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Clinical Quality Review topics for September 2014 -After ruling out ectopic, involve OB in patients with 2nd trimester miscarriage (these patient are more likely to need an intervention/procedure), or in unwell patients with 1st trimester miscarriage -Discuss with the patient how they will get the prescription, and what the backup plan is if they can’tRead more

Patients with lower quadrant pain should typically have gonadal examinations. There are relative exceptions–such as virginal women without history of pelvic examinations or IBD patients with symptoms very typical of previous IBD flairs–but gonadal examinations should still be considered in these patients. Ideally, these examinations should take place before CT imaging.   Patients with previousRead more

QTip: Patients with new neurologic deficits that present outside the reperfusion window or with unknown duration of symptoms may have a time-sensitive dangerous condition other than acute ischemic stroke (e.g. intracranial hemorrhage) and should be considered for expeditious evaluation +/- neuroimaging.Read more

QTip: Some patients who are discharged with few or no diagnostics (e.g. xray) or treatments (e.g. antibiotics) feel as though their evaluation was inadequate. Taking an extra minute or two to explain why these interventions aren’t indicated can make your patient feel much better about their visit. Satisfaction gambits include emphasizing the harms of theRead more

Elmhurst ER QTip: Once a study has been ordered, a multi-step process is initiated that may be difficult to interrupt. If, for example, a blood test is ordered but then deemed unnecessary, simply canceling the order in the physician order entry system is often inadequate to prevent that blood test from being run. In theseRead more