LISTSERV mailing list manager LISTSERV 16.5

Help for PED-EM-L Archives


PED-EM-L Archives

PED-EM-L Archives


PED-EM-L@LISTSERV.BROWN.EDU


View:

Message:

[

First

|

Previous

|

Next

|

Last

]

By Topic:

[

First

|

Previous

|

Next

|

Last

]

By Author:

[

First

|

Previous

|

Next

|

Last

]

Font:

Proportional Font

LISTSERV Archives

LISTSERV Archives

PED-EM-L Home

PED-EM-L Home

PED-EM-L  September 2001

PED-EM-L September 2001

Subject:

Re: PED-EM-L Digest - 9 Sep 2001 to 10 Sep 2001 (#2001-197)

From:

Martin Herman <[log in to unmask]>

Reply-To:

Martin Herman <[log in to unmask]>

Date:

Tue, 11 Sep 2001 10:49:03 -0500

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (899 lines)

First, regarding the MVA that was intubated with a GCS of 11. Does that seem
aggresive to anyone else? He was agitated but perhaps some pain medication
might have been all he needed.


Next issue, age.
LeBonheur cuts off at the 18th birthday for most cases. We do take
chronicall ill patients over 18 if they are followed by a specialists and
that specialist has not transferred the care t an adult counterpart.

Burns are sent to the Burn Cneter if they are over 15.

Penetrating trauma goes to the Level I trauma center if 14 or more.

Not exactly a uniform policy.. Seems the main issue is whether or not the
patient would want a parent there, and if the hospital and staff are set up
to interact through a parent . also suspect so eof it has to do with whether
the facility has the appropriate medications on formulary or even the best
size tubes, and equipment.  I know we have a hard time finding a large bore
( 14g) needle when adult trauma presents.

Just my thoughts,

Martin Herman, M.D.

-----Original Message-----
From: Pediatric Emergency Medicine Discussion List
[mailto:[log in to unmask]]On Behalf Of Automatic digest
processor
Sent: Monday, September 10, 2001 11:02 PM
To: Recipients of PED-EM-L digests
Subject: PED-EM-L Digest - 9 Sep 2001 to 10 Sep 2001 (#2001-197)


There are 9 messages totalling 838 lines in this issue.

Topics of the day:

  1. September PEM studies
  2. Tapering Systemic steroids--when and how?
  3. Penetrating Trauma
  4. 18-21 year olds (4)
  5. sedation of children needing air transport
  6. Trauma

For more information, send mail to [log in to unmask] with the
message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html

----------------------------------------------------------------------

Date:    Mon, 10 Sep 2001 11:16:07 -0400
From:    "Dr. Itai Shavit" <[log in to unmask]>
Subject: September PEM studies

The studies were last updated on Sep 10 and are updated on a regular basis:

http://www.pediatric-emergency-references.com

Itai Shavit MD
ACH, Canada

------------------------------

Date:    Mon, 10 Sep 2001 13:06:46 -0400
From:    Michael Forbes <[log in to unmask]>
Subject: Re: Tapering Systemic steroids--when and how?

True story...8 month old prev healthy dx'd with asthma by their PCP who
treated for 21 days with prednisolone 2 mg/kg...child presented to ED on day
25 after start of prednisolone, 4 d post end of steroids in obvious
sepsis...pancultured and empiric antibiotics+ACV started...blood cx+ for
yeast in 12h, CSF+ for yeast as well, child herniated at 18h.  Final path:
Candida albicans in every body fluid.

The lesson I took from this patient was not to 'fear' steroids but have a
healthy respect for this class of drug that [due to little Class I evidence]
is still prescribed, largely on an empiric basis.  Furthermore, the
prescribed dose and duration was arguably too large, of debatable benefit
and unconventional.

>>> "Mark D. Moncino, MD" <[log in to unmask]> 09/08/01 12:20 PM >>>
One month.............no real risk for less than that.   Having said that,
I am not sure there is a reason for a pediatrician or ER doc'to be putting
kids on the equivalent of 2 mg/kg/day for that long.  Nonetheless, if one
did, I would tell parents, and document in the chart, about VZ risks and
the need to inform their MD's IF the chid becomes severely ill after a
somewhat prolonged course of steroids.   The child with a subspecialist
following them will be a red flag to future providers......not so if the
Pediatrician or ER doc places a child on an extended course of steroids.

