Documentation for Medical Records

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Publisher :
ISBN 13 : 9781584261834
Total Pages : 538 pages
Book Rating : 4.2/5 (618 download)

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Book Synopsis Documentation for Medical Records by : Barbara Odom-Wesley

Download or read book Documentation for Medical Records written by Barbara Odom-Wesley and published by . This book was released on 2008-08 with total page 538 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Documentation for Health Records

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Publisher :
ISBN 13 : 9781584262626
Total Pages : 744 pages
Book Rating : 4.2/5 (626 download)

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Book Synopsis Documentation for Health Records by : Cheryl Gregg Fahrenholz

Download or read book Documentation for Health Records written by Cheryl Gregg Fahrenholz and published by . This book was released on 2013-01-01 with total page 744 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Registries for Evaluating Patient Outcomes

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Publisher : Government Printing Office
ISBN 13 : 1587634333
Total Pages : 385 pages
Book Rating : 4.5/5 (876 download)

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Book Synopsis Registries for Evaluating Patient Outcomes by : Agency for Healthcare Research and Quality/AHRQ

Download or read book Registries for Evaluating Patient Outcomes written by Agency for Healthcare Research and Quality/AHRQ and published by Government Printing Office. This book was released on 2014-04-01 with total page 385 pages. Available in PDF, EPUB and Kindle. Book excerpt: This User’s Guide is intended to support the design, implementation, analysis, interpretation, and quality evaluation of registries created to increase understanding of patient outcomes. For the purposes of this guide, a patient registry is an organized system that uses observational study methods to collect uniform data (clinical and other) to evaluate specified outcomes for a population defined by a particular disease, condition, or exposure, and that serves one or more predetermined scientific, clinical, or policy purposes. A registry database is a file (or files) derived from the registry. Although registries can serve many purposes, this guide focuses on registries created for one or more of the following purposes: to describe the natural history of disease, to determine clinical effectiveness or cost-effectiveness of health care products and services, to measure or monitor safety and harm, and/or to measure quality of care. Registries are classified according to how their populations are defined. For example, product registries include patients who have been exposed to biopharmaceutical products or medical devices. Health services registries consist of patients who have had a common procedure, clinical encounter, or hospitalization. Disease or condition registries are defined by patients having the same diagnosis, such as cystic fibrosis or heart failure. The User’s Guide was created by researchers affiliated with AHRQ’s Effective Health Care Program, particularly those who participated in AHRQ’s DEcIDE (Developing Evidence to Inform Decisions About Effectiveness) program. Chapters were subject to multiple internal and external independent reviews.

The Computer-Based Patient Record

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Publisher : National Academies Press
ISBN 13 : 030957885X
Total Pages : 257 pages
Book Rating : 4.3/5 (95 download)

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Book Synopsis The Computer-Based Patient Record by : Committee on Improving the Patient Record

Download or read book The Computer-Based Patient Record written by Committee on Improving the Patient Record and published by National Academies Press. This book was released on 1997-10-28 with total page 257 pages. Available in PDF, EPUB and Kindle. Book excerpt: Most industries have plunged into data automation, but health care organizations have lagged in moving patients' medical records from paper to computers. In its first edition, this book presented a blueprint for introducing the computer-based patient record (CPR). The revised edition adds new information to the original book. One section describes recent developments, including the creation of a computer-based patient record institute. An international chapter highlights what is new in this still-emerging technology. An expert committee explores the potential of machine-readable CPRs to improve diagnostic and care decisions, provide a database for policymaking, and much more, addressing these key questions: Who uses patient records? What technology is available and what further research is necessary to meet users' needs? What should government, medical organizations, and others do to make the transition to CPRs? The volume also explores such issues as privacy and confidentiality, costs, the need for training, legal barriers to CPRs, and other key topics.

