SOGH January 2018 NewsletterDayna Smith, M.D. and Jane Van Dis, M.D.Co-editors, SOGH NewsletterThe Society of OB/GYN Hospitalists is dedicated to improving outcomes for hospitalized women and supporting those who share this mission.Comments or Questions about the Newsletter? Contact us!
PRESIDENT'S MESSAGEDear Colleagues, Recently a colleague asked me, “Do you ever just feel like you’re careening from one thing to the next?” Sadly, my answer was a resounding yes. And lately it’s been more than a “feeling.” On more than one occasion, I’ve failed to keep all the balls in the air…like realizing just minutes before the school play that the tickets I’d bought were for Saturday (and it was Sunday). Or when I stumbled through a presentation before a large audience because, as it turns out, the slide show I was running was not my updated version. Needless to say, careening is an all-too-familiar feeling. But as I write this, the New Year is just a few days away which means it’s time to reflect on the past year, contemplate what’s ahead, and perhaps even proclaim a New Year’s resolution. I’ve never been one to declare a resolution, at least not openly, for fear that someone might actually hold me to it, or worse yet, be aware of my failure to uphold it. But this year I’ve decided to take the “go big or go home" approach and am not only committing to a New Year’s resolution, but am proclaiming it publicly. Inspired by Dr. Haramati’s sobering yet inspiring talk “Managing Stress, Building Resilience” (1) my New Year’s resolution is to practice mindfulness in 2018. For those who may not be familiar, mindfulness simply put, is focusing the mind on what is happening in the present moment. Mindfulness can be achieved using a variety of techniques (meditation, imagery, breathing techniques, etc.) but regardless of the medium, science shows us that when we practice mindfulness, stress hormones are lowered which leads to lower blood pressure, lower heart rate, improved concentration, and reduced feelings of perceived stress, anxiety, pain and depression (1). The concept of mindfulness and other practices that help to reduce stress are gaining more and more attention in medicine as the issues of stress and burnout are becoming more prevalent. This is especially good news for OB/GYN hospitalists due to the high-stress, high stakes nature of our work. In the New Year, I encourage you all to be “mindful” of these issues and when that careening feeling creeps in, that you consider giving a stress-relieving practice like mindfulness a try. This is my New Year’s resolution - and you can even hold me to it. All the best in the New Year! Tanner Colegrove, M.D. References and Resources: 1) May Clinic Healthy Lifestyle Consumer Health IN THE NEWSCongratulations to Dr. Meredith V. Morgan! Dr. Meredith V. Morgan receives award presented by Dr. Terry Simon.
The Woman's Hospital of Texas, in Houston, received three awards from a survey done by Professional Research Consultants. (PRC). The Five Star Excellence Award is for scoring in the top 10% nationally. For the 2016 survey, there were 578 hospitalists that participated. One of the awards was presented in 2017 to Dr. Meredith V. Morgan, the Medical Director for Hospitalists Services. Since its inception over nine years ago, Dr. Morgan has been at the helm of the OB/GYN Hospitalist program at Woman's, a hospital that delivers well over 11,000 babies per year. Dr. Morgan is the immediate Past President of SOGH. Congratulations Dr. Morgan!
"CODE THIS!" (Case of the Month)The Review of Systems The Missing Link To Achieving The Elusive “Comprehensive” History” by Lori-Lynne A. Webb, CPC and Renée Allen, MD, MHSc., FACOGJanuary, 2018 Most OB Hospitalist practices have a template that covers the 12 body systems for the review of systems (ROS) and for the physical exam section within the Electronic Medical Records (EMR) system. The “Evaluation and Services Management” publication, created and revised in 2017 by the Centers for Medicare and Medicaid Services (CMS), does not state a required number of negatives per system necessary for documentation. Instead, the publication directs you to document all positive and pertinent negative responses in the ROS section of the H&P. According to this CMS guide; “A complete ROS inquires about the system(s) directly related to the problem(s) identified in the HPI plus all additional (minimum of ten) organ systems. Individual documentation is required of those systems with positive or pertinent negative responses. For the remaining Systems, a notation indicating all other systems are negative is permissible. However, in the absence of such a notation, you must individually document at least ten systems.” An important issue for OB Hospitalists is, how many systems were reviewed and what level of acuity does our documentation support? Below are the systems that make up the ROS. To achieve a “complete” or “comprehensive” ROS review, at least ten (10) of these systems need clear documentation within the medical record for that specific encounter. Take note that there are 14 body systems listed. Thus, 10 of the 14 must be documented to qualify for a “comprehensive” ROS.
