Topic: Case StudyA 30-year-old woman comes to your office because of a persistent cough that has been bothering her for the past 3 months. Her cough is dry and is more frequent during the evenings. She also notes frequent nasal congestion, especially when she is exposed to dust and cold weather. She reports no hemoptysis, weight loss, wheezing, fever, or changes in his appetite. What additional questions would you ask to learn more about her cough? What would be included in your HPI and your subjective questioning?How would you classify her cough based on the duration to help with the diagnosis?What diagnostic tests do you want to include to help you with your diagnosis?Create a differential diagnosis flow sheet for this patient and include the diagnostics as well as the pharmacological management and rationale related to the differentials. Support your discussion with evidence-based research that is no older than 5 years.About one page in length. At least 3 references, not older than 5 years.

Transcript Capstone Video: Delinquent Medical Records and JCAHO [ Music ] >> Okay look, if you want to take a break, that's fine -- >> No, I don't want to take a break, I want to finish. >> Okay, so do I, I just don't want to stress out in the process so look, let's just take a step back for a minute and relax. We know Jayco is not coming next week, okay, we know we're not due for another survey for about a year so we have time to check everything out and make sure that we know what we need to do to stay compliant. Don't worry, we'll be compliant. >> I know, I know. Let's just move on. Next item. >> Okay. Inpatient surgeries is one of the review items for Jayco, right? >> Right, yes. >> Okay, but outpatient surgeries? >> I'm pretty sure. >> What about other procedures; endoscopies, cardiac caths? >> I don't know, I don't know. I just -- I don't know. I looked through the Jayco manual, I couldn't find it. I went through policy and procedure and it is not in there. Now can this possibly never have been documented before? How could that be? Let's -- what's next on the agenda? >> We haven't even finished -- >> No, I know. I don't know. >> Okay. >> Okay? So let's just move on. Next item is delinquent medical reports. >> Okay, well this -- this, I think, is a behavioral problem. >> Oh, so what? We should just send them all to the psych ward? >> No, no. Maybe we should talk to the chief of staff, basically this is just coming up with an incentive for physicians to finish their reports on time, right? So whether it's a positive incentive or a negative incentive, basically a punishment for physicians who don't complete their reports in a timely manner, I don't know. I don't know which is more effective, maybe the chief of staff can help. >> You want to talk to them then? >> I'll be happy to you. >> Are we done yet? >> No. >> I want to take a break. I need to take a break. >> Be my guest. [ Silence ] >> The denominator for the operative rate should include inpatient reports and outpatient reports, catheterization reports and endoscopy reports and any other procedures requiring dictated reports. The timeliness of the submission of reports is sometimes problematic. In the past, hospitals have tried many methods of positive and negative reinforcement for getting physicians to submit dictated reports in a timely manner, including but not limited to food, raffles or movie tickets. And as a negative reinforcement, taking delinquent charts to the physician's office, suspending the physician's admittance privileges and even kicking them off the medical staff. Watch the video entitled, “Delinquent Medical Records and JCAHO”, and answer the following questions. 1. What should be included as part of the operative rate? 2. What can be done to reduce the number of delinquent medical records? 3. Does Keeler’s and Gonzalez’s reaction surprise you? Why or why not?