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This article addresses employment as a critical part of community reintegration for polytrauma patients. Interdisciplinary polytrauma teams can work to effectively identify and eliminate known barriers to employment for veterans and offer continued support and guidance. This article discusses key themes pertinent to vocational reentry for service members/veterans, identifies evidenced-based employment models, highlights the essential role of everyday technology in meeting support needs, and describes 2 exemplar polytrauma models: the Louis Stokes Cleveland Veteran Affairs Medical Center in Cleveland, Ohio, and the Service member Transitional Advanced Rehabilitation (STAR) program at the Hunter Holmes McGuire Veterans Affairs Medical Center in Richmond, Virginia., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Patient falls are considered a significant safety risk, but little evidence regarding the significance of falls in children is available. A multisite, observational study of fall events occurring in pediatric inpatients (younger than 18 years of age) from Child Health Corporation of America member hospitals was conducted to determine the prevalence and significance of falls. Fall prevalence was 0.84 per 1,000 patient days with 48% classified as preventable. Injuries occurred in 32%, but only two falls resulted in an increased length of stay; none resulted in permanent disability or death. Only 47% of the children who fell were identified to be at risk for fall. Alert mechanisms were used in 60% and preventive measures in 23%. These findings suggest that while inpatient pediatric fall rates are lower than those of adults, greater diligence in identification and risk reduction may further reduce the prevalence of falls and the proportion of fall-related injuries.

Steps toward maintaining a standardized chargemaster include: Building a corporate chargemaster maintenance team. Developing a core research function. Designating hospital liaisons. Publishing timely reports on facility compliance. Using system codes to identify charges. Selecting chargemaster maintenance software. Developing a standard chargemaster data repository. Educating staff.

To help emergency department (ED) nurses effectively capture charge information, hospitals should create a one-page form that contains a list of possible charges for selection. Hospitals should use and maintain a formal protocol for ED visit charges so they can be consistently assigned. Hospitals that use coders to enter ED charges should give them workspace in the department so they can answer questions for the clinical staff and provide documentation training as needs arise.

The task of standardizing chargemasters is huge, but so is the payoff. A standard chargemaster means improved charge capture and collections, uniform price and volume analysis, and reduced risk of payer audits and penalties, among other things. Having a central chargemaster team and adequate time and resources are essential to success.

When treating seriously ill patients, those working in the healing professions may be particularly vulnerable to their own stress symptoms. Left unattended, these professionals may go down the dark road leading to burnout, with impaired effectiveness as caregivers, diseases rooted in stress, as well as increased suicides, drug and alcohol addiction, and exacerbation of personality disorders. Early intervention may help reduce the associated problems. In this paper, we present an elementary debriefing system, a psychotherapeutic approach, to be used by the affected individual. While this methodology may be far more simplistic than those utilized in different schools of healing or caregiving, its appeal is its simplicity and practicality. We are proposing that the individual caregiver systematically consider the following: the Background of the situation; how it Affects thinking and feeling; the Troublesome element(s); how one is Handling element(s); and an Empathetic/empowering conclusion (BATHE). Ideally, these considerations may help alleviate caregivers' anguish in troublesome situations and may complement their awareness of their patients' suffering as well.