Hospital

To: NHS Litigation Authority, Re: Chandler Bing v Friends Health NHS Foundation Trust Dear Sir/ Madam, Thank you for your referral of the case concerning Mr. Chandler Bing’s missed fracture scaphoid bone received on 31 August 2010. The following is the Letter of Advice to the NHSLA concerning the above-mentioned case. The Claimant: 1. The Claimant was born on 8 April 1969. As a result of the events referred to in their particulars of claim the claimant is now represented by Bloomingdale Solicitors to launch to launch a civil action against Friends Health NHS Foundation Trust on 31 August 2010.

The Defendant: 2. The Defendant was at all relevant times responsible for the management control, and administration of Friends Health NHS Foundation Trust, and for the employment of doctors, nurses, and other medical specialist s including emergency medicine, radiology and orthopaedic surgeons at and for the purpose of the said hospital. Duty of care: 3. Each of the doctors, nurses, and other staff employed at the hospital who treated the Claimant at the hospital owed the Claimant a duty of care. This duty included a duty in respect of: a. The advice given to the Claimant; . The diagnosis made in respect of the condition of the Claimant; c. The treatment prescribed for the Claimant and advice as to the effect of the treatment; d. The monitoring of the Claimant whilst treatment was given to the Claimant. 4. The Defendant is vicariously liable for any such breach of duty on behalf of any of its employees. Procedural Steps: 1. Protocol Steps: a. Obtaining health records: to provide sufficient information to alert the Healthcare provider where an adverse outcome has been serious; to request for specific medical records involving the case. . Request for copies of patient’s clinical records with approved standard forms. c. Make sure the copy records to be provided within 40 days of the request and for a cost not exceeding changes permissible under the Access to Health Records Act 1990. d. If the Healthcare provider fails to provide health records within 40 days, their advisers can then apply to Court for an order for pre-action disclosure. e. If Healthcare provider considers additional health records are required from a third party, these should be requested through the patient.

Third party Healthcare providers are expected to co-operate. 2. The response: Letter of response: a. Provide requested records and invoice for copying. b. Comments on events and/or chronology. c. If breach of duty and causation are accepted, suggestions for resolving the claims and request for further information offer to settle. d. If breach of duty and/or causation are denied, outline explanations for what happened by Healthcare provider suggests further steps like further investigations, obtaining expert evidence, meetings, negotiations or mediation, or an invitation to issue proceedings. e.

Healthcare provider should acknowledge receipt of letter of claim within 14 days of receipt. f. Healthcare provider should, within 3 months of letter of claim, provide a reasoned answer. g. If claim is admitted, then the Healthcare provider says so. h. If any part of claim is admitted, then Healthcare provider makes clear which issues of breach of duty and/or causation are admitted and which are denied and why. i. If claim is denied, include specific comments on allegation of negligence, and if synopsis or chronology of relevant events provided and is disputed, Healthcare provider’s version of events provided. . Additional documents, for instance, internal protocol, copies provided. k. If patient made an offer to settle at this stage as a counter-offer by supporting medical evidence, and/or other evidence in addition to claim in healthcare provider’s possession. l. If parties reach agreement on liability, but time is needed to resolve claim, then aim to agree a reasonable period. Witness Evidence: The witnesses concerned in this case include: 1. Claimant’s family members and colleagues concerning the accused loss of function in daily activities of living. . Healthcare providers beside the medical doctor in Accident and Emergency Department, including accident and emergency doctors and consultants, radiologists, orthopaedic specialists, nurses, family doctors, etc, who have treated the Claimant. 3. The Claimant himself. Where a witness statement or a witness summary is not served, the party will not be able to call that witness to give oral evidence unless the Court allows it. Matters to be covered in the witness’s statement will include: 1.

Occupation and working ability of the Claimant, if this has changed, since the injury, previous occupation of the Claimant. 2. Brief description of marital and family circumstances including dates of birth of all the family members of the Claimant. 3. The Claimant’s amount of the sequence of events relating to the treatment in question. Care should be taken to avoid importing text and phraseology from medical records or reports that the Claimant would not use in the normal course of discussing the case. 4.

If the witness’s factual recollection of events differs in any important respect from the medical records, or from the version of facts set out in the Defendant, the statement should acknowledge this and comment upon these differences. 5. The witness should describe the effects of the injury; this will include the effects on his physical condition, emotional condition, the practicalities of everyday life, the Claimant’s financial affairs, family life, and future plans and projects. Additional witnesses should state their relationship to the Claimant. If a amily member is providing a statement which is collaborative of the Claimant’s amount of events, the witness should confirm that he or she has read the Claimant’s statement and state that he or she agrees with its contents, insofar as those within his or her knowledge. The statement should then deal with issues of which the witness can give primary evidence. Where a party is required to serve a witness statement and he is unable to obtain such a statement, for example because the witness refuses to communicate with the Defendant’s solicitor, he may apply to the Court for the permission to serve only a witness summary instead.

This application should be made without notice. The witness summary is a summary of the evidence which would otherwise go into a witness statement, or if the evidence is not known, matters about which the party serving the witness summary will question the witness. Expert Evidence: 1. In clinical negligence disputes, expert opinions may be needed: a. On breach of duty and causation. b. On the patient’s condition and prognosis. c. To assist in valuing aspects of the Claims. The main expert witnesses to be considered include: a.

