What happened to the ACEP report card ?

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TooMuchResearch said:
WTF is ACEP?
But really, who's going to produce our practice guidelines if ACEP falls? AAEM?
Click to expand...

They won't fall.

In fact, there is only a very small chance they will change. That has to be our hope.

HH
 
TimesNewRoman said:
I can only assume team health or USACS asked for it to be taken down.
Click to expand...

The fact that ACEP would remove a tool that would make it easy for EPs to avoid poor practice climates (because it makes it harder for a CMG to staff bad departments) tells you everything you need to know about the organization.

And absolutely AAEM can publish practice guidelines.
 
Guideline number one: Avoid placing central lines after too much caffeine.
Guideline number two: Gomers go to ground.
Guideli-
 
The ACEP report card measured how prepared each state was to provide emergency care to its residents. States with few ED beds, bad legal environment, lack of disaster preparedness, etc, were given failing grades. Not surprisingly, since most states actually don’t have enough ED beds and other emergency resources, most states received poor grades.
ACEP’s 2014 Report Card on Emergency Medicine Reveals Major Access-to-Care Deficit - ACEP Now
The idea was to use the report card to advocate for federal and state policy changes that improve emergency care and thus improve our jobs. My understanding is that this report card was determined not to be an effective advocacy tool and was actually counter productive in some instances and therefore the report card is no longer produced.
If you are asking about ACEP clinical policies, ACEP still produces these. Here is a link to current policies. I regularly refer to the ACEP asymptomatic hypertension policy in my charting.
Clinical Policies
 
RuralEDDoc said:
The ACEP report card measured how prepared each state was to provide emergency care to its residents. States with few ED beds, bad legal environment, lack of disaster preparedness, etc, were given failing grades. Not surprisingly, since most states actually don’t have enough ED beds and other emergency resources, most states received poor grades.
ACEP’s 2014 Report Card on Emergency Medicine Reveals Major Access-to-Care Deficit - ACEP Now
The idea was to use the report card to advocate for federal and state policy changes that improve emergency care and thus improve our jobs. My understanding is that this report card was determined not to be an effective advocacy tool and was actually counter productive in some instances and therefore the report card is no longer produced.
If you are asking about ACEP clinical policies, ACEP still produces these. Here is a link to current policies. I regularly refer to the ACEP asymptomatic hypertension policy in my charting.
Clinical Policies
Click to expand...

Except that the report card spoke the truth, and it was censored.
On any given day during "season" (tourist/snowbird), we have about a dozen or so "boarders" in our ER.
Thus, there aren't enough beds to meet normal demand, let alone have any sort of surge capacity.
God forbid a true tragedy like a terrorist event or a hurricane hit should directly hit my city. We're screwed.
Wait. A hurricane hit us indirectly last year. We were screwed.
The policy-makers need to address this.
 
TooMuchResearch said:
You refer to their policies in your notes? Like your notes have references?
Click to expand...

I do this, too.

from my charts, taken verbatim:

"Care was taken to review the current clinical guidelines regarding management of asymptomatic HTN in the ER with patient. In accordance with these guidelines, decision made/agreement reached between physician and patient to follow a course of care consisting of discharge home and PMD follow-up in the coming days. Care was taken to educate patient on the warning signs/symptoms to necessitate immediate return for acute management. Patient verbalized understanding of and agreement with the plan for continued care."

Take notice of the following:

1. The phrase "care was taken" is used a few times. Sounds great when you read it out loud in front of a jury. Care is taken to do so many things in my charts.
2. The phrase "decision made/agreement reached between physician and patient" indicates a lot, as well.
3. Patient "verbalized understanding of and agreement with" the plan for continued care.

This is all available to me when I type HTN:ASYMPTOMATIC (autopopulated after the first three keystrokes, generally) in CERNER. Charting is done in less than 45 seconds. Discharged.
 
Hmm, yeah I have a stock discharge thing that mentions all that discussed it, answered questions, discussed follow up, etc.
But referencing things that are readily available (I.e. your insurer's attorneys will have it regardless) seems unnecessary and makes the charts unreadable.
Maybe one of our experienced med mal consultants can weigh in, but I don't buy that pasting in a bunch of stock text matters much.
 
