EMS Telemedicine Screening and Deferral of ED Care

EMS Telemedicine Screening

An interesting recent article in MedPage Today describes the use of telemedicine consultation with an emergency physician in the dispatch center by Huston Fire Department medics to screen and refer selected patients, who request ambulance transport to the ED, to alternative venues for care.   This is a new take on the deferral of ED care pathway that various hospitals, health care systems, government payers, and EM groups have used to reduce the number of so-called … Continue reading

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Significant Clinical Challenges in the ED, PQRS, and QCDRs

Significant Clinical Challenges

In an article published in the April 2015 issue of Annals of Emergency Medicine, Drs. Griffey, Pines, et al proposed an alternative to using diagnostic codes to develop performance measures in an effort to address “one of the primary functions of ED care, which involves diagnosing, risk stratifying, and treating patients’ potentially life-threatening conditions according to symptoms (ie, chief complaints)”. The authors point out that there are advantages and disadvantages to using diagnosis codes to identify … Continue reading

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Puppy Lessons for the Emergency Department #2

Last week our 7 mo. old Labradoodle got sick, and once again I have been reminded of some important considerations for ER care. Thought I would share them. Probably the first and foremost truth is that when children become ill, parents invariably feel guilty. They may not always express that feeling, but thoughts of ‘what did I do wrong?’ or ‘did we give her the wrong food?’ are inevitable, especially when the symptoms involve the GI … Continue reading

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I Dream of Julene, or Can Physicians Ever Really Retire?


It began with the routine sorting of admissions. As first year post-grads on a three-month long internal medicine rotation, the three of us each picked up, in rotation, two early morning admissions. My first was a pretty straightforward cellulitis case, and most everything that needed to be done had been done in the ED. The second patient was a 79-year-old woman who was ‘found down’ by an apartment neighbor who heard her cries through poorly insulated … Continue reading

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Lifting All the Boats in Emergency Medicine

rising tide lifts all boats

Like many specialties, especially those engaged in hospital based practice, emergency medicine finds itself facing a number of challenges related to health care and payment reform, the most immediate of which is to maintain its current share of health care revenues in the face of resistance on many levels.  There will always be a role for emergency physicians in managing seriously and critically ill and injured patients, but there is a real question about the ability … Continue reading

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