Even with the lack of medical concern ......the lawyers who turn good care,
into malpractice cases, necessitates the extra documentation.

mark

At 03:06 AM 9/7/2001, Dr. Mosarrat Qureshi wrote:
>Dear Netters,
>
>What is the consensus for tapering steroids? i.e. after putting a child on
>systemic steroids e.g. prednisolone 2mg/kgday for how long, you need to
>taper it off rather than stopping it abruptly ?
>In other words, how many days after being on systemic steroids--good
>dose--are you concerned about Adrenal suppression?
>
>Thanks in advance
>
>Dr. Mosarrat J. Qureshi,  M.D.
>Pediatritian
>King Khalid University Hospital,
>Riyadh, Saudi Arabia
>
>For more information, send mail to [log in to unmask] with the
>message: info PED-EM-L
>The URL for the PED-EM-L Web Page is:
>   http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html

For more information, send mail to [log in to unmask] with the
message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html



**********************************************************************
This email and any files transmitted with it are confidential and
intended solely for the use of the individual or entity to whom they
are addressed. If you have received this email in error please notify
the West Penn Allegheny Health System at (412) 359-3131 and contact the

Information Security Department at telephone ext.1746.

This footnote also confirms that this email message has been swept by
MIMEsweeper for the presence of computer viruses.

www.mimesweeper.com
**********************************************************************

------------------------------

Date:    Mon, 10 Sep 2001 16:33:34 -0400
From:    Steven Zane Miller MD <[log in to unmask]>
Subject: Penetrating Trauma

What opinions/evidence is there regarding the management of penetrating
thoraco - abdominal trauma - in otherwise stable patients. Do any of you
support limited PED exploration - to judge the depth and track of the
wound - with subsequent management tailored by that - as opposed to
laporoscopy to look for occult  diaphragmatic injuries

Steve Miller, MD
Columbia - NYC

------------------------------

Date:    Mon, 10 Sep 2001 14:51:46 -0400
From:    Geoffrey Capraro <[log in to unmask]>
Subject: 18-21 year olds

Dear List Subscribers:

Our pediatric emergency department is situated in a large teaching
hospital, and sees a significant number of children aged 18-21.  For
institutional reasons, we are seeing a great deal more recently.

Our group is just curious to know- what upper age limit applies for
your PED?

Do different rules apply to different settings?

What should the upper age limit be?

Thanks,

Geoff Capraro
PEM Fellow Boston Medical Center


------------------ Reply Separator --------------------
Originally From: Richard B Ismach <[log in to unmask]>
Subject:  Re: NP's in ED
Date: 09/08/2001 03:00pm


Kate, et al -

As I told you off-line, we use both Nurse Practitioners and
Physician Assistants in our adult ED fast track.  We use NPs and PAs
interchangeably, but in a few ways PAs are better:

   * In Georgia, PAs can prescribe independently, but NPs cannot
     (not a problem in most states).
   * PAs usually have better procedural training (e.g., wound
     repair) at graduation.  After a few years of practice, the
     difference vanishes.
   * PAs are trained to practice fairly independently, but to work
     with and under a physician's direction.  Some NPs expect to
     practice completely independently, without any interference
     from a physician.  In an ED setting, a physician will certainly
     be named in any lawsuit involving a non-physician provider.
     Thus, EPs are sometimes more comfortable working with PAs than
     with NPs.

Despite these issues, we are happy with a mix of PAs and NPs in our
fast track.

Billing is as Zach outlined: both NPs and PAs can bill (at 85% of
the physician's fee) for E&M or procedural services.  However, many
private insurers, at least in Georgia, are now refusing to pay for
PA or NP services in the ED.  It is well established that customers
(patients) are better satisfied and costs are lower with
non-physician providers.  Thus, this seems to be just a ploy to
avoid paying some claims.  Still, this may be a major issue in some
settings.

The alternative is for the physician to bill for services of the PA
or NP.  I am less familiar with this - all the departments I've
worked in had the non-physician provider bill directly, using their
own number.  This requires the physician to see each patient, a
potential problem for everyone's efficiency.

