Practical Diagnostic Accuracy of Nasopharyngeal Swab Testing for Novel Coronavirus Disease 2019 (COVID-19)
Introduction: The novel coronavirus (SARS-CoV-2) is the cause of COVID-19, which has had a devastating international impact. Prior reports of testing have reported low sensitivities of nasopharyngeal polymerase chain reaction (PCR), and reports of viral co-infections have varied from 0-20%. Therefore, we sought to determine the accuracy of nasopharyngeal PCR for COVID-19 and rates of viral co-infection.Methods:We conducted a retrospective chart review of all patients who received viral testing between March 1, 2020 –April 28, 2020. Test results of a complete viral pathogen panel and COVID-19 testing were abstracted. ...
Source: Western Journal of Emergency Medicine - September 29, 2020 Category: Emergency Medicine Source Type: research

This Article Corrects: “Identifying Patients at Greatest Risk of Mortality due to COVID-19: A New England Perspective”
We examined the factors that increase the risk of mortality among hospitalized COVID-19 patients.Methods: This was a retrospective cohort study including confirmed COVID-19 patients admitted to the four Trinity Health of New England hospitals (THONE) in Connecticut and Massachusetts who either died or were discharged between March 1 –April 22, 2020. Demographics, comorbidities, and outcomes of care were extracted... (Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - September 28, 2020 Category: Emergency Medicine Source Type: research

Point-of-care Lung Ultrasound Is Useful to Evaluate Emergency Department Patients for COVID-19
Introduction:Coronavirus disease 2019 (COVID-19) can be a life-threatening lung disease or a trivial upper respiratory infection depending on whether the alveoli are involved. Emergency department (ED) evaluation of symptomatic patients with normal vital signs is frequently limited to chest auscultation and oro-nasopharyngeal swabs. We tested the null hypothesis that patients being screened for COVID-19 in the ED with normal vital signs and without hypoxia would have a point-of-care lung ultrasound (LUS) consistent with COVID-19 less than 2% of the time.Methods: We performed a retrospective, structured, blinded ultrasound ...
Source: Western Journal of Emergency Medicine - September 28, 2020 Category: Emergency Medicine Source Type: research

A Video-based Debriefing Program to Support Emergency Medicine Clinician Well-being During the COVID-19 Pandemic
We report the details of our program and results of our evaluation of its acceptability and perceived value to emergency clinicians during the pandemic.Methods: ED attending physicians, resident physicians, and non-physician practitioners (NPP) at our quaternary-care academic medical center were invited to participate in role-based, weekly one-hour facilitated debriefings using Zoom. ED attendings with experience in debriefing led each session and used an explorative approach... (Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - September 26, 2020 Category: Emergency Medicine Source Type: research

Risk Stratification of COVID-19 Patients Using Ambulatory Oxygen Saturation in the Emergency Department
Introduction: It is difficult to determine illness severity for coronavirus disease 2019 (COVID-19) patients, especially among stable-appearing emergency department (ED) patients. We evaluated patient outcomes among ED patients with a documented ambulatory oxygen saturation measurement.Methods: This was a retrospective chart review of ED patients seen at New York University Langone Health during the peak of the COVID-19 pandemic in New York City. We identified ED patients who had a documented ambulatory oxygen saturation. We studied the outcomes of high oxygen requirement (defined as>4 liters per minute) and mechanical ...
Source: Western Journal of Emergency Medicine - September 25, 2020 Category: Emergency Medicine Source Type: research

Preparedness, Adaptation, and Innovation: Approach to the COVID-19 Pandemic at a Decentralized, Quaternary Care Department of Emergency Medicine
The COVID-19 pandemic has required healthcare systems to be creative and adaptable in response to an unprecedented crisis. Below we describe how we prepared for and adapted to this pandemic at our decentralized, quaternary-care department of emergency medicine, with specific recommendations from our experience. We discuss our longstanding history of institutional preparedness, as well as adaptations in triage, staffing, workflow, and communications. We also discuss innovation through working with industry on solutions in personal protective equipment, as well as telemedicine and methods for improving morale. These prepared...
Source: Western Journal of Emergency Medicine - September 25, 2020 Category: Emergency Medicine Source Type: research

Responding to a Pandemic: The Role of EM-CCM on ICU Boarders in an Urban Emergency Department
(Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - September 25, 2020 Category: Emergency Medicine Source Type: research

