Articles Archives - Page 7 of 40 - The Western Journal of Emergency Medicine

Intracranial Traumatic Hematoma Detection in Children Using a Portable Near-infrared Spectroscopy Device

Kirschen, MP.

We sought to validate a handheld, near-infrared spectroscopy (NIRS) device for detecting intracranial hematomas in children with head injury.

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Ultrasound Hypotension Protocol Time-motion Study Using the Multifrequency Single Transducer Versus a Multiple Transducer Ultrasound Device

Sabbadini, L.

Ultrasound hypotension protocols (UHP) involve imaging multiple body areas, each with different transducers and imaging presets. The time for task switching between presets and transducers to perform an UHP has not been previously studied. A novel hand-carried ultrasound (HCU) has been developed that uses a multifrequency single transducer to image areas of the body (lung, heart, abdomen, superficial) that would typically require three transducers using a traditional cart-based ultrasound (CBU) system. Our primary aim was to compare the time to complete UHPs with a single transducer HCU to a multiple transducer CBU.

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Acceptability of Contraceptive Services in the Emergency Department: A Cross-sectional Survey

Alexander, AB.

Unintended pregnancy disproportionately affects marginalized populations and has significant negative health and financial impacts on women, their families, and society. The emergency department (ED) is a promising alternative setting to increase access to sexual and reproductive health (SRH) services including contraception, especially among marginalized populations. The primary objective of this study was to determine the extent to which adult women of childbearing age who present to the ED would be receptive to receiving contraception and/or information about contraception in the ED. As a secondary objective, we sought to identify the barriers faced in attempting to obtain SRH care in the past.

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Pediatric Emergency Departments and Urgent Care Visits in Houston after Hurricane Harvey

Fanny, SA.

Natural disasters are increasingly common and devastating. It is essential to understand children’s health needs during disasters as they are a particularly vulnerable population. The objective of this study was to evaluate pediatric disease burden after Hurricane Harvey compared to the preceding month and the same period in the previous year to inform pediatric disaster preparedness.

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Effect of a Prescription Drug Monitoring Program on Emergency Department Opioid Prescribing

Gupta, R.

Our goal was to determine whether implementation of a prescription drug monitoring program (PDMP) altered emergency department (ED) opioid prescription rates overall and in patients of different pain severities.

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Paramedic-performed Prehospital Point-of-care Ultrasound for Patients with Undifferentiated Dyspnea: A Pilot Study

Schoeneck, JH.

Thoracic ultrasound is frequently used in the emergency department (ED) to determine the etiology of dyspnea, yet its use is not widespread in the prehospital setting. We sought to investigate the feasibility and diagnostic performance of paramedic acquisition and assessment of thoracic ultrasound images in the prehospital environment, specifically for the detection of B-lines in congestive heart failure (CHF).

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Climate Change Adaptation: Prehospital Data Facilitate the Detection of Acute Heat Illness in India

Ranadive, N.

Extreme heat is a significant cause of morbidity and mortality, and the incidence of acute heat illness (AHI) will likely increase secondary to anthropogenic climate change. Prompt diagnosis and treatment of AHI are critical; however, relevant diagnostic and surveillance tools have received little attention. In this exploratory cross-sectional and diagnostic accuracy study, we evaluated three tools for use in the prehospital setting: 1) case definitions; 2) portable loggers to measure on-scene heat exposure; and 3) prevalence data for potential AHI risk factors.

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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

Increased Emergency Department Hallway Length of Stay is Associated with Development of Delirium

van Loveren, K.

Our study aimed to determine 1) the association between time spent in the emergency department (ED) hallway and the development of delirium and 2) the hospital location of delirium development.

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Population Health Research Design

Universal Screening for Hepatitis C Virus in the ED Using a Best Practice Advisory

Ford, JS.

In 2019 the United States Preventive Services Task Force (USPSTF) released draft guidelines recommending universal hepatitis C virus (HCV) screening for individuals aged 18–79. We aimed to assess the efficacy of an emergency department-based HCV screening program, by comparing screening practices before and after its implementation.

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Population Health Research Design

Emergency Medicine Influencers’ Twitter Use During the COVID-19 Pandemic: A Mixed-methods Analysis

Leibowitz, MK.

The objective of this study was to analyze the messages of influential emergency medicine (EM) Twitter users in the United States (US) during the early stages of the coronavirus disease 2019 (COVID-19) global pandemic by characterizing the themes, emotional tones, temporal viewpoints, and depth of engagement with the tweets.

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Provider Workforce

Unheard Victims: Multidisciplinary Incidence and Reporting of Violence in an Emergency Department

McGuire, SS.

Workplace violence in the emergency department (ED) is a serious threat to staff and is likely to go unreported. We sought to identify the incidence of violence among staff at our academic ED over a six-month period.

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Provider Workforce

Help Us Help You: Engaging Emergency Physicians to Identify Organizational Strategies to Reduce Burnout

Baugh, JJ.

Burnout is a major threat to patient care quality and physician career longevity in emergency medicine. We sought to develop and implement a quality improvement process to engage emergency department (ED) faculty in identifying sources of burnout and generating interventions targeted at improving the work environment.

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Critical Care

Sternal Intraosseous Devices: Review of the Literature

Laney, JA.

The intraosseous (IO) route is one of the primary means of vascular access in critically ill and injured patients. The most common sites used are the proximal humerus, proximal tibia, and sternum. Sternal IO placement remains an often-overlooked option in emergency and prehospital medicine. Due to the conflicts in Afghanistan and Iraq the use of sternal IOs have increased.

