As outlined previously in conference, we’re live with a new discharge process. In short: when it’s time to discharge a patient, you will have a discharge conversation with the patient to discuss their visit, follow up and return precautions, and then prepare the AVS and order the discharge. The nurses and BAs will then hand paperwork to the patient, remove the IV and remove their name from the trackboard. Detailed instructions are attached. PLEASE read them in detail so you know how to do this.
Also, we recommend that you use the free text discharge instruction box to outline specific things you would like the nurse to reiterate when they hand the patient their paperwork. If you don’t have one, you can take .MSHEDDISCHARGE from my list of smartphrases. You should at least be outlining their follow up plan and return precautions in addition to a brief summary of what happened in the ED.
Be aware that this is potentially a lot more work for our nursing colleagues. Be collegial and respectful as we work through the kinks.
Who is responsible for filling out the MDM section in EPIC? Can I just ignore the new MDM template and free-text my MDM in the ED Course? Do I have to check any of the boxes in the MDM section? How do I use the Problem List?
Q: Who is responsible for filling out the MDM section in EPIC? A: For both PA & resident cases: the resident or PA should first fill out the MDM, just like the HPI/ROS/PE. Then, the attending should review it and make any desired additions or edits, in addition to writing their own note in the attending section of the note. For PA cases, the attending needs to document a substantive portion of the physical exam, HPI and make clear their plan in order to bill under the attending.
Q: Can I just ignore the new MDM template and free-text my MDM in the ED Course? A: Technically, yes, but the 2023 MDM guidelines have very specific requirements. If you don’t use the MDM template, you would need to make sure you are meeting those requirements on your own, or else your chart may be down-coded. For example, if a patient presents in respiratory distress from asthma, simply mentioning that you treated their asthma would not get you to a level 5. Instead, a level 5 chart would require (among other things) that you document that their asthma represents a “severe exacerbation of a chronic illness”. The new MDM template is designed to make this easy, and to remind you to document various common things we do that are necessary for coding.
Q: Do I have to check any of the boxes in the MDM section? A: No! Only check them if they apply to the patient. If none of them apply, then you might just have a low-complexity encounter, which is fine. For example, if the problem is “medication refill”, and the patient is stable with no acute issue, then you would not check any of the “threat to life”, “moderate exacerbation of chronic disease”, or “severe exacerbation of chronic disease” buttons.
Q: How do I use the Problem List? Do I need to do this AND a separate assessment and plan? A: The idea is to write your assessment and plan for each problem! No need to write it a second time. If the problem happens to be a threat to life or bodily functions, or a chronic illness with moderate or severe exacerbation, you should check those boxes too.
Q: I have an idea for improving the new MDM template, OR a different question! A: Please feel free to reach out to Brendan Connell and Nick Gavin (for issues relating to the Epic template), and to Erick Eiting (for questions regarding the new MDM requirements). We will be happy to help!
What is the protocol for medicine floor admissions?
A: Admit the patient as you normally would. While a provider note is encouraged, given the pace of the ED, a provider note is NOT required prior to admission, however the .edadmit note is required. This should only take you a few minutes, but it is important for patient care to write a brief story, reason for admission, and next steps for the admitting team / what to follow up on. For patients with abnormal vitals on arrival, repeat vitals are encouraged.
What is FAQ?
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What is FAQ?
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What is FAQ?
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What is FAQ?
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What is FAQ?
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What is FAQ?
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What is FAQ?
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Social Work changes by time and departmental zone. Click on “Social Work” for more information.
For Expedited follow up with a sub-specialist, follow the Red Arrows: DC/Transfer > ED Follow Up > “Complete This Form”