Patients Presenting with Bull-related Injuries to a Southern Indian Emergency Department
The objective of this study was to evaluate the demographic and clinical characteristics of bull-related injuries at a hospital in Tamil Nadu, India.Methods:This was a prospective, observational study of patients who presented to an emergency department (ED) in Madurai, India, with a reported history of bull-related injuries between June 2017 and March 2019. We recorded information about patient demographics, location of injury, disposition, initial Injury Severity... (Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - September 25, 2020 Category: Emergency Medicine Source Type: research

Emergency Department Management of COVID-19: An Evidence-Based Approach
The novel coronavirus, SARs-CoV-2, causes a clinical disease known as COVID-19. Since being declared a global pandemic, a significant amount of literature has been produced and guidelines are rapidly changing as more light is shed on this subject. Decisions regarding disposition must be made with attention to comorbidities. Multiple comorbidities portend a worse prognosis. Many clinical decision tools have been postulated; however, as of now, none have been validated. Laboratory testing available to the emergency physician is nonspecific but does show promise in helping prognosticate and risk stratify. Radiographic testing...
Source: Western Journal of Emergency Medicine - September 25, 2020 Category: Emergency Medicine Source Type: research

Plastic Surgery Complications: A Review for Emergency Clinicians
The number of aesthetic surgical procedures performed in the United States is increasing rapidly. Over 1.5 million surgical procedures and over three million nonsurgical procedures were performed in 2015 alone. Of these, the most common procedures included surgeries of the breast and abdominal wall, specifically implants, liposuction, and subcutaneous injections. Emergency clinicians may be tasked with the management of postoperative complications of cosmetic surgeries including postoperative infections, thromboembolic events, skin necrosis, hemorrhage, pulmonary edema, fat embolism syndrome, bowel cavity perforation, intr...
Source: Western Journal of Emergency Medicine - September 25, 2020 Category: Emergency Medicine Source Type: research

How the COVID-19 Epidemic Affected Prehospital Emergency Medical Services in Tehran, Iran
Introduction: Coronavirus disease 2019 (COVID-19) has substantially impacted the healthcare delivery system in Tehran, Iran. The country ’s first confirmed positive test for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was on February 18, 2020. Since then, the number of cases has steadily increased in Iran and worldwide. Emergency medical services (EMS) quickly adapted its operations to accommodate a greater number of patients, and it worked to decrease the risk of COVID-19 spread among EMS personnel, given the disease’s high transmissibility.Methods: We evaluated the chief complaint as well as ...
Source: Western Journal of Emergency Medicine - September 25, 2020 Category: Emergency Medicine Source Type: research

Physician Wellness During a Pandemic
Introduction: We are currently in the midst of the coronavirus disease 2019 (COVID-19) pandemic. Research into previous infectious disease outbreaks has shown that healthcare workers are at increased risk for burnout during these dire times, with those on the front lines at greatest risk. The purpose of this prospective study was to determine the effect that the COVID-19 pandemic has had on the wellness of emergency physicians (EP).Methods: A survey was sent to 137 EPs in a multi-hospital network in eastern Pennsylvania. We compared 10 primary and two supplemental questions based on how the physicians had been feeling in t...
Source: Western Journal of Emergency Medicine - September 25, 2020 Category: Emergency Medicine Source Type: research

Underutilization of the Emergency Department During the COVID-19 Pandemic
Introduction:The novel coronavirus 2019 (COVID-19) pandemic in the United States (US) prompted widespread containment measures such as shelter-in-place (SIP) orders. The goal of our study was to determine whether there was a significant change in overall volume and proportion of emergency department (ED) encounters since SIP measures began.Methods: This was a retrospective, observational, cross-sectional study using billing data from January 1, 2017 –April 20, 2020. We received data from 141 EDs across 16 states, encompassing a convenience sample of 26,223,438 ED encounters. We used a generalized least squares regres...
Source: Western Journal of Emergency Medicine - September 24, 2020 Category: Emergency Medicine Source Type: research

Effect of an Aerosol Box on Intubation in Simulated Emergency Department Airways: A Randomized Crossover Study
The objective of this study was to measure the effect of an aerosol box on intubation performance across a variety of simulated difficult airway scenarios in the emergency department.Methods: This was a randomized, crossover design study. Participants were randomized to intubate one of five airway scenarios with and without an aerosol box in place, with randomization of intubation sequence. The primary outcome was time to intubation. Secondary outcomes included number of intubation attempts, Cormack-Lehane view, percent of glottic opening, and resident physician perception of intubation difficulty.Results:... (Source: West...
Source: Western Journal of Emergency Medicine - September 24, 2020 Category: Emergency Medicine Source Type: research

