Jonathan T. Ketzler

Implementation of a handheld electronic point-of-care billing system improved efficiency in the critical care unit.

Coding and billing are time consuming and important considerations for critical care practitioners. A 1-year prospective, observational study incorporated the use of a personal digital assistant and MDeverywhere software (Hauppauge, New York) for patient coding and billing. Twelve months of data were examined before electronic implementation (pre-elec) and compared with a 12-month period after implementation (post-elec) by using an unpaired t test or z test with P < .05 considered significant. The total number of charges was 2479 pre-elec and 2243 post-elec. The days from date of service to billing for services significantly decreased from 37.8 pre-elec to 12.4 post-elec (P < .001); days in accounts receivable significantly decreased from 92.0 to 73.0 (P < .001). The net collection rate increased from 44.7% pre-elec to 49.3% post-elec (P < .001). Duplicate charges significantly decreased from 5.0% pre-elec to 1.4% post-elec ( P < .001). The return on investment was 1.97-fold (197%). The initiation of personal digital assistant technology to facilitate billing and coding resulted in significant improvements.

The GlideScope for videolaryngoscopy-assisted nasotracheal-to-orotracheal tube exchange in the intensive care unit in a patient with a known difficult airway ☆

A 77 year old, nasally intubated man with a history of repeated episodes of airway obstruction requiring intubation due to recurrent laryngitis and a hypopharyngeal mass, needed nasotracheal-to-orotracheal tube exchange. The GlideScope videolaryngoscope was inserted, achieving a full view of the glottic inlet with the nasotracheal tube in situ. An endotracheal tube (ETT) loaded on a GlideRite Rigid Stylet was advanced through the oropharynx into view. Advancement of this ETT to the glottic opening was tested and achieved. With both tracheal tubes in view, the nasotracheal tube cuff was deflated and withdrawn from the glottic opening. While maintaining videoscopic visualization, the orotracheal tube was advanced through the vocal cords into the trachea. The benefits of this technique versus existing alternatives are discussed.

Anesthesia and Co-Existing Disease: DISEASE

Anesthesia and co-existing disease , Anesthesia and co-existing disease , کتابخانه دیجیتالی دانشگاه علوم پزشکی و خدمات درمانی شهید بهشتیAnesthesia And Co Existing Disease *FREE* anesthesia and co existing disease Stoelting’s Anesthesia and Co-Existing Disease. With Stoelting’s Anesthesia and Co-Existing Disease, you’ll have the succinct, however thorough steering you will need to effectively stay away from or deal with issues stemming from pre-current medical circumstances. Superior evaluation from specialists inside the space will assist you overcome...AUTONOMIC HYPERREFLEXIA SLU Editor Dean F Connors MD PhD AUTONOMIC HYPERREFLEXIA For the Boards... Author Jafrul Islam MD DISEASE STATES 2003 2004 Jafrul Islam MD RESPONDING TO ANESTHETIC COMPLICATIONS 4 Respiratory arrest Brief periods of apnea may be seen as a result of IV anesthetic administration or after prolonged bagging with 100 oxygen due to decreased blood CO 2 levels If the patient is not breathing spontaneously TURN OFF THE VAPORIZER alert a Practice Guidelines for Sedation and Analgesia by Non Practice Guidelines for Sedation and Analgesia by Non Anesthesiologists 3 believes that automated apnea monitoring by detection of exhaled CO 2 or other means may decrease risks during both moderate and deep sedation while cautioning practitioners that impedance Normochromic anemia Wikipedia Normochromic anemia is a form of anemia in which the concentration of hemoglobin in the red blood cells is within the standard rang but there is an insufficient number of red blood cells Conditions where this is found include aplastic posthemorrhagic and hemolytic anemias and anemia of chronic disease MCH average amount of hemoglobin found in the red blood cells in the body or MCHC CMS Manual System Survey Procedures §416 42 a 1 • Verify that there is evidence for every medical record in the survey sample of an assessment by a physician of the patient’s risk for the planned surgery and anesthesia • Ask the ASC to provide you with its policies and procedures for assessment of anesthesia and procedural risk Safe Travels USA Comprehensive Plan Summary of Coverage Safe Travels USA Comprehensive Plan Summary of Coverage STCH 14591 18 Plan is underwritten by GBG Insurance Limited Medical Maximum per Policy 50 000 100 000 250 000 500 000 1 000 000 Neurosurgery Oxford Academic Neurosurgery the official journal of the Congress of Neurological Surgeons publishes research on clinical and experimental neurosurgery covering the very lates 7 01 546 Spinal Cord and Dorsal Root Ganglion Stimulation MEDICAL POLICY – 7 01 546 Spinal Cord and Dorsal Root Ganglion Stimulation BCBSA Ref Policy 7 01 25 Effective Date July 1 2018 Last Revised May 1 2019 Glossary of Dental Clinical and Administrative Terms Glossary of Dental Clinical and Administrative Terms There are many terms used daily by dentists and their staff in the course of delivering care to patients maintaining patient records and preparing claims LWW Journals Beginning with A Lippincott Journals Subscribers use your username or email along with your password to log in Anaesthetic management of patients with pre existing The main perioperative risk factor for anaphylaxis is a previous uninvestigated perioperative immediate hypersensitivity reaction • The main concerns are potential uncontrolled asthma in atopy severe uncontrolled asthma and strict avoidance of all cyclooxygenase 1 COX 1 inhibitors in NSAID exacerbated respiratory disease cross reactivity to gelatin based colloid in ? gal syndrome non Guidelines for Preventing Health Care Associated Disclaimer All MMWR HTML versions of articles are electronic conversions from ASCII text into HTML This conversion may have resulted in character translation or format errors in the HTML version Users should not rely on this HTML document but are referred to the electronic PDF version and or the original MMWR paper copy