The ROS is a critical component of our documentation. Given the focused nature of many of our patient encounters in a triage or OBED, we likely aren’t going to be assessing very many systems. The complexity of our encounters are often determined by our medical decision making. Usage of statements such as “ROS negative” or “negative other than in the HPI” is unacceptable and does not support the required documentation for a ROS when documenting the history portion of the encounter. While it is acceptable to use verbiage in the documentation such as, “all body systems were reviewed and are negative.” If you employ this statement in your clinical documentation, make sure you are indeed performing a 10-plus system review and that the review is pertinent to the patient’s chief complaint and HPI. Querying systems that have no relevance to the HPI is not considered appropriate practice. If you are currently using statements such as “ROS negative” or “negative other than in the HPI”, such statements only cover those systems described in your HPI and are not adequate documentation of 10 systems. CMS notes in their recommendations for documentation of the patients’ history additional useful tips on the proper Documentation of History (click here)
- Describing any new ROS and/or PFSH information or noting there is no change in the information
- Noting the date and location of the earlier ROS and/or PFSH
Example of proper ROS “comprehensive” documentation with a List by Body System for a Laboring Patient REVIEW OF SYSTEMS: Example of proper ROS “comprehensive” documentation with a Statement for a Patient with Persistent UTI: REVIEW OF SYSTEMS: 10 body systems reviewed and are negative, except the patient still reports dysuria and polyuria. The patient has a recent diagnosis of UTI and has not yet completed her antibiotic regimen with Macrobid. Dr. Renée Allen served co-author of this column. She is the SOGH Liaison to the ACOG Committee on Health Economics and Coding and Co-Chair of the Development Committee. She currently works as an OB/GYN Hospitalist with Mednax/Obstetrix at Eastside Medical Center in Snellville, Georgia. Questions regarding this case? Contact us at [email protected] SIM CORNERAIM Obstetric Hemorrhage Safety Bundle
January, 2018
Ready, Educate, Simulate, Repeat! As OBGYN hospitalists, we fill a unique role on the Labor and Delivery Unit. We serve as the liaison between the hospital’s healthcare staff, administration, private physicians, and the patient. It is this unique role that makes us the perfect providers to be the champion for implementation of the AIM Patient Safety Bundles at our individual institutions. AIM, or the Alliance for Innovation on Maternal Health, works at national, state, and facility levels to promote safe health care for every woman. Department Ready:
Simulation: Physical Space: Delivery room with possible transfer to operating room. Primary Issue being assessed: Staff knowledge and treatment of obstetric hemorrhage. (Keep in mind user may modify drill to assess effective communication in emergencies, patient flow in a physical space, unit’s preparedness with necessary tools and materials to meet staff’s needs in an emergency etc.). Scenario:
Weight: 225 lb PMH: Gestational diabetes PSH: None NKDA Meds: glyburide 5mg daily, PNV SH: denies all toxic habits FH all healthy per pt Labs: Blood type B+ CBC : WBC 11.2 H/H 11.7/33.1 Plts 165 She is typed and screened, no crossed matched blood. Participants:
Participants should go through steps of:
a) Bleeding responds in delivery room with use of meds.
b) Bleeding responds in OR s/p
- D&C for retained products or
- Identification and treatment of laceration or
- Placement of compression balloon
c) Bleeding responds in OR s/p x-lap where compression sutures are used, or hysterectomy, or no response s/p hysterectomy and patient goes into DIC. Debrief:
I hope you will join me in my "New Year's Resolution" of helping my facility implement and execute both the AIM Patient Safety Bundles of Obstetric Hemorrhage and Hypertension by the end of 2018! References and resources:
SOGH Simulation Co-Chair STACY NORTON, MD F.A.C.O.G. Dr. Norton is the Team Lead physician at Memorial Herman The Woodlands Medical Center. Questions or comments, please email us at [email protected] Addendum: Sample Hemorrhage Cart
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