Telemedicine to Decrease Personal Protective Equipment Use and Protect Healthcare Workers
(Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - September 24, 2020 Category: Emergency Medicine Source Type: research

CODE BLUE-19: A Proposed Protocol to Mitigate COVID-19 Transmission in the Emergency Department when Receiving Out-of-hospital Cardiac Arrest Patients
Resuscitation of cardiac arrest in coronavirus disease 2019 (COVID-19) patients places the healthcare staff at higher risk of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Unfortunately, COVID-19 status is unknown in most patients presenting to the emergency department (ED), and therefore special attention must be given to protect the healthcare staff along with the other patients. This is particularly true for out-of-hospital cardiac arrest patients who are transported to the ED. Based on the current data available on transmissibility of SARS-CoV-2, we have proposed a protocolized approach to o...
Source: Western Journal of Emergency Medicine - September 24, 2020 Category: Emergency Medicine Source Type: research

In-situ Simulation Use for Rapid Implementation and Process Improvement of COVID-19 Airway Management
Introduction:The coronavirus disease 2019 (COVID-19) pandemic presents unique challenges to frontline healthcare workers. In order to safely care for patients new processes, such as a plan for the airway management of a patient with COVID-19, must be implemented and disseminated in a rapid fashion. The use of in-situ simulation has been used to assist in latent problem identification as part of a Plan-Do-Study-Act cycle. Additionally, simulation is an effective means for training teams to perform high-risk procedures before engaging in the actual procedure. This educational advance seeks to use and study in-situ simulation...
Source: Western Journal of Emergency Medicine - September 24, 2020 Category: Emergency Medicine Source Type: research

WestJEM Volume 21, Issue 5
(Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - September 15, 2020 Category: Emergency Medicine Source Type: research

The Utility of Serum Creatinine Kinase in Emergency Department Patients with Possible Substance-use Related Conditions
Introduction: Our goal was to assess the diagnostic utility and temporal kinetics of serum creatine kinase (CK) measurement as a predictor of acute kidney injury (AKI) in emergency department (ED) patients who present with possible substance-use related conditions.Methods: This was a retrospective chart review of ED patients with a urine drug screen (UDS) ordered and resulted between 2009 –2013. Data was extracted electronically from EPIC Systems electronic health records, populated into a Microsoft Excel file, and includes demographics, chief complaint, vital signs, neuro-psychiatric physical examination findings, l...
Source: Western Journal of Emergency Medicine - September 5, 2020 Category: Emergency Medicine Source Type: research

The Utility of Serum Creatinine Phosphokinase in Emergency Department Patients with Possible Substance Use Related Conditions
Objectives:Our purpose was to assess the diagnostic utility and temporal kinetics of serum CK measurement as a predictor of acute kidney injury in emergency department (ED) patients who present with possible substance-use related conditions.Methods:This is a retrospective chart review of ED patients with a urine drug screen ordered and resulted between 2009 and 2013. Data was extracted electronically from EPIC electronic medical records, populated into a Microsoft excel file, and includes demographics, chief complaint, vital signs, neuro-psychiatric physical examination findings, laboratory findings, psychiatric consult or...
Source: Western Journal of Emergency Medicine - September 5, 2020 Category: Emergency Medicine Source Type: research

Patient Characteristics and Clinical Process Predictors of Patients Leaving Without Being Seen from the Emergency Department
Introduction: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.Methods: This was a cross-sectional study in a 95,000 annual visit adult ED comparing patients LWBS, with controls. Data were drawn from four seasonally adjusted four-week periods (30,679 total visits). Process measures included 1) arrivals per hour; 2) “door-to-provider” time; ...
Source: Western Journal of Emergency Medicine - August 26, 2020 Category: Emergency Medicine Source Type: research

2020 CORD Abstracts Special Issue
(Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - August 25, 2020 Category: Emergency Medicine Source Type: research