Some PA resources on the web:
    http://www.aapa.org/
    http://www.sempa.org./

Rich

--
Richard B Ismach, MD, MPH
Assistant Professor of Emergency Medicine
Emory University School of Medicine
Office: (404) 712-9656
Pager:  (404) 686-5500 -> 11037

------------------------------

Date:    Mon, 10 Sep 2001 17:24:30 -0400
From:    marc Lampell <[log in to unmask]>
Subject: sedation of children needing air transport

I am a medical director for air transport of children. Typical transport
time is less than 30 minutes. We have used various medications to sedate
children including midazolam, morphine, and etomidate to facilitate safe
transport. Which medication(s) do you believe to be the preferred choice.
Is anyone aware of an article that addresses this issue?
Marc Lampell, MD

------------------------------

Date:    Mon, 10 Sep 2001 23:37:55 +0100
From:    "ashes.mukherjee" <[log in to unmask]>
Subject: Trauma

This is a multi-part message in MIME format.

------=_NextPart_000_001F_01C13A51.9E119940
Content-Type: multipart/alternative;
        boundary="----=_NextPart_001_0020_01C13A51.9E119940"


------=_NextPart_001_0020_01C13A51.9E119940
Content-Type: text/plain;
        charset="Windows-1252"
Content-Transfer-Encoding: quoted-printable


A question,

I had a 12 yr Boy hit by a car at approximately 15mph over his left leg =
head hitting the windscreen. Temporary loss of consciousness at site =
seen by off-duty paramedic. Brought into the emergency dept on a spinal =
board hemodynamically stable RR-2o, PERL, 2" lacn over lt eyebrow with =
no evidence of # GCS - E2-3M6V2  with no other obvious injuries. Was =
varying from being agitated to calm. His CXR was normal and his pelvic =
X-ray showed a fracture of his Rt suprapubic ramus. Abdomen was soft and =
nontender.  He was intubated for CT scan and the scan was normal. What =
would the general opinion be of the next step of management.

Ash



------=_NextPart_001_0020_01C13A51.9E119940
Content-Type: text/html;
        charset="Windows-1252"
Content-Transfer-Encoding: quoted-printable

<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN">
<HTML><HEAD><TITLE></TITLE>
<META http-equiv=3DContent-Type content=3D"text/html; =
charset=3Dwindows-1252"><BASE=20
href=3D"file://C:\Program Files\Common Files\Microsoft =
Shared\Stationery\Nature\">
<STYLE>BODY {
        MARGIN-TOP: 0px
}
UL {
        FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: "Comic Sans MS", "Arial"
}
OL {
        FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: "Comic Sans MS", "Arial"
}
DIR {
        FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: "Comic Sans MS", "Arial"
}
MENU {
        FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: "Comic Sans MS", "Arial"
}
DIV {
        FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: "Comic Sans MS", "Arial"
}
DT {
        FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: "Comic Sans MS", "Arial"
}
DD {
        FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: "Comic Sans MS", "Arial"
}
ADDRESS {
        FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: "Comic Sans MS", "Arial"
}
BLOCKQUOTE {
        FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: "Comic Sans MS", "Arial"
}
PRE {
        FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: "Comic Sans MS", "Arial"
}
BR {
        FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: "Comic Sans MS", "Arial"
}
P {
        FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: "Comic Sans MS", "Arial"
}
LI {
        FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: "Comic Sans MS", "Arial"
}
H1 {
        FONT-SIZE: 12pt; COLOR: maroon; FONT-FAMILY: "Comic Sans MS",
"Arial"
}
H2 {
        FONT-SIZE: 14pt; COLOR: purple; FONT-FAMILY: "Comic Sans MS",
"Arial"
}
H3 {
        FONT-SIZE: 12pt; COLOR: blue; FONT-FAMILY: "Comic Sans MS", "Arial"
}
</STYLE>