Orthopaedic specialists. b. Accident and Emergency specialists. c. Radiology specialists. 2. The new Civil Procedure Rules will encourage economy in the use of experts and a less adversarial expert culture. It is recognized that in clinical negligence disputes, the parties and their advisers will require flexibility in their approach to expert evidence. Decisions on whether experts should be instructed jointly; and on whether reports might be disclosed sequentially or by exchange, should rest with the parties and their advisers.

Sharing expert evidence may be appropriate on issues relating to the value of the Claim. However, this protocol does not attempt to be prescriptive on issues in relation to expert evidence. 3. Obtaining expert evidence will often be an expensive step and may take time, especially in specialized areas of medicine, where there are limited numbers of suitable experts. Patients and Healthcare providers, and their advisers, will therefore need to consider carefully how best to obtain any necessary expert help quickly and cost effectively. . Assistance in locating a suitable expert is available from a number of sources. Here the NHSLA has already supplied a number of experts for this case. 5. This is a case of missed fracture of the waist of the scaphoid, for a patient initially seen in the Accident and Emergency Department, is often a clinical diagnosis rather than a radiological diagnosis, because this fracture may not become apparent on an X-Ray until often a period of 10 days, and sometimes konger, has elapsed. . Tenderness in the anatomical snuffbox at the base of the dorsal aspect of the thumb, or pain produced by proximal pressuring on the wrist joint in radial deviation by comparison to the unaffected side, together with diminished power of grip, is an indication for the forearm to be put into a scaphoid plaster of Paris. 7. The patient must have the plaster checked the following day and will need to be X-Rayed again in 10 to 14 days if a fracture line was not initially visible. 8.

When a fracture of the scaphoid is suspected, “scaphoid views” should be asked for. 9. The doctor at Accident and Emergency Department must ensure that 4 views have been carried out: Anterior-Posterior, Lateral, Supination oblique, and Pronation oblique. 10. If there is doubt about the diagnosis or the fracture is displaced, then a more senior or orthopaedic opinion must be sought forthwith, otherwise a scaphoid plaster must be applied, and the patient referred to the next Accident and Emergency review clinic or fracture clinic. 11.

There is a component of contributory negligence by the Claimant who insists to remove the plaster in the follow up clinic despite he was strongly advised not to do so. The effect of this contributory negligence on the Claims should be further explored and evaluated. Quantum of damages: The means to calculate the quantum of damages made in this case of clinical negligence include various heads of the following damage: 1. Pain, suffering and loss of amenity; 2. Loss of earnings; 3. Care and assistance; 4. Travel and parking; 5. Miscellaneous expenses.

The Claims on items (1), (3), (4) and (5) are measured quite subjectively by the patient affected. The calculation of loss of earning could be done by using the Ogden tables, which are involving a set of statistical tables for use in Court case in the United Kingdom. Beside the age of this patient (Date of Birth=08/04/1969) being 41 years old on the date of claim (that is 12-11-2010) is known, we still need to know about the patient’s earning per annum, what is his occupation, whether he had any disability resulted, his qualifications, and his planned age for retirement.

In case where the period of loss of earnings will continue for many years into the future, it is particular important to ensure that amount is taken of likely periodic changes to the Claimant’s income. The Claimant will want to point to anticipated career progression. In such cases, the Court will either: 1. Determine the average multiplicand, based upon the likely earnings throughout the period of loss, which will be applied to the full period of the loss, or; 2. Use stepped multiplicands for each stage of the Claimants career.

Generally, this will result in a lower multiplicand at the beginning and possibly at the very end of the period of loss, with one or more higher multiplicands to represent the likely career progression that would have been followed. There is a need to interview the Claimant in more details to decide these uncertainties for a more comprehensive evaluation. Last but not least, the importance of expert evidence in such a case is vital. Medical evidence can provide an indication as to what work the Claimant will be capable of undertaking, both at present and in the future.

This, together with evidence of the Claimant’s employment prospective, will assist the Court in determining what will happen to the Claimant in the future. Another means to calculate for the approximate quantum of the damage in this patient is to look into common laws and journals for similar cases for comparison and a rough estimation of quantification of similar claims. In Johns v Greater Glasgow Health Board1, a 44 years old lady broke her scaphoid bones in both wrists in a fall. The fractures were only diagnosed three months later. As a result the fractures would not unit, causing continuous incapacity and pain.

Bone grafting was contemplated, despite an earlier unsuccessful attempt. Held, that solatium was properly valued at 11,000 pounds with wage loss to date and for a further 4 years. In W v Ministry of Defence2, which is a case of failure to diagnose fractured scaphoid from Clinical Risk 2010; Volume 16: p. 198 (by Collier et al). The case was settled concerning damages awarded to the Claimant pursuant to the delay in the diagnosis of the fracture of his hand, without which the Claimant could have avoided undergoing surgery and regained his complete and normal wrist function.

W made an offer to settle in the sum of 15,000 pounds. The amount awarded to the Claimant was reduced to 9,000 pounds after further negotiation. 1. Johns v Greater Glasgow Health Board (1990) SLT 459. 2. W v Ministry of Defence (2009) MLC 1652 In B v Norfolk & Norwich University Hospital3, the Claimant, a male nurse aged 29 years, had attended the Norfolk & Norwich University Hospital NHS Trust after falling off his bike in July 2004. His left fractured scaphoid bone wad missed and a non-united scaphoid fracture with humpback deformity and associated ligament damage had occurred.