Development and Implementation of a Community Paramedicine Program in Rural United States
Introduction: Community paramedicine (CP) is an innovative care model focused on medical management for patients suffering from chronic diseases or other conditions that result in over-utilization of healthcare services. Despite their value, CP care models are not widely used in United States healthcare settings. More research is needed to understand the feasibility and effectiveness of implementing CP programs. Our objective was to develop a CP program to better meet the needs of complex, high-utilizer patients in a rural setting.Methods:We conducted an observational descriptive case series in a community, 25-bed, critica...
Source: Western Journal of Emergency Medicine - August 24, 2020 Category: Emergency Medicine Source Type: research

Post-traumatic Stress Disorder in Family-witnessed Resuscitation of Emergency Department Patients
Introduction:Family presence during emergency resuscitations is increasingly common, but the question remains whether the practice results in psychological harm to the witness. We examine whether family members who witness resuscitations have increased post-traumatic stress disorder (PTSD) symptoms at one month following the event.Methods:We identified family members of critically ill patients via our emergency department (ED) electronic health record. Patients were selected based on their geographic triage to an ED critical care room. Family members were called a median of one month post-event and administered the Impact ...
Source: Western Journal of Emergency Medicine - August 24, 2020 Category: Emergency Medicine Source Type: research

Dumpster Diving in the Emergency Department: Quantity and Characteristics of Waste at a Level I Trauma Center
Introduction: 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.Methods: We conducted a 24-hour (weekday) ED waste audit in an urban, tertiary-care academic medical center. ...
Source: Western Journal of Emergency Medicine - August 24, 2020 Category: Emergency Medicine Source Type: research

Buprenorphine for Opioid Use Disorder in the Emergency Department: A Retrospective Chart Review
We describe our experience regarding buprenorphine implementation in the emergency department (ED), characteristics of patients who received buprenorphine, and rates of outpatient follow-up.Methods: We conducted a retrospective chart review of all patients in the ED for whom buprenorphine was administered to treat opioid withdrawal during an 18-month period from January 30, 2017 –July 31, 2018. Data extraction of a priori-defined variables was recorded. We used descriptive statistics to characterize the cohort of patients.Results: A total of 77 patients were included for analysis. Thirty-three patients (43%) who rece...
Source: Western Journal of Emergency Medicine - August 24, 2020 Category: Emergency Medicine Source Type: research

Development and Implementation of a Community Paramedic Program in Rural United States
Introduction: Community paramedicine (CP) is an innovative care model focused on medical management for patients suffering from chronic diseases or other conditions that result in over-utilization of healthcare services. Despite their value, CP care models are not widely used in United States healthcare settings. More research is needed to understand the feasibility and effectiveness of implementing CP programs. Our objective was to develop a CP program to better meet the needs of complex, high-utilizer patients in a rural setting.Methods:We conducted an observational descriptive case series in a community, 25-bed, critica...
Source: Western Journal of Emergency Medicine - August 24, 2020 Category: Emergency Medicine Source Type: research

Point-of-sale Naloxone: Novel Community-based Research to Identify Naloxone Availability
Introduction: Expanding naloxone availability is important to reduce opioid-related deaths. Recent data suggest low, variable urban naloxone availability. No reports describe naloxone availability at the point of sale (POSN). We characterize POSN without prescription across a Midwestern metropolitan area, via a unique poison center-based study.Methods: Pharmacies were randomly sampled within a seven-county metropolitan area, geospatially mapped, and distributed among seven investigators, who visited pharmacies and asked, “May I purchase naloxone here without a prescription from my doctor?” Following “No,&...
Source: Western Journal of Emergency Medicine - August 24, 2020 Category: Emergency Medicine Source Type: research

Sepsis Alerts in Emergency Departments: A Systematic Review of Accuracy and Quality Measure Impact
Introduction: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.Methods: We searched multiple health literature databases from the earliest available dates to August 2018. Articles were screened based on abstract, again via manuscript, and further narrowed with set inclusion criteria: 1) adult patients in the ED diagnosed with sepsis, severe sepsis, or septic sho...
Source: Western Journal of Emergency Medicine - August 24, 2020 Category: Emergency Medicine Source Type: research

Resident Research in Emergency Medicine: An Introduction and Primer
Training in research methodology represents an important aspect of emergency medicine (EM) resident education, but best methods for design, implementation, and dissemination of resident research remain elusive. Here we describe recommendations and best practices from the existing literature on EM resident research, including helpful tips on how to best implement a resident research program. (Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - August 24, 2020 Category: Emergency Medicine Source Type: research

