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Physician documentation
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There have been several concerns about the quality of documentation in electronic health records (EHRs) when compared to paper charts. This study compares the accuracy of physical examination findings documentation between the two in initial progress notes.
5p
visteverogers
24-06-2023
5
2
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Assess information integrity (concordance and completeness of documented exam indications from the electronic health record [EHR] imaging order requisition, compared to EHR provider notes), and assess potential impact of indication inaccuracies on exam planning and interpretation.
6p
visteverogers
24-06-2023
4
2
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Problem-based charting (PBC) is a method for clinician documentation in commercially available electronic medical record systems that integrates note writing and problem list management. We report the effect of PBC on problem list utilization and accuracy at an academic intensive care unit (ICU).
7p
visteverogers
24-06-2023
5
2
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Accurate documentation in the medical record is essential for quality care; extensive documentation is required for reimbursement. At times, these 2 imperatives conflict. We explored the concordance of information documented in the medical record with a gold standard measure.
6p
vighostrider
25-05-2023
5
2
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Electronic health record documentation by intensive care unit (ICU) clinicians may predict patient outcomes. However, it is unclear whether physician and nursing notes differ in their ability to predict short-term ICU prognosis. We aimed to investigate and compare the ability of physician and nursing notes, written in the first 48 hours of admission, to predict ICU length of stay and mortality using 3 analytical methods.
7p
vighostrider
25-05-2023
8
2
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In this article, we propose 7 core measures of EHR use that reflect multiple dimensions of practice efficiency: total EHR time, work outside of work, time on documentation, time on prescriptions, inbox time, teamwork for orders, and an aspirational measure for the amount of undivided attention patients receive from their physicians during an encounter, undivided attention.
5p
vighostrider
25-05-2023
10
2
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There is minimal research on demographics, type of injury and diagnosis of injured workers with shoulder problems. The purposes of this study were: 1) to document the demographics of patients with shoulder complaints referred to an Early Shoulder Physician Assessment (ESPA) Program and to describe the recommended management, and 2) to examine the relationship between patient characteristics and their subjective complaints of pain and functional difficulty.
8p
vianttinic2711
20-04-2021
8
2
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To perform validation of the Romanian Knee disability and Osteoarthritis Outcome Score for Joint Replacement (KOOSJR). Method: Ninety-six patients (101 knees) with advanced osteoarthritis (OA) scheduled for total knee replacement completed Romanian translations of KOOSJR and IKDC (International Knee Documentation Committee – subjective knee form) and Euroqol EQ-5D-5 L, and the treating physician completed the original knee society score (KSS).
5p
vipalau2711
30-12-2020
7
0
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(BQ) Welcome to Fast Facts About Neurocritical Care: A Quick Reference for the Advanced Practice Provider . This book is a very nonexclusive resource for anyone who works in neurocritical care, including physician assistants, nurse practitioners, clinical nurse specialists, and bedside nurses. I would not even be surprised to find it in the hands of a medical student, intern, or resident.
1161p
nanhankhuoctai7
01-07-2020
25
3
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After completing this chapter, you will understand which calls may be handled by the medical assistant and which require the physician's attention. This chapter helps you identify which calls are considered emergencies and how to properly route these calls. You will learn how to effectively handle difficult telephone situations or complaints and how to properly document messages taken.
53p
abcxyz123_05
18-04-2020
18
2
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The purpose of this study is to explore how knowledge can be managed across boundaries when implementing innovations in the healthcare sector is desired, in this specific case a healthcare quality register. The research is based on a qualitative, case study approach and comprises methodologies such as semi-structured interviews and document analysis. The findings of this study describe knowledge transferred across boundaries on a syntactic, semantic, and pragmatic level.
20p
quenchua1
06-11-2019
22
1
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(BQ) Continued part 1, part 2 of the document The critical care physician with the acute nephrology has presents the following contents: Classical biochemical work up of the patient with suspected aki, acute kidney injury biomarkers, acute kidney injury biomarkers, prevention and protection, renal replacement therapy,...and other contents. Invite you to refer.
140p
thuongdanguyetan05
05-07-2019
19
2
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(BQ) Part 1 of the document The critical care physician with the acute nephrology has contents: Renal outcomes after acute kidney injury, etiology and pathophysiology of acute kidney injury, kidney organ interaction, acute kidney injury in pregnancy,... and other contents. Invite you to refer.
140p
thuongdanguyetan05
05-07-2019
15
0
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Chapter 3 - Legal and ethical issues in medical practice, including HIPAA. In this chapter you will learn: Define ethics, bioethics, and medical law; discuss the measures a medical practice must take to avoid malpractice claims; discuss medical documentation and how it applies to medical law;...
70p
nhanmotchut_5
02-11-2016
47
3
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Chapter 11 - Telephone techniques. In this chapter, you will learn key terms associated with telephone techniques. After completing this chapter, you will understand which calls may be handled by the medical assistant and which require the physician's attention. This chapter helps you identify which calls are considered emergencies and how to properly route these calls. You will learn how to effectively handle difficult telephone situations or complaints and how to properly document messages taken.
34p
whocarea
05-09-2016
45
2
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(BQ) Continued part 1, part 2 of the document Acute nephrology for the critical care physician presents the following contents: Classical biochemical work up of the patient with suspected aki, acute kidney injury biomarkers, acute kidney injury biomarkers, prevention and protection, renal replacement therapy,...
180p
thangnamvoiva4
01-07-2016
44
3
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(BQ) Part 1 of the document Acute nephrology for the critical care physician presents the following contents: AKI - Defi nitions and clinical context, epidemiology of AKI, renal outcomes after acute kidney injury, etiology and pathophysiology of acute kidney injury, acid–base, kidney organ interaction, acute kidney injury in pregnancy
100p
thangnamvoiva4
01-07-2016
40
2
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(BQ) Continued part 1, part 2 of the document The arrhythmic patient in the emergency department - A practical guide for cardiologists and emergency physicians presents the following contents: Wide QRS complex tachycardia in the emergency setting, acute management of arrhythmias in patients with known congenital heart disease, acute management of arrhythmias in patients with known congenital heart disease, acute management of arrhythmias in patients with channelopathies,...
118p
thangnamvoiva3
01-07-2016
64
4
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(BQ) Part 1 of the document The arrhythmic patient in the emergency department - A practical guide for cardiologists and emergency physicians presents the following contents: Management of arrhythmic patients in the emergency department - General principles; first evaluation and management in the emergency department; management of bradyarrhythmias in emergency,...
96p
thangnamvoiva3
01-07-2016
61
2
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Chapter 4 - Electronic health records in the hospital. After studying this chapter, you should be able to: Explain the functions of an EHR in an acute care hospital, list the primary benefits of a hospital HER, list the uses of clinical documentation in an inpatient setting,...
13p
tangtuy12
01-06-2016
39
1
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