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A note from Dr. Pete Paganussi, editor of VACEP's EPIC since 1999

A woman rises well before dawn and heads out into the darkness. She makes her way around the back of her house down towards the barn by the stream. There is a chill in the air that makes her shiver a bit. Dew clings to the ankle-deep grass and wets her boots with each step. She opens the door and from within the dark hallows there is a rustling followed by a deeply pitched, staccato snort. Her heart races as she approaches the stall. The animal raises its’ head in anticipation. Their eyes lock in mutual reverence. She smiles as the elegant beast nuzzles her with his head. There, lives and breaths, her passion.

A man waits on a hilltop over 300 miles from his home. He sits and stares at the night sky and the wonderful canopy of stars above his head. He has finished setting up his Celestron cpc 800 telescope with great care. It is his pride and joy this device that allows him a window into the universe. Now he waits for just the right moment to photograph this extraordinary event. It begins like a symphony. The celestial beauty will swell and soar, but not immediately. It will transpire over minutes and then reach an apogee of pure perfection. A lunar eclipse unfolds, begging to be viewed and photographed in all its stark beauty. He would not miss this for the world!

Click here to read more from Dr. Paganussi.
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A treatment choice for agitation associated with schizophrenia or
bipolar I disorder.

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Oct. 2014


Showing support for the value of VACEP and ACEP
Member in the news: Chris Thompson, M.D., FACEP
"I have been serving as the Chair of Emergency Medicine at Liberty University College of Osteopathic Medicine as well as the advisor for the Emergency Medicine Interest Group (EMIG). The entire class is 160 students and there are over SIXTY in the EMIG. The group moved independently to support both ACOEP and ACEP equally, underscoring the obvious importance and synergy between emergency and osteopathic medicine and the wonderful scope of opportunity available to medical students through ACEP. I look forward to introducing them to the Virginia ACEP Board of Directors."

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Mark Your Calendar: VACEP Winter Annual Meeting

Mark Your Calendar: VACEP Winter Annual Meeting
Feb. 6-9, 2015
The Omni Homestead
Hot Springs, Virginia

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Death Certificate Signature Efforts
VACEP has been collaborating with the Medical Society of Virginia (MSV) and the office of the chief medical examiner (OCME) and representatives of the Virginia Funeral Directors’ Association to develop a form that will help expedite the completion of death certificates.

The responsibility for completing the certificate lies with the funeral director who will seek signature by a healthcare provider. In 2013, the General Assembly expanded the list of providers who can sign to include physicians, nurse practitioners, physician assistants, hospitalist or chief medical officers.

Generally certificates are signed within 24 hours of death, as required by Virginia statute. On occasion, though, there are delays as health care providers are not sure if they are the correct provider to sign. Likewise, questions arise as to whether the certificate should be signed by a medical examiner if the death is one that is subject to their jurisdiction.

This new form is designed to facilitate good communication between funeral directors and healthcare providers. It is not mandatory but is intended as a resource to equip healthcare providers with the information needed to complete certificates in a timely manner. Click here to view the form.

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Visit EM Career Central this to find your next job in emergency medicine.

We need your input on EKG billing!
Dr. Edward Walsh was hoping to get some feedback from VACEP colleagues regarding EKG billing. CMS is pretty clear about reimbursing the more contemporaneous and clinically relevant interpretation. In our case, as EM docs, that is almost always our interpretation rather than the 72-hour cardiology over-read. Since the over-read generally has no immediate clinical benefit there is no value added to the service. CMS generally reimburses us preferentially because ours is the most clinically relevant interpretation.

In our hospital we are credentialed for the initial reading only, but not the final read. We have been getting reimbursed for EKG's for decades. The hospital admin now wants to examine this process. They are trying to make it a care issue but it's really a financial ploy for the admin to wrest billing control away from the ED.

Dr. Walsh was curious if other groups around the state have had similar issues. He would be grateful for any feedback or advice on the subject.

If you have any information, please email Dr. Walsh.

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13 Fellows Approved (Renewed) in Virginia
Here is a report of members from VACEP who were recently approved for fellow status. Their FACEP designation became effective on Oct. 27, 2014, the date of the convocation at ACEP14.
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OMD Training Dec. 11 PEMS/TEMS Office
VACEP Board of Directors Meeting Dec. 12 10 a.m.-3 p.m.
West Creek Emergency Center, Short Pump, VA
VACEP White Coats on Call Jan. 27, 2015 Richmond, Virginia
VACEP Annual Meeting
Feb. 6-9, 2015 Omni Homestead Resort


Check Your MOC Requirements
To check your MOC requirements and see what you have completed and what you need to complete, go to your MOC Requirements and Status Page on ABEM MOC Online. To access your page, go to and sign in using your User ID and password. Click on the "ABEM MOC Online" button, and then the orange "View Your ABEM MOC Requirements and Status" button.