<META content=3D"MSHTML 5.50.4134.600" name=3DGENERATOR></HEAD>
<BODY bgColor=3D#ffffff =
background=3Dcid:001e01c13a49$3c4d3140$303aff3e@mukherjee>
<DIV>&nbsp;</DIV>
<DIV>A question,</DIV>
<DIV>&nbsp;</DIV>
<DIV>I had a 12 yr Boy hit by a car at approximately 15mph over his left =
leg=20
head hitting the windscreen. Temporary loss of consciousness at site =
seen by=20
off-duty paramedic. Brought into the emergency dept on a spinal board=20
hemodynamically stable RR-2o, PERL, 2" lacn over lt eyebrow with no =
evidence of=20
# GCS - E2-3M6V2&nbsp; with no other obvious injuries. Was varying from =
being=20
agitated to calm. His CXR was normal and his pelvic X-ray showed a =
fracture of=20
his Rt suprapubic ramus. Abdomen was soft and nontender.&nbsp; He was =
intubated=20
for CT scan and the scan was normal. What would the general opinion be =
of the=20
next step of management.</DIV>
<DIV>&nbsp;</DIV>
<DIV>Ash</DIV>
<DIV><BR>&nbsp;</DIV></BODY></HTML>

------=_NextPart_001_0020_01C13A51.9E119940--

------=_NextPart_000_001F_01C13A51.9E119940
Content-Type: image/jpeg;
        name="clouds.jpg"
Content-Transfer-Encoding: base64
Content-ID: <001e01c13a49$3c4d3140$303aff3e@mukherjee>
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------=_NextPart_000_001F_01C13A51.9E119940--

------------------------------

Date:    Mon, 10 Sep 2001 19:00:05 -0500
From:    "John L. Meade, MD" <[log in to unmask]>
Subject: Re: 18-21 year olds

I am persistently astounded by the ever-enlarging definition of "Pediatric".
I got married, graduated from college and started medical school when I was
21. I would have been sorely insulted had I been shown to the PED if I had
gotten sick at that time.

JM

John L. Meade, MD, FACEP
Chief Executive Officer
Emerald Healthcare Group, P.A.
Doctor's Resource Group, Inc.
http://www.statdoc.com/

-----Original Message-----
From: Pediatric Emergency Medicine Discussion List
[mailto:[log in to unmask]]On Behalf Of Geoffrey Capraro
Sent: Monday, September 10, 2001 13:52
To: [log in to unmask]
Subject: 18-21 year olds

Dear List Subscribers:

Our pediatric emergency department is situated in a large teaching
hospital, and sees a significant number of children aged 18-21.  For
institutional reasons, we are seeing a great deal more recently.

Our group is just curious to know- what upper age limit applies for
your PED?

Do different rules apply to different settings?

What should the upper age limit be?

Thanks,

Geoff Capraro
PEM Fellow Boston Medical Center


------------------ Reply Separator --------------------
Originally From: Richard B Ismach <[log in to unmask]>
Subject:  Re: NP's in ED
Date: 09/08/2001 03:00pm


Kate, et al -

As I told you off-line, we use both Nurse Practitioners and
Physician Assistants in our adult ED fast track.  We use NPs and PAs
interchangeably, but in a few ways PAs are better:

   * In Georgia, PAs can prescribe independently, but NPs cannot
     (not a problem in most states).
   * PAs usually have better procedural training (e.g., wound
     repair) at graduation.  After a few years of practice, the
     difference vanishes.
   * PAs are trained to practice fairly independently, but to work
     with and under a physician's direction.  Some NPs expect to
     practice completely independently, without any interference
     from a physician.  In an ED setting, a physician will certainly
     be named in any lawsuit involving a non-physician provider.
     Thus, EPs are sometimes more comfortable working with PAs than
     with NPs.

Despite these issues, we are happy with a mix of PAs and NPs in our
fast track.

Billing is as Zach outlined: both NPs and PAs can bill (at 85% of
the physician's fee) for E&M or procedural services.  However, many
private insurers, at least in Georgia, are now refusing to pay for
PA or NP services in the ED.  It is well established that customers
(patients) are better satisfied and costs are lower with
non-physician providers.  Thus, this seems to be just a ploy to
avoid paying some claims.  Still, this may be a major issue in some
settings.

The alternative is for the physician to bill for services of the PA
or NP.  I am less familiar with this - all the departments I've
worked in had the non-physician provider bill directly, using their
own number.  This requires the physician to see each patient, a
potential problem for everyone's efficiency.

Some PA resources on the web:
    http://www.aapa.org/
    http://www.sempa.org./

Rich

--
Richard B Ismach, MD, MPH
Assistant Professor of Emergency Medicine
Emory University School of Medicine
Office: (404) 712-9656
Pager:  (404) 686-5500 -> 11037

For more information, send mail to [log in to unmask] with the
message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html

------------------------------

Date:    Tue, 11 Sep 2001 09:28:33 +1000
From:    Steven Doherty <[log in to unmask]>
Subject: Re: 18-21 year olds

Hi Geoff,

18-21 is staggering!  In Australia all of these would be considered adults.