Anesthesia and Co-Existing Disease: Anesthesia and Co-Existing Disease

Anesthesia and co-existing disease , Anesthesia and co-existing disease , کتابخانه دیجیتالی دانشگاه علوم پزشکی و خدمات درمانی شهید بهشتیAnesthesia And Co Existing Disease *FREE* anesthesia and co existing disease Stoelting’s Anesthesia and Co-Existing Disease. With Stoelting’s Anesthesia and Co-Existing Disease, you’ll have the succinct, however thorough steering you will need to effectively stay away from or deal with issues stemming from pre-current medical circumstances. Superior evaluation from specialists inside the space will assist you overcome...AUTONOMIC HYPERREFLEXIA SLU Editor Dean F Connors MD PhD AUTONOMIC HYPERREFLEXIA For the Boards... Author Jafrul Islam MD DISEASE STATES 2003 2004 Jafrul Islam MD RESPONDING TO ANESTHETIC COMPLICATIONS 4 Respiratory arrest Brief periods of apnea may be seen as a result of IV anesthetic administration or after prolonged bagging with 100 oxygen due to decreased blood CO 2 levels If the patient is not breathing spontaneously TURN OFF THE VAPORIZER alert a Practice Guidelines for Sedation and Analgesia by Non Practice Guidelines for Sedation and Analgesia by Non Anesthesiologists 3 believes that automated apnea monitoring by detection of exhaled CO 2 or other means may decrease risks during both moderate and deep sedation while cautioning practitioners that impedance Normochromic anemia Wikipedia Normochromic anemia is a form of anemia in which the concentration of hemoglobin in the red blood cells is within the standard rang but there is an insufficient number of red blood cells Conditions where this is found include aplastic posthemorrhagic and hemolytic anemias and anemia of chronic disease MCH average amount of hemoglobin found in the red blood cells in the body or MCHC CMS Manual System Survey Procedures §416 42 a 1 • Verify that there is evidence for every medical record in the survey sample of an assessment by a physician of the patient’s risk for the planned surgery and anesthesia • Ask the ASC to provide you with its policies and procedures for assessment of anesthesia and procedural risk Safe Travels USA Comprehensive Plan Summary of Coverage Safe Travels USA Comprehensive Plan Summary of Coverage STCH 14591 18 Plan is underwritten by GBG Insurance Limited Medical Maximum per Policy 50 000 100 000 250 000 500 000 1 000 000 Neurosurgery Oxford Academic Neurosurgery the official journal of the Congress of Neurological Surgeons publishes research on clinical and experimental neurosurgery covering the very lates 7 01 546 Spinal Cord and Dorsal Root Ganglion Stimulation MEDICAL POLICY – 7 01 546 Spinal Cord and Dorsal Root Ganglion Stimulation BCBSA Ref Policy 7 01 25 Effective Date July 1 2018 Last Revised May 1 2019 Glossary of Dental Clinical and Administrative Terms Glossary of Dental Clinical and Administrative Terms There are many terms used daily by dentists and their staff in the course of delivering care to patients maintaining patient records and preparing claims LWW Journals Beginning with A Lippincott Journals Subscribers use your username or email along with your password to log in Anaesthetic management of patients with pre existing The main perioperative risk factor for anaphylaxis is a previous uninvestigated perioperative immediate hypersensitivity reaction • The main concerns are potential uncontrolled asthma in atopy severe uncontrolled asthma and strict avoidance of all cyclooxygenase 1 COX 1 inhibitors in NSAID exacerbated respiratory disease cross reactivity to gelatin based colloid in ? gal syndrome non Guidelines for Preventing Health Care Associated Disclaimer All MMWR HTML versions of articles are electronic conversions from ASCII text into HTML This conversion may have resulted in character translation or format errors in the HTML version Users should not rely on this HTML document but are referred to the electronic PDF version and or the original MMWR paper copy

