Perspective: Door-to-needle times for tPA in stroke hard to meet
By Charles A. Pilcher MD FACEP
September/October, 2011
Under current guidelines from the American Stroke Association, tissue plasminogen activator (tPA, commonly known as a “clot buster” drug) should be administered within 3-4.5 hours of “last seen normal” – and 1 hour of patient arrival – to potentially ameliorate a new onset stroke. While tPA remains the standard of care, outcomes are not guaranteed and risks are significant. Every case is different. Reducing the time needed to deliver clot-busting tPA to patients with ischemic stroke is critical. To read “the rest of the story,” click HERE.
Did the doctor see that? Audit trails of EMR metadata provide compelling record of “if and when”
Many malpractice cases hinge on the question of “Did a practitioner actually see an item in question, and if so, did he/she act on it. As electronic medical records https://pilchermd.com/2008/03/30/template-charts-and-the-emr-the-good-the-bad-and-the-ugly/ evolve and become more common, these questions are readily answered. Every EMR keeps a record of who accessed a chart, what part, and when. While accessing the data may require a forensic IT specialists, a simple request for production may be sufficient. A few EMR’s may have the option of disabling the audit trail or metadata – a bad idea.
Bitten by orca? No problem. New medical billing codes include bizarre injuries.
The new ICD-10 (International Classification of Diseases) codes used by doctors and hospitals for billing for their work are coming soon. “There’s a code for that” is likely to become the new catch phrase. “Bitten by orca – initial encounter” could only be confused with “Bitten by orca – subsequent encounter.” Or was it a sea lion? How about a “turtle bite” – or was it actually a “tortoise”? Perhaps one is injured by a burning water ski. Yup. There’s a code for that. Medical coders will soon be able to specify whether someone was injured by walking into a lamppost, or it falling on them. While crocheting? Or was it knitting? Playing the piano, or worse yet, vacuuming? Injured in a chicken coop, opera house or prison kitchen? Crushed by an alligator? Blown apart by a letter bomb? Not a problem. The federally-mandated codes will be increasing from the current 18,000 to over 140,000.