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On "unnecessary" ED visits: background reading

Here are a bunch of very informative pieces on why trying to blame excessive costs or busy-ness on low acuity patients in the ED is, at be...


Seth Trueger, MD, MPH, FACEP @MDaware
Emergency physician in Chicago. Interests include social media for health professions, payment and delivery reform, crowding, airway, and resuscitation. Digital Media Editor for JAMA Network Open; I receive salary support for this roleFormerly Social Media Editor for Annals of EM.

EP Monthly:
Since January 1, 2013, I have worked as the Social Media Editor for Emergency Physicians Monthly. In this capacity, I primarily write tweets for the @epmonthly account; various people write for the account and all of my tweets are signed "-ST" except when I forget to. This is a compensated position, and views are my own and not those of any employer or association of mine, and the disclaimer below applies as well.

Etymology for the uninitiated:

The term "MD aware" is used in clinical medicine to relay that a physician has been notified of some sort of information. For example, after noting a change in status or a new lab or vital sign value, the nurse tells the doctor and document "finger stick 37, MD aware" to record that the doctor has been told.

All too frequently, nurses are compelled -- mostly by institutional guidelines -- to notify physicians of minor status changes, or lab alert values that have little to no clinical relevance; in this instance, many physicians will indicate both their receipt of the new (but unimportant) information, as well as acknowledge the perfunctory nature of the exchange by responding "MD aware." For example, "I hate to bother you, but the patient's finger stick is 131" (technically elevated but -- particularly in the ED -- clinically irrelevant) "Thanks; MD aware."

Matt Pirotte, MD
Emergency physician in Chicago. Interests include all things ED critical care, including procedures and vascular access.



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Much of the above is adapted and/or taken verbatim from Andy Neill and Steve Carroll

This pretty much applies.