Drivers of ED efficiency: a statistical and cluster analysis of volume, staffing, and operations David Anderson, Laura Pimentel, Bruce Golden, Edward Wasil, Jon Mark Hirshon
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.034
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: October 2 2015
x The percentage of patients leaving before treatment is completed (LBTC) is an important indicator of emergency department performance. The objective of this study is to identify characteristics of hospital operations that correlate with LBTC rates.
ED patient satisfaction: factors associated with satisfaction with care Catherine A. Marco, Andy Davis, Sylvia Chang, Dennis Mann, James E. Olson
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.023
The American Journal of Emergency Medicine , Vol. 33 , Issue 11 ,
Published online: August 17 2015
x Patient satisfaction is associated with improved patient compliance with therapy, reduced malpractice risk, and improved job satisfaction among the emergency department (ED) staff [1]. Previous studies have shown numerous factors to be associated with improved patient satisfaction, including effective pain management, effective communication, timeliness of care, empathy, and technical competence [2-5]. This study was undertaken to measure patient satisfaction among ED patients and to assess the relationship between patient and physician demographic factors and patient satisfaction.
ED operational factors associated with patient satisfaction Molly Goloback, Danielle M. McCarthy, Michael Schmidt, James G. Adams, Peter S. Pang
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.051
The American Journal of Emergency Medicine , Vol. 33 , Issue 1 ,
Published online: October 3 2014
x High patient satisfaction scores are associated with improved patient outcomes [1,2]. As such, patient satisfaction scores have become critical quality benchmarks for hospitals, are publically reported, and are often tied to financial incentives [3–6].
Lack of adverse effects from flumazenil administration: an ED observational study Tammy T. Nguyen, Michelle Troendle, Kirk Cumpston, S. Rutherfoord Rose, Brandon K. Wills
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.031
The American Journal of Emergency Medicine , Vol. 33 , Issue 11 ,
Published online: July 21 2015
x Flumazenil is an effective benzodiazepine (BZD) antagonist. Empiric use of flumazenil in the emergency department (ED) is not widely recommended due to concerns of seizures, which are commonly associated with coingestants and BZD withdrawal.
Freestanding EDs and the Emergency Medicine Resident: A Valuable Part of Resident Education? Kseniya Orlik, Christina M. Campana, Michael S. Beeson, Erin L. Simon
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.081
The American Journal of Emergency Medicine , Vol. 33 , Issue 8 ,
Published online: April 30 2015
x The goal of emergency medicine (EM) residency training is to prepare physicians for independent practice. This includes all practice environments from the tertiary care center to rural emergency departments (EDs) with limited resources. The EM resident must be effectively taught the fundamental skills, knowledge, and humanistic qualities that make up the foundation of EM practice [1,2].
Effective prevention of posttraumatic tattoo using hydrosurgical debridement in the ED Jung Soo Park, Jin Hong Min
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.033
The American Journal of Emergency Medicine , Vol. 34 , Issue 4 ,
Published online: August 18 2015
x Traumatic tattoos can result from the accidental deposition of foreign particles in the dermis. These pigmented particles can become permanently lodged in the dermis after wound re-epithelialization and lead to irregular black or blue skin discoloration. Different methods exist for tattoo removal. The best strategy is to prevent traumatic tattoo formation by immediately removing the foreign particles before the healing process begins. Here, we present a fine-tuned, hydrosurgical debridement system to selectively debride wounds and preserve as much viable tissue as possible.
Care plans reduce ED visits in those with drug-seeking behavior Frederick Fiesseler, Renee Riggs, David Salo, Richard Klemm, Ashley Flannery, Richard Shih
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.038
The American Journal of Emergency Medicine , Vol. 33 , Issue 12 ,
Published online: August 25 2015
x Patients with drug-seeking behavior can be both labor and resource intensive to the emergency department (ED).
Homelessness and ED use: myths and facts- the author's reply Hao Wang, Vicki A. Nejtek, Richard D. Robinson
DOI: http://dx.doi.org/10.1016/j.ajem.2015.10.008
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: October 12 2015
x We would like to thank Dr Doran for the commentary regarding our recent publication, “The role of charity care and primary care physician assignment on ED use in homeless patients” [1]. The primary goal of our study was not to compare homeless patients with the general population, but to compare emergency department (ED) use in a homeless population as a function of whether they received charity care or were assigned to a primary care physician (PCP). Our rationale to conduct this comparison study grew out of our desire to better serve these patients by assigning homeless patients to a PCP rather than have them receive care by a variety of different rotating emergency physicians.
