Articles Archives - The Western Journal of Emergency Medicine

Is National Resident Matching Program Rank Predictive of Resident Performance or Post-graduation Achievement? 10 Years at One Emergency Medicine Residency

Wall, MD, MPH, et al.

Each year residency programs expend considerable effort ranking applicants for the National Residency Matching Program (NRMP). We explored the relationship between residents’ NRMP rank list position as generated at our institution and their performance in residency and post-graduation to determine whether such efforts are justified.

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Design Your Clinical Workplace to Facilitate Competency-Based Education

Caretta-Weyer, MD, MHPE, et al.

The true intent of the ACGME Milestones is to represent the developmental trajectory of a resident over time. The variability in faculty ratings, which may initially seem frustrating, are instead intentionally important to the process of monitoring development in our trainees. There is no perfect assessment tool and there will be variability in assessments. And that’s okay.

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Emergency Department Operations

SurgeCon: Priming a Community Emergency Department for Patient Flow Management

Patey, MD, et al.

We assessed the impact of SurgeCon, an ED patient-management protocol, on total patient visits, patients who left without being seen (LWBS), length of stay for departed patients (LOSDep), and physician initial assessment time (PIA) in a rural community hospital ED.

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Emergency Department Operations

Decreasing the Lag Between Result Availability and Decision-Making in the Emergency Department Using Push Notifications

Koziatek, MD, et al.

We implemented a system that electronically alerts ED providers when test results are available for review via a smartphone- and smartwatch-push notification. We hypothesized this would reduce the time from result to clinical decision-making.

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Emergency Department Operations

Transportation Preferences of Patients Discharged from the Emergency Department in the Era of Ridesharing Apps

Tomar, MD, et al.

Patients discharged from the emergency department (ED) may encounter difficulty finding transportation home, increasing length of stay and ED crowding. We sought to determine the preferences of patients discharged from the ED with regard to their transportation home, and their awareness and past use of ridesharing services such as Lyft and Uber.

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Emergency Department Operations

Impact of Emergency Department Phlebotomists on Left-Before-Treatment-Completion Rates

Stowell, MD, et al.

The percentage of patients who leave before treatment completion (LBTC) is an important marker of department efficiency. Our study aimed to assess the impact of an ED phlebotomist, dedicated to obtaining blood specimen collection on waiting patients, on LBTC rates.

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This Article Corrects: “Best Practices for Evaluation and Treatment of Agitated Children and Adolescents (BETA) in the Emergency Department: Consensus Statement of the American Association for Emergency Psychiatry”

Gerson, MD, et al.

There was a dosing error in Table 2 regarding haloperidol dosing in pediatric agitation. The dose is listed as 0.55 mg/kg/dose and should be corrected to 0.05–0.1 mk/kg/dose.

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Variations in Opioid Prescribing Behavior by Physician Training

Leventhal, MD, et al.

Patients often present to the emergency department (ED) with painful conditions seeking analgesic relief. While there is known variability in the prescribing behaviors of emergency physicians, it is unknown if there are differences in these behaviors based on training level or by resident specialty.

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Association of Vital Signs and Process Outcomes in Emergency Department Patients

Hodgson, MD, et al.

We sought to determine the association of abnormal vital signs with emergency department (ED) process outcomes in both discharged and admitted patients.

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Epidemiology of Community-Onset Staphylococcus aureus Bacteremia

Yarovoy, MD, et al.

The incidence of methicillin-resistant S. aureus (MRSA) has recently decreased across much of the United States, and we seek to describe risk factors for CO-MRSA bacteremia, which will aid emergency providers in their choice of empiric antibiotics

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Mortality and Thrombosis in Injured Adults Receiving Tranexamic Acid in the Post-CRASH-2 Era

Benipal, BS, et al.

Our objective was to estimate mortality and adverse events in adults with trauma receiving TXA in studies published after the CRASH-2 trial.

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Patient Communication

What Are We Measuring? Evaluating Physician-Specific Satisfaction Scores Between Emergency Departments

Sharp, MD, et al.

The goals of this study were to determine whether Press Ganey ED satisfaction scores for emergency physicians working at two different sites were consistent between sites, and to identify factors contributing to any variation.

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Population Health Research Design

Access to Top-Cited Emergency Care Articles (Published Between 2012 and 2016) Without Subscription

Hamzy, MBBS, et al.

We describe access to the 500 most-cited emergency medicine (EM) articles (published between 2012 and 2016) in terms of publisher-based access (open access or subscription), alternate access routes (self-archived or author provided), and relative cost of access.