RustedFox said:
Except that the report card spoke the truth, and it was censored.
On any given day during "season" (tourist/snowbird), we have about a dozen or so "boarders" in our ER.
Thus, there aren't enough beds to meet normal demand, let alone have any sort of surge capacity.
God forbid a true tragedy like a terrorist event or a hurricane hit should directly hit my city. We're screwed.
Wait. A hurricane hit us indirectly last year. We were screwed.
The policy-makers need to address this.
Click to expand...

I don’t think the report card was censored. It just isn’t produced anymore since it wasn’t meeting it’s intended advocacy goal. It takes an incredible amount of effort to produce the report card and if ACEP felt it wasn’t effective, it was wise to stop producing it.
ACEP still advocates for exactly the issues you mention - increased capacity, malpractice reform, disaster preparedness, etc.
Regarding referencing guidelines in charts - I think most of us do this in some form or another:
“Pt with Heart score of 2 and low risk for major cardiac event in 30 days - dc home with plan for outpatient stress test”
“Pt with PORT score of 65, will treat with outpatient antibiotics and PCP follow up in 2-3 days”
“Pt with BP of 188/97, no symptoms at this time, per ACEP asymptomatic HTN policy, will dc patient at this time, discussed checking BP daily and keeping a record to discuss with PCP in one week, return precautions given for headache, chest pain...”
 
RuralEDDoc said:
I don’t think the report card was censored. It just isn’t produced anymore since it wasn’t meeting it’s intended advocacy goal. It takes an incredible amount of effort to produce the report card and if ACEP felt it wasn’t effective, it was wise to stop producing it.
ACEP still advocates for exactly the issues you mention - increased capacity, malpractice reform, disaster preparedness, etc.
Regarding referencing guidelines in charts - I think most of us do this in some form or another:
“Pt with Heart score of 2 and low risk for major cardiac event in 30 days - dc home with plan for outpatient stress test”
“Pt with PORT score of 65, will treat with outpatient antibiotics and PCP follow up in 2-3 days”
“Pt with BP of 188/97, no symptoms at this time, per ACEP asymptomatic HTN policy, will dc patient at this time, discussed checking BP daily and keeping a record to discuss with PCP in one week, return precautions given for headache, chest pain...”
Click to expand...

RuralEDDoc said:
I don’t think the report card was censored. It just isn’t produced anymore since it wasn’t meeting it’s intended advocacy goal. It takes an incredible amount of effort to produce the report card and if ACEP felt it wasn’t effective, it was wise to stop producing it.
ACEP still advocates for exactly the issues you mention - increased capacity, malpractice reform, disaster preparedness, etc.
Regarding referencing guidelines in charts - I think most of us do this in some form or another:
“Pt with Heart score of 2 and low risk for major cardiac event in 30 days - dc home with plan for outpatient stress test”
“Pt with PORT score of 65, will treat with outpatient antibiotics and PCP follow up in 2-3 days”
“Pt with BP of 188/97, no symptoms at this time, per ACEP asymptomatic HTN policy, will dc patient at this time, discussed checking BP daily and keeping a record to discuss with PCP in one week, return precautions given for headache, chest pain...”
Click to expand...

Sure, I reference HEART, but it's just "HEART score low risk...f/u w/ PCP ( or cardiology)."
"PERC negative, no further workup for PE indicated."
For HTN, I don't reference anything, just "no symptoms, labs okay, f/u w/ PCP this week." If something bad happens, the clinical policy from the organization I'm not part of is in the public domain.
I also try to keep my documentation concise. I've been finding more fluff in my templates and cutting it all lately.
 
I do the same as TMR above if it's appropriate -- HEART this, PERC / Wells that, etc. Suspect many of us do.

I also am critical of HEART and PERC. As with all guidelines, they're guidelines. If you're suspicious of those respective conditions in someone who is low-risk by criteria but you're still reasonably bothered they might be one of those < 2 in 100 despite ticking boxes, screw the scoring systems and do the testing. A good story with a "low-risk HEART" gets you a stress test.

Anyway: I've seen actual footnotes in a physician note exactly one time. Talk about a cross of being impressed and entertained.
 
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