Guide to Clinical Documentation

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Publisher : F.A. Davis
ISBN 13 : 0803629974
Total Pages : 301 pages
Book Rating : 4.8/5 (36 download)

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Book Synopsis Guide to Clinical Documentation by : Debra Sullivan

Download or read book Guide to Clinical Documentation written by Debra Sullivan and published by F.A. Davis. This book was released on 2011-12-22 with total page 301 pages. Available in PDF, EPUB and Kindle. Book excerpt: Develop the skills you need to effectively and efficiently document patient care for children and adults in clinical and hospital settings. This handy guide uses sample notes, writing exercises, and EMR activities to make each concept crystal clear, including how to document history and physical exams and write SOAP notes and prescriptions.

2022 Hospital Compliance Assessment Workbook

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Publisher :
ISBN 13 : 9781635852448
Total Pages : pages
Book Rating : 4.8/5 (524 download)

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Book Synopsis 2022 Hospital Compliance Assessment Workbook by : Joint Commission Resources

Download or read book 2022 Hospital Compliance Assessment Workbook written by Joint Commission Resources and published by . This book was released on 2021-12-30 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt:

Care of the Acutely Ill Adult

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Publisher : Oxford University Press
ISBN 13 : 0192527088
Total Pages : 481 pages
Book Rating : 4.1/5 (925 download)

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Book Synopsis Care of the Acutely Ill Adult by : Fiona Creed

Download or read book Care of the Acutely Ill Adult written by Fiona Creed and published by Oxford University Press. This book was released on 2020-10-08 with total page 481 pages. Available in PDF, EPUB and Kindle. Book excerpt: This key textbook equips all nurses with the knowledge and skills required to care for the deteriorating patient in the clinical environment. The book emphasises the importance of systematic assessment, interpretation of clinical signs of deterioration, and the need to escalate the patient in a timely manner. Using a unique system-based approach, each chapter contains structured learning outcomes and concludes with a competence-based skills assessment to perfect the reader's practice skills. These skills are recommended as essential for every nurse in an acute area and key to successful practice. Restructured for ease of use, this new edition has been fully updated to match current guidelines, with new chapters on pain management and the ethics and ceilings of treatment. Written by senior nurses, this key textbook uses real life case studies to link knowledge to practice and is essential reading for all nurses working in acute care settings and undertaking study in the field.

Taking Action Against Clinician Burnout

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Publisher : National Academies Press
ISBN 13 : 0309495474
Total Pages : 335 pages
Book Rating : 4.3/5 (94 download)

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Book Synopsis Taking Action Against Clinician Burnout by : National Academies of Sciences, Engineering, and Medicine

Download or read book Taking Action Against Clinician Burnout written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2020-01-02 with total page 335 pages. Available in PDF, EPUB and Kindle. Book excerpt: Patient-centered, high-quality health care relies on the well-being, health, and safety of health care clinicians. However, alarmingly high rates of clinician burnout in the United States are detrimental to the quality of care being provided, harmful to individuals in the workforce, and costly. It is important to take a systemic approach to address burnout that focuses on the structure, organization, and culture of health care. Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being builds upon two groundbreaking reports from the past twenty years, To Err Is Human: Building a Safer Health System and Crossing the Quality Chasm: A New Health System for the 21st Century, which both called attention to the issues around patient safety and quality of care. This report explores the extent, consequences, and contributing factors of clinician burnout and provides a framework for a systems approach to clinician burnout and professional well-being, a research agenda to advance clinician well-being, and recommendations for the field.

Medical Record Auditor

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Publisher : American Medical Association Press
ISBN 13 : 9781603592949
Total Pages : 0 pages
Book Rating : 4.5/5 (929 download)

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Book Synopsis Medical Record Auditor by : Deborah J. Grider

Download or read book Medical Record Auditor written by Deborah J. Grider and published by American Medical Association Press. This book was released on 2011 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: "This book helps readers understand the principles of medical record documentation and chart auditing. It introduces readers to principles of medical record documentation and how to conduct a medical record chart review in the physcian's or outpatient office"--Provided by publisher.

How to Practice Academic Medicine and Publish from Developing Countries?