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Critical Care

Alternatives to Rapid Sequence Intubation: Contemporary Airway Management with Ketamine

Merelman, BS, et al.

Ketamine, a dissociative anesthetic, can be used to facilitate two alternatives to RSI to augment airway safety in these scenarios: delayed sequence intubation – the use of ketamine to allow airway preparation and preoxygenation in the agitated patient; and ketamine-only breathing intubation, in which ketamine is used without a paralytic to facilitate ETI as the patient continues to breathe spontaneously.

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Emergency Department Access

A Geospatial Analysis of Freestanding and Hospital Emergency Department Accessibility via Public Transit

Carlson, MD, et al.

In order to explore the effect of freestanding emergency departments (FSED) on access to care for urban underserved populations, we performed a geospatial analysis comparing the proximity of FSEDs and hospital EDs to public transit lines in three United States (U.S.) metropolitan areas: Houston, Denver, and Cleveland.

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Are Rural and Urban Emergency Departments Equally Prepared to Reduce Avoidable Hospitalizations?

Greenwood-Ericksen, MD, et al.

A cross-sectional, web-based survey was emailed to medical directors and/or nurse managers of the 135 hospital-based EDs in Michigan. Questions included presence of clinical pathways, services to reduce admissions, and barriers to connecting patients to outpatient services.

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Provider Workforce

Burnout, Drop Out, Suicide: Physician Loss in Emergency Medicine, Part I

Stehman, MD, et al.

Burned-out physicians are unlikely to seek professional treatment and may attempt to deal with substance abuse, depression and suicidal thoughts alone. This paper reviews the scope of burnout, contributors, and consequences both for medicine in general and for EM in particular.

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Provider Workforce

Response to: “Emergency Medicine Physician Assistant Postgraduate Training Programs: Program Characteristics and Training Curricula”

Kraus, DO, et al.

We thank Mr. Wu, PA-C, MHS (President, the Society of Emergency Medicine Physician Assistants [SEMPA]) for his insightful letter in response to our paper, “Emergency Medicine Physician Assistant (EMPA) Postgraduate Training Programs: Program Characteristics and Curricula.”

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Antivenom Treatment Is Associated with Fewer Patients using Opioids after Copperhead Envenomation

Freiermuth, MD, et al.

There is rising concern that an initial opioid prescription from the emergency department (ED) can lead to long-term addiction. This analysis sought to determine whether use of Fab antivenom (FabAV) for copperhead envenomation affected opioid use.

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Availability of Bedside and Laboratory Testing for Carbon Monoxide Poisoning in the Upper Midwestern United States

Masters, MD, et al.

The objective of this study was to assess the ability to test patients for carbon monoxide (CO) exposure in all hospitals in three United States (U.S.) Midwestern states.

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Feasibility of Telesimulation and Google Glass for Mass Casualty Triage Education and Training

McCoy, MD, et al.

Our goal was to evaluate the feasibility and effectiveness of using telesimulation to deliver an emergency medical services (EMS) course on mass casualty incident (MCI) training to healthcare providers overseas.

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Targeted Simulation-based Leadership Training for Trauma Team Leaders

Rosenman, MD, et al.

Traditionally, healthcare curricula have included leadership as a small component of broader teamwork training, with very few examples of leadership-focused curricula. The objective of this work is to describe a novel simulation-based team leadership curriculum that easily adapts to individual learners.

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The Flipped Classroom: A Critical Appraisal

Kraut, MD, et al.

The objective of this study was to review and critically appraise the medical education literature pertaining to a flipped-classroom (FC) education model, and to highlight influential papers that inform our current understanding of the role of the FC in medical education.

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This Article Corrects: “Best Practices for Evaluation and Treatment of Agitated Children and Adolescents (BETA) in the Emergency Department: Consensus Statement of the American Association for Emergency Psychiatry”

Gerson, MD, et al.

West J Emerg Med. 2019 May;20(3):537. Pediatric BETA Consensus Guideline Working Group members should not be included in full author list. The author list has now been corrected on this erratum.

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Endemic Infections

Challenging the One-hour Sepsis Bundle

Kalantari, DO, et al.

Our purpose here is to highlight the areas where evidence is only as strong as the methodological constructs of the research used. This article is a narrative review of the available, limited evidence on which the one-hour bundle was based.

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Pertussis: The Identify, Isolate, Inform Tool Applied to a Re-emerging Respiratory Illness

Koenig, MD, et al.

Pertussis, commonly referred to as “whooping cough,” is a highly contagious acute respiratory infection that has exhibited cyclical outbreaks throughout the last century. Although vaccines have provided some immunity, many populations, including infants and pregnant women, remain at risk for serious illness.

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