Current Issue: Volume 20 Issue 4 Archives - The Western Journal of Emergency Medicine

Provider Workforce

Resource Utilization in Non-Academic Emergency Departments with Advanced Practice Providers

Aledhaim, NREMT-P, et al.

The objectives of this study were to compare resource utilization in EDs that use APPs in their staffing model with those that do not and to estimate costs associated with the utilized resources.

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Societal Impact on Emergency Care

How a Bill Becomes a Law, or How a Truly Terrible Bill Becomes Less Awful

Moulin, MD, et al.

The fundamental challenge is that our policymakers and legislators do not share our understanding or experiences. Their contact with emergency medicine (EM) is as a patient and family member, or through news stories of sympathetic patients.

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Preferences for Firearm Locking Devices and Device Features Among Participants in a Firearm Safety Event

Simonetti, MD, MPH, et al.

The aim of this study was to describe preferences for firearm locking devices and device features among firearm safety event participants.

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Legalized Cannabis in Colorado Emergency Departments: A Cautionary Review of Negative Health and Safety Effects

Roberts, MD.

Cannabis research may offer novel treatment of seizures, spasticity from multiple sclerosis, nausea and vomiting from chemotherapy, chronic pain, improvements in cardiovascular outcomes, and sleep disorders. Progress has been slow due to absent standards for chemical composition of cannabis products and limitations on research imposed by federal classification of cannabis as illegal.

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Evidence-Informed Practice: Diagnostic Questions in Urinary Tract Infections in the Elderly

Pescatore, DO, et al.

We performed a historical and clinical review of the growing body of literature suggesting measurable differences in the systemic immune response manifest among patients with asymptomatic pyuria and UTI, including increases in the pro-inflammatory cytokine interleukin-6 and the acute phase reactant procalcitonin.

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The Surgical Intervention for Traumatic Injury Scale: A Clinical Tool for Traumatic Brain Injury

Sribnick, MD, PhD, et al.

There is no widely used method for communicating the possible need for surgical intervention in patients with traumatic brain injury (TBI). This study describes a scoring system designed to communicate the potential need for surgical decompression in TBI patients.

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Daylight Saving Time is not Associated with an Increased Number of Trauma Activations

Lee, MD, et al.

Prior studies have reported that during the period of Daylight Saving Time (DST) adjustment, there are a greater number of motor vehicle collisions. These studies noted that the increase in collisions occurs mainly on the following Monday after the time change. We hypothesize that changes in sleep patterns may be one of the reasons for this increase.

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Critical Care

Evaluation and Management of Angioedema in the Emergency Department

Long, MD, et al.

Angioedema is defined by non-dependent, non-pitting edema that affects several different sites and is potentially life-threatening due to laryngeal edema. This narrative review provides emergency physicians with a focused overview of the evaluation and management of angioedema.

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Critical Care

Skill Proficiency is Predicted by Intubation Frequency of Emergency Medicine Attending Physicians

Gillett, MD, et al.

Endotracheal intubation (ETI) is a procedure that is specifically taught in residency, but little is known how best to maintain proficiency in this skill throughout the practitioner’s career. The goal of this study was to identify how the frequency of intubation correlated with measured performance.

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Critical Care

Improvement in the Safety of Rapid Sequence Intubation in the Emergency Department with the Use of an Airway Continuous Quality Improvement Program

Sakles, MD, et al.

The purpose of this investigation is to describe an airway continuous quality improvement (CQI) program and its effect on the safety of rapid sequence intubation (RSI) in the emergency department (ED) over a 10-year period.

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Thromboembolic Risk of 4-Factor Prothrombin Complex Concentrate versus Fresh Frozen Plasma for Urgent Warfarin Reversal in the Emergency Department

Maguire, PharmD, et al.

Our study found a significantly higher risk of thromboembolic events in patients receiving 4F-PCC compared to FFP for urgent warfarin reversal. This difference remained statistically significant when controlled for CNS bleeds and administration of vitamin K.

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Radiograph Interpretation Discrepancies in a Community Hospital Emergency Department

Tranovich, DO, et al.

Studies have found conflicting results regarding the radiographic interpretation discrepancies between EPs and trained radiologists. The aim of this study was to identify the number of radiologic interpretation discrepancies between EPs and radiologists in a community ED setting.

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Modification of the Emergency Severity Index Improves Mortality Prediction in Older Patients

Malinovska, MD, et al.

Older patients frequently present to the emergency department (ED) with nonspecific complaints (NSC), such as generalized weakness. They are at risk of adverse outcomes, and early risk stratification is crucial. The aim of this study was to assess the predictive power of additional clinical parameters in NSC patients.

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We Need Our Village: CORD’s Response to the ACGME’s Common Program Requirements

Moreira, MD, et al.

Until 2019, the Emergency Medicine ACGME (Accreditation Council for Graduate Medical Education) program requirements stated that institutions were required to provide protected non-clinical time for core faculty. Specifically, core faculty could not be required to generate clinical or other income to support that protection. These core faculty could not average more than 28 clinical hours per week, or 1344 clinical hours per year. In the new proposed program requirements, the requirement to ensure this non-clinical time has been removed.

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Trials and Tribulations in Implementation of the Emergency Medicine Milestones from the Frontlines

Sheng, MD, et al.

As part of medical education’s shift toward competency-based education (CBE), the Accreditation Council for Graduate Medical Education (ACGME) announced the Milestones Project in 2008 to create an outcomes-based model of competency development. The goal was to characterize specific accomplishments or behaviors demonstrated by physician trainees as they progressed toward independent practice.

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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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