Original Research

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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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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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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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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Perspectives on Home-based Healthcare as an Alternative to Hospital Admission After Emergency Treatment

Amy Stuck, PhD, RN, et al.

The study objective was to explore emergency physicians’ (EP) awareness, willingness, and prior experience regarding transitioning patients to home-based healthcare following emergency department (ED) evaluation and treatment; and to explore patient selection criteria, processes, and services that would facilitate use of home-based healthcare as an alternative to hospitalization.

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Replacement of Dislodged Gastrostomy Tubes After Stoma Dilation in the Pediatric Emergency Department

Shiloni Bhambani, MD, et al.

A dislodged gastrostomy tube (GT) is a common complaint that requires evaluation in the pediatric emergency department (ED) and, on occasion, will require stoma dilation to successfully replace the GT. The objective of this study was to describe the frequency that stoma dilation is required, the success rate of replacement, complications encountered, and the techniques used to confirm placement of the GT after dilation.

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A Comparison of Urolithiasis in the Presence and Absence of Microscopic Hematuria in the Emergency Department

Jason M. Mefford, MD, et al.

The evaluation of urolithiasis is largely influenced by the results of a urinalysis (UA). While the presence of microscopic hematuria favors a diagnosis of urolithiasis in a patient presenting with symptoms suggestive of ureteral colic, it is estimated that 10–20% of patients with urolithiasis can present without microscopic hematuria on UA.

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Outcomes by Mode of Transport of ST Elevation MI Patients in the United Arab Emirates

Edward L. Callachan, et al.

The purpose of this multicenter study was to assess differences in demographics, medical history, treatment times, and follow-up status among patients with ST-elevation myocardial infarction (STEMI), who were transported to the hospital by emergency medical services (EMS) or by private vehicle, or were transferred from other medical facilities.

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Outcomes by Mode of Transport of ST Elevation MI Patients in the United Arab Emirates

Edward L. Callachan, MHealthSci, et al.

The purpose of this multicenter study was to assess differences in demographics, medical history, treatment times, and follow-up status among patients with ST-elevation myocardial infarction (STEMI), who were transported to the hospital by emergency medical services (EMS) or by private vehicle, or were transferred from other medical facilities.

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Societal Impact on Emergency Care

Impact of Health Policy Changes on Emergency Medicine in Maryland Stratified by Socioeconomic Status

Laura Pimentel, MD, et al.

The insurance provisions of the Patient Protection and Affordable Care Act (ACA) began implementation and a major revision of MD’s Medicare waiver ushered in a Global Budget Revenue (GBR) structure for hospital reimbursement. Our objective was to analyze the impact of these policy changes on emergency department (ED) utilization, hospitalization practices, insurance profiles, and professional revenue.

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Emergency Department Access

Prevalence of Homelessness in the Emergency Department Setting

Brett J. Feldman, MSPAS, PA-C, et al.

According to the National Alliance to End Homelessness, the national rate of homelessness has been cited as 17.7 homeless people/10,000 people in the general population, and 24.8 homeless veterans/10,000 veterans in the general population.

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Endemic Infections

Correlation of Physical Exam Findings with Fever in Patients with Skin and Soft Tissue Infections

Author Affiliation Jillian Mongelluzzo, MD University of California, San Francisco, San Francisco General Hospital, Department of Emergency Medicine, San Francisco, California Brian Tu, BA University of California, San Francisco, San Francisco General Hospital, Department of Emergency Medicine, San Francisco, California Barbara Grimes, PhD University of California, San Francisco, San Francisco, Department of Epidemiology and Biostatistics, […]

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Contact Information

WestJEM/ Department of Emergency Medicine
UC Irvine Health

333 The City Blvd. West, Rt 128-01
Suite 640
Orange, CA 92868, USA
Phone: 1-714-456-6389
Email: editor@westjem.org

Our Philosophy

Emergency Medicine is a specialty which closely reflects societal challenges and consequences of public policy decisions. The emergency department specifically deals with social injustice, health and economic disparities, violence, substance abuse, and disaster preparedness and response. This journal focuses on how emergency care affects the health of the community and population, and conversely, how these societal challenges affect the composition of the patient population who seek care in the emergency department. The development of better systems to provide emergency care, including technology solutions, is critical to enhancing population health.