The Claimant thus made a Part 36 Offer for the sum of 14,000 pounds that was agreed with the Defendants in March 2006. In N v Pontypridd & Rhona NHS Trust4, the Claimant injured his right wrist in a fall whilst ice-skating on March 14, 1998. He attended the Hospital’s Accident and Emergency Department and was noted as having a tender scaphoid. An X-Ray of the wrist was taken which was interpreted as disclosing no fracture. Nonetheless the wrist was set in plaster of Paris and the Claimant released. On March 19, 1998, the Claimant re-attended the Hospital’s Accident and Emergency Department still in pain.

The cast was removed; no X-Ray was repeated. The Claimant was given tubi-grip dressing and told to exercise the wrist. On April 29, 1998, the Claimant attended a different Hospital complaining pain and swelling over scaphoid region. X-Ray showed a fracture of scaphoid bone in his right dominant hand. On May 29, 1998, the fracture showed sign of delayed union. As a result, a settlement of total damage of 12,500 pounds; general damage of 8,000 pounds, and special damage for income loss and care of 4,500 pounds were awarded.

In P v United Bristol Healthcare NHS Trust5, the Claimant was involved in a fracas at nightclub in Bristol and arrested for punching security camera. The Claimant attended Accident and Emergency Department at the Bristol Royal Infirmary on 27 May 2000 and he experienced problems relating to his right wrist. The SHO treated the injury as being a sprain and no X-Ray was taken. The Claimant’s GP then identified tenderness in anatomical snuffbox. An X-Ray confirmed fracture through scaphoid being missed by Accident and Emergency Department. The Claim was finally settled for 40,000 pounds with causation proved. 3.

B v Norfolk & Norwich University Hospital (2006) MLC 1350 4. N v Pontypridd & Rhona NHS Trust (2003) MLC 1031 5. P v United Bristol Healthcare NHS Trust (2004) MLC 1159 QBD Settlement Where a Claimant has received State Benefits as a result of a disease and is subsequently awarded compensation, the Department for Work and Pension (DWP) will seek to recover these benefits from the Defendant via a system operated by the Compensation Recover Unit (CRU). The CRU is also responsible for collecting from a Defendant the cost of any NHS treatment that a Claimant has received following a clinical negligence.

Notifying the DWP: Section 4 of the 1997 Act requires the compensator to inform the DWP not later than 14 days after receiving the Claim. The Notification should be made on Form CR1 which is sent to the DWP. On receipt of Form CRU1, the CRU will send Form CRU4 to the Defendant. The Claim then progresses to the settlement stage. When ready to make an offer of compensator, the compensator submits form CRU4 to obtain a Certificate. The CRU acknowledges receipt of form CRU4 within 14 days. The CRU sends the Certificate to the compensator- a copy will also be sent to the Claimant’s solicitor.

The compensator will then settle the compensation claim and pay the relevant amount to the DWP within 14 days of the settlement. The compensator will also complete and send to the DWP Form CRU102 detailing the outcome of the Claim. The rules relating to recovery of benefit apply to clinical negligence claims. Due to their complexity, especially relating to causation, the CRU has set up a specialist group to deal with the claims, and makes a special request their compensators inform the CRU about clinical negligence claims as soon as the pre-action correspondence is received.

Part 36 Offer: A party who wishes to make a Part 36 Offer must first apply for a Certificate of Recoverable Benefit from the CRU. Although Part 36 does not spell it out , guidance from case law suggests that the offer should therefore particularize the various heads of damage, and indicate the amount of benefits to be deducted against each head. Mediation: The parties should consider whether some form of Alternative Dispute Resolution Procedure would be more suitable than litigation, and if so, endeavour to agree which form to adopt.

Both the Claimant and Defendant may be required by the Court to provide evidence that alternative means of resolving their dispute were considered. The Courts take the view that litigation should be a last resort, and that claims should not be issued prematurely when a settlement is still actively being explored. Parties are warned that if the protocol is not followed, then the Court must have regard to such conduct when determining costs. Mediation is one option for resolving disputes without litigation: it is a form of facilitated negotiation assisted by an independent neutral party.

The Clinical Disputes Forum has published a guide to mediation which will assist, available at www. clinicaldisputesforum. org. uk The Legal Services Commission has published a booklet on “Alternatives to Courts”, CLS Direct Information Leaflets 23, which lists a number of organizations that provide ADR services. It is expressly recognized that no party can or should be forced to mediate or enter into any form of ADR. (Total: 3000 words) Bibliography: 1. Lewis: Clinical Negligence: A Practical Guide, 6th edition, Tottel Publishing. . Khan M, Robson M, Clinical Negligence, 2nd edition, Cavendish Publishing. 3. Powers and Harris: Clinical Negligence, 3rd edition, Butterworths. 4. Woolf S (1995) Access to Justice – Interim Report HMSO. 5. Woolf S (1996) Access to Justice – Final Report HMSO. 6. (1999) The Civil Procedure Rules HMSO. 7. “Making Amends”, at www. dh. gov. uk 8. ”NHS Redress Bill” at www. publications. parliment. uk 9. Civil Litigation Handbook by Woolf, Lord Justice; Burn, Suzanne; Peysner John (2001), The Law Society. 10. A. A. S.

Zuckerman, Ross Cranston (1995), Reform of Civil Procedure- Essays on “Access to justice”, Oxford University Press. 11. The Judicial Studies Board, Guidelines for the Assessment of General Damages in Personal Injury Cases, 9th edition, Oxford University Press. 12. Personal Injury & Clinical Negligence: Tough Conditions – The Lawyer 10/10/05, www. lexisnexis. com 13. Opinion: Edwina Rawson: The Lawyer 26/09/05, www. lexisnexis. com 14. Butterworths: “Risk Assessment in Litigation: Conditional Fee Agreements, Insurance and Funding”, David Chalk 15.

