Delinquent Medical Records: Who Are the Stakeholders for Timely Medical Documentation?

The explosion of electronic documentation associated with Meaningful Use-certified electronic health record systems has led to a massive increase in provider workload for completion and finalization of patient encounters. Delinquency of required documentation affects multiple areas of hospital operations. We present the major stakeholders affected by delinquency of the electronic medical record and examine the differing perspectives to gain insight for successful engagement to reduce the burden of medical record delinquency.

Chronic Lymphocytic Leukemia Resulting in Hemorrhagic Brain Masses After Sepsis.

Chronic lymphocytic leukemia (CLL) rarely results in central nervous system (CNS) involvement. When CLL does affect the CNS, it typically manifests as leptomeningeal involvement, not commonly causing parenchymal involvement unless having undergone a higher grade transformation. We report a case of a patient with untreated CLL who presented with a large right frontal hemorrhagic mass along with additional bilateral masses after being found unresponsive.

Multimodality Monitoring in the Neurocritical Care Unit.

Purpose Of Review: This article focuses on the multiple neuromonitoring devices that can be used to collect bedside data in the neurocritical care unit and the methodology to integrate them into a multimodality monitoring system. The article describes how to apply the collected data to appreciate the physiologic changes and develop therapeutic approaches to prevent secondary injury.

Recent Findings: The neurologic examination has served as the primary monitor for secondary brain injury in patients admitted to the neurocritical care unit.

Use of intraosseous hypertonic saline in critically ill patients.

Background: Rapid administration of hypertonic saline 23.4% is crucial in treatment of herniation syndromes. Hypertonic 23.

Many Neurology Readmissions Are Nonpreventable.

Introduction: Reducing unplanned hospital readmissions has become a national focus due to the Centers for Medicare and Medicaid Services' (CMS) penalties for hospitals with high rates. A first step in reducing unplanned readmission is to understand which patients are at high risk for readmission, which readmissions are planned, and how well planned readmissions are currently captured in comparison to patient-level chart review.

Methods: We examined all 5455 inpatient neurology admissions over a 2-year period to University of California San Francisco Medical Center and Johns Hopkins Hospital via chart review.

A Model for the Departmental Quality Management Infrastructure Within an Academic Health System.

As quality improvement and patient safety come to play a larger role in health care, academic medical centers and health systems are poised to take a leadership role in addressing these issues. Academic medical centers can leverage their large integrated footprint and have the ability to innovate in this field. However, a robust quality management infrastructure is needed to support these efforts.

Facilitating Early-In-Day Discharge for Multiple Sclerosis Patients Treated With Intravenous Methylprednisolone: A Quality Improvement Project.

Background And Purpose: Delays in patient hospital discharge affect care value through costs of prolonged length of stay and barriers to patient flow within the hospital. We sought to facilitate early-in-day discharges (EIDDs) without extending length of stay for inpatients with multiple sclerosis admitted for acute exacerbations and treated with intravenous (IV) methylprednisolone.

Methods: We developed a standardized admission order set, a provider checklist, and a patient checklist to better coordinate in-hospital care and discharge planning for patients with multiple sclerosis admitted for IV methylprednisolone treatment.

Brain code and coma recovery: aggressive management of cerebral herniation.

Cerebral herniation occurs due to lateral or vertical shifts in brain tissue as a complication of an intra- or extra-axial nervous system pathology. Midline shift of midline brain structures has been independently associated with poor outcome in a variety of neurologic injuries. Herniation may present as a subacute phenomenon constituting mild and progressive alteration of consciousness or as a hyperacute scenario wherein there is rapid decompensation of intracranial compliance.

Long-term assessment of post-cardiac-arrest neurological outcomes with somatosensory evoked potential in rats.

Cardiac arrest (CA) can produce complex changes in somatosensory evoked potentials (SSEPs). Somatosensory evoked potentials (SSEPs) indicate the intactness of somatosensory pathways and are commonly used for brain function monitoring during surgeries. Multiresolution biorthogonal wavelet analysis was applied to SSEPs recorded during established CA experiments and post-CA long-term recovery periods in rats.

Management of cardiac arrest patients to maximize neurologic outcome.

Purpose Of Review: Each year, hundreds of thousands of people will be resuscitated after a cardiac arrest. A significant portion of these patients will lapse into a disease state which is the product of modern emergency and critical care medicine: the postcardiac arrest syndrome. The ability to return a patient to his or her prior state of health after cardiac arrest, once completely beyond the capacities of clinicians, is now one of the most important areas of medical science.