Mass casualty chemical exposure and implications for respiratory failure.

Exposure to chemical agents, both deliberate and accidental, over the past 100 years has resulted in the deaths of thousands and a significant number of casualties requiring hospitalization. The respiratory system is an important portal of entry into the human body for many of these agents, and pulmonary symptoms are a hallmark of many chemical exposures. The 4 major chemical warfare agents are: lung-damaging, blood, blister, and nerve compounds. The review will cover historical exposures, signs and symptoms, treatment, and long-term consequences. There are numerous examples of deliberate (as well as accidental) exposure to harmful chemicals, and each incident requires the provider to understand the signs and symptoms of the particular chemical so that the correct treatment is provided. The respiratory implications of these agents appear to be dose and timing dependent, with full recovery often seen if supportive measures and appropriate antidotes are administered in a timely fashion.

The devil is in the details: maximizing revenue for daily trauma care.

BACKGROUND: Falling reimbursement rates for trauma care demand a concerted effort of charge capture for the fiscal survival of trauma surgeons. We compared current procedure terminology code distribution and billing patterns for Subsequent Hospital Care (SHC) before and after the institution of standardized documentation. METHODS: Standardized SHC progress notes were created. The note was formulated with an emphasis on efficiency and accuracy. Documentation was completed by residents in conjunction with attendings following standard guidelines of linkage. Year-to-year patient volume, length of stay (LOS), injury severity, bills submitted, coding of service, work relative value units (wRVUs), revenue stream, and collection rate were compared with and without standardized documentation. RESULTS: A 394% average revenue increase was observed with the standardization of SHC documentation. Submitted charges more than doubled in the first year despite a 14% reduction in admissions and no change in length of stay. Significant increases in level II and level III billing and billing volume (P < .05) were sustainable year to year and resulted in an average per patient admission SHC income increase from $91.85 to $362.31. CONCLUSIONS: Use of a standardized daily progress note dramatically increases the accuracy of coding and associated billing of subsequent hospital care for trauma services.