Emergency Questions: 1001 conversation-savers for any situation

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The clinical process to prioritise patients, completed before a full assessment to support effective management of demand and flow, identifying time critical requirements for patients. Context Ambulances will pre-alert the ED if they are conveying a patient who needs to be received by a clinical team. These patients must be received by the appropriate team immediately on arrival. Navigation typically happens before the patient comes under the responsibility of the ED and is not a counted activity in the patient’s journey. This activity, at an early point of a patient’s experience, may not involve a clinician and therefore is not based on clinical judgement. Navigation should not be confused with redirection, which is conducted by a clinician.

The following Current Procedural Terminology (CPT) Genetic Analysis Procedure code should be billed. Please note: This is an update from the CPT code identified in the Expanded Coverage for Spinal Muscular Atrophy - Prenatal Carrier Testing article published in the September 2014 issue of the Medicaid Update. Additionally, this billing guidance supersedes the previous billing guidance published in the September 2014 issue of the Medicaid Update. CPT Code The terminology surrounding patient flow – pre-hospital and from the ED front door – is inconsistent, with terms such as streaming, assessment and triage used interchangeably. Since national implementation of streaming models in EDs in 2017/18, providers have said clearer definitions of initial assessment would be helpful. Initial assessment must add value to the patient’s journey and not cause inappropriate clinical duplication. Although initial assessment models may differ across the country and be based on one or more of the processes defined below. They should encompass the recommendations in Table 3 below. Transgender Related Care and Services Update article published in the May 2016 issue of the Medicaid Update; and

Streaming should be done only by clinicians who are registered and trained in local guidelines and bound by local clinical governance. Patients may also be asked to use digital streaming tools (digital enablers) and where they are staff should be available to support them to do so if required; the clinical governance and accountability remain with the clinical service. A clinical activity to direct patients to the most appropriate service based on their presenting symptoms, chief complaint and acuity. Context

Several validated triage systems are in use across England, such as the Manchester Triage System, Canadian Triage and Acuity Scale and the Emergency Severity Index Rapid assessment and treatment (RAT) Definition Triage should be performed in an environment that is sufficiently private for exchange of confidential information but not isolated from the department. Where clinicians from other providers work within an initial assessment system, service development and governance structures should be shared. New Yorkers who are unable to enroll by December 15 will still be able to enroll in health insurance, with effective dates slightly later in the year, as shown in the following table: Open Enrollment Period It builds on and replaces clinical streaming in the accident and emergency department (2017) and initial assessment of emergency department patients (RCEM 2017), which recommended beginning initial assessment of patients presenting to ED within 15 minutes . This document has been developed with the Royal College of Emergency Medicine (RCEM) after consultation with key stakeholders (NHS England, RCEM, Royal College of Nursing (RCN), Care Quality Commission, regional UEC clinical advisors, Society of Acute Medicine, emergency department clinicians across England), and agreed for England. RCEM will consult the other UK nations to achieve consistency wherever possible.Technical streaming tools used in EDs may assist in this process. Redirection options are agreed by the hospital on implementing the digital enablers. Examples are community pharmacies, dental services, or other specialist services in primary and community care. Referral Definition

The annual Open Enrollment Period (OEP) for NY State of Health, the New York State (NYS) official health plan marketplace (Marketplace), launched on November 16, 2023, for health insurance in 2024. New Yorkers shopping for health insurance coverage through the Marketplace are offered a wide selection of high-quality, comprehensive Qualified Health Plans (QHPs), with the support of certified enrollment assistors to guide the enrollment process, determine eligibility, and access any potential financial assistance. Additionally, enhanced tax credits for coverage continue through 2025. New Yorkers have until December 15, 2023, to renew or enroll in a health plan for coverage starting January 1, 2024. ED’ in this document refers to the location where the initial patient assessment takes place. Assessment can be performed by a type 1 (ED) or type 3 (UTC) service. Hospitals may have a UTC at the front door which performs the streaming function. NYRx covers medically necessary hormones that are Federal Drug Administration (FDA)-approved or compendia-supported for the treatment of gender dysphoria consistent with the guidance provided in the January 2017 and July 2020 Medicaid Update issues mentioned above. The official compendia sources would include American Hospital Formulary Service (AHFS) and Micromedex DrugDex. NYRx maintains a current list of drugs that meet these criteria under the section "Cross-Sex Hormones" in the NYRx, the Medicaid Pharmacy Program Preferred Drug List. Questions and Additional Information:Occurs when a patient has been assessed by an appropriately qualified practitioner in an emergency care facility and the decision made to refer them to another specialty for further care. In this case, a full ECDS ED episode has occurred. Context A timeline reconstructed by the New York Times using hundreds of videos, 911 calls, and evacuation alerts shows the fire jumping the Lāhainā highway—one of the few exits out of town—at 3:22 PM Body-cam footage of police officers fighting the blaze with garden hoses records one saying to the other, “Everything is on fire.” The core principle is that on arrival at hospital, patients are directed to a treatment area or service staffed with appropriate healthcare practitioners to manage their clinical needs. Patient arrival

Triage should be performed by a clinician who is trained and competent in using the specific triage system being applied. Its correct use ensures robust and reproducible assessment. The triage process should start as soon as possible after the patient arrives in the department, and if the patient has not already been streamed will also be the patient’s initial assessment. Sufficient resources need to be allocated to triage to cope with variations in demand (both in numbers and time taken to complete triage), not average demand.Claims will no longer pend for required documentation as the screening is now covered for all NYS Medicaid members who are considering pregnancy or are currently pregnant. MMC Billing Instructions Patients should be assessed promptly by locally agreed processes within 15 minutes of arrival. However, patients who have a booked appointment via NHS 111 at a co-located UTC are not required to have a further assessment on arrival if they are seen within 30 minutes of their appointment time. An exception to this would be if the patient’s clinical condition has deteriorated before arrival and in this case further clinical assessment would be of value. Rapid assessment and treatment is the initiation of investigations and treatment as determined by a team including senior decision-makers. Context NY State of Health Annual Open Enrollment Period Launched November 16, 2023 for 2024 Health Insurance Streaming explicitly assumes protocols are in place that allow patients to be immediately transferred to the ED if clinically required and appropriate.