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Publisher : Springer Nature
ISBN 13 : 9811652481
Total Pages : 475 pages
Book Rating : 4.8/5 (116 download)

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Book Synopsis How to Practice Academic Medicine and Publish from Developing Countries? by : Samiran Nundy

Download or read book How to Practice Academic Medicine and Publish from Developing Countries? written by Samiran Nundy and published by Springer Nature. This book was released on 2021-10-23 with total page 475 pages. Available in PDF, EPUB and Kindle. Book excerpt: This is an open access book. The book provides an overview of the state of research in developing countries – Africa, Latin America, and Asia (especially India) and why research and publications are important in these regions. It addresses budding but struggling academics in low and middle-income countries. It is written mainly by senior colleagues who have experienced and recognized the challenges with design, documentation, and publication of health research in the developing world. The book includes short chapters providing insight into planning research at the undergraduate or postgraduate level, issues related to research ethics, and conduct of clinical trials. It also serves as a guide towards establishing a research question and research methodology. It covers important concepts such as writing a paper, the submission process, dealing with rejection and revisions, and covers additional topics such as planning lectures and presentations. The book will be useful for graduates, postgraduates, teachers as well as physicians and practitioners all over the developing world who are interested in academic medicine and wish to do medical research.

Principles and Practice of Hospital Medicine

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Publisher : McGraw Hill Professional
ISBN 13 : 0071603905
Total Pages : 2351 pages
Book Rating : 4.0/5 (716 download)

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Book Synopsis Principles and Practice of Hospital Medicine by : Sylvia McKean

Download or read book Principles and Practice of Hospital Medicine written by Sylvia McKean and published by McGraw Hill Professional. This book was released on 2011-12-30 with total page 2351 pages. Available in PDF, EPUB and Kindle. Book excerpt: The definitive guide to the knowledge and skills necessary to practice Hospital Medicine Presented in full color and enhanced by more than 700 illustrations, this authoritative text provides a background in all the important clinical, organizational, and administrative areas now required for the practice of hospital medicine. The goal of the book is provide trainees, junior and senior clinicians, and other professionals with a comprehensive resource that they can use to improve care processes and performance in the hospitals that serve their communities. Each chapter opens with boxed Key Clinical Questions that are addressed in the text and hundreds of tables encapsulate important information. Case studies demonstrate how to apply the concepts covered in the text directly to the hospitalized patient. Principles and Practice of Hospital Medicine is divided into six parts: Systems of Care: Introduces key issues in Hospital Medicine, patient safety, quality improvement, leadership and practice management, professionalism and medical ethics, medical legal issues and risk management, teaching and development. Medical Consultation and Co-Management: Reviews core tenets of medical consultation, preoperative assessment and management of post-operative medical problems. Clinical Problem-Solving in Hospital Medicine: Introduces principles of evidence-based medicine, quality of evidence, interpretation of diagnostic tests, systemic reviews and meta-analysis, and knowledge translations to clinical practice. Approach to the Patient at the Bedside: Details the diagnosis, testing, and initial management of common complaints that may either precipitate admission or arise during hospitalization. Hospitalist Skills: Covers the interpretation of common “low tech” tests that are routinely accessible on admission, how to optimize the use of radiology services, and the standardization of the execution of procedures routinely performed by some hospitalists. Clinical Conditions: Reflects the expanding scope of Hospital Medicine by including sections of Emergency Medicine, Critical Care, Geriatrics, Neurology, Palliative Care, Pregnancy, Psychiatry and Addiction, and Wartime Medicine.

Medical Record Chart Analyzer

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Publisher : American Medical Association Press
ISBN 13 :
Total Pages : 388 pages
Book Rating : 4.3/5 (91 download)

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Book Synopsis Medical Record Chart Analyzer by : Deborah J. Grider

Download or read book Medical Record Chart Analyzer written by Deborah J. Grider and published by American Medical Association Press. This book was released on 2002 with total page 388 pages. Available in PDF, EPUB and Kindle. Book excerpt: The quality of coding is an important factor in determining the financial health of a practice. When problems occur they must be solved quickly. But before they can be solved, they must be found. Medical Record Chart Analyzer includes medical record documentation with a systematic guide to the medical record review process for the physician's or outpatient office. Learning objectives are included at the beginning of most chapters to overview chapter content and help measure progress. Medical chart review and coding tips are located throughout the book. The application exercises allow the reader to master each topic one chapter at a time. Also included is a final examination to test documentation and auditing skills. By the end of the book, the reader will be able to conduct reviews independently. Authored by Deborah J. Grider, CPC, CPC-H, CCS-P, CCP, an experienced professional in the fields of reimbursement, procedural and diagnostic coding, medical practice management and compliance. Readers can earn up to 10 CEU credits from AAPC.