Anesthesia and Co-Existing Disease: Frontmatter

Anesthesia and co-existing disease , Anesthesia and co-existing disease , کتابخانه دیجیتالی دانشگاه علوم پزشکی و خدمات درمانی شهید بهشتیAnesthesia And Co Existing Disease *FREE* anesthesia and co existing disease Stoelting’s Anesthesia and Co-Existing Disease. With Stoelting’s Anesthesia and Co-Existing Disease, you’ll have the succinct, however thorough steering you will need to effectively stay away from or deal with issues stemming from pre-current medical circumstances. Superior evaluation from specialists inside the space will assist you overcome...AUTONOMIC HYPERREFLEXIA SLU Editor Dean F Connors MD PhD AUTONOMIC HYPERREFLEXIA For the Boards... Author Jafrul Islam MD DISEASE STATES 2003 2004 Jafrul Islam MD RESPONDING TO ANESTHETIC COMPLICATIONS 4 Respiratory arrest Brief periods of apnea may be seen as a result of IV anesthetic administration or after prolonged bagging with 100 oxygen due to decreased blood CO 2 levels If the patient is not breathing spontaneously TURN OFF THE VAPORIZER alert a Practice Guidelines for Sedation and Analgesia by Non Practice Guidelines for Sedation and Analgesia by Non Anesthesiologists 3 believes that automated apnea monitoring by detection of exhaled CO 2 or other means may decrease risks during both moderate and deep sedation while cautioning practitioners that impedance Normochromic anemia Wikipedia Normochromic anemia is a form of anemia in which the concentration of hemoglobin in the red blood cells is within the standard rang but there is an insufficient number of red blood cells Conditions where this is found include aplastic posthemorrhagic and hemolytic anemias and anemia of chronic disease MCH average amount of hemoglobin found in the red blood cells in the body or MCHC CMS Manual System Survey Procedures §416 42 a 1 • Verify that there is evidence for every medical record in the survey sample of an assessment by a physician of the patient’s risk for the planned surgery and anesthesia • Ask the ASC to provide you with its policies and procedures for assessment of anesthesia and procedural risk Safe Travels USA Comprehensive Plan Summary of Coverage Safe Travels USA Comprehensive Plan Summary of Coverage STCH 14591 18 Plan is underwritten by GBG Insurance Limited Medical Maximum per Policy 50 000 100 000 250 000 500 000 1 000 000 Neurosurgery Oxford Academic Neurosurgery the official journal of the Congress of Neurological Surgeons publishes research on clinical and experimental neurosurgery covering the very lates 7 01 546 Spinal Cord and Dorsal Root Ganglion Stimulation MEDICAL POLICY – 7 01 546 Spinal Cord and Dorsal Root Ganglion Stimulation BCBSA Ref Policy 7 01 25 Effective Date July 1 2018 Last Revised May 1 2019 Glossary of Dental Clinical and Administrative Terms Glossary of Dental Clinical and Administrative Terms There are many terms used daily by dentists and their staff in the course of delivering care to patients maintaining patient records and preparing claims LWW Journals Beginning with A Lippincott Journals Subscribers use your username or email along with your password to log in Anaesthetic management of patients with pre existing The main perioperative risk factor for anaphylaxis is a previous uninvestigated perioperative immediate hypersensitivity reaction • The main concerns are potential uncontrolled asthma in atopy severe uncontrolled asthma and strict avoidance of all cyclooxygenase 1 COX 1 inhibitors in NSAID exacerbated respiratory disease cross reactivity to gelatin based colloid in ? gal syndrome non Guidelines for Preventing Health Care Associated Disclaimer All MMWR HTML versions of articles are electronic conversions from ASCII text into HTML This conversion may have resulted in character translation or format errors in the HTML version Users should not rely on this HTML document but are referred to the electronic PDF version and or the original MMWR paper copy

CLINICAL GUIDELINE DEVELOPMENT IN CRITICAL CARE MEDICINE

Restructuring medical care has been a major political focus over the past decade or so. Physicians, nurses, allied health care professionals, and administrators are challenged to be increasingly cost conscious while maintaining the quality of health care delivery. That growing trend is possibly most apparent in the evaluation, risk stratification, general therapy, and application of limited, costly resources in the management of critically ill patients. Such patients consume a large percentage of an individual hospitals and the national health care budget, frequently in the last few days of life. 7 As the American population ages and new diagnostic technologies and innovative therapies develop, there will be increasing demands to use scarce and expensive critical care resources appropriately and effectively. Limited resources and altered allocation of health care dollars will force clinicians to be more efficient, contain costs, and, possibly, limit access to or use of some therapies. Limiting resource allocation is most reasonable when data are sufficient to establish that a cohort of patients will not receive a sustained benefit from the proposed therapy. One of the most commonly applied means to facilitate provision of both cost-effective and safe care by clinicians is the appropriate development, application, review, and refinement of practice guidelines. Although not meant to be a cookbook, guidelines should act as a framework within which to work. Ideally, they should organize current knowledge; resolve clinical controversies; and promote more efficient, effective, and consistent medical practices. 12 Furthermore, some guidelines aid patient care by developing clinical algorithms and establishing means to review use of procedures and provide quality assurance, and prospectively evaluating controversial or innovative therapies. This article defines current approaches to developing and establishing clinical guidelines, reviews validating techniques, discusses specific guidelines that are of special interest to critical care practitioners, and comments on future developments.