Archives

Emergency Department Operations

Characteristics of United States Emergency Departments that Routinely Perform Alcohol Risk Screening and Counseling for Patients Presenting with Drinking–related Complaints

Volume 15, Issue 4, July 2014
Michael A. Yokell, ScB et al.

Emergency department (ED) screening and counseling for alcohol misuse have been shown to reduce at-risk drinking. However, barriers to more widespread adoption of this service remain unclear.

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Emergency Department Operations

Unrecognized Hypoxia and Respiratory Depression in Emergency Department Patients Sedated For Psychomotor Agitation: Pilot Study

Volume 15, Issue 4, July 2014
Kenneth Deitch, DO et al.

The incidence of respiratory depression in patients who are chemically sedated in the emergency department (ED) is not well understood. As the drugs used for chemical restraint are respiratory depressants, improving respiratory monitoring practice in the ED may be warranted. The objective of this study is to describe the incidence of respiratory depression in patients chemically sedated for violent behavior and psychomotor agitation in the ED.

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Emergency Department Operations

Does Prolonged Length of Stay in the Emergency Department Affect Outcome for Stroke Patients?

Volume 15, Issue 3, May 2014
Minal Jain, MBBS, MPH et al.

Conflicting data exist regarding the association between the length of stay (LOS) of critically ill patients in the emergency department (ED) and their subsequent outcome. However, such patients are an overall heterogeneous group, and we therefore sought to study the association between EDLOS and outcomes in a specific subgroup of critically ill patients, namely those with acute ischemic stroke/transient ischemic attack (AIS/TIA).

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Emergency Department Operations

Follow Up for Emergency Department Patients After Intravenous Contrast and Risk of Nephropathy

Volume 15, Issue 3, May 2014
Getaw Worku Hassen, MD, PhD et al.

Contrast-induced nephropathy (CIN), defined as an increase in serum creatinine (SCr) greater than 25% or ≥0.5 mg/dL within 3 days of intravenous (IV) contrast administration in the absence of an alternative cause, is the third most common cause of new acute renal failure in hospitalized patients. It is known to increase in-hospital mortality up to 27%. The purpose of this study was to investigate the rate of outpatient follow up and the occurrence of CIN in patients who presented to the emergency department (ED) and were discharged home after computed tomography (CT) of the abdomen and pelvis (AP) with IV contrast.

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Emergency Department Operations

Skin Infections and Antibiotic Stewardship: Analysis of Emergency Department Prescribing Practices, 2007–2010

Volume 15, Issue 3, May 2014
Daniel J. Pallin, MD, MPH et al.

National guidelines suggest that most skin abscesses do not require antibiotics, and that cellulitis antibiotics should target streptococci, not community-associated MRSA (CA-MRSA). The objective of this study is to describe antimicrobial treatment of skin infections in U.S. emergency departments (EDs) and analyze potential quality measures.

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Emergency Department Operations

Hospital Factors Impact Variation in Emergency Department Length of Stay more than Physician Factors

Volume 15, Issue 2, March 2014
Scott P. Krall, MD et al.

To analyze the correlation between the many different emergency department (ED) treatment metric intervals and determine if the metrics directly impacted by the physician correlate to the “door to room” interval in an ED (interval determined by ED bed availability). Our null hypothesis was that the cause of the variation in delay to receiving a room was multifactorial and does not correlate to any one metric interval.

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Emergency Department Operations

Impact of a Teaching Service on Emergency Department Throughput

Volume 15, Issue 2, March 2014
Courtney M. Smalley, MD et al.

There are 161 emergency medicine residency programs in the United States, many of which have medical students rotating through the emergency department (ED). Medical students are typically supervised by senior residents or attendings while working a regular shift. Many believe that having students see and present patients prolongs length of stay (LOS), as care can be delayed.

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Emergency Department Operations

Emergency Department Length of Stay: Accuracy of Patient Estimates

Volume 15, Issue 2, March 2014
Brendan T. Parker, MS et al.

Managing a patient’s expectations in the emergency department (ED) environment is challenging. Previous studies have identified several factors associated with ED patient satisfaction. Lengthy wait times have shown to be associated with dissatisfaction with ED care. Understanding that patients are inaccurate at their estimation of wait time, which could lead to lower satisfaction, provides administrators possible points of intervention to help improve accuracy of estimation and possibly satisfaction with the ED. This study was undertaken to examine the accuracy of patient estimates of time periods in an ED and identify factors associated with accuracy.