Clinical Handbook of Psychiatry & the Law

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Publisher : Lippincott Williams & Wilkins
ISBN 13 : 9780781778916
Total Pages : 348 pages
Book Rating : 4.7/5 (789 download)

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Book Synopsis Clinical Handbook of Psychiatry & the Law by : Paul S. Appelbaum

Download or read book Clinical Handbook of Psychiatry & the Law written by Paul S. Appelbaum and published by Lippincott Williams & Wilkins. This book was released on 2007 with total page 348 pages. Available in PDF, EPUB and Kindle. Book excerpt: Thoroughly updated for its Fourth Edition, this award-winning handbook gives mental health professionals authoritative guidance on how the law affects their clinical practice. Each chapter presents case examples of legal issues that arise in practice, clearly explains the governing legal rules, their rationale, and their clinical impact, and offers concrete action guides to navigating clinico-legal dilemmas. This edition addresses crucial recent developments including new federal rules protecting patients' privacy, regulations minimizing use of seclusion and restraint, liability risks associated with newer psychiatric medications, malpractice risks in forensic psychiatry, and new structured assessment tools for violence risk, suicidality, and decisional capacity.

Nursing Know-how

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Publisher : Lippincott Williams & Wilkins
ISBN 13 : 9780781791946
Total Pages : 424 pages
Book Rating : 4.7/5 (919 download)

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Book Synopsis Nursing Know-how by :

Download or read book Nursing Know-how written by and published by Lippincott Williams & Wilkins. This book was released on 2009 with total page 424 pages. Available in PDF, EPUB and Kindle. Book excerpt: Provides information on documentation issues, including electronic medical records, legal and ethical implications, and documentation in acute cases, along with a variety of charting examples.

ICD-9-CM Official Guidelines for Coding and Reporting

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Publisher :
ISBN 13 :
Total Pages : 76 pages
Book Rating : 4.3/5 (2 download)

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Book Synopsis ICD-9-CM Official Guidelines for Coding and Reporting by :

Download or read book ICD-9-CM Official Guidelines for Coding and Reporting written by and published by . This book was released on 1991 with total page 76 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Writing Patient/Client Notes

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Publisher : F.A. Davis
ISBN 13 : 080365846X
Total Pages : 295 pages
Book Rating : 4.8/5 (36 download)

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Book Synopsis Writing Patient/Client Notes by : Ginge Kettenbach

Download or read book Writing Patient/Client Notes written by Ginge Kettenbach and published by F.A. Davis. This book was released on 2016-05-11 with total page 295 pages. Available in PDF, EPUB and Kindle. Book excerpt: Develop all of the skills you need to write clear, concise, and defensible patient/client care notes using a variety of tools, including SOAP notes. This is the ideal resource for any health care professional needing to learn or improve their skills—with simple, straight forward explanations of the hows and whys of documentation. It also keeps pace with the changes in Physical Therapy practice today, emphasizing the Patient/Client Management and WHO’s ICF model.

Electronic Medical Records

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Publisher : ACP Press
ISBN 13 : 9781930513013
Total Pages : 478 pages
Book Rating : 4.5/5 (13 download)

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Book Synopsis Electronic Medical Records by : Jerome H. Carter

Download or read book Electronic Medical Records written by Jerome H. Carter and published by ACP Press. This book was released on 2001 with total page 478 pages. Available in PDF, EPUB and Kindle. Book excerpt: Clinical Infomation Systems are increasingly important in Medical Practice. This work is a two-part book detailing the importance, selection and implementation of information systems in the health care setting. Volume One discusses the technical, organizational, clinical and administrative issues pertaining to EMR implementation. Highlighted topics include: infrastructure of the electronic patient records for administrators and clinicians, understanding processes and outcomes, and preparing for an EMR. The second workbook is filled with sample charts and questions, guiding the reader through the actual EMR implementation process.