The Law Society: “Conditional Fees: A survival Guide”, Napier and Bawdon 16. The Law Society: “Civil Litigation Handbook”, Peysner. 17. “Mediating Clinical Negligence Claims”, Roger Wicks, www. medneg. com articles 18. “Guide to Mediation”, www. clinical-disputes-forum. org. uk 19. “Guide to Mediating Clinical Negligence Claims”, www. clinical-disputes-forum. org. uk 20. Kemp and Kemp The Quantum of Damages, Sweet and Maxwell. 21. Medical Litigation Online, www. medneg. com 22. AvMA Medical and Legal Journal 23. “General Damages – the NHS Case”, Philip Havers Q.

C. and Mary O’Rourke, Quantum, Sweet & Maxwell (2000) 24. Practice Direction at www. justice. gov. uk 25. NHSLA website www. nhsla. com 26. Civil Procedure Rules at www. justice. gov. uk 27. Pre-action Protocol for the Resolution of Clinical Disputes and Practice Direction – Protocols, www. justice. gov. uk 28. “Guidelines on Experts’ Discussions in the Context of Clinical Disputes”, Clinical Risk (2000) 6, 149-152 29. The “Draft Guidelines On Experts’ Discussions in the Context of Clinical Disputes” (published by the Clinical Disputes Forum) 30.

Part 36 and its Practice Direction, www. justice. gov. uk. 31. The NHS Redress Act 2006 can be found online at www. legislation. gov. uk/ukpga/2006/44 32. Johns vs Greater Glasgow Health Board, (1990) SLT 459, www. medneg. com 33. W v Ministry of Defence, (2009) MLC 1652, www. medneg. com 34. B v Norfolk & Norwich University Hospital (2006) MLC 1350, www. medneg. com 35. N v Pontypridd & Rhona NHS Trust (2003) MLC 1031, www. medneg. com 36. P v United Bristol Healthcare NHS Trust (2004) MLC 1159 QBD, www. medneg. com

Healthcare Reimbursement Medical coding is an important process, in which descriptive information (patient medical records) is reviewed, and assigned detailed numeric, or alphanumeric diagnosis, and procedure codes’, for the purpose of reimbursing hospitals’, or physicians’ offices’, for services’ rendered (Ehow. com, 1999-2001; AHIMA. org, 2011). These codes are then translated into payment amounts, to be submitted to insurance companies’, for compensation (Ehow. om, 1999-2001). The hospitals’ and physicians’ rely on “complete coding accuracy”, or codes without “any” errors, or inadequacies (clean claims), to be submitted to insurance companies in a suitable time, in order to be processed, and reimbursed for services’ performed (Campus. ctuonline. edu, 2001-2011).

The more detailed information the coder provides, the more accurate the billing and coding will be (Campus. ctuonline. edu, 2001-2011). Accurate coding is beneficial to the financial business end of hospitals’, and physicians’ offices’ because, if the coding is not correct, insurance companies will not pay the costs for the claims’ (Ehow. om, 1999-2001; AHIMA. org, 2011). Therefore, this can result in thousands of dollars’ in loss revenue for medical organizations’. To date, there are no “National” standards to really determine medical coding productivity (Ehow. com, 1999-2001). Coding productivity is determined by each individual medical organization, establishing their own “principles of productivity”, based on record categories, such as “inpatient or outpatient status (Ehow. com, 1999-2001).

According to the HCPro survey (1999-2001), twenty-nine per cent of facilities used a “three records coded per hour” system, as a “benchmark” (standard), for coding inpatient records’ (Ehow. com, 1999-2001). Furthermore, the American Health Information Management Association (AHIMA), established a certain amount of benchmarks, for coders to get claims in on time also (Ehow. com, 1999-2001); for inpatient charts, there was a benchmark of two to four charts per hour, and for outpatient records, standard coding time, was five to twenty records per hour, depending on the type (Ehow. com, 1999-2001).

It is important coders meet the requirements, and work to minimize errors (Ehow. com, 1999-2001); the more accurate, and productive the coder is, the more the facility will be reimbursed for services rendered (Ehow. com, 1999-2001). It is crucial for coders to comply with State and Federal guidelines (Ehow. com, 1999-2001). Compliance guidelines are established in the “Internal Classification for Diseases, 9th Revision, Clinical Modification (ICD-9-CM) for coding and reporting, issued by the Center for Medicare, and Medicaid Services (CMS), and the National Center for Health Statistics (NCHS)” (Ehow. com, 1999-2001).

Also, assigning diagnosis and procedure codes is required under the “Health Insurance Portability and Accountability Act of 1996 (HIPPA)” (Ehow. com, 1999-2001). Between the coder and the healthcare provider, it is important for both parties to work together, to “complete precise documentation, coding assignments, and reporting of diagnoses and procedures” (Compliance. uclahealth. org, n. d; Campus. ctuonline. edu, 2001-2011). There cannot be enough importance put on “accurate documentation”, because without accuracy, coding will not be successful (Compliance. uclahealth. org, n. d; Campus. ctuonline. edu, 2001-2011).