Effect of Resident Physicians in a Supervisory Role on Efficiency in the Emergency Department
Introduction: While patient throughput and emergency department (ED) length of stay (LOS) are recognized as important metrics in the delivery of efficient care, they must be balanced with the educational mission of academic centers. Prior studies examining the impact of learners on throughput and LOS when staffing directly with attending physicians have yielded mixed results. Herein we sought to examine the impact of a staffing model involving a supervisory resident “pre-attending” (PAT) on ED throughput and LOS, as this model offers a valuable educational experience for residents, but may do so at the expense ...
Source: Western Journal of Emergency Medicine - August 24, 2020 Category: Emergency Medicine Source Type: research

Creation and Implementation of a Mastery Learning Curriculum for Emergency Department Thoracotomy
Introduction:Emergency department thoracotomy (EDT) is a lifesaving procedure within the scope of practice of emergency physicians. Because EDT is infrequently performed, emergency medicine (EM) residents lack opportunities to develop procedural competency.   There is no current mastery learning curriculum for residents to learn EDT. The purpose of this study was to develop and implement a simulation-based mastery learning curriculum to teach and assess EM residents’ performance of the EDT. Methods: We developed an EDT curriculum using a mastery learning framework. The minimum passing standard (MPS) for a p...
Source: Western Journal of Emergency Medicine - August 24, 2020 Category: Emergency Medicine Source Type: research

Academic Emergency Medicine Faculty Experiences with Racial and Sexual Orientation Discrimination
The objective of this study was to determine the current experiences and perceptions of discrimination on the basis of race and sexual orientation among academic emergency medicine (EM) faculty.Methods:We conducted a cross-sectional survey of a convenience sample of EM faculty across six programs. Survey items included the Overt Gender Discrimination at Work (OGDW) Scale adapted for race and sexual orientation, and the frequency and source of experienced and observed discrimination. Group comparisons were made using t-tests or chi-square analyses, and relationships between race or sexual orientation, and we evaluated physi...
Source: Western Journal of Emergency Medicine - August 21, 2020 Category: Emergency Medicine Source Type: research

Age-adjusted and Expanded Lactate Thresholds as Predictors of All-Cause Mortality in the Emergency Department
This study investigates whether age is a necessary variable to consider when using lactate levels as a marker of prognosis and a guide for management decisions in the ED.Methods: This was a retrospective cohort study in an urban, tertiary-care teaching hospital. A total of 13,506 lactate levels were obtained over a 4.5-year period. All adult patients who had a lactate level obtained by the treating provider in the ED were screened for inclusion. The main outcome measure was in-hospital mortality using age-adjusted cohorts and expanded lactate thresholds with secondary outcomes comparing mortality based on the primary clini...
Source: Western Journal of Emergency Medicine - August 21, 2020 Category: Emergency Medicine Source Type: research

Paramedic Pain Management Practice with Introduction of a Non-opiate Treatment Protocol
This study was two-armed. The first arm employed a pre/post retrospective chart review model examining medication administrations reported to the Massachusetts Ambulance Trip Information System between January 1, 2017 –December 31, 2018. We abstracted instances of opiate and non-opiate... (Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - August 21, 2020 Category: Emergency Medicine Source Type: research

Intention to Leave Emergency Medicine: Mid-career Women Are at Increased Risk
This study sought to determine whether there is a gender difference in reporting burnout and seriously considering leaving the specialty of EM, and secondarily to explore the factors reported as contributing to burnout.Methods: This was a secondary analysis of the 2014 American Board of Emergency Medicine Longitudinal Survey of Emergency Physicians. We used multiple logistic regression to determine which factors were associated with reporting serious consideration of leaving EM, when stratified by years in practice and adjusting for individual, departmental, and institutional factors.Results: The response rate was 82%, (n ...
Source: Western Journal of Emergency Medicine - August 21, 2020 Category: Emergency Medicine Source Type: research

Using an Online Vaccination Registry to Confirm Tetanus Status in Children with Tetanus-prone Wounds
Introduction:  Tetanus vaccination status is an important consideration for emergency physicians managing patients with tetanus-prone wounds. Physicians must identify at-risk patients, but vaccination histories are often unknown and commonly lack documentation. The study objective was to determine the potential impact of an online immunization registry (Florida SHOTS – State Health Online Tracking System) on the appropriate administration of tetanus prophylaxis for pediatric patients managed in the emergency department (ED).Methods:  We conducted a retrospective review of all patients less than 18 years old...
Source: Western Journal of Emergency Medicine - August 21, 2020 Category: Emergency Medicine Source Type: research

