Healthcare Fraud: Auditing and Detection Guide, 2nd Edition

Anomalies and Abnormal Patterns

During my nursing school days, I asked my instructor if I could practice teaching by presenting an in-service to my peers. After several discussions, it was determined that I would do a class on reading EKGs. In preparation, I gathered materials, developed case studies to work on, and prepared notes for the actual presentation. I presented various anomalies such as Torsades de pointes, which is a heart rhythm that may cause a blackout or sudden death. Ventricular fibrillation is another deadly rhythm that can cause collapse and sudden cardiac death within minutes, unless medical help is initiated immediately. I ended the presentation by giving the class a series of EKG strips and asking them to interpret the results.

Toward the end of the class, a peer asked me a very good question: “What if you see an abnormal rhythm and do not know what it is?” A quick glance at the teacher told me I was on my own. My response was simple. “All you have to remember is ‘what is normal;’ everything else is abnormal. In addition, do not forget to look at the patient! If the patient is smiling and chatting away on the phone, the abnormal strip may just be movement or an ‘artifact.’ If the patient is blue and not breathing, then you know to call a code and ask questions later.”