I'm not sure that I can answer your question but the most sensible approach
to this I have seen is that 17 and over are adults, 15 and under are kids.
16 year olds at school are kids and 16 year olds who work are adults.  There
are of course always exceptions to this rule but to me it sounds pretty
sensible.

Cheers,



Dr Steve Doherty
Emergency Physician
Tamworth Base Hospital
(02) 6768 3316

This message is intended for the addressee named and may contain
confidential information. If you are not the intended recipient, please
delete it and notify the sender. Views expressed in this message are those
of the individual sender, and are not necessarily the views of New England
Area Health Service.

>>> Geoffrey Capraro <[log in to unmask]> 09/11/01 05:51am >>>
Dear List Subscribers:

Our pediatric emergency department is situated in a large teaching
hospital, and sees a significant number of children aged 18-21.  For
institutional reasons, we are seeing a great deal more recently.

Our group is just curious to know- what upper age limit applies for
your PED?

Do different rules apply to different settings?

What should the upper age limit be?

Thanks,

Geoff Capraro
PEM Fellow Boston Medical Center


------------------ Reply Separator --------------------
Originally From: Richard B Ismach <[log in to unmask]>
Subject:  Re: NP's in ED
Date: 09/08/2001 03:00pm


Kate, et al -

As I told you off-line, we use both Nurse Practitioners and
Physician Assistants in our adult ED fast track.  We use NPs and PAs
interchangeably, but in a few ways PAs are better:

   * In Georgia, PAs can prescribe independently, but NPs cannot
     (not a problem in most states).
   * PAs usually have better procedural training (e.g., wound
     repair) at graduation.  After a few years of practice, the
     difference vanishes.
   * PAs are trained to practice fairly independently, but to work
     with and under a physician's direction.  Some NPs expect to
     practice completely independently, without any interference
     from a physician.  In an ED setting, a physician will certainly
     be named in any lawsuit involving a non-physician provider.
     Thus, EPs are sometimes more comfortable working with PAs than
     with NPs.

Despite these issues, we are happy with a mix of PAs and NPs in our
fast track.

Billing is as Zach outlined: both NPs and PAs can bill (at 85% of
the physician's fee) for E&M or procedural services.  However, many
private insurers, at least in Georgia, are now refusing to pay for
PA or NP services in the ED.  It is well established that customers
(patients) are better satisfied and costs are lower with
non-physician providers.  Thus, this seems to be just a ploy to
avoid paying some claims.  Still, this may be a major issue in some
settings.

The alternative is for the physician to bill for services of the PA
or NP.  I am less familiar with this - all the departments I've
worked in had the non-physician provider bill directly, using their
own number.  This requires the physician to see each patient, a
potential problem for everyone's efficiency.

Some PA resources on the web:
    http://www.aapa.org/
    http://www.sempa.org./

Rich

--
Richard B Ismach, MD, MPH
Assistant Professor of Emergency Medicine
Emory University School of Medicine
Office: (404) 712-9656
Pager:  (404) 686-5500 -> 11037

For more information, send mail to [log in to unmask] with the
message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html

*********************************************************************
This message is intended for the addressee named and may
contain confidential information. If you are not the intended
recipient, please delete it and notify the sender. Views
expressed in this message are those of the individual sender,
and are not necessarily the views of NSW Health.
*********************************************************************

------------------------------

Date:    Tue, 11 Sep 2001 13:09:16 +1200
From:    Richard Aickin <[log in to unmask]>
Subject: Re: 18-21 year olds

In New Zealand we use 0-15yrs as the paediatric age group, with an extension
to 18yrs for young people with chronic illness to allow for transition
between adult/paediatric services.
My view is that the adolescent age group is rather poorly served by both the
paediatric and adult services here.  I'm not sure if I'd been admitted at
the age of 17yrs whether I would have preferred to be on a ward surrounded
by 2 year olds or by 90yr olds.
Regards,
Richard

