Articles Archives - Page 14 of 40 - The Western Journal of Emergency Medicine

Descriptive Analysis of Components of Emergency Medicine Residency Program Websites

Pollock, JR.

Most emergency medicine (EM) applicants use the internet as a source of information when evaluating residency programs. Previous studies have analyzed the components of residency program websites; however, there is a paucity of information regarding EM program websites. The purpose of our study was to analyze information on EM residency program websites.

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A Novel, Low-cost, Low-fidelity Pericardiocentesis Teaching Model

Lord, S.

Pericardiocentesis is a high-risk/low-frequency procedure important to emergency medicine (EM). However, due to case rarity it is not often performed on a patient during residency training. Because the coronavirus disease 2019 pandemic limited cadaver-based practice, we developed a novel, low-cost, low-fidelity pericardiocentesis model using three dimensional-printing technology to provide advances on prior home-made models.

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The Role of Gender in Nurse-Resident Interactions: A Mixed-methods Study

Manchanda, ECC.

The role of gender in interprofessional interactions is poorly understood. This mixed-methods study explored perceptions of gender bias in interactions between emergency medicine (EM) residents and nurses.

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Cross-sectional Analysis of Food Insecurity and Frequent Emergency Department Use

Estrella, A.

Emergency department (ED) patients have higher than average levels of food insecurity. We examined the association between multiple measures of food insecurity and frequent ED use in a random sample of ED patients.

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Perceptions of Emergency Care by Sexual and Gender Minorities in Colorado: Barriers, Quality, and Factors Affecting Identity Disclosure

LaPlant, WG.

Expanding on data concerning emergency department (ED) use and avoidance by the sexual minority (those who identify as lesbian, gay, bisexual, queer, other [LGTBQ+]) and gender minority (those who identify as transgender, gender nonconforming, other) community may inform future ED LGTBQ+ training and clinical practice. Investigation objectives included characterizing rates of emergency care avoidance, identifying barriers to emergency care, and assessing emergency care quality and cultural competency for sexual and gender minorities.

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Racial Discrimination from Patients: Institutional Strategies to Establish Respectful Emergency Department Environments

Chary, AN.

Social identity-based discrimination from patients against healthcare providers is a prevalent and well- documented phenomenon. Numerous studies and essays detail clinicians’ experiences of slurs, harassment, and violence from patients based on racial identity. In this essay, we advance arguments about how emergency departments (ED) should respond to interpersonal racism from patients. We use an anthropological definition of race as a socially constructed way of categorizing humans based on perceived physical traits, such as skin and hair color.9 However, race does not have an inherent biological or genetic basis: there is greater physical and genetic variation within racial groups than between them, and racial categories vary across societies. Rather, race is assigned in ways that afford privilege, wealth, and power to some, while disadvantaging others.

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An Assessment of the Social Determinants of Health in an Urban Emergency Department

Ordonez, E.

Social determinants of health (SDOH) have significant impacts on patients who seek care in the emergency department (ED). We administered a social needs screening tool and needs assessment survey to assess SDOH and evaluate for trends in the population of patients visiting our ED.

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Emergency Department Operations

The Effects of Implementing a “Waterfall” Emergency Physician Attending Schedule

Spiegelman, L.

Increases in emergency department (ED) crowding and boarding are a nationwide issue resulting in worsening patient care and throughput. To compensate, ED administrators often look to modifying staffing models to improve efficiencies.

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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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Critical Care

Comparing Drugs for Out-of-hospital, Shock-refractory Cardiac Arrest: Systematic Review and Network Meta-analysis of Randomized Controlled Trials

Srisurapanont, K.

The benefit of medications used in out-of-hospital, shock-refractory cardiac arrest remains controversial. This study aims to compare the treatment outcomes of medications for out-of-hospital, shock-refractory ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT).

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Critical Care

Utilization of Point-of-care Echocardiography in Cardiac Arrest: A Cross-sectional Pilot Study

Wolfe, Y.

Point-of-care (POC) echocardiography (echo) is a useful adjunct in the management of cardiac arrest. However, the practice pattern of POC echo utilization during management of cardiac arrest cases among emergency physicians (EP) is unclear. In this pilot study we aimed to characterize the utilization of POC echo and the potential barriers to its use in the management of cardiac arrest among EPs.

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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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Critical Care

Quality Improvement Initiative to Increase Rate of and Time to Post-intubation Analgesia in the Emergency Department

Imhoff, B.

Intubation and mechanical ventilation are common interventions performed in the emergency department (ED). These interventions cause pain and discomfort to patients and necessitate analgesia and sedation. Recent trends in the ED and intensive care unit focus on an analgesia-first model to improve patient outcomes. Initial data from our institution demonstrated an over-emphasis on sedation and an opportunity to improve analgesic administration. As a result of these findings, the ED undertook a quality improvement (QI) project aimed at improving analgesia administration and time to analgesia post-intubation.

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Critical Care

Randomised Controlled Trial Assessing Head Down Deep Breathing Method Versus Modified Valsalva Manoeuvre for Treatment of Supraventricular Tachycardia in the Emergency Department

Lim, HC.

