Westjem, Author at The Western Journal of Emergency Medicine

Societal Impact on Emergency Care

Why the EMTALA Mandate for Emergency Care Does not Equal Healthcare “Coverage”

Nicolas T. Sawyer, MD, MBA.

House GOP members Rep. Mark Meadows (R-NC) and Rep. Raúl Labrador (R-ID) recently made alarming and misleading statements about American emergency departments’ role in U.S. healthcare.

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Emergency Department Operations

The Economics of an Admissions Holding Unit

Kraftin E. Schreyer, MD, et al.

With increasing attention to the actual cost of delivering care, return-on-investment calculations take on new significance. Boarded patients in the emergency department (ED) are harmful to clinical care and have significant financial opportunity costs. We hypothesize that investment in an admissions holding unit for admitted ED patients not only captures opportunity cost but also significantly lowers direct cost of care.

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Technology in Emergency Care

Ultrasound vs. Computed Tomography for Severity of Hydronephrosis and Its Importance in Renal Colic

Megan M. Leo, MD et al.

Supporting an “ultrasound-first” approach to evaluating renal colic in the emergency department (ED) remains important for improving patient care and decreasing healthcare costs. Our primary objective was to compare emergency physician (EP) ultrasound to computed tomography (CT) detection of hydronephrosis severity in patients with suspected renal colic.

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Emergency Department Access

Patient Perspectives on Accessing Acute Illness Care

Mary K. Finta, BA, BS, et al.

Older adults use the emergency department (ED) at high rates, including for illnesses that could be managed by their primary care providers (PCP). Policymakers have implemented barriers and incentives, often financial, to try to modify use patterns but with limited success. This study aims to understand the factors that influence older adults’ decision to obtain acute illness care from the ED rather than from their PCPs.

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Education

Effectiveness of Resident Physicians as Triage Liaison Providers in an Academic Emergency Department

Victoria Weston, MD, et al.

Emergency department (ED) crowding is associated with detrimental effects on ED quality of care. Triage liaison providers (TLP) have been used to mitigate the effects of crowding. Prior studies have evaluated attending physicians and advanced practice providers as TLPs, with limited data evaluating resident physicians as TLPs. This study compares operational performance outcomes between resident and attending physicians as TLPs.

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Treatment Protocol Assessment

Emergency Department Pain Management Following Implementation of a Geriatric Hip Fracture Program

Scott D. Casey, MS, et al.

Over 300,000 patients in the United States sustain low-trauma fragility hip fractures annually. Multidisciplinary geriatric fracture programs (GFP) including early, multimodal pain management reduce morbidity and mortality. Our overall goal was to determine the effects of a GFP on the emergency department (ED) pain management of geriatric fragility hip fractures.

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Practice Variability

Physician Variability in Management of Emergency Department Patients with Chest Pain

Peter B. Smulowitz, MD, MPH, et al.

Chest pain is a common emergency department (ED) presentation accounting for 8–10 million visits per year in the United States. Physician-level factors such as risk tolerance are predictive of admission rates. The recent advent of accelerated diagnostic pathways and ED observation units may have an impact in reducing variation in admission rates on the individual physician level.

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Pitfalls in Electrocardiographic Diagnosis of Acute Coronary Syndrome in Low-Risk Chest Pain

Semhar Z. Tewelde, MD, et al.

Less than half of patients with a chest pain history indicative of acute coronary syndrome have a diagnostic electrocardiogram (ECG) on initial presentation to the emergency department. The physician must dissect the ECG for elusive, but perilous, characteristics that are often missed by machine analysis.

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Ethical and Legal Issues

Optimizing the Use of a Precious Resource: The Role of Emergency Physicians in a Humanitarian Crisis

Parveen K. Parmar, MD, MPH, et al.

Emergency physicians (EP) are uniquely suited to provide care in crises as a result of their broad training, ability to work quickly and effectively in high-pressure, austere settings, and their inherent flexibility. While emergency medicine training is helpful to support the needs of crisis-affected and displaced populations, it is not in itself sufficient. In this article we review what an EP should carefully consider prior to deployment.

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Screening for Victims of Sex Trafficking in the Emergency Department: A Pilot Program

Bryn E. Mumma, MD, MAS, et al.

Our primary objective in this study was to evaluate the feasibility of a screening survey to identify adult victims of sex trafficking in the ED. We also compared the sensitivity of emergency physician concern and a screening survey for identifying sex trafficking victims in the ED and determined the most effective question(s) for identifying adult victims of sex trafficking.

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Difference in R01 Grant Funding Among Osteopathic and Allopathic Emergency Physicians over the Last Decade

Martina Antony, DO, et al.

The aim of the study was to determine if a medical degree disparity exists between those who successfully receive an EM R01 grant and those who do not, and to determine the publication characteristics of those recipients.

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Prehospital Care

Altitude-Related Change in Endotracheal Tube Cuff Pressures in Helicopter EMS

Stacy N. Weisberg, MD, MPH, et al.

Air-medical critical care providers are frequently called upon to provide advanced airway management to our critically ill patients. The majority of these cases involve the transport of patients who have been intubated with standard endotracheal tubes (ETT).

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Prehospital Care

Emergency Medical Services Professionals’ Attitudes About Community Paramedic Programs

Robert J. Steeps, MHS, RN, NRP, et al.

The number of community paramedic (CP) programs has expanded to mitigate the impact of increased patient usage on emergency services. However, it has not been determined to what extent emergency medical services (EMS) professionals would be willing to participate in this model of care. With this project, we sought to evaluate the perceptions of EMS professionals toward the concept of a CP program.