Dr Richard Aickin
Clinical Director
Children's Emergency Department
Starship Children's Hospital
Private Bag 92024
Auckland

email [log in to unmask]
Office Ph/fax (9) 375 4308
Office Ph/fax Ext 5208
Emergency Department (9) 307 4902
Mobile 021 884 636
Locator 93 4275


> -----Original Message-----
> From: Steven Doherty [SMTP:[log in to unmask]]
> Sent: Tuesday, September 11, 2001 11:29 AM
> To:   [log in to unmask]
> Subject:      Re: 18-21 year olds
>
> Hi Geoff,
>
> 18-21 is staggering!  In Australia all of these would be considered
> adults.
>
> I'm not sure that I can answer your question but the most sensible
> approach to this I have seen is that 17 and over are adults, 15 and under
> are kids.  16 year olds at school are kids and 16 year olds who work are
> adults.  There are of course always exceptions to this rule but to me it
> sounds pretty sensible.
>
> Cheers,
>
>
>
> Dr Steve Doherty
> Emergency Physician
> Tamworth Base Hospital
> (02) 6768 3316
>
> This message is intended for the addressee named and may contain
> confidential information. If you are not the intended recipient, please
> delete it and notify the sender. Views expressed in this message are those
> of the individual sender, and are not necessarily the views of New England
> Area Health Service.
>
> >>> Geoffrey Capraro <[log in to unmask]> 09/11/01 05:51am >>>
> Dear List Subscribers:
>
> Our pediatric emergency department is situated in a large teaching
> hospital, and sees a significant number of children aged 18-21.  For
> institutional reasons, we are seeing a great deal more recently.
>
> Our group is just curious to know- what upper age limit applies for
> your PED?
>
> Do different rules apply to different settings?
>
> What should the upper age limit be?
>
> Thanks,
>
> Geoff Capraro
> PEM Fellow Boston Medical Center
>
>
> ------------------ Reply Separator --------------------
> Originally From: Richard B Ismach <[log in to unmask]>
> Subject:  Re: NP's in ED
> Date: 09/08/2001 03:00pm
>
>
> Kate, et al -
>
> As I told you off-line, we use both Nurse Practitioners and
> Physician Assistants in our adult ED fast track.  We use NPs and PAs
> interchangeably, but in a few ways PAs are better:
>
>    * In Georgia, PAs can prescribe independently, but NPs cannot
>      (not a problem in most states).
>    * PAs usually have better procedural training (e.g., wound
>      repair) at graduation.  After a few years of practice, the
>      difference vanishes.
>    * PAs are trained to practice fairly independently, but to work
>      with and under a physician's direction.  Some NPs expect to
>      practice completely independently, without any interference
>      from a physician.  In an ED setting, a physician will certainly
>      be named in any lawsuit involving a non-physician provider.
>      Thus, EPs are sometimes more comfortable working with PAs than
>      with NPs.
>
> Despite these issues, we are happy with a mix of PAs and NPs in our
> fast track.
>
> Billing is as Zach outlined: both NPs and PAs can bill (at 85% of
> the physician's fee) for E&M or procedural services.  However, many
> private insurers, at least in Georgia, are now refusing to pay for
> PA or NP services in the ED.  It is well established that customers
> (patients) are better satisfied and costs are lower with
> non-physician providers.  Thus, this seems to be just a ploy to
> avoid paying some claims.  Still, this may be a major issue in some
> settings.
>
> The alternative is for the physician to bill for services of the PA
> or NP.  I am less familiar with this - all the departments I've
> worked in had the non-physician provider bill directly, using their
> own number.  This requires the physician to see each patient, a
> potential problem for everyone's efficiency.
>
> Some PA resources on the web:
>     http://www.aapa.org/
>     http://www.sempa.org./
>
> Rich
>
> --
> Richard B Ismach, MD, MPH
> Assistant Professor of Emergency Medicine
> Emory University School of Medicine
> Office: (404) 712-9656
> Pager:  (404) 686-5500 -> 11037
>
> For more information, send mail to [log in to unmask] with the
> message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>   http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
>
> *********************************************************************
> This message is intended for the addressee named and may
> contain confidential information. If you are not the intended
> recipient, please delete it and notify the sender. Views
> expressed in this message are those of the individual sender,
> and are not necessarily the views of NSW Health.
> *********************************************************************
>
> For more information, send mail to [log in to unmask] with the
> message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>   http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html