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Critical Care

Alteplase for Acute Ischemic Stroke Beyond 3 hours: Enthusiasm Outpaces Evidence

Garg, R.

In a 2014 editorial, Shy pointed out a statistical error in ECASS III.3 The trial’s reported adjusted primary analysis did not account for the baseline imbalance in prior stroke status. The ECASS III authors have not addressed this statistical error in the literature. In a recent publication, Alper et al used the raw data to reanalyze the ECASS III data with appropriate adjustments. In a multivariate model adjusted for both baseline National Institutes of Health Stroke Scale (NIHSS) scores (P = .03 between groups) and prior stroke status (P = .003 between groups) there was a non-significant difference between alteplase and placebo for all efficacy outcomes.4

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Critical Care

Emergency Tracheal Intubation in Patients with COVID-19: A Single-center, Retrospective Cohort Study

Hawkins, A.

The objective of this study was to compare airway management technique, performance, and peri-intubation complications during the novel coronavirus pandemic (COVID-19) using a single-center cohort of patients requiring emergent intubation.

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Critical Care

Performance of Emergency Heart Failure Mortality Risk Grade in the Emergency Department

Garg, Nidhi.

The purpose of this study was to validate and assess the performance of the Emergency Heart Failure Mortality Risk Grade (EHMRG) to predict seven-day mortality in US patients presenting to the emergency department (ED) with acute congestive heart failure (CHF) exacerbation.

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Impact of Social Determinants of Health, Health Literacy, Self-perceived Risk, and Trust in the Emergency Physician on Compliance with Follow-up

Sutton, J.

Patients presenting to the emergency department (ED) with “low-risk” acute coronary syndrome (ACS) symptoms can be discharged with outpatient follow-up. However, follow-up compliance is low for unknown nonclinical reasons. We hypothesized that a patient’s social factors, health literacy, self-perceived risk, and trust in the emergency physician may impact follow-up compliance.

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Anti-immigrant Rhetoric and the Experiences of Latino Immigrants in the Emergency Department

Ornelas, C.

Anti-immigrant rhetoric and increased enforcement of immigration laws have induced worry and safety concerns among undocumented Latino immigrants (UDLI) and legal Latino residents/citizens (LLRC), with some delaying the time to care.1 In this study, we conducted a qualitative analysis of statements made by emergency department (ED) patients – a majority of whom were UDLI and LLRC – participating in a study to better understand their experiences and fears with regard to anti-immigrant rhetoric, immigration enforcement, and ED utilization.

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Importance of Mentoring on Workplace Engagement of Emergency Medicine Faculty: A Multi-institutional Study

Lucas, RH.

Mentoring in emergency medicine (EM) has not been well studied despite a larger body of literature that has described the value of mentoring in academic medicine on career satisfaction and scholarly output. Over half of all EM faculty nationally are of junior faculty ranks. The aim of this study was to identify the frequency and types of mentoring in EM, how types of mentoring in EM differ by gender, and how mentoring correlates with workplace satisfaction for EM faculty.

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Nicotine Patch Prescription Fulfillment Rates for Emergency Department Patients

Emerman, CL.

Smoking cessation has significant health benefits, and the emergency department (ED) can be an important venue for smoking cessation counseling. Nicotine replacement therapy with transdermal patches has been shown to be associated with smoking cessation in a variety of studies. This study evaluated fulfillment rates for prescriptions for nicotine replacement transdermal patches (NRT-P) from the ED.

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Utilization of Educational Videos to Improve Communication and Discharge Instructions

Wray, A.

When discharging a patient from the emergency department (ED), it is crucial to make sure that they understand their disposition and aftercare instructions. However, numerous factors make it difficult to ensure that patients understand their next steps. Our objective was to determine whether patient understanding of ED discharge and aftercare instructions could be improved through instructional videos in addition to standard written discharge instructions.

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Diabetes Patient Surveillance in the Emergency Department: Proof of Concept and Opportunities

Sava, MG.

The purpose of this study was to characterize the at-risk diabetes and prediabetes patient population visiting emergency department (ED) and urgent care (UC) centers in upstate South Carolina.

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Code Status Documentation Availability and Accuracy Among Emergency Patients with End-stage Disease

Russell, E.

Some patients with end-stage disease who may neither want nor benefit from aggressive resuscitation receive such treatment if they cannot communicate in an emergency. Timely access to patients’ current resuscitation wishes, or “code status,” should be a key metric of electronic health records (EHR). We sought to determine what percentage of a cohort of patients with end-stage disease who present to the emergency department (ED) have accessible, code status documents, and for those who do, how quickly can this documentation be retrieved.

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Study of Haloperidol for Abdominal Pain in the Emergency Department (SHAPE)

Knudsen-Lachendro, K.

Intravenous haloperidol has been shown to decrease milligram morphine equivalents (MME) of analgesia and reduce hospital admissions for diabetic gastroparesis. The objective of this study was to evaluate whether haloperidol decreases MME for the treatment of non-specific abdominal pain diagnoses in the emergency department (ED), including gastroparesis, cyclic vomiting, cannabinoid hyperemesis syndrome, and unspecified abdominal pain. The primary outcome compared the difference in MME between encounters. Secondary outcomes included admission rate, pain scores, length of stay, rescue therapy administration, and adverse effects.

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Acute Kidney Injury After CT in Emergency Patients with Chronic Kidney Disease: A Propensity Score-matched Analysis

Kene, M.

Acute kidney injury (AKI) after intravenous contrast administration for computed tomography (CT) occurs infrequently, but certain patients may be susceptible. This study evaluated AKI incidence among emergency department (ED) patients with pre-existing chronic kidney disease (CKD) undergoing CT exams.

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