Societal Impact on Emergency Care

Barriers to Accessing Acute Care for Newly Arrived Refugees

Zeidan, MD, et al.

The goal of this study was to understand barriers to access of acute care by newly arrived refugees, and identify potential improvements from refugees and resettlement agencies.

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Time Cost of Standardized Nursing Screens in the Emergency Department

Migdal, MD, et al.

Various policies require that screening questions be asked of all patients who present to the emergency department (ED). No studies have previously examined the potential time costs of standardized screens. Our objective was to analyze the time nursing spent conducting standardized nursing screens and calculate the corresponding time cost.

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Another Perspective on Cannabis and Emergency Medicine in Colorado

Heard, MD, et al.

This editorial is written in response to Roberts BA. Legalized Cannabis in Colorado Emergency Departments: A Cautionary Review of Negative Health and Safety Effects.

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Musculoskeletal Injuries and Outcomes Pre- and Post- Emergency Medicine Training Program

Mattson, BA, et al.

Musculoskeletal injuries (MSI) comprise a large portion of the trauma burden in low- and middle-income countries (LMIC). Rwanda recently launched its first emergency medicine training program (EMTP) at the University Teaching Hospital-Kigali (UTH-K), which may help to treat such injuries; yet no current epidemiological data is available on MSI in Rwanda.

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Emergency Department Operations

Predicting Emergency Department “Bouncebacks”: A Retrospective Cohort Analysis

Montoy, MD, et al.

The ability to accurately identify which patients are more likely to revisit the ED could allow EDs and health systems to develop more focused interventions, but efforts to reduce revisits have not yet found success. Whether patients with a high number of ED visits are at increased risk of a return visit remains underexplored.

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Critical Care

Diagnosis of Acute Heart Failure in the Emergency Department: An Evidence-Based Review

Long, MD, et al.

Heart failure is a common presentation to the emergency department (ED), which can be confused with other clinical conditions. This review provides an evidence-based summary of the current ED evaluation of heart failure.

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Impact of Global Budget Revenue Policy on Emergency Department Efficiency in the State of Maryland

Ren, MS, et al.

On January 1, 2014, the State of Maryland implemented the Global Budget Revenue (GBR) program. We investigate the impact of GBR on length of stay (LOS) for inpatients in emergency departments (ED) in Maryland.

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Patient Communication

Efficacy of a Short Role-Play Training on Breaking Bad News in the Emergency Department

Servotte, RN, et al.

Many medical students and residents feel stressed and uncomfortable with such situations because of insufficient training. Our randomized controlled study aimed to assess the efficacy of a four-hour BBN simulation-based training on perceived self-efficacy, the BBN process, and communication skills.

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Status of Emergency Signal Functions* in Myanmar Hospitals: A Cross-Sectional Survey

Hyun Seo, MD, et al.

To examine the ECS capacity in Myanmar, we used the Emergency Care Assessment Tool (ECAT), which features newly developed tools for assessing sentinel conditions and signal functions (key interventions to address morbidity and mortality) in emergency care facilities.

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Identifying Emergency Department Symptom-Based Diagnoses with the Unified Medical Language System

Slovis, MD, et al.

There is no well-defined method for identifying patients with a SBD without individual chart review. We describe a method for automated identification of SBDs from ICD-10 codes using the Unified Medical Language System (UMLS) Metathesaurus.

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Identifying and Overcoming Barriers to Resident Use of Point-of-Care Ultrasound

Schnittke, MD, et al.

Emergency medicine residency programs have rigorous point-of-care ultrasound (POCUS) curricula. However, this training does not always readily translate to routine use in clinical decision-making. This study sought to identify and overcome barriers that could prevent resident physicians from performing POCUS during clinical shifts.

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Vitamin D Deficiency and Long-Term Cognitive Impairment Among Older Adult Emergency Department Patients

Evans, MD, et al.

Currently, no effective interventions exist to prevent LTCI after an acute illness. Identifying early and modifiable risk factors for LTCI is the first step toward effective therapy. We hypothesized that Vitamin D deficiency at ED presentation was associated with LTCI in older adults.

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Risk Factors Associated with Emergency Department Recidivism in the Older Adult

Sheikh, MD.

Our objective was to review risk factors predictive of older adult recidivism in the emergency department. Certain risk factors and themes commonly occurred in the literature. These recurring factors included increasing age, male gender, certain diagnoses (abdominal pain, traumatic injuries, and respiratory complaints), psychosocial factors (depression, anxiety, poor social support, and limited health literacy), and poor general health (cognitive health and physical functioning).