The cost of decontaminating an ED after finding a bed bug: results from a single academic medical center Vicken Totten, Holli Charbonneau, Wyatt Hoch, Samir Shah, Johnathan Michael Sheele
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.020
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: December 14 2015
x The common bed bug, Cimex lectularius L, is a resurgent problem in industrialized nations, including the United States. The US National Electronic Injury Surveillance System–All Injury Program showed that emergency department (ED) visits related to bed bugs rose from 2156 in 2007 to 15
What else could be done for management of cancer patients in ED? Challenges and suggestions (cancer patients and emergency service) Birdal Yıldirim, Emine Nese Yeniçeri, Ozgur Tanrıverdi, Mehmet Ünaldı, Özcan Başaran, Ömer Doğan Alataş, Ethem Acar
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.046
The American Journal of Emergency Medicine , Vol. 33 , Issue 10 ,
Published online: July 28 2015
x Cancer treatment often involves multiple specialties, and a multidisciplinary approach is needed in management of cancer patients through the disease trajectory [1]. Primary care physicians (PCPs) and emergency physicians have the most probability to encounter cancer patients apart from oncologists. Emergency physicians in particular are encountering a growing number of cancer patients, often near the end of life, and their presentation to the ED often involves palliative care.
ED, heal thyself Nora V. Becker, Ari B. Friedman
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.002
The American Journal of Emergency Medicine , Vol. 32 , Issue 2 ,
Published online: November 11 2013
x Emergency department (ED) wait times have continued to worsen despite receiving considerable attention for more than 2 decades and despite the availability of a variety of methods to restructure care in a more streamlined fashion. This article offers an economic framework that abstracts away from the details of operations research to understand the fundamental disincentives to improving wait times. Hospitals that reduce wait times are financially penalized if they must provide more uncompensated care as a result.
Novel use of ultrasound in the ED: ultrasound-guided hematoma block of a proximal humeral fracture Emily Lovallo, Daniel Mantuani, Arun Nagdev
DOI: http://dx.doi.org/10.1016/j.ajem.2014.06.035
The American Journal of Emergency Medicine , Vol. 33 , Issue 1 ,
Published online: July 1 2014
x Proximal humeral fractures are a common injury after falls, particularly in the elderly population. An ultrasound-guided hematoma block is a novel technique for analgesia in cases when standard intravenous analgesia is not efficacious. We present a case in which ultrasound-guided hematoma block was the ideal method for adjunctive pain control in a patient with a comminuted humeral head fracture.
Point-of-care ultrasound in pediatric urolithiasis: an ED case series Amitabh Chandra, Jessica Zerzan, Alexandar Arroyo, Marla Levine, Eitan Dickman, Mark Tessaro
DOI: http://dx.doi.org/10.1016/j.ajem.2015.05.048
The American Journal of Emergency Medicine , Vol. 33 , Issue 10 ,
Published online: June 22 2015
x Urolithiasis is relatively uncommon in the pediatric population, but its incidence is increasing [1,2]. Urinary tract calculi are associated with significant morbidity in the pediatric population: compared to adults, children have a higher need for urologic intervention, more recurrences, and a higher association with chronic kidney disease [3-5].
ED antibiotic use in a developing country B. Armel, K. Berechid, S. Himmich, J. Tadili, A. Kettani, M. Faroudy, A. Azzouzi, A. Benchekroun, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.037
The American Journal of Emergency Medicine , Vol. 32 , Issue 2 ,
Published online: December 9 2013
x Antibiotics are frequently started in emergency departments (EDs). Several studies performed in developed countries evaluated the quality of antibiotic use in these departments [1,2]. No data appraising antimicrobial practice in EDs are available in developing countries. The aims of the study were to evaluate anti-infective treatments initially delivered to patients hospitalized in an ED in Morocco and to define factors impairing the appropriateness of these prescriptions.