In addition to this, under the “National Correct Coding Initiative (NCCI), the consequences of inaccurate coding, or increased errors’, can result in criminal prosecution” (Campus. ctuonline. edu, 2001-2011). Some of the benefits of the “Outpatient Code Editor” (OCE) software, which helps maintain consistency, in processing claims for coders is, “editing claims for accuracy, assigning’ APCs, as well as assigning CMS-designated status indicators’, in addition to computing discounts, determining claim dispositions’, if packaging is appropriate, and helps’ determine payment adjustments, if necessary (Cms. ov, n. d. ). Coding references is an important tool, used to assist coders with more accurate coding by identifying minuscule differences between similar CPT codes from operative reports the first time (Medetrac. com, 2010-2012). The coding clinic is a resource newsletter that provides’ coding advice for HCPCS Level II coders (Casto & Layman, 2011). This newsletter is an important resource, because it “provides actual examples’, correct code assignments’ for new technologies, articles’, and a bulletin of coding changes’ and/or corrections” (Casto & Layman, 2011).

The CPT assistant is a newsletter from the American Medical Association (AMA), used for coding communications, to keep coders up to date, clinical explanations’ for baffling codes, coding consultations’ to answer questions, anatomical illustrations, and information equivalent with the Federal Register (Medetrac. com, 2010-2012). Lab and drug dictionaries are used by coders to alert them to common spelling errors, pronunciations’, and words that are similar in form, and meaning (Medetrac. com, 2010-2012).

Lab and drug dictionaries would eliminate errors’ coders’ could make, when two words sound the same, or have similar spelling (Medetrac. com, 2010-2012); in addition, the dictionaries would present what common abbreviations to use, and not use, in medical orders (Medetrac. com, 2010-2012). This is useful because it would eliminate primary mistakes on the reports. Medical dictionaries is a reference which list drugs, treatments, medical abbreviations, medical terms, definitions, translations, signs and symptoms of common disorders, and practical phases, used in daily communication with patients (Medetrac. com, 2010-2012).

Lastly, anatomy references for coders are used to enhance, and interpret a coders understanding, of medical documentation, and correct code assignments (Codingbooks. com, 2011). After reviewing all the information gathered on the “coding reference, the coding clinic, and the CPT assistant, the lab, and drug dictionaries, the medical dictionaries, and the anatomy reference, the conclusion that has been drawn, is “all” of the references are equally important, when used together to guarantee coding accuracy for all coders.

References

1. AHIMA. org. (2011). Medical Coding. American Health Information Management Association.
2. AHIMA. Retrieved November 17, 2011 from http://www. ahima. org/coding/ Casto, B. A. , & Layman, E. (2011).
3. Principles of Healthcare Reimbursement. 3rd Edition. American Health Information Management Association (AHIMA). Illinois: AHIMA Press. Codingbooks. com. (2011).
4. Anatomy and terminology for eyes and bars. Anatomy and terminology for coders elearning. Course Overview. Description. Coding Store. Contexo Media. Access Intelligence, LLC. Retrieved November 21, 2011 from http://www. codingbooks. com/books/coding_reference/Anatomy-and-Terminology-for-Coders-eLearning_25. html Cms. gov. (n. d. ).
5. Outpatient Code Editor (OCE). OCE Purpose: Purpose of the OPPS I/OCE functionality. Centers for Medicare and Medicaid Services. U. S. Department of Health and Human Services.
6. Retrieved November 21, 2011 from http://www. cms. gov/OutpatientCodeEdit/10_Purpose. asp#TopOfPage Colorado Technical University Online. (2011).
7. Course materials: Healthcare reimbursements: Regulatory issues and coding compliance. HIT201-1104B-02 Phase 1 Individual Project activity: Healthcare Reimbursement [Multimedia presentation].
8. Retrieved from Colorado Technical University Online Virtual Campus, November 21, 2011from https://campus. ctuonline. du/Classroom/Pages/multimediacoursetext. aspx? classid=260129&tid=130&uid=251269&HeaderText=Course Materials: HIT201-1104B-02: Healthcare Reimbursement Colorado Technical University Online. (2011).
9. Course material: Processing physician office claims. HIT201-1104B-02 Phase 1 Individual Project activity: Healthcare Reimbursement [Multimedia presentation].
10. Retrieved from Colorado Technical University Online Virtual Campus, November 17, 2011 from HIT201-1104B-02: https://campus. ctuonline. edu/courses/HIT201/p1/hub1/14921. pdf Compliance. uclahealth. org. (n. d. ). ICD-9-CM official guidelines for coding and reporting.
11. Effective October 1, 2008. Retrieved November 21, 2011 from http://compliance. uclahealth. org/Workfiles/PDFs/ICD_9_CM_Official_Guidelines_for_Coding_and_Reporting_Effect ive_October_1_2008. pdf Ehow. com. (1999-2001).
12. Importance of medical coding for hospitals. Reimbursements. Written by Jacqueline Wilson, Ehow Contributor. Demand Media, Inc. Retrieved November 17, 2011 from http://www. ehow. com/facts_5918637_importance-medical-coding-hospitals. html Ehow. com. (1999-2001).
13. Medical coding productivity standards. Productivity standards. Written by Cynthia Murphy, Ehow Contributor. Demand Media, Inc. Retrieved November 17, 2011.

There have been many current events that have violated human rights, one of them is that Venezuela is suffering from lack of food and medicine they are given and their leader isn’t doing anything about this but other leaders are trying to help out Venezuela , there are many things that are being done in order to Prevent future events like this, because this can’t start happening around the world, Colombia, Cuba, and Argentina are already starting to have problems like this and this could get out of control.

Venezuela use to be one the the wealthiest countries until the 19th century, that’s when they started to have economic and political crisis. Venezuela’s president, Nicolas Maduro is denying the fact that Venezuela people are staring and not having access to good health care. Many people are starving and others are in the hospital, and not having enough medicine for everyone because the hospitals are getting filled with injured people.

