
Your mindset is the way you make sense of the world around you. This lens influences the way you think, the way you feel, and how you might behave in certain situations. Let's talk about mindset myths that can get us into trouble and ways to cultivate a mindset to support your cancer survivorship in authentic ways. Let’s Talk About It!
Healthy Eating Habits:
Understanding Nutrition Labels: Teaches how to read and interpret food labels, focusing on serving sizes, calorie intake, and nutrients to limit or include.
Tips for Healthy Eating: Offers practical advice such as incorporating a variety of foods, practicing moderation, staying hydrated, and eating mindfully.
Benefits of Regular Exercise:
Physical Benefits: Discusses how exercise aids in weight management, muscle and bone health, cardiovascular health, and flexibility.
Mental Benefits: Explains the psychological advantages, including stress reduction, improved mood, and better sleep.
Tips for Staying Active:
Encourages consistency, variety in exercises, setting realistic goals, and finding enjoyable activities to maintain motivation.
Maintaining a Balanced Lifestyle:
Integrating Nutrition and Exercise: Suggests meal planning and incorporating physical activity into daily routines.
Monitoring Progress: Recommends tracking food intake and exercise, regular health check-ups, and provides tips for achieving balance, such as getting sufficient sleep, managing stress, and staying socially active.
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R3 Stem Cell Therapy: A New Hope for Women with Ovarian FailureR3 Stem Cell
Discover the groundbreaking advancements in stem cell therapy by R3 Stem Cell, offering new hope for women with ovarian failure. This innovative treatment aims to restore ovarian function, improve fertility, and enhance overall well-being, revolutionizing reproductive health for women worldwide.
DECODING THE RISKS - ALCOHOL, TOBACCO & DRUGS.pdfDr Rachana Gujar
Introduction: Substance use education is crucial due to its prevalence and societal impact.
Alcohol Use: Immediate and long-term risks include impaired judgment, health issues, and social consequences.
Tobacco Use: Immediate effects include increased heart rate, while long-term risks encompass cancer and heart disease.
Drug Use: Risks vary depending on the drug type, including health and psychological implications.
Prevention Strategies: Education, healthy coping mechanisms, community support, and policies are vital in preventing substance use.
Harm Reduction Strategies: Safe use practices, medication-assisted treatment, and naloxone availability aim to reduce harm.
Seeking Help for Addiction: Recognizing signs, available treatments, support systems, and resources are essential for recovery.
Personal Stories: Real stories of recovery emphasize hope and resilience.
Interactive Q&A: Engage the audience and encourage discussion.
Conclusion: Recap key points and emphasize the importance of awareness, prevention, and seeking help.
Resources: Provide contact information and links for further support.
International Cancer Survivors Day is celebrated during June, placing the spotlight not only on cancer survivors, but also their caregivers.
CANSA has compiled a list of tips and guidelines of support:
https://cansa.org.za/who-cares-for-cancer-patients-caregivers/
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - ...rightmanforbloodline
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
The facial nerve, also known as cranial nerve VII, is one of the 12 cranial nerves originating from the brain. It's a mixed nerve, meaning it contains both sensory and motor fibres, and it plays a crucial role in controlling various facial muscles, as well as conveying sensory information from the taste buds on the anterior two-thirds of the tongue.
Letter to MREC - application to conduct studyAzreen Aj
Application to conduct study on research title 'Awareness and knowledge of oral cancer and precancer among dental outpatient in Klinik Pergigian Merlimau, Melaka'
COPD Treatment in Ghatkopar,Mumbai. Dr Kumar DoshiDr Kumar Doshi
Are you or a loved one affected by Chronic Obstructive Pulmonary Disease (COPD)? Discover comprehensive and advanced treatment options with Dr. Kumar Doshi, a preeminent COPD specialist based in Ghatkopar, Mumbai.
Dr. Kumar Doshi is dedicated to delivering the highest standard of care for COPD patients. Whether you are seeking a diagnosis, a second opinion, or exploring new treatment avenues, this presentation will guide you through the exceptional services available at his practice in Ghatkopar, Mumbai.
COPD Treatment in Ghatkopar,Mumbai. Dr Kumar Doshi
Building a Better Regional Anesthesia Note (on paper or in an EHR)
1. Building a Better Regional Anesthesia Procedure Note
J.C. Gerancher, MD, Winston-Salem, N.C.
July, 2005
In many facilities, practitioners do not place enough emphasis
on documenting regional anesthesia procedures in the
medical record. As a result, they can expose themselves to
malpractice risk, jeopardize payment and, most importantly,
miss opportunities to guide good patient care. The good news
is that it is easy to build a better procedure note for your
institution that will likely help you deliver excellent care,
provide legal protection, and maximize billing success.
You can begin by visiting a website I designed, www.allnumbedup.com. If you click on
“Regional Anesthesia and Acute Pain Management Forms,” you will find free
templates for three types of regional anesthesia procedure notes: one for peripheral
nerve blocks, one for neuraxial blocks, and a third for combined regional anesthesia
blocks. Some were written by multiple authors at several institutions, and all are in
pdf format.
I recommend customizing your forms to suit your needs. While doing so, keep these
goals in mind. The form should:
Encourage efficiency while ensuring thoughtfulness. Anesthesiologists can
check boxes for routine aspects of procedures, but the form should also require
written contributions for decisions that need individualization. For example, on our
procedure notes, the anesthesiologist must fill in the drug concentration and
volume for each injection and, when using a nerve stimulator, record the
parameters that elicit a motor response or paresthesia.
Guide the anesthesiologist to meet the standard of care in every case. On
our forms, for example, the anesthesiologist can simply check a box if he has
performed an IV test with epinephrine, but he must record the rationale when he
does not.
Require the anesthesiologist to characterize the patient's state of
consciousness. Currently, many medico-legal disputes appear to center on the
patient's level of sedation. A medical record that documents this crisply will protect
practitioners and the facility from certain legal challenges that could arise when
this is not documented.
Require the anesthesiologist to document how he responds to clinical
variations. For example, our form requires the anesthesiologist to record actions
taken when injection creates a pressure rise or paresthesia, and/or when
aspiration of blood is encountered.
Facilitate successful and accurate billing. Precise documentation will help
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Yes You Can Get Reimbursed for Nerve Blocks
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A Surgeon's Perspective: The Power of PNBs
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2. ensure proper reimbursement. For example, the record should show that the
surgeon has requested certain peripheral nerve blocks for post-op pain
management. Without this documentation, the insurer may be less likely to
reimburse. The procedure note should also ensure that an anesthesiologist
medically directs each block, which is important in a residency or other training
program. We simply attach our forms to our reimbursement requests, and this
obviates the need for our coders/billers to “hunt and peck” through incomplete,
illegible records.
I hope our regional anesthesia forms and the advice in this column will help you
establish your own winning documentation strategy. Best of luck!
Dr. Gerancher is Associate Professor and Head of the Regional Anesthesia and Acute
Pain Management Section at Wake Forest University School of Medicine, Winston-
Salem, North Carolina. University School of Medicine and Section Head of Regional
Anesthesia and Acute Pain Management in Winston-Salem, N.C.
Brought to you as an educational service by
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Ultrasound and Nerve Stimulation: Perfect
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The Post-Opioid Era
Practical Pain Control
In Our PACU, Blocks Made Miles of Difference
Filling the Analgesic Gap
Is Regional Anesthesia More Cost-Efficient?
Prime Patients Early for PNB Success
With Nerve Blocks, Time is Safety
Nerve Blocks Improve Patient Well-Being
The PNBs Have It
Continuous Peripheral Nerve Blocks: The Jury Is
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