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    1 OF 107

    Syncope Prognosis Based on Emergency Department Diagnosis: A Prospective Cohort Study.
    Acad Emerg Med 2017 Nov 14. Epub 2017 Nov 14.
    Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.
    Objective: Relatively little is known about outcomes after disposition among syncope patients assigned various diagnostic categories during emergency department (ED) evaluation. We sought to measure the outcomes among these groups within 30 days of the initial ED visit.

    Methods: We prospectively enrolled adult syncope patients at six EDs and excluded patients with pre-syncope, persistent mental status changes, intoxication, seizure, and major trauma. Read More

    A risk assessment score and initial high-sensitivity troponin combine to identify low-risk of acute myocardial infarction in the emergency department.
    Acad Emerg Med 2017 Nov 13. Epub 2017 Nov 13.
    Emergency Department, Christchurch Hospital, Christchurch, NZ.
    Objectives: Early discharge of patients with presentations triggering assessment for possible acute coronary syndrome is safe when clinical assessment indicates low-risk, biomarkers are negative, and electrocardiograms (ECGs) are non-ischemic. We hypothesized that the Emergency Department Assessment of Chest Pain Score (EDACS) combined with a single measurement of high-sensitivity cardiac troponin (hs-cTn) could allow early discharge of a clinically meaningful proportion of patients.

    Methods: We pooled data from 4 patient cohorts from New Zealand and Australia presenting to an ED with symptoms suggestive of ACS. Read More

    Topical Tranexamic Acid Compared With Anterior Nasal Packing for Treatment of Epistaxis in Patients Taking Antiplatelet Drugs: Randomized Controlled Trial.
    Acad Emerg Med 2017 Nov 10. Epub 2017 Nov 10.
    Emergency Medicine Research Center, Department of Emergency Medicine, Shariati Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
    Objective: We evaluated the efficacy of topical application of the injectable form of tranexamic acid (TXA) compared with anterior nasal packing (ANP) for the treatment of epistaxis in patients taking antiplatelet drugs (Aspirin, Clopidegrol or both) who presented to the emergency department (ED).

    Methods: A randomized, parallel group clinical trial was conducted at 2 EDs. A total of 124 participants were randomized to receive topical TXA (500 mg in 5 ml) or ANP, 62 patients per group. Read More

    Comparing state-wide and single-center data to predict high-frequency emergency department utilization among patients with asthma exacerbation.
    Acad Emerg Med 2017 Nov 4. Epub 2017 Nov 4.
    Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA.
    Background: Previous studies examining high-frequency ED utilization have primarily used single-center data, potentially leading to ascertainment bias if patients visit multiple centers. The goals of this study were (1) to create a predictive model to prospectively identify patients at risk of high-frequency ED utilization for asthma, and (2) to examine how that model differed using state-wide versus single-center data.

    Methods: To track ED visits within a state, we analyzed 2011-2013 data from the New York State Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases (SEDD). Read More

    Early Recurrence of First Unprovoked Seizures in Children.
    Acad Emerg Med 2017 Nov 4. Epub 2017 Nov 4.
    Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York.
    Objectives: The risk of early seizure recurrences after first unprovoked seizures in children is largely unknown. We aimed to determine the rate of seizure recurrence within 14 days of first, unprovoked seizures in children and identify associated risk factors. Secondarily, we aimed to determine the risk of recurrence at 48 hours and 4 months. Read More

    Training and Assessing Critical Airway, Breathing and Hemorrhage Control Procedures for Trauma Care: Live Tissue versus Synthetic Models.
    Acad Emerg Med 2017 Oct 27. Epub 2017 Oct 27.
    Department of Urologic Surgery, University of Washington.
    Introduction: Optimal teaching and assessment methods and models for emergency airway, breathing and hemorrhage interventions are not currently known. The University of Minnesota Combat Casualty Training consortium (UMN CCTC) was formed to explore the strengths and weaknesses of synthetic training models (STMs) versus Live tissue (LT) models. In this study, we compare the effectiveness of best in class STMs versus an anesthetized caprine (goat) model for training and assessing 7 procedures: Junctional hemorrhage control, Tourniquet (TQ) placement, Chest seal, Needle thoracostomy (NCD), Nasopharyngeal airway (NPA), Tube thoracostomy, and Cricothyrotomy (Cric). Read More

    Disseminating and Sustaining Emergency Department Innovations for Older Adults: Good Ideas Deserve Better Policies.
    Acad Emerg Med 2017 Oct 27. Epub 2017 Oct 27.
    Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
    Older adults often visit the emergency department (ED) with chief complaints that understate or detract from their true complex health care needs. These needs are frequently missed because addressing them requires a time-consuming effort that is antithetical to the (necessarily) rapid, complaint-specific protocols of the ED. Key ED performance indices (e. Read More

    Air Ambulance Delivery and Administration of Four-factor Prothrombin Complex Concentrate Is Feasible and Decreases Time to Anticoagulation Reversal.
    Acad Emerg Med 2017 Oct 27. Epub 2017 Oct 27.
    Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS.
    Objectives: The objective was to evaluate the feasibility, safety, and preliminary efficacy of four-factor prothrombin complex concentrate (4-factor PCC) administration by an air ambulance service prior to or during transfer of patients with warfarin-associated major hemorrhage to a tertiary care center for definitive management (interventional arm) compared to patients receiving 4-factor PCC following transfer by air ambulance or ground without 4-factor PCC treatment (conventional arm).

