Volume 14 Issue 1 Archives - The Western Journal of Emergency Medicine

Healthcare Utilization

Sedation-assisted Orthopedic Reduction in Emergency Medicine: The Safety and Success of a One Physician/One Nurse Model

Introduction: Much of the emergency medical research on sedation-assisted orthopedic reductions has been undertaken with two physicians––one dedicated to the sedation and one to the procedure. Although the dual-physician model is advocated by some, evidence in support of its superiority is lacking.

Conclusion: Sedation-assisted closed reduction of major joint dislocations and forearm fractures can be performed effectively and safely in the ED using a one physician/one nurse model. A policy that requires a separate physician (or nurse anesthetist) to administer medications for all sedation-assisted ED procedures appears unwarranted.

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Practice Variability

Variation in Specialists’ Reported Hospitalization Practices of Children Sustaining Blunt Abdominal Trauma

Introduction: Children with blunt abdominal trauma (BAT) are often hospitalized despite no intervention. We identified factors associated with emergency department (ED) disposition of children with BAT and differing computed tomography (CT) findings.

Conclusion: Substantial variation exists between specialties in reported hospitalization practices of asymptomatic children after abdominal trauma with minor CT findings. Better evidence is needed to guide disposition decisions.

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Practice Variability

Variation in Specialists’ Reported Hospitalization Practices of Children Sustaining Blunt Head Trauma

Introduction: Questions surround the appropriate emergency department (ED) disposition of children who have sustained blunt head trauma (BHT). Our objective was to identify physician disposition preferences of children with blunt head trauma (BHT) and varying computed tomography (CT) findings.

Conclusion: Substantial variation exists between specialties in reported hospitalization practices of neurologically-normal children with BHT and traumatic CT findings.

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Practice Variability

The Treatment of Cutaneous Abscesses: Comparison of Emergency Medicine Providers’ Practice Patterns

Introduction: Cutaneous abscesses are commonly treated in the emergency department (ED). This study sought to describe the ED treatments administered to adults with uncomplicated superficial cutaneous abscesses, defined as purulent lesions requiring incision and drainage that could be managed in an ED or outpatient setting.

Conclusion:Variability exists in the treatment strategies for abscess care. Most providers used narcotic analgesics in addition to local anesthetic, linear incisions, and packing. Most providers did not irrigate, order wound cultures, or routinely prescribe oral antibiotics unless specific risk factors or physical signs were present.

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Population Health Research Design

The Impact of Emergency Physician Turnover on Planning for Prospective Clinical Trials

Introduction: Emergency physician (EP) turnover is a significant issue that can have strong economic impact on hospital systems, as well as implications on research efforts to test and improve clinical practice.

Conclusion: EP workforce changes over an 18-month period were common. This has implications for emergency department directors, researchers, and individual EPs. Those planning research involving interventions upon EPs should account for turnover as it may have an impact when designing clinical trials to improve performance on healthcare delivery metrics for time-sensitive medical conditions such as stroke, acute myocardial infarction, or trauma.

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Emergency Department Crowding is Associated with Reduced Satisfaction Scores in Patients Discharged from the Emergency Department

Introduction: Emergency department (ED) crowding has been shown to negatively impact patient outcomes. Few studies have addressed the effect of ED crowding on patient satisfaction. Our objective was to evaluate the impact of ED crowding on patient satisfaction in patients discharged from the ED.

Conclusion: Increased crowding, as measured by ED occupancy rate and EDWIN score, was significantly associated with reduced patient satisfaction. Although causative attribution was limited, our study suggested yet another negative impact resulting from ED crowding.

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Perceptions of Emergency Department Crowding in the Commonwealth of Pennsylvania

Introduction: The state of emergency department (ED) crowding in Pennsylvania has not previously been reported.

Conclusion: ED crowding is a common problem in Pennsylvania and is worsening in the majority of hospitals, despite the implementation of a variety of interventions.

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Guidelines for Field Triage of Injured Patients: In conjunction with the Morbidity and Mortality Weekly Report published by the Center for Disease Control and Prevention

The Centers for Disease Control and Prevention (CDC) has published significant data and trends related to the national public health burden associated with trauma and injury. In the United States (U.S.), injury is the leading cause of death for persons aged 1–44 years. In 2008, approximately 30 million injuries resulted in an emergency department (ED) evaluation; 5.4 million (18%) of these patients were transported by Emergency Medical Services (EMS). EMS providers determine the severity of injury and begin initial management at the scene.

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Fatality and Injury Severity of Older Adult Motor Vehicle Collisions in Orange County, California, 1998–2007

Introduction:Injuries and fatalities in adult drivers 18–65 years of age have decreased in recent years due to safer vehicles, enhanced medical policies, and implementation of injury prevention policies. The objective of this study was to examine injury severity and fatality rates in older drivers compared to their younger counterparts in Orange County, California.

Conclusion: The decrease in collision fatalities was greater in the 25–64-year-old group compared to the older adult population. This disparity highlights the need for further injury prevention efforts for older drivers.

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Accuracy of Handheld Point-of-Care Fingertip Lactate Measurement in the Emergency Department

Introduction: We examined the accuracy and time-saving effect of a handheld Point-of-care (POC) device for the measurement of fingertip and whole blood lactate as compared with reference laboratory testing in critically ill ED patients.

Conclusion: Fingertip POC lactate measurement is an accurate method to determine lactate levels in infected ED patients with normal or modestly elevated lactate values and significantly decreases time to test results.

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Healthcare Utilization

Impact of Emergency Department Management of Atrial Fibrillation on Hospital Charges

Introduction: Emergency department (ED) cardioversion (EDCV) and discharge of patients with recent onset atrial fibrillation or atrial flutter (AF) has been shown to be a safe and effective management strategy. This study examines the impact of such aggressive ED management on hospital charges.

Conclusion: ED cardioversion of recent onset AF patients results in significant hospital savings.

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