Since the hospital doesn’t have enough supplies for everyone they ask patients to bring their own medicine and which most patients can’t afford. According to ” Venezuela’s health care crisis ” the video states that even when their own patients bring in their own medicine, they are stolen inside the hospital.This Hospital use to have staff 24/7 working on surgerys and helping other patients while now there are people that have been waiting to have surgery for days.

The Violation of the Universal Declaration of Human Rights is Article 7 which is “You have the right to be treated by the law in the same way as everyone else.Everyone has the right protection against violation of their human rights” and Article 8 “If your rights under law are violated , you have the right to see justice done in court or tribunal.”

This is saying that every person in Venezuela should be treated the same and have the same health care. People in venezuela are dying and starving because of the lack of food and medicine and health care they are given. According to CNN, this crisis that is happening in Venezuela had started around 2015 where people were having less than one meal a day. It’s sad to see that newborns are being put in cardboard boxes after their mother give birth.

According to FP people have been use to having one meal a day while others are hunting for dogs pigeons and cats. People In Latin America would feel rich with just one dollar or maybe some clean water while people here in America are wasting food and aren’t grateful for one dollar. This rich Country is suffering because of one person which is their leader Nicolas Maduro.

We can start helping Venezuela by just donating one dollar, because that would mean a lot to them. Donald Trump is also helping out with this situation.According to U.S.NEWS president Donald Trump he states that he promises “strong and swift economic actions” to counter Maduro’s antidemocratic measures.” What Donald Trump is doing is he is restricting the revenue that Nicolas Maduro planned and benefit from oils form the United States.

In Conclusion, Venezuela is struggling in food and health care because of their bad Leader Nicolas Maduro. People are dying faster and families are starving because they don’t have food. This is a huge crisis, this was one of the wealthiest countries but now is the one leaving in poverty, people are eating pets and birds which is not usual.

President Donald Trump and other leaders in Latin America for example Mexico they are trying their best to help out venezuela because everyone is supposed to be treated the same way, and in a way people in America can be helping out by donating one dollar which to them means a lot .

Working in a critical care department with a 150-bed capacity was challenging for me as aclinical nursing manager. One of the struggles was controlling the infection rate in thedepartment it is need to be minting and working to reduce the high rate so is not easy toachieve. For example, the report for one of the infraction control indicators showed that therate of central line-associated bloodstream infection (CLABSI) was high. Clinical governance plays an important role in improving healthcare systems by enhancing and maintaining the continuity of the healthcare provided, creating an evidence-based framework for managing the healthcare provider, refining professional performance by providing scientific resources, and minimising the risk to the patient.

It is also important to guarantee patient satisfaction .Working with the clinical governance department lead to the idea for reducing the high rate of CLABSI by using bundles to monitor staff members during insertion of the central line and to make sure that is the blood instruction with the clean producer. The care bundles are providing the evidence based interventions by collecting the interventions in one protocol, that will help to get an excellent outcome .

The result of implementing bundles was excellent, and the rate of CLABSI went down by 50% in the first month, and within three months the rate had dropped by more than 80%. Staff role in ensuring quality and safety:the quality of the nurses’ work and safety of patients is essential toproviding excellent care to patients. nurses are the major part of health care providers andit is essential that they take care of preventing medical errors and maintain patient safety.

The clinical manager has the role to ensure that bundles were properly implemented and supervised by using one staff member in each shift to check the bundles to verify that all of the health care providers were committed to the bundles instructions. This helped to ensure consistency in the quality of care provided to the patients.(Barbara et al., 2014) Empowering consumers:empowering nurses to take a more active role in their healthcare experience canlead to providing better healthcare. I believe that requiring continuing education allows thenurses to improve their expertise. Furthermore, having nurses share their knowledge isimportant because it helps them to become role models. Nurses must belief in their value andmake sure they apply what they belief in realty to provide better care for patients.

Also,creating a positive communication environment is crucial to improving the relationshipbetween patients and nurses, which is reflected in the healthcare outcome. Improving thepersonal – central can have a significant impact on delivering excellent healthcare.The prerequisites for a professional nurse focus on the nurse’s attributes and include beingprofessionally competent, having developed interpersonal skills, being committed to the job,being able to demonstrate clarity of beliefs and values, and knowing oneself . The empowerment is most successful when it is internal, ratherthan external. Therefore, nursing students must be taught how to empower themselves a supported. Empowering nurses can lead to promote health care and that will reflect in patient health.

The Indian Systems of Medicine include Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy is ancient and has the roots in traditional system of medical treatments in tune with the Mother Nature. Medical Tourism is the emerging industry next to the IT boom and India is the second best destination as of now. Especially the Indian Systems of Medicine, in South India can become the leader in medical Tourism Industry.

This paper tries to appraise the facts and future possibilities based on a SWOT perspective. Introduction Without sound health we cannot achieve anything in our life, nor enjoy what ever we have. In service sector the concept of Medical Tourism is catching up at lightning speed across the world. The act of traveling to other countries for medical, surgical and other forms of healthcare along with recreation is called Medical Tourism. People from advanced countries, including the United States and Europe, see a benefit in traveling to developing third world countries, like India, Thailand, Philippines, South Africa, and etc. hile combining medical treatments with inexpensive vacation. According to a study conducted by the Confederation of Indian Industry and Mc Kinsey consultants (2004), 1,50,000 foreigners visited India for treatment, with the number rising by 15 percent a year. The number has increased to 2, 72,000 in 2007 and has crossed the 3 lakhs mark in 2008. ASSOCHAM has predicted that this will grow by 22 to 25% in the coming years. Scope The main demand for medical tourism is generated from millions of Indians who live abroad, though a growing number of foreigners are also keen on speedy and in expensive treatment.

