Healthcare workers know that their job never ends. Patients don’t stop coming to the hospital because it is a weekend, holiday or late at night. Therefore, we provide 24-hour coverage and support in order to take care of our patients – because that is what we do! We are super-humans who save lives! But at what cost? At some point in your career you have likely had to take on night shift and that means that you have to fight your own circadian rhythm in order to stay awake! How messed up is that?!? This is my personal survival guide (with help from my nurses) for surviving the vampire shifts! I will start this list of with more serious topics to take note of. Then, in true night shift fashion, we will take a 90 degree turn and jump off the deep end with some fun suggestions from those who have made a few life mistakes previously!
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Decoding MIPS in Emergency Medicine – Radiology Edition
In our last edition, we discussed some ways of altering practice models or properly documenting patient care so that we stay within the current MIPS guidelines while continuing to provide the highest quality care. In this edition, we will discuss some of the MIPS guidelines as they pertain to Radiographic studies that are commonly ordered in ER/Urgent Care settings. As always, appropriate documentation as to why, or why not, a test was ordered is crucial not only for MIPS, but from a legal standpoint as well. So, let’s get into it!
[Read more…] about Decoding MIPS in Emergency Medicine – Radiology EditionGraduated, passed boards, got a job… now what?
“Don’t Hurt Anyone”
My first job as a nurse practitioner was ideal. I knew all the physicians. I knew all the nurses. I knew all the administrators. Yet, I was scared beyond belief. First and for most I did not want to hurt my patients. Second, I wanted the staff that I worked with to accept me as a competent nurse practitioner. I remember clearly two conversations from those first few days; “John, don’t hurt anyone” and two, “John, one of the most important things is know what you don’t know”.
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MEASLES: Coming soon to a practice setting near you (Are you ready?)
In case you have been in a news and media blackout recently, Measles is back. I have seen headlines such as “Measles cases rocket toward record level”, “555 Measles cases spread to 20 states,” and “Measles outbreak hits ‘completely avoidable’ 25-year high”…despite being declared eliminated in the United States in 2000. If you are still in current practice, odds are that none of us have seen measles in front of us or thought that we had pretty much eliminated it. Personally, I have only seen one case a few years back and it was in an un-immunized child of a migrant farm worker. To be honest, it could have been very easily overlooked as just another “viral illness” or “viral exanthem”. Sometimes, it pays to be lucky rather than good. The purpose of this blog is to help prepare you in case this walks into your practice setting…making you both lucky and good.
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Revolution in Healthcare
As we all know, we are in the middle of a Revolution of sorts in Health Care. The practice of medicine is becoming less about the art of medicine and more about the business of medicine. Patient Satisfaction is a major concern, and satisfaction ratings along with Quality measures, such as MIPS, are going to play a large role in how we are reimbursed by insurance payors. And when you look at the MIPS guidelines, one of the first questions that comes to mind is ‘How do I satisfy these requirements while keeping my patients happy’? Well, we are going to go over a few of the common MIPS standards here and how you can meet those standards while providing the care that patients want or expect.
Sensitivity, Specificity, Predictive Values, Pre/Post-test Probability, and Likelihood Ratios explained
The purpose of this post is to explain the concept of sensitivity, specificity, predictive values, and likelihood ratios.
Screening Tests
Screening tests (surveillance tests) are tools use to assess the likelihood that a patient may have a certain disease. They are not definitive, but if positive, will heighten suspicion that would warrant use of a gold standard diagnostic test to rule in or rule out a certain diagnosis. The goal of screening tests is to reduce the morbidity and mortality in a population group (Maxim, Niebo, & Utell, 2014). Examples of screening tests include routine EKGs, PSA, PAP smears, and mammograms. For example, a male with an elevated PSA may have prostate cancer, BPH, or prostatitis. Positive results of screening tests need to be compared to the established gold standard test that is regarded as definitive. In this case, a prostate biopsy is considered a definitive test, as it will reveal the etiology of the elevated PSA. Screening tests are less invasive and less costly, whereas the gold standard test may be more invasive, expensive, or too late (discovered during an autopsy). Ideally, gold standard tests, such as coronary angiography, breast biopsy, or colposcopy should have 100% sensitivity and specificity. However, in reality, this may not be the case, as it may be the best test given the clinical picture at the time (Maxim, Niebo, & Utell, 2014).
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