question about your practice

[epidural man]

Do all your patients get routinely monitored - even without sedation? If so...why?

We monitor all our patients - and now with inspections and such, we are getting hit because that brings a bunch of requirements, questions, etc - and I asked the question. Do we need to monitor? Why? Do other people doing procedures in the hospital monitor? Does derm doing a biopsy monitor?

We didn't during fellowship. IR doesn't with a lot of procedures, and I don't when in radiology doing CT-guided blocks.

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[unchockey21]

Only with sedation

 

[willabeast]

A few years ago a nurse was doing a routine vein IV insertion in pre op area with patient on an EKG monitor. Patient had a cardiac arrest. Does not happen very often but EKG electrodes are not that expensive. I look at it this way. People die all the time. If they die in my office, then I get blamed. The more monitoring you have on the record, the less money the plantiffs get.

 

[Ronin1]

Sedation continuous monitoring. All other procedures just vitals before and after

 

[lobelsteve]

No sedation, no monitoring.

 

[epidural man]

A few years ago a nurse was doing a routine vein IV insertion in pre op area with patient on an EKG monitor. Patient had a cardiac arrest. Does not happen very often but EKG electrodes are not that expensive. I look at it this way. People die all the time. If they die in my office, then I get blamed. The more monitoring you have on the record, the less money the plantiffs get.

Maybe that’s true but you also have more scrutiny from credentialed bodies and inspectors and sets up a lot of other issue that could be avoided if you don’t monitor.

 

[pmrmd]

Like Steve said. No sedation, no monitoring.

 

[painfree23]

those who do sedation, are you doing it in a clinic?

 

[gdub25]

No monitoring, and no IV. I feel that’s worth mentioning since one of the hospitals I work at requires IVs for every patient getting an injection even if they aren’t receiving sedation for “just in case” purposes. I too am in favor of no sedation for procedures. We do about 1000 injections a month as a group and no one gets sedation or monitoring.

 

[Ferrismonk]

Sedation = full monitors including EtCO2. Cervical = pulse ox so I can monitor potential vagal response. Otherwise no monitoring in procedure suite. Pre and post vitals.

And yes, everything I do is in office.

 

[unchockey21]

those who do sedation, are you doing it in a clinic?

I do sedation in our ASC with full monitoring. In fellowship, we’d do in office stim trials and kyphos and we’d push the sedation ourselves for those. Used pulse ox and BP.

 

[pastafan]

Office. No sedation, no monitoring. If the rare patient becomes vagal put pulse ox on finger and get BP.

 

[deleted185747]

We monitor only if deactivating/V00 pacemaker-defibulator for a RFA

 

[painfree23]

Can you bill extra for in office sedation?

 

[lonelobo]

Can you bill extra for in office sedation?

only reason people really do it, not out of the kindness of their hearts

 

[unchockey21]

Can you bill extra for in office sedation?

Yeah, we did in fellowship when we were doing SCS trials or kyphos.

 

[painfree23]

Yeah, we did in fellowship when we were doing SCS trials or kyphos.

Do you know what codes you used in fellowship? wouldn’t mind using a little for kyphos, not for billing but for comfort, but would want to get reimbursed some if I’m offering it.

 

[emd123]

I don't IV sedate and I don't put local anesthetic in the epidural space. I only do vitals before and after. Only exception: Sympathetic blocks where I start a saline lock and put a pulse ox on the patient and check pressures during. So far, I've never needed to use IV access on any of these or had any issues where the monitoring was helpful. If you're not sedating or putting local in the epidural space, you don't need to monitor a patient anymore than you need to monitor their family members in the waiting room. You're simply not doing anything to these that can have a meaningful impact on their vital signs.

 

[emd123]

We monitor only if deactivating/V00 pacemaker-defibulator for a RFA

I'm assuming by "deactivating" you are referring to putting a magnet on their pacemaker?
If so, you're not deactivating the devices. You're simply turning off the sensing feature, and not stopping these devices from pacing. I'm not saying its a bad idea to monitor these, but I just wanted to clarify that for the uninitiated who might be reading this thread. It's a common misconception, that a magnet "turns off the pacemaker." They do not.

One thing I do make sure to do, is that when I "put the magnet on" the patient, I don't just place it on them, or wedge it between their body and the procedure table or ask them to hold it on their. I use wide foam tape to tape the magnet on (two large pieces, X shape) so I know for sure it's still in contact with the battery, when they lay down. It's not enough to just press it up against the patient once or hope it stay there when the patient lays down.

 

[painfree23]

I'm assuming by "deactivating" you are referring to putting a magnet on their pacemaker?
If so, you're not deactivating the devices. You're simply turning off the sensing feature, and not stopping these devices from pacing. I'm not saying its a bad idea to monitor these, but I just wanted to clarify that for the uninitiated who might be reading this thread. It's a common misconception, that a magnet "turns off the pacemaker." They do not.

One thing I do make sure to do, is that when I "put the magnet on" the patient, I don't just place it on them, or wedge it between their body and the procedure table or ask them to hold it on their. I use wide foam tape to tape the magnet on (two large pieces, X shape) so I know for sure it's still in contact with the battery, when they lay down. It's not enough to just press it up against the patient once or hope it stay there when the patient lays down.

Be careful, you are not ALWAYS turning off the sensing feature; every company is different, some will change the rate to a back up standard rate (80bpm)

 

[Ferrismonk]

I'm assuming by "deactivating" you are referring to putting a magnet on their pacemaker?
If so, you're not deactivating the devices. You're simply turning off the sensing feature, and not stopping these devices from pacing. I'm not saying its a bad idea to monitor these, but I just wanted to clarify that for the uninitiated who might be reading this thread. It's a common misconception, that a magnet "turns off the pacemaker." They do not.

He did say "V00". That's asynchronous.