They are influenced by two important facts: India now has many world-class private hospitals and the alternative medicines are available in abundance. Foreigners are visiting India for serious medical help as well as rejuvenation therapies and other specific purposes. Medical Tourism has been a popular concept in countries like Malaysia, Thailand, Singapore, Costa Rica, Hungary, India, Israel, Jordan, and Lithuania. South Africa specializes in medical Safaris-visit the country for a safari, with a stock over for plastic surgery.

Due to liberalization of our economy and internalization of health care profession, India has entered the industry in only recent times. India’s corporate hospitals are fully equipped with up market and efficiency. The Indian Systems of Medicine also has become a valid reason for them especially in preventive cure and alternative medicines. Medical Tourism is poised to be the next Indian success story after Information Technology. According to recent study of ASSOCHAM, in 2008 the size of industry was estimated Rs 1500 crore and it would grow into Rs. 9500 crores by 2015 with an annual growth rate of 30 %.

The Indian government has predicted that India’s $ 17 billion –a-year health care industry would grow by 13% in next four years. Indian Systems of Medicine (ISM) The Indian Systems of Medicine include Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy together characterized under the department of AYUSH in the union health and family welfare ministry. During the ninth plan, with an expenditure of more than Rs. 1,000 crore, a quantum jump in outlays on schemes for development and promotion of AYUSH system of medicine has been achieved during Tenth and Eleventh Plan.

Indians are known for their hospitality and warmth. India has an incomparably rich heritage in ancient systems of medicine that make up a veritable treasure house of knowledge for both preventive and curative health care. Around 1000 BC when Indian Systems of Medicine (ISM) were fully documented in Charaka Samhita and Sushruta Samhita. Thus, ISM is considered to be one of the oldest organized systems of medicine for positive health and cure of human sickness. The most important and massive ancient compilation of the school of medicine is known as Charaka Samhita.

It contains several chapters dealing at length with internal medicine. About six hundred drugs of plant, animal and mineral origin are described in it. But traditional medicine was ignored when western medical knowledge and procedures were introduced into the country. Once again the same has regained its limelight. Ayurveda : Ayurveda means the “science of life” in Sanskrit. It is one of oldest and the best documented among the ancient systems of medicine. From the Charaka Samhita (600 B. C) and the Susruta samhita. Yoga & Naturopathy : Yoga is not really a system of medicine.

Its objectives are self- realization and spiritual union with all –pervasive divine cosmic power. But certain intermediary practices and yogic attitudes have proved beneficial for reducing stress, preventing many lifestyle-related diseases, and promoting general health and well being. Naturopathy is based on the fundamental principles of airbed. The basic tenet of Naturopathy is to live according to the laws of nature: disease occurs due to the accumulation of toxins in the body, and to cure the ailment, the body is purified with the use of natural methods, dietary regulations and exercise.

Unani

The Unani system originated in the fourth and fifth century BC in Greece under the patronage of Hippocrates (460BC-377)and Galen. The system is based on the humoural theory that good health depends on the balance of the four humours: blood, phlegm, yellow bile and black bile.

Siddha

Siddha means a “master” thus the name denoted the mastery of such practices. The most famous of the siddha was Nagarjuna, whose rasatantra forms the basis of this system. The distinctive features of siddha are its reliance on minerals and metallic compounds, and its emphasis on rejuvenation therapies.

Homeopathy

The term homeopathy comes from the Greek word ‘ homios’ means like and ‘pathos’ means suffering. Homeopathy works by looking at the symptoms, will take into account the individual’s mental, physical, emotional,and spiritual health before deciding the treatment. Homeopathy is based on the principles that ‘like cures like’. Current State of Affairs The American Medical Association (AMA) has conducted a cost comparison study of health care in different countries.

The surgical procedures and the dental treatment procedures have a cost advantage – approximately 1/6th of the cost in USA. Also the waiting period for even a simple surgery is minimum 6 months and specialty treatments are 9-12 months in USA / UK which is almost instant in India. AMA has proved though there are many

The state like Kerala, Karnataka, Tamil Nadu and other states in India plays a key role in medical tourism. Kerala-The Pioneer State Kerala has pioneered health tourisim in India. Kerala has strongly focused on Ayurveda and its wide array of treatments and medications, good facilities are also available in other traditional forms of medicine as well as in modern medical treatment. Kerala is Capitalizing on its Rich Cultural Heritage and alternate Medical Therapies. Karnataka’s Foray The government of Karnataka has ambitious plans to make Karnataka the top health tourism destination not only in India but internationally. In fact, the government is setting up a Bangalore International Health City

Corporation for provision of a wide variety health care products and treatments. Tamil Nadu Tamil Nadu has multi speciality hospitals that offer the best medical treatment at surprisingly low rates. In the state various other forms of medicine, viz, Siddha, Ayurveda, Unani, Nature Therapy and Yoga are also practiced, which the foreigners are inclined to patronize. The Tourism Department is taking steps to promote the “illness to wellness” concept by developing tourism with health care. Andhra Pradesh The famous Nizamia General Hospital is the one of its kind probably in the whole world to use Unani system of medicine, since 1938 and treating almost 1500 outpatients every day.