A Method for Grouping Emergency Department Visits by Severity and Complexity
Introduction:Triage functions to quickly prioritize care and sort patients by anticipated resource needs. Despite widespread use of the Emergency Severity Index (ESI), there is still no universal standard for emergency department (ED) triage. Thus, it can be difficult to objectively assess national trends in ED acuity and resource requirements. We sought to derive an ESI from National Hospital Ambulatory Medical Care Survey (NHAMCS) survey items (NHAMCS-ESI) and to assess the performance of this index with respect to stratifying outcomes, including hospital admission, waiting times, and ED length of stay (LOS).Methods: We ...
Source: Western Journal of Emergency Medicine - August 21, 2020 Category: Emergency Medicine Source Type: research

Triage in The Time of Diphtheria
In this study we review the implementation of the emergency department (ED) triage process and patient flow management during the diphtheria outbreak. No previous study in Indonesia has provided a detailed report on the triage process during infectious disease outbreaks.Method: We modified our pre-existing hospital triage method according to the “identify, isolate, and inform” principle. We developed novel criteria for triage to identify triage-suspected cases and also a diphtheria package to simplify the diagnostic process. Four separate rooms were modified to isolation spaces to enable medical staff to observ...
Source: Western Journal of Emergency Medicine - August 21, 2020 Category: Emergency Medicine Source Type: research

COVID-19: A Driver for Disruptive Innovation of the Emergency Medicine Residency Application Process
Recommendations from the Council of Residency Directors Application Process Improvement Committee (CORD-APIC)The coronavirus disease (COVID-19) pandemic has had a significant impact on undergraduate medical education with limitation of patient care activities and disruption to medical licensing examinations. In an effort to promote both safety and equity, the emergency medicine (EM) community has recommended no away rotations for EM applicants and entirely virtual interviews during this year ’s residency application cycle. These changes affect the components of the EM residency application most highly regarded by pro...
Source: Western Journal of Emergency Medicine - August 20, 2020 Category: Emergency Medicine Source Type: research

Improving Understanding of Screening Questions for Social Risk and Social Need Among Emergency Department Patients
Introduction:With recent healthcare policy changes, including the creation of accountable care organizations, screening for social risks such as food and housing insecurity has become increasingly common in the healthcare system. However, the wide variety of different tools used for screening makes it challenging to compare across systems. In addition, the majority of tools used to measure social risks have only been tested in primary care settings and may not be optimal for emergency department (ED) use. Therefore, the goal of this study was to create a brief social screening tool for use in EDs.Methods: We developed an i...
Source: Western Journal of Emergency Medicine - August 20, 2020 Category: Emergency Medicine Source Type: research

Insurance Does Not Affect Adverse Events While Awaiting Surgery for Ankle Trauma in One System
Introduction: Ankle injuries that are not properly cared for can have devastating effects on a patient ’s health and ability to maintain an active lifestyle. Recommended outpatient surgery may be difficult to obtain for many groups of patients, including those without insurance or minority races. Patients who are of low socioeconomic status also have worse outcomes following trauma. The purpose of this study was to examine whether insurance status impacts the number of adverse events that patients face prior to receiving surgical treatment following an emergency department (ED) visit for an acute ankle injury.Methods...
Source: Western Journal of Emergency Medicine - August 20, 2020 Category: Emergency Medicine Source Type: research

Feasibility of Health Literacy Tools for Older Patients in the Emergency Department
This study evaluates the feasibility of using a volunteer research associate (RA) to administer two separate health literacy assessment tools in the emergency department (ED), specifically in an older population of patients. The outcomes measured were administration time and interruptions.Methods: Using a prospective, cross-sectional study with a convenience sample, adult patients over the age of 55 presenting between June –August 2018 to one urban, academic ED were evaluated by a volunteer RA using either the Newest Vital Sign (NVS) or the Short Assessment of Health Literacy (SAHL). All patients 55 years of age or o...
Source: Western Journal of Emergency Medicine - August 20, 2020 Category: Emergency Medicine Source Type: research

