RedScrubs
The Resource for Medical Professionals

“Many times, the EASIEST part of taking care of patients is making the diagnosis and knowing what the treatment is. The part that his harder and requires more creativity and (often) leg or telephone work, it putting the plan into action. “Sealing the deal” is one thing to call it. It’s like when you were in high school, getting to second or third base was usually MUCH easier than closing in on home! Anyway, the other night we had a mess of a situation. An elderly, somewhat demented lady who only spoke Arabic (and who was DNR incidentally) was sent in from the nursing home with vomiting for 6 hours.” This blog explores the real challenges in ER – getting the Treatment Plan into action and a workable part of patient care. This is an interesting case study of a woman with food stuck in her esophagus and the antics the attending had to go through to get an endoscopy procedure in place and ready to go! My question is, if nursing home staff had been more aware and not so busy shoveling food into a patient who probably had swallowing difficulties, would this have ever happened in the first place? Of course, speculations of this kind are always difficult to make without all of the facts.

Quite a bit of attention has been paid to the prevention of surgical site infections over the past few years — and this is one area that CMS/Medicare is targeting in its ever expanding “never event” list (I have ranted a bit about this before). From the CMS web site detailing a July 31, 2008 press release:
In last year’s final rule, CMS listed eight preventable conditions for which it would not make additional payments. In this year’s proposed rule, CMS identified nine potential categories of conditions, but based on public comments, is finalizing three of these. The new additional conditions in this year’s final rule include:
* Surgical site infections following certain elective procedures, including certain orthopedic surgeries, and bariatric surgery for obesity
* Certain manifestations of poor control of blood sugar levels
* Deep vein thrombosis or pulmonary embolism following total knee replacement and hip replacement procedures