------------------------------

End of PED-EM-L Digest - 9 Sep 2001 to 10 Sep 2001 (#2001-197)
**************************************************************

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html

Top of Message | Previous Page | Permalink

Advanced Options


Options

Log In

Log In

Get Password

Get Password


Search Archives

Search Archives


Subscribe or Unsubscribe

Subscribe or Unsubscribe


Archives

May 2019
April 2019
March 2019
February 2019
January 2019
December 2018
November 2018
October 2018
September 2018
August 2018
July 2018
June 2018
May 2018
April 2018
March 2018
February 2018
January 2018
December 2017
November 2017
October 2017
September 2017
August 2017
July 2017
June 2017
May 2017
April 2017
March 2017
February 2017
January 2017
December 2016
November 2016
October 2016
September 2016
August 2016
July 2016
June 2016
May 2016
April 2016
March 2016
February 2016
January 2016
December 2015
November 2015
October 2015
September 2015
August 2015
July 2015
June 2015
May 2015
April 2015
March 2015
February 2015
January 2015
December 2014
November 2014
October 2014
September 2014
August 2014
July 2014
June 2014
May 2014
April 2014
March 2014
February 2014
January 2014
December 2013
November 2013
October 2013
September 2013
August 2013
July 2013
June 2013
May 2013
April 2013
March 2013
February 2013
January 2013
December 2012
November 2012
October 2012
September 2012
August 2012
July 2012
June 2012
May 2012
April 2012
March 2012
February 2012
January 2012
December 2011
November 2011
October 2011
September 2011
August 2011
July 2011
June 2011
May 2011
April 2011
March 2011
February 2011
January 2011
December 2010
November 2010
October 2010
September 2010
August 2010
July 2010
June 2010
May 2010
April 2010
March 2010
February 2010
January 2010
December 2009
November 2009
October 2009
September 2009
August 2009
July 2009
June 2009
May 2009
April 2009
March 2009
February 2009
January 2009
December 2008
November 2008
October 2008
September 2008
August 2008
July 2008
June 2008
May 2008
April 2008
March 2008
February 2008
January 2008
December 2007
November 2007
October 2007
September 2007
August 2007
July 2007
June 2007
May 2007
April 2007
March 2007
February 2007
January 2007
December 2006
November 2006
October 2006
September 2006
August 2006
July 2006
June 2006
May 2006
April 2006
March 2006
February 2006
January 2006
December 2005
November 2005
October 2005
September 2005
August 2005
July 2005
June 2005
May 2005
April 2005
March 2005
February 2005
January 2005
December 2004
November 2004
October 2004
September 2004
August 2004
July 2004
June 2004
May 2004
April 2004
March 2004
February 2004
January 2004
December 2003
November 2003
October 2003
September 2003
August 2003
July 2003
June 2003
May 2003
April 2003
March 2003
February 2003
January 2003
December 2002
November 2002
October 2002
September 2002
August 2002
July 2002
June 2002
May 2002
April 2002
March 2002
February 2002
January 2002
December 2001
November 2001
October 2001
September 2001
August 2001
July 2001
June 2001
May 2001
April 2001
March 2001
February 2001
January 2001
December 2000
November 2000
October 2000
September 2000
August 2000
July 2000
June 2000
May 2000
April 2000
March 2000
February 2000
January 2000
December 1999
November 1999
October 1999
September 1999
August 1999
July 1999
June 1999
May 1999
April 1999
March 1999
February 1999
January 1999
December 1998
November 1998
October 1998
September 1998
August 1998
July 1998
June 1998
May 1998
April 1998
March 1998
February 1998
January 1998
December 1997
November 1997
October 1997
September 1997
August 1997
July 1997
June 1997
May 1997
April 1997
March 1997
February 1997
January 1997
December 1996
November 1996
October 1996
September 1996
August 1996
July 1996
June 1996
May 1996
April 1996
March 1996
February 1996
January 1996
December 1995
November 1995
October 1995
September 1995
August 1995
July 1995
June 1995
May 1995
April 1995
March 1995
February 1995
January 1995
December 1994
November 1994
October 1994
September 1994

ATOM RSS1 RSS2



LISTSERV.BROWN.EDU

CataList Email List Search Powered by the LISTSERV Email List Manager