The state made rejuvenation theraphy , alternative medicine, yoga and traditional healing systems as its main tourist attraction. Maharastra’s Unlimited Potential This state, as a gateway to India, offers tremendous potential to develop medical tourism. The latest addition in Mumbai is the Asian Heart Institute at Bandra-Kurla complex, which offers state-of-the art facilities for all types of heart complications and even preventive cardiological treatment to avoid heart alignments and keep under control a host of heart problems. This institute in collaborating with the Cleveland Institute, U. S. A offers ‘Five Star’ services at reasonable prices. Medical Infrastructure

In India, it is estimated that there are 15,000 hospitals, 8,75,000 hospital beds, 5,00,000 doctors, 7,37,000 Nurses, 170 medical colleges, 3, 50,000 retail chemist outlets. Around 18,000 new doctors are added every year. Almost 80,000 additional beds are still required. A self-sustained healthcare hub with super specialty hospitals of international standards, ancillary facilities, research institutions, health resort, rehabilitation centers and residential apartments may be floated through a public-private partnership. Conclusion : India’s growing economy and the world’s high cost medical treatments are the bright opportunities for promoting Medical Tourism. To gain an competitive advantage over other countries the government may use our unique, ancient and traditional Indian Systems of Medicine as a USP and can participate in developing the needed infrastructure facilities, creating network and connectivity with health, tourism and other related industries, tie-ups with other countries. The sky is open for ISM Medical Tourism.

The medical field comprises a vast base of knowledge. Computer storage serves as the best way to house all this information. There are many types of computers that can help with diagnosing illnesses, doing procedures to treat illnesses, and even helping to reduce the degree of invasive procedures during testing.

Many facilities are also switching from handwriting patient information logs to computerized patient logs. Including computers in each patient’s room to have their entire file readily available and easily accessible to retrieve and record new patient information. There are more computers than I can name that are used for medical purposes. With many of these we are able to provide many types of tests that can save lives and help in early detection of illnesses. Some include: Ultrasound, MRI and CT, Mammograms, and EKG. Computers in the medical field have made such advancement, particularly in nursing.

With such a shortage of nurses, hospitals are trying to find a way to improve the efficiency of their nurses. More and more hospitals across the country are now using mobile computers. These mobile computers are also know as COWS (computers on wheels). Hospitals are using these mobile computers as the nurses station. By using the computers, nurses have access to all their patients information, medical records, diagnostic equipment, barcode scanners, etc. This cuts down on time they would otherwise use to run around gathering this information.

Nurses have begun using computers to assess patients on point of admission in the privacy of the patients room. While the patients is being assessed, the nurse is able to see previous admissions, pertinent medical information, medication, and doctors’ notes. Using the computer also gives the nurse more time to spend with her patient. After the initial assessment, nurses can also use the computer to begin writing a plan of care, record interventions and outcomes, and communicate the information to other departments.

Another great aspect of using the computer, is the elimination of trying to read illegible handwriting. Once a doctors orders is in the computer the nurse is able to clearly read them and dictate to the patient. This cuts down on time spent paging the doctor and waiting for a call back simply to clarify an order. This also helps to get medication doses correct. Medication errors are also being reduced due to the use of computers. Most hospitals are now using bar code scanners while administering medication. The nurse scans the patients armband, then scans the barcode on the medication.

If the medication is not for that patient, an alert will come across the computer screen. Or sometime a patient is prescribed a new medication that cannot be taken with another. Most of the computer systems have this information so another alert will come up of this is the case. There are a few disadvantages of using a computer. If there is a problem with the computer system that causes it to go offline then it delays the nurse in all she needs to do, give medication, chart, etc. In conclusion, computers have made so many improvements in the medical field.

There is more time spent with the patient instead of charting. The computer can flag unsafe medications, providing medication safeguards. Quick return of lab results is another advantage because all the results will be stored in the computer. Using the computer for e-mail, consults, etc, will shorten wasted time and improve communication between departments. Discharge instructions can be given to the patient as an easy to read list tailored to their diagnosis and needs instead of the old-fashioned paper with notes scribbled across the bottom.

Most importantly, the use of computers improves the quality of patient care. The are not really any disadvantages to using computers, but one has to remember, the computer is only as good as the person entering information into it.

Works Cited

1. Eggland, Ellen Thomas “Using Computers to Document. ” Nursing 27. 1 (2007) MasterFILE Premier.
2. EBSCO Lippencott, Williams & Williams “Using Computers to speed up the nursing process. ” Nursing 32. 8 (2008): 70.
3. MasterFILE Premier. EBSCO “Medicine Meets the Computer” Wilson Quarterly; Summer 2009, Vol. 33 Issue 3, p 83-84

Following hospital/unit specific policies and procedures. Providing privacy while performing all procedures and treatments. Providing patient/ family education prior to performing procedures and treatments. Attempting procedure or treatment no more than twice before soliciting advise e from a more experienced care provider. Documenting according to hospital/unit policies. Maintaining patient/family safety. Following hospital/unit specific policies and procedures related to patient/ family safety and confidentiality. Providing orientation of unit and surroundings to patient/family. Maintaining patient/family confidentiality.

Knowledgeable about use of equipment/supplies. Documenting appropriate safety measures per unit. Page TWO Demonstrating positive and courteous manner in dealing with patients, physic scans and coworkers. Handling patients and employee information with appropriate sensitivity and safeguarding to ensure confidentiality. Exhibiting flexibility when work assignments need to be adjusted to meet the needs of our patients. Present a professional appearance and approach with patients and staff. Performing Medical Assistant tasks, including but not limited to, vital signs an Keg’s- Preparing patients for physician and practitioner exams.