Emergency Department Operations

Emergency Department Operations

Accuracy of Hemolyzed Potassium Levels in the Emergency Department

Wilson, M.

In the emergency department (ED), pseudohyperkalemia from hemolysis may indirectly harm patients by exposing them to increased length of stay, cost, and repeat blood draws. The need to repeat hemolyzed potassium specimens in low-risk patients has not been well studied. Our objective was to determine the rate of true hyperkalemia among low-risk, adult ED patients with hemolyzed potassium specimens.

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Emergency Department Operations

Patient Characteristics and Clinical Process Predictors of Patients Leaving Without Being Seen from the Emergency Department

Rathlev, N.

Delays in patient flow in the emergency department (ED) result in patients leaving without being seen (LWBS). This compromises patient experience and quality of care. Our primary goal was to develop a predictive model by evaluating associations between patients LWBS and ED process measures and patient characteristics.

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Emergency Department Operations

Dumpster Diving in the Emergency Department: Quantity and Characteristics of Waste at a Level I Trauma Center

Hsu, S.

Healthcare contributes 10% of greenhouse gases in the United States and generates two milion tons of waste each year. Reducing healthcare waste can reduce the environmental impact of healthcare and lower hospitals’ waste disposal costs. However, no literature to date has examined US emergency department (ED) waste management. The purpose of this study was to quantify and describe the amount of waste generated by an ED, identify deviations from waste policy, and explore areas for waste reduction.

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Emergency Department Operations

Sepsis Alerts in Emergency Departments: A Systematic Review of Accuracy and Quality Measure Impact

Hwang, MI.

For early detection of sepsis, automated systems within the electronic health record have evolved to alert emergency department (ED) personnel to the possibility of sepsis, and in some cases link them to suggested care pathways. We conducted a systematic review of automated sepsis-alert detection systems in the ED.

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Emergency Department Operations

Financial Implications of Boarding: A Call for Research

Canellas, MM.

Boarding, the practice of holding patients in emergency departments (ED) after a decision has been made to admit them to the hospital,1 is well known to adversely affect patient care. Multiple investigations have shown that boarding negatively impacts quality and patient safety outcomes including mortality,2-7 readmission rate,8 hospital length of stay,2,5,8,9 and patient satisfaction.10-12 In addition, boarding is known to be a major contributor to overall ED crowding,13 which also has been demonstrated to have significant negative impact on quality and safety.13,14 Multiple operational tactics are known to reduce boarding but, concerningly, adoption of them has been inconsistent.13,15 Also concerning, ED boarding appears to be worsening over time, based upon our unpublished year-over-year review of two large national ED operations benchmarking databases, the Emergency Department Benchmarking Alliance and the Academy of Administrators in Academic Emergency Medicine/Association of Academic Chairs of Emergency Medicine.16,17

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Emergency Department Operations

“Friction by Definition”: Conflict at Patient Handover Between Emergency and Internal Medicine Physicians at an Academic Medical Center

Kanjee, Z.

Patient handoffs from emergency physicians (EP) to internal medicine (IM) physicians may be complicated by conflict with the potential for adverse outcomes. The objective of this study was to identify the specific types of, and contributors to, conflict between EPs and IM physicians in this context.

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Emergency Department Operations

A Scoping Review of Emergency Department Discharge Risk Stratification

Jaffe, TA.

Although emergency department (ED) discharge presents patient-safety challenges and opportunities, the ways in which EDs address discharge risk in the general ED population remains disparate and largely uncharacterized. In this study our goal was to conduct a review of how EDs identify and target patients at increased risk at time of discharge.

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Emergency Department Operations

Retrospective Analysis of Adult Patients Presenting to the Acute Care Setting Requesting Prescriptions

Shepherd, L.

Patient visits to the emergency department (ED) or urgent care centre (UCC) for the sole purpose of requesting prescriptions are challenging for the patient, the physician, and the department. The primary objective of this study was to determine the characteristics of these patients, the nature of their requests, and the response to these requests. Our secondary objective was to determine the proportion of these medication requests that had street value.

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Emergency Department Operations

Are Smaller Emergency Departments More Prone to Volume Variability?

Nourazari, S.

Daily patient volume in emergency departments (ED) varies considerably between days and sites. Although studies have attempted to define “high-volume” days, no standard definition exists. Furthermore, it is not clear whether the frequency of high-volume days, by any definition, is related to the size of an ED. We aimed to determine the correlation between ED size and the frequency of high-volume days for various volume thresholds, and to develop a measure to identify high-volume days.

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Emergency Department Operations

Impact of a Novel Emergency Department Forward Treatment Area During the New York City COVID-19 Surge

Moskovitz, JB.

Coronavirus disease 2019 (COVID-19) caused a disproportionate number of patients to seek emergency care at hospitals in New York City (NYC) during the initial crisis. Our urban emergency department (ED), a member of the NYC public hospital system had to process the increased volume while also differentiating our patients’ critical needs. We established a forward treatment area (FTA) directly in front of the ED to accomplish these goals from March 23–April 16, 2020.

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Emergency Department Operations

Impact of Coronavirus Disease 2019 Pandemic on Crowding: A Call to Action for Effective Solutions to “Access Block”

Savioli, G.

Healthcare patterns change during disease outbreaks and pandemics. Identification of modified patterns is important for future preparedness and response. Emergency department (ED) crowding can occur because of the volume of patients waiting to be seen, which results in delays in patient assessment or treatment and impediments to leaving the ED once treatment is complete. Therefore, ED crowding has become a growing problem worldwide and represents a serious barrier to healthcare operations.

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Emergency Department Operations

The Impact of COVID-19 Pandemic on Emergency Department Visits at a Canadian Academic Tertiary Care Center

Kwok, ESH.

Public health response to the coronavirus 2019 (COVID-19) pandemic has emphasized social distancing and stay-at-home policies. Reports of decreased emergency department (ED) visits in non-epicenters of the outbreak have raised concerns that patients with non-COVID-19 emergencies are delaying or avoiding seeking care. We evaluated the impact of the pandemic on ED visits at an academic tertiary care center.

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Emergency Department Operations

Reduction in Emergency Department Presentations in a Regional Health System during the Covid-19 Pandemic

Mann, E.

Nationally, there has been more than a 40% decrease in Emergency Department (ED) patient volume during the coronavirus disease 2019 (Covid-19) crisis, with reports of decreases in presentations of time-sensitive acute illnesses. We analyzed ED clinical presentations in a Maryland/District of Columbia regional hospital system while health mitigation measures were instituted.

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Emergency Department Operations

What is a Freestanding Emergency Department? Definitions Differ Across Major United States Data Sources

Herscovici, BS, et al.

Despite the growing number of freestanding emergency departments (FSED) in the United States (US), FSED definitions differ across major US data sources of healthcare facilities and use. We compare these sources and propose a universal definition of FSED (and its two major types) to improve communications regarding these facilities and their patients.

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Emergency Department Operations

“Breaking” the Emergency Department: Does the Culture of Emergency Medicine Present a Barrier to Self-Care?

O’Shea, MBBS, MA, et al.

Our goal was to critically examine emergency physician’s (EP) beliefs about taking breaks for self-care on shift. Our operational definition of a break for self-care included time not engaging in direct patient care, eating, drinking, using the bathroom, or leaving a clinical area for a mental break

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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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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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Contact Information

WestJEM/ Department of Emergency Medicine
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Orange, CA 92868, USA
Phone: 1-714-456-6389
Email: editor@westjem.org

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WestJEM
ISSN: 1936-900X
e-ISSN: 1936-9018

CPC-EM
ISSN: 2474-252X

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.