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Emergency Department Operations

Impact of Decontamination Therapy on Ultrasound Visualization of Ingested Pills

Volume 15, Issue 2, March 2014
Jason Bothwell, MD, et al.

Acute toxic ingestion is a common cause of morbidity and mortality. Emergency physicians (EP) caring for overdose (OD) patients are often required to make critical decisions with incomplete information. Point of care ultrasound (POCUS) may have a role in assisting EPs manage OD patients. We evaluated the impact of different liquid adjuncts used for gastric decontamination on examiners’ ability to identify the presence of tablets using POCUS, and assessed examiners’ ability to quantify the numbers of tablets in a simulated massive OD.

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Emergency Department Operations

Impact of an Abbreviated Cardiac Enzyme Protocol to Aid Rapid Discharge of Patients with Cocaine-associated Chest Pain in the Clinical Decision Unit

Volume 15, Issue 2, March 2014
Faheem W. Guirgis, MD et al.

In 2007 there were 64,000 visits to the emergency department (ED) for possible myocardial infarction (MI) related to cocaine use. Prior studies have demonstrated that low- to intermediate-risk patients with cocaine-associated chest pain can be safely discharged after 9–12 hours of observation. The goal of this study was to determine the safety of an 8-hour protocol for ruling out MI in patients who presented with cocaine-associated chest pain.

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Emergency Department Operations

The July Effect: Is Emergency Department Length of Stay Greater at the Beginning of the Hospital Academic Year?

Volume XV, Issue 1, February 2014
Christine Riguzzi, MD et al.

The objective of this study is to determine if the average ED LOS at the beginning of the hospital academic year differs for teaching hospitals with residents in the ED, when compared to other months of the year, and as compared to non-teaching hospitals without residents.

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Emergency Department Operations

The Impact of Working with Medical Students on Resident Productivity in the Emergency Department

Volume 14, Issue 6, November 2013
Travis Cobb, MD, et al.

Academic emergency departments (ED) strive to balance educational needs of residents and medical students with service requirements that optimize patient care. No study to date has evaluated whether resident precepting of medical students affects residents’ clinical productivity. Understanding the interplay of these variables may allow for ED staffing that maximizes productivity. We sought to determine whether the precepting of medical students impacts resident productivity.

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Emergency Department Operations

Predictive Value of Capnography for Suspected Diabetic Ketoacidosis in the Emergency Department

Volume 14, Issue 6, November 2013
Hassan Soleimanpour, MD, et al.

Metabolic acidosis confirmed by arterial blood gas (ABG) analysis is one of the diagnostic criteria for diabetic ketoacidosis (DKA). Given the direct relationship between end-tidal carbon dioxide (ETCO2), arterial carbon dioxide (PaCO2), and metabolic acidosis, measuring ETCO2 may serve as a surrogate for ABG in the assessment of possible DKA. The current study focuses on the predictive value of capnography in diagnosing DKA in patients referring to the emergency department (ED) with increased blood sugar levels and probable diagnosis of DKA.

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Emergency Department Operations

Measuring Power in an Emergency Department to Improve Processes and Decrease the Length of Stay to their Optimum Value

Volume 14, Issue 5, September 2013
Bert A. Silich, MD, MS

Many emergency departments (EDs) compare themselves to national productivity benchmarks, such as the average patients/hour or relative value units (RVUs)/hour. Making these comparisons does not provide a tool to determine which processes need improvement, most urgently, within the ED to improve efficiency. Furthermore, there has been no clear means to determine how to set reasonable goals based on the capabilities of the particular ED under study.

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Emergency Department Operations

Perception of Noise by Emergency Department Nurses

Volume 14, Issue 5, September 2013
John Graneto, DO, MEd, et al.

Noise in the emergency department (ED) may be perceived to be high by both patients and nurses alike. This increased noise level is hypothesized to be responsible for communication interference and subsequent disruption of complex procedures and decision-making. The objective of this study is to quantify ambient noise level in an ED while obtaining coincident subjective surveys from nurses in the assessment of actual versus perceived noise.

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Contact Information

WestJEM/ Department of Emergency Medicine
UC Irvine Health

3800 W Chapman Ave Ste 3200
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.