supportive measures the patient did expire. A review of patient’s labs and clinical status ultimately determined that the cause of death was DIC. Discussion: In most cases, DIC can be differentiated from other microangiopathic hemolytic anemias (MAHAs). However, the diagnosis of DIC is not
based on a single test but a composite of factors – including patient history, clinical signs and symptoms, and a combination of laboratory tests. Therefore, when making the diagnosis of DIC, it is important to eliminate other disease processes, as DIC can be “the Great Imitator”.
ADVANCED CARE PLANNING IN THE OUTPATIENT SETTING Benjamin Horn, Daniel Poole, Kristie Searcy, Justin Harrel, Megan Lear, Patrick Bass III; Department of Medicine, Louisiana State University, Shreveport, LA.
Introduction: Advance care planning (ACP), is a process that supports any person at any age or stage of health in understanding and sharing their personal values, life goals, and preferences in future medical care [1]. Studies suggest that ACP discussions improve end-of-life quality of care, prevent overtreatment, and strengthen relationships while simultaneously respecting patient autonomy [2]. The global impact of COVID-19 has also created a need for advanced care planning more than ever before [3]. During the COVID-19 pandemic, roughly 19% of family caregivers revisited or updated advance directives of care recipients and/or had some type of contingency plan if they were to become ill [4]. While these conversations are best held in calm and controlled settings, studies have found that physicians in a hospital setting were more likely to engage in ACP conversations when compared to an outpatient physician [5]. The goal of our study was to provide a structure of alerts to remind providers to offer the service and education on how to properly document the encounter to be reimbursed for time through the Medicare system.
Methods/Results: The research was conducted at a resident-run community care clinic for patients. A universal smart phrase and code were utilized for the ACP discussion and documentation purposes for the EMR system. The inclusion criteria for those that residents held ACP conversations with was age of 65-years or older. The research was conducted from November 2021 to February 2022 using two distinct interventions: (1) clinicians were notified by a messaging system in the EMR when they had a patient of appropriate age and (2) a flier was provided by nursing staff to patients identifying them as participants who should consider asking to hold an ACP discussion with their provider. A total of 19 ACP conversations were held during the first intervention and 3 ACP conversations were held during the second intervention. Discussion: Our project showed ACP conversations were more likely to occur when the responsibility is placed on the physician rather than the patient. Advanced Care Planning in the outpatient setting should be considered for all patients aged 65 years of age and older.
TNF-A INHIBITOR-INDUCED PERICARDIAL EFFUSION IN THE SETTING OF SERONEGATIVE RHEUMATOID ARTHRITIS Aakash Kapoor, Andriane Melanthiou, Cynthia Michael; Department of Medicine, Leonard J. Chabert Medical Center, Houma, LA.
Introduction: Pericardial effusions pose a critical, but rare, complication of TNF-a inhibitors, even in the setting of chronic usage. Pericardial effusions may develop with any condition that affects the pericardium and most frequently have an autoimmune or viral etiology.
arthritis, gout, bipolar disorder and depression presented with complaints of nausea, vomiting, chest discomfort, and shortness of breath. Four months prior, she discontinued her Etanercept in anticipation of an elective outpatient surgery. After resuming Etanercept shortly after her procedure, she began to experience similar presenting symptoms, for which she was seen at a neighboring facility. Echocardiogram performed at the time revealed 37
Case: A 52-year-old female with non-ischemic cardiomyopathy, NSTEMI, CKD3, HTN, rheumatoid
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