Counseling on Access to Lethal Means-Emergency Department (CALM-ED): A Quality Improvement Program for Firearm Injury Prevention
Introduction:Suicide is the 10th leading cause of death in the United States, with firearms reported as the cause of death in up to 50% of these cases. Our goal was to evaluate the feasibility of the Counseling on Access to Lethal Means intervention in the Emergency Department (CALM-ED) by non-physician personnel.Methods: We conducted this single-center, prospective, quality improvement study (QI) in an urban, academic ED with over 90,000 annual patient visits. The study looked at adult patients who were discharged after presenting to the ED with suicidal crisis. Assessment of access to lethal means was conducted at the be...
Source: Western Journal of Emergency Medicine - August 20, 2020 Category: Emergency Medicine Source Type: research

Two-Item Fall Screening Tool Identifies Older Adults at Increased Risk of Falling after Emergency Department Visit
Introduction: Few emergency department (ED)-specific fall-risk screening tools exist. The goals of this study were to externally validate Tiedemann et al ’s two-item, ED-specific fall screening tool and test handgrip strength to determine their ability to predict future falls. We hypothesized that both the two-item fall screening and handgrip strength would identify older adults at increased risk of falling.Methods:A convenience sample of patients ages 65 and older presenting to a single-center academic ED were enrolled. Patients were asked screening questions and had their handgrip strength measured during their ED ...
Source: Western Journal of Emergency Medicine - August 20, 2020 Category: Emergency Medicine Source Type: research

Development and Usability Testing of a Web-based COVID-19 Self-triage Platform
We describe the iterative development and usability testing of such a tool. We hypothesized that adult users could understand and recall the recommendations provided by a COVID-19 web-based, self-triage tool.Methods: We convened a multidisciplinary panel of medical experts at two academic medical schools in an iterative redesign process of a previously validated web-based, epidemic screening tool for the current COVID-19 pandemic. We then conducted a cross-sectional usability study over a 24-hour period among faculty, staff, and students at the two participating universities. Participants were randomly... (Source: Western ...
Source: Western Journal of Emergency Medicine - August 19, 2020 Category: Emergency Medicine Source Type: research

Point-of-care Ultrasound for Intubation Confirmation of COVID-19 Patients
The novel coronavirus disease of 2019 (COVID-19) is associated with significant morbidity and mortality, as well as large numbers of patients requiring endotracheal intubation. While much of the literature has focused on the intubation technique, there is scant discussion of intubation confirmation. Herein, we discuss the limitations of traditional confirmatory approaches, summarize the literature supporting a role for point-of-care ultrasound in this application, and propose an algorithm for intubation confirmation among COVID-19 patients. (Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - August 18, 2020 Category: Emergency Medicine Source Type: research

MIST (Modified Intubating Sequence for Transmissibility) Bundle for Infectious Diseases with Aerosol Hazard
We describe a methodical, 10-step approach from decision-making and meticulous drug and equipment choices to donning of personal protective equipment, and procedural concerns. This bundled approach will help reduce unplanned actions, which in turn may reduce the risk of aerosol transmission during airway management in resource-limited settings. (Source: Western Journal of Emergency Medicine)
Source: Western Journal of Emergency Medicine - August 17, 2020 Category: Emergency Medicine Source Type: research

Homeless Shelter Characteristics and Prevalence of SARS-CoV-2
Introduction: The unfolding COVID-19 pandemic has predictably followed the familiar contours of well established socioeconomic health inequities, exposing and often amplifying preexisting disparities. People living in homeless shelters are at higher risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) compared to the general population. The purpose of this study was to identify shelter characteristics that may be associated with higher transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).Methods:We conducted a cross-sectional assessment of five congregate shelters in R...
Source: Western Journal of Emergency Medicine - August 17, 2020 Category: Emergency Medicine Source Type: research

Streamlining Care in Crisis: Rapid Creation and Implementation of a Digital Support Tool for COVID-19
The unprecedented COVID-19 pandemic has resulted in rapidly evolving best practices for transmission reduction, diagnosis, and treatment. A regular influx of new information has upended traditionally static hospital protocols, adding additional stress and potential for error to an already overextended system. To help equip frontline emergency clinicians with up-to-date protocols throughout the evolving COVID-19 crisis, our team set out to create a dynamic digital tool that centralized and standardized resources from a broad range of platforms across our hospital. Using a design thinking approach, we rapidly built, tested, ...
Source: Western Journal of Emergency Medicine - August 17, 2020 Category: Emergency Medicine Source Type: research