If you have any questions, you can send an email to, or call 517.332.4800, ext. 383.

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New leadership and staff with EMRA
As you may be aware, EMRA conducts elections each ACEP to select our new Board members. We are fortunate, once again, to have new resident leaders to bring their vision, enthusiasm and professionalism to continue to provide outstanding benefits to our members and to guide the strategic direction of our organization.
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Summary of 2014 Council Resolutions — from ACEP14
At the ACEP Board of Directors, directly following ACEP 14, the Board of Directors unanimously voted to adopt all resolutions adopted by the 2014 ACEP Council. Click here to view the 2014 Resolutions.
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Whether you are job hunting, need to be credentialed, or just trying to stay organized...
Meet your new best friend — the ACEP Portfolio Tracker.

'Physician, Heal Thyself': The Importance of Creating Resiliency
Dr. Kaplan's lecture at ACEP14 has been repurposed as an online course in ACEP eCME. It’s free to members.
    To watch the course:
    1. Go to
    2. Log in with your ACEP username and password
    3. Click the “Course Catalog” tab
    4. Find the “Sort By” function on the right side of the screen, and sort by “Recently Added” in the drop-down box
    5. Click “Launch” under the course title

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Smart Watch app big winner at 1st emergency medicine hackathon
CodeTimer, a smart watch app designed to time chest compressions and prompt first responders to administer medications to patients suffering cardiac arrest outside the hospital, took the top prize at the American College of Emergency Physicians’ first annual emergency medicine “Hackathon.” This event — which is part of the ACEP14 annual Scientific Assembly conference — is dedicated to solving emergency medicine problems with technology solutions.
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ER strategy: Streamlining care for patients with less serious illnesses
Medesto, California-based Memorial Medical Center invested $3.7 million to expand its emergency department to increase space for true emergency patients, while streamlining care for those with less serious illnesses, The Modesto Bee reported. The design includes additional seating in the lobby aimed to reduce patient wait times...
Prevention is key: Workplace violence in the hospital
By Keith Carlson
With the recent news of several nurses in a Minnesota hospital being injured by a patient wielding a metal bar, the issue of healthcare workers facing violence in the workplace is again receiving media scrutiny. Those employed in emergency departments understand they are particularly subject to the emotional volatility of patients who may face long waits in particularly busy facilities.
Flu season may bring rise in ER visits over Ebola fears
The Boston Globe
As the flu season gets underway over the next few weeks, public health officials have been preparing for a unique set of challenges. Some people are still looking for a last-minute flu shot due to delays in immunization shipments from two manufacturers, and those experiencing fever, aches, and fatigue from the flu may be more likely to head to the emergency room...


Slideshow: Healthcare leaders explore emergency department solutions
Health Leaders Media
The emergency department is one of the most vital components of a healthcare organization. The ED presents a number of challenges, as healthcare leaders must find ways to produce optimal outcomes and improve patient satisfaction, while reducing wait times. Four senior healthcare executives discuss the ways they are trying to improve their EDs, while combating these issues.
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New EHR vendors and technology needed for continued innovation
By Scott E. Rupp
In the span of the last five years, use and implementation of electronic health records in the U.S. has dramatically accelerated because of federal mandates and financial incentives directly related the meaningful use program. Because of these efforts, as well as time and resources invested by healthcare providers, electronic health records are more popular than at any point in the past and are now "the heart of health IT," according to research firm Frost & Sullivan.
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Prescription narcotics are potent painkillers, but they can be deadly
The Washington Post
America is in pain — and being killed by its painkillers. It starts with drugs such as OxyContin, Percocet and Vicodin — prescription narcotics that can make days bearable if you are recovering from surgery or suffering from cancer. But they can be as addictive as heroin and are rife with deadly side effects.
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When patients don't follow up
The New York Times
Patients frequently miss appointments and tests that their healthcare providers schedule. No-show rates range from 5 to 55 percent. In some instances, like when a patient skips a cardiac stress test, for example, then has a heart attack, the hospital might classify what occurred as a "systems error." Ideally, such cases lead to new policies that prevent similar events. But what about less drastic cases, in which follow-up is necessary but not an emergency? Should patients be held responsible for not showing up? Or does the medical profession have an ethical and legal duty to try to track down the individuals?
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Hand-hygiene compliance drops at the end of shifts
Hospital workers are less likely to wash their hands toward the end of their shifts, according to new research that suggests the lack of compliance is due to fatigue from the demands of the job. Researchers, led by Hengchen Dai, a Ph.D. candidate at the University of Pennsylvania, analyzed three years of hand-washing data from more than 4,000 caregivers in 35 hospitals across the U.S. published by the American Psychological Association.
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Jessica Taylor, MultiView Senior Medical Editor, 202.684.7169  
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