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American Association for Emergency Psychiatry Task Force on Medical Clearance of Adult Psychiatric Patients. Part II: Controversies over Medical Assessment, and Consensus Recommendations

Michael P. Wilson, MD, PhD et al.

The emergency medical evaluation of psychiatric patients presenting to United States emergency departments (ED), usually termed “medical clearance,” often varies between EDs. A task force of the American Association for Emergency Psychiatry (AAEP), consisting of physicians from emergency medicine, physicians from psychiatry and a psychologist, was convened to form consensus recommendations for the medical evaluation of psychiatric patients presenting to U.S.EDs.

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Managing Acute Behavioural Disturbances in the Emergency Department Using the Environment, Policies and Practices: A Systematic Review

Tracey J. Weiland, MPsych/PhD, MAPS, et al.

Effective strategies for managing acute behavioural disturbances (ABDs) within emergency departments (EDs) are needed given their rising occurrence and negative impact on safety, psychological wellbeing, and staff turnover. Our objective was to systematically review the efficacy of strategies for ABD management within EDs that involved changes to environment, architecture, policy and practice.

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Critical Care

Derivation and Validation of The Prehospital Difficult Airway IdentificationTool (PreDAIT): A Predictive Model for Difficult Intubation

Jestin N. Carlson, MD, MS, et al.

Endotracheal intubation (ETI) in the prehospital setting poses unique challenges where multiple ETI attempts are associated with adverse patient outcomes. Early identification of difficult ETI cases will allow providers to tailor airway-management efforts to minimize complications associated with ETI.

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Critical Care

Efficacy and Safety of Tranexamic Acid in Prehospital Traumatic Hemorrhagic Shock: Outcomes of the Cal-PAT Study

Michael M. Neeki, DO, MS, et al.

The California Prehospital Antifibrinolytic Therapy (Cal-PAT) study seeks to assess the safety and impact on patient mortality of tranexamic acid (TXA) administration in cases of trauma-induced hemorrhagic shock. The current study further aimed to assess the feasibility of prehospital TXA administration by paramedics within the framework of North American emergency medicine standards and protocols.

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Critical Care

Evaluating the Laboratory Risk Indicator to Differentiate Cellulitis from Necrotizing Fasciitis in the Emergency Department

Michael M. Neeki, DO, MS, et al.

Necrotizing fasciitis (NF) is an uncommon but rapidly progressive infection that results in gross morbidity and mortality if not treated in its early stages. This study analyzed the ability of the LRINEC score to accurately rule out NF in patients who were confirmed to have cellulitis, as well as the capability to differentiate cellulitis from NF.

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Critical Care

Index to Predict In-hospital Mortality in Older Adults after Non-traumatic Emergency Department Intubations

Kei Ouchi, MD, MPH, et al.

Our goal was to develop and validate an index to predict in-hospital mortality in older adults after non-traumatic emergency department (ED) intubations.

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A User’s Guide to the ALiEM Emergency Medicine Match Advice Web Series

Michael A. Gisondi, MD, et al.

ALiEM EM Match Advice is a web series hosted on the Academic Life in Emergency Medicine website. This article serves as a user’s guide to the series, including a timeline for viewing each episode, brief summaries of the panel discussions, and reflection questions for discussion between students and their faculty advisors.

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Academic Primer Series: Five Key Papers about Study Designs in Medical Education

Michael Gottlieb, MD, et al.

A proper understanding of study design is essential to creating successful studies. This is also important when reading or peer reviewing publications. In this article, we aimed to identify and summarize key papers that would be helpful for faculty members interested in learning more about study design in medical education research.

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Academic Primer Series: Key Papers About Competency-Based Medical Education

Robert Cooney, MD, MSMedEd, et al.

Competency-based medical education (CBME) presents a paradigm shift in medical training. This outcome-based education movement has triggered substantive changes across the globe. Since this transition is only beginning, many faculty members may not have experience with CBME nor a solid foundation in the grounding literature.

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Academic Primer Series: Key Papers About Peer Review

Lalena M. Yarris, MD, MCR, et al.

Peer review is a key component of academic publishing, and aims to provide rigor and relevance to the publishing process.This paper is a narrative review that highlights some important literature that may assist junior educators who are seeking to learn more about the peer-review process.

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Academic Primer Series: Key Papers About Teaching with Technology

Megan Boysen-Osborn, MD, MHPE, et al.

The acquisition of knowledge was previously limited by one’s access to experts, instructors or textbooks, but now learners have access to resources from around the globe. Learners can choose from digital textbooks, open-access journals, online encyclopedias, podcasts, blogs, free open-access medical education (FOAM), massive open online courses (MOOCs), the Khan academy, and TED talks.

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Pain Perception in Latino vs. Caucasian and Male vs. Female Patients: Is There Really a Difference?

Molly Aufiero, DO, et al.

Pain is one of the most common complaints in emergency departments (ED) nationwide. The perception of pain in others is, therefore, an important component of patient assessment and treatment. There are difficulties in studying pain since it is subjective, which raises the question of what is a clinically significant change in pain.

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Feasibility of an ED-to-Home Intervention to Engage Patients: A Mixed-Methods Investigation

Jessica R. Schumacher, PhD, et al.

Older, chronically ill patients with limited health literacy are often under-engaged in managing their health and turn to the emergency department (ED) for healthcare needs. We tested the impact of an ED-initiated coaching intervention on patient engagement and follow-up doctor visits in this high-risk population. We also explored patients’ care-seeking decisions.

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