Supraventricular tachycardia (SVT) is commonly encountered in the emergency department (ED). Vagal manoeuvres are internationally recommended therapy in stable patients. The head down deep breathing (HDDB) technique was previously described as an acceptable vagal manoeuvre, but there are no studies comparing its efficacy to other vagal manoeuvres. Our objective in this study was to compare the rates of successful cardioversion with HDDB and the commonly practiced, modified Valsalva manoeuvre (VM).

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Critical Care

Effectiveness of Mechanical Chest Compression Devices over Manual Cardiopulmonary Resuscitation: A Systematic Review with Meta-analysis and Trial Sequential Analysis

Sheraton, M.

Our goal was to systematically review contemporary literature comparing the relative effectiveness of two mechanical compression devices (LUCAS and AutoPulse) to manual compression for achieving return of spontaneous circulation (ROSC) in patients undergoing cardiopulmonary resuscitation (CPR) after an out-of-hospital cardiac arrest (OHCA).

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Response to “Misunderstanding the Match: Do Students Create Rank Lists Based on True Preferences?”

Schnapp, BH.

We agree fully that “reciprocal liking” may be an important causal factor behind some of the mismatch between student behavior and theoretically ideal Match behavior. Indeed, it likely explains why programs and applicants go out of their way to communicate liking for one another despite official National Resident Matching Program (NRMP) policy discouraging communications…

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Comment on “Misunderstanding the Match: Do Students Create Rank Lists Based on True Preferences?”

Connors, NJ.

We would like to thank the authors for exploring students’ understanding of the National Residency Match Program (NRMP) algorithm,1 as it is both complex and potentially confusing. In their paper, the authors make significant value judgments about what should and should not affect an applicant’s rank list. They make assumptions about what an optimal match would be for applicants and assert that a program’s opinion of an applicant is not a reason to change a preference for one residency over another. An applicant’s perceived competitiveness based on program reputation alone should not dissuade them from ranking highly a very competitive program, as the NRMP algorithm prioritizes applicants’ preferences over those of programs. However, if an applicant has some evidence that a certain program thinks especially highly of them, we believe that bit of data may suggest how a program views their fit with the residency. Programs should be cautious when alerting applicants about their relative rank list positions as applicants may interpret that as a guarantee. Ranking an applicant highly may not necessarily mean they are guaranteed to match, but rather in a position to match based on data from previous match years.

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An Automated Tobacco Cessation Intervention for Emergency Department Discharged Patients

Chiu, DT.

Nearly 14% of US adults currently smoke cigarettes. Cigarette smoking causes more than 480,000 deaths each year in the United States. Emergency department (ED) patients are frequently asked for their use of tobacco. Manual selection of pre-formed discharge instructions is the norm for most ED. Providing tobacco cessation discharge instructions to ED patients presents another avenue to combat the tobacco use epidemic we face. The objective of the study is to evaluate the effectiveness of an automated discharge instruction system in increasing the frequency of discharging current tobacco users with instructions for tobacco cessation.

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Emergency Absentee Voting for Hospitalized Patients and Voting During COVID-19: A 50-State Study

Tang, OY.

Voters facing illness or disability are disproportionately under-represented in terms of voter turnout. Earlier research has indicated that enfranchisement of these populations may reinforce the implementation of policies improving health outcomes and equity. Due to the confluence of the coronavirus 2019 (COVID-19) pandemic and the 2020 election, we aimed to assess emergency absentee voting processes, which allow voters hospitalized after regular absentee deadlines to still obtain an absentee ballot, and election changes due to COVID-19 in all 50 states.

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Endemic Infections

The Appropriate Use of Testing for COVID-19

Zitek, MD.

Many public officials are calling for increased testing for the 2019 novel coronavirus disease (COVID-19), and some governments have taken extraordinary measures to increase the availability of testing. However, little has been published about the sensitivity and specificity of the reverse transcriptase-polymerase chain reaction (RT-PCR) nasopharyngeal swabs that are commonly used for testing.

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Endemic Infections

Paradigm Shift for COVID-19 Response: Identifying High-risk Individuals and Treating Inflammation

Kivela, MD.

As an emergency and wellness physician, scientist, father, and 55-year-old man, I have a keen interest in the coronavirus and the resulting COVID-19/severe acute respiratory syndrome (SARS) CoV2 illness. Based on all I have heard from the scientific community, a review of the literature, and a review of historical facts related to other epidemics, I believe we are missing some key points, particularly with regard to how we are approaching prevention of morbidity and mortality.

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Endemic Infections

Healthcare Ethics During a Pandemic

Iserson, MD.

As clinicians and support personnel struggle with their responsibilities to treat during the current COVID-19 pandemic, several ethical issues have emerged.

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Endemic Infections

Alternative Care Sites: An Option in Disasters

Iserson, MD.

During the current COVID-19 pandemic, the limited surge capacity of the healthcare system is being quickly overwhelmed. Similar scenarios play out when an institution’s systems fail, or when local or regional disasters occur. In these situations, it becomes necessary to use one or more alternative care sites (ACS).

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