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An Academic Relative Value Unit System: Do Transparency, Consensus, and Accountability Work?

Carmody, MD.

Core departmental education responsibilities are often distributed inequitably across academic departments. An approach using an incentive program, which emphasizes transparency, equity, and consensus may help academic departments share core education responsibilities and reward scholarly activity.

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The Standardized Letter of Evaluation Narrative: Differences in Language Use by Gender

Miller, MD, et al.

The emergency medicine (EM) Standardized Letter of Evaluation (SLOE) format limits word count and provides detailed instructions for writers. The objective of this study is to examine differences in language used to describe men and women applicants within the SLOE narrative.

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Safety of Tiered-Dispatch for 911 Calls for Abdominal Pain

Abramson, MD, et al.

Under this system, patients reporting a chief complaint of abdominal pain received the closest BLS ambulance dispatched alone emergency if located within three miles of the incident. The objective of this study was to determine the safety of BLS-only dispatch to abdominal pain by determining the frequency of time-sensitive events.

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Impact of an Extraglottic Device on Pediatric Airway Management in an Urban Prehospital System

Ostermayer, MD, et al.

Increasingly, emergency medical services (EMS) systems are deploying prehospital extraglottic airways (EGA) for primary pediatric airway management, yet little is known about their efficacy. We evaluated the impact of a pediatric prehospital airway management protocol change, inclusive of EGAs, on airway management and patient outcomes in children in cardiac arrest or respiratory failure.

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Ketamine as Monotherapy in Difficult Airways Is Not Ready for Prime Time

Driver, MD, et al.

We appreciate the discussion outlined by Merelman et al. regarding the important role ketamine has in emergency airway management, 1 and agree with the sentiment that ketamine may be preferable to other agents in many different clinical scenarios.

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Author Response to: “Ketamine as Monotherapy in Difficult Airways Is Not Ready for Prime Time”

Merelman, BS, et al.

We appreciate the response to our manuscript “Alternatives to Rapid Sequence Intubation: Contemporary Airway Management with Ketamine” and value the authors’ perspectives, both competing and complementary.

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Randomized Controlled Trial of Simulation vs Standard Training for Teaching Medical Students High-quality Cardiopulmonary Resuscitation: The Methodological Issue

Rad, MD, et al.

We read with great interest the paper by McCoy et al.1 published in the January 2019 issue of your valuable journal.

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Author Response to: “Randomized Controlled Trial of Simulation vs Standard Training for Teaching Medical Students High-quality Cardiopulmonary Resuscitation: The Methodological Issue”

Eric McCoy, MD.

Thank you for your interest in our study entitled “Randomized Controlled Trial of Simulation vs Standard Training for Teaching Medical Students High-quality Cardiopulmonary Resuscitation.” Your comments and questions were insightful and appreciated.

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Incidence of Clostridium difficile Infection After Sepsis Protocol Antibiotics

LaFave, DO, et al.

This study was designed to investigate those concerns by focusing on in-hospital Clostridium difficile infection (CDI), which is a known complication of exposure to antibiotics.

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Boarding of Mentally Ill Patients in Emergency Departments: American Psychiatric Association Resource Document

Nordstrom, MD, et al.

The treatment of severe mental illness has undergone a paradigm shift over the last 50 years, away from a primary emphasis on hospital-based care and toward community-based care.

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Nicotine Gateway Effects on Adolescent Substance Use

Ren, MS, et al.

The growing use of tobacco and electronic nicotine delivery systems (“vaping”) among teenagers represents a major public health concern. Smoking is not only the leading cause of preventable death worldwide, but epidemiological, clinical, and preclinical data have also shown that adolescent exposure to tobacco or nicotine can lead to subsequent abuse of nicotine and other substances.

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Emergency Department Access

Examining the Effect of the Affordable Care Act on Two Illinois Emergency Departments

Probst, MD, et al.

This study aimed to compare the characteristics and severity of ED visits in an Illinois academic medical center (AMC) and community hospital (CH) of a single health system before and after the implementation of the Affordable Care Act (ACA).

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Case for Open Access and the Current Situation with the University of California and Elsevier

Renaud, M.Ed, et al.

In recent months, the University of California has gained significant attention for taking a strong stance in support of open access publishing of UC research as it negotiates new agreements with major journal publishers.

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