    Methods: This was a retrospective chart review of patients presenting to a large academic medical center. All patients presenting to the emergency department (ED) treated with 4-factor PCC from April 1, 2014, through June 30, 2016, were identified. Read More

    Contributions of Academic Emergency Medicine Programs to U.S. Health Care: Summary of the AAAEM-AACEM Benchmarking Data.
    Acad Emerg Med 2017 Oct 26. Epub 2017 Oct 26.
    Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA.
    Objectives: The societal contribution of emergency care in the United States has been described. The role and impact of academic emergency departments (EDs) has been less clear. Our report summarizes the results of a benchmarking effort specifically focused on academic emergency medicine (EM) practices. Read More

    Communicating Value in Simulation: Cost Benefit Analysis and Return on Investment.
    Acad Emerg Med 2017 Oct 26. Epub 2017 Oct 26.
    Emergency Medicine University of Central Florida College of Medicine National Medical Director, SimLEARN Veteran Health Administration, 13800 Veterans Way, Building 13 Orlando, Florida, 32832.
    Value-based health care requires a balancing of medical outcomes with economic value. Administrators need to understand both the clinical and economic effects of potentially expensive simulation programs to rationalize the costs. Given the often-disparate priorities of clinical educators relative to health care administrators, justifying the value of simulation requires the use of economic analyses few physicians have been trained to conduct. Read More

    Hot Off the Press: Prehospital Advanced Cardiac Life Support for Out-of-hospital Cardiac Arrest.
    Acad Emerg Med 2017 Oct 16. Epub 2017 Oct 16.
    University of Western Ontario, Goderich, Ontario, Canada.
    This retrospective cohort study examined the rate of survival to hospital discharge among adult patients with out-of-hospital cardiac arrest, comparing patients who received care only from basic cardiac life support (BCLS)-trained emergency medical service (EMS) crews to patients who had an advanced cardiac life support (ACLS)-trained EMS crew on scene at some point during the resuscitation. There was no difference in the primary outcome of rate of survival to hospital discharge (10.9% with ACLS care and 10. Read More

    Peripheral Intravenous Cannula Insertion and Use in the Emergency Department; an Intervention Study.
    Acad Emerg Med 2017 Oct 16. Epub 2017 Oct 16.
    Department of Emergency Medicine, Royal Brisbane and Women's Hospital.
    Objectives: To examine cannulation practice and effectiveness of a multi-modal intervention to reduce peripheral intravenous cannula (PIVC) insertion in emergency department (ED) patients.

    Methods: A prospective before and after study and cost analysis was conducted at a single tertiary ED in Australia. Data were collected 24 hours a day for two weeks pre- and post-implementation of a multi-modal intervention. Read More

    Fluid Resuscitation in Patients With Severe Burns: A Meta-analysis of Randomized Controlled Trials.
    Acad Emerg Med 2017 Oct 11. Epub 2017 Oct 11.
    Center for Evidence-Based Health Care, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.
    Objectives: Fluid resuscitation is the mainstay treatment to reconstitute intravascular volume and maintain end-organ perfusion in patients with severe burns. The use of a hyperosmotic or isoosmotic solution in fluid resuscitation to manage myocardial depression and increased capillary permeability during burn shock has been debated. We conducted a systematic review and meta-analysis to compare the efficacies of hyperosmotic and isoosmotic solutions in restoring hemodynamic stability after burn injuries. Read More

    Behavioral Changes in Children After Emergency Department Procedural Sedation.
    Acad Emerg Med 2017 Oct 9. Epub 2017 Oct 9.
    Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.
    Objective: The purpose of this study was to determine the proportion of children undergoing procedural sedation for fracture reduction in the emergency department (ED) observed to experience negative postdischarge behaviors. Predictors of negative behaviors were evaluated, including anxiety.

    Methods: This was a prospective cohort study of children receiving intravenous ketamine sedation for ED fracture reduction. Read More

    What's Next for Acute Heart Failure Research?
    Acad Emerg Med 2017 Oct 9. Epub 2017 Oct 9.
    Division of Cardiology, Stony Brook University Medical Center, Stony Brook, NY.
    Each year over one million