Creating ED point-of-care testing protocols: an expert panel and Delphi process Jesse M. Pines, Mark S. Zocchi, Mary-Elizabeth Buchanan, Khaled Alghamdi, Danielle Lazar, Alex Rosenau, Manish Shah, Debbie Travers
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.018
The American Journal of Emergency Medicine , Vol. 33 , Issue 3 ,
Published online: December 18 2014
x In recent years, point-of-care (POC) testing has gained popularity in emergency departments (EDs) to facilitate rapid laboratory test results [1-4]. Despite increasing popularity, few studies have addressed POC use early in ED care, specifically around ED triage. Availability of laboratory testing may help risk-stratify patients by providing additional information early in ED care. In a prospective study, triage POC testing changed patient management in 14% of cases, Emergency Severity Index (ESI) triage level in 15%, and 56% found POC testing to be helpful in the triage process [5].
Point-of-care ultrasonography at the ED maximizes patient confidence in emergency physicians Pierre-Géraud Claret, Xavier Bobbia, Sébastien Le Roux, Yann Bodin, Claire Roger, Rémi Perrin-Bayard, Laurent Muller, Jean Emmanuel de La Coussaye
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.042
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: December 21 2015
x Point-of-care ultrasonography (POCUS) performed by emergency physicians (EPs) has become routine practice in emergency departments (EDs) [1] and is a required component of residency training in emergency medicine [2,3]. Previous studies about POCUS have largely focused on its accuracy, safety, efficiency, effect on outcomes, and optimal clinical use [4–10]. What has been less investigated in the literature is patient confidence in the clinician who performs the POCUS and patient feelings, or satisfaction, regarding POCUS.
ED intensivists and ED intensive care units Scott D. Weingart, Robert L. Sherwin, Lillian L. Emlet, Isaac Tawil, Julie Mayglothling, Jon C. Rittenberger
DOI: http://dx.doi.org/10.1016/j.ajem.2012.10.015
The American Journal of Emergency Medicine , Vol. 31 , Issue 3 ,
Published online: February 4 2013
x In recent years, a group of emergency physicians (EPs) have chosen to pursue fellowship training in critical care. With this training, an EP can practice in inpatient critical care units. However, another role is open to these practitioners as well: the role of the emergency department (ED) intensivist (EDI) [1]. Some EDs have formed units capable of providing aggressive critical care during the patient's ED stay. These ED intensive care units (EDICUs) allow critical care to be provided to the patient regardless of the availability of an intensive care unit (ICU) bed.
Evaluation of ED patient and visitor understanding of living wills and do-not-resuscitate orders Mary Colleen Bhalla, Michael U. Ruhlin, Jennifer A. Frey, Scott T. Wilber
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.030
The American Journal of Emergency Medicine , Vol. 33 , Issue 3 ,
Published online: October 25 2014
x Since the implementation of the Patient Self Determination Act of 1990, every patient that comes to the hospital must be asked about their advanced directive status and be provided with information about different options [1]. There are currently 2 types of do-not-resuscitate (DNR) orders in Ohio: “DNR Comfort Care (CCO)” and “DNR Comfort Care Arrest (CCA)” [2]. The DNR orders are separate from any “living will” that the patient may elect to draft for the purpose of withdrawing or withholding care in case they are ever in a permanently unconscious state [3].
Streptococcus gallolyticus (bovis ): a rare presentation of meningitis in the EDJoshua D. Gray, Christopher J. Wilson
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.055
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: June 22 2015
x Bacterial meningitis is a fairly common and often deadly manifestation of altered mental status in the elderly, carrying a mortality rate of greater than 20% despite antibiotic therapy [1]. Most commonly caused by Streptococcus pneumoniae , Listeria monocytogenes , Escherichia coli , and Klebsiella pneumoniae . We present a case of meningitis caused by Streptococcus gallolyticus in an elderly, otherwise healthy woman. There have been no reports in the emergency medicine literature and only a few reports in the literature of S gallolyticus as a cause of altered mental status and meningitis, specifically of immunocompetent patients.
A comparison of ED and direct admission care of cancer patients with febrile neutropenia Diwura K. Owolabi, Richard Rowland, Lauren King, Rick Miller, Gajanan G. Hegde, Jennifer Shang, John Lister, Arvind Venkat
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.028
The American Journal of Emergency Medicine , Vol. 33 , Issue 7 ,
Published online: April 23 2015
x We compared the quality of care in admitted febrile neutropenic cancer patients presenting through the emergency department (ED) vs those directly admitted (DA) from the clinic or infusion center. We hypothesized that the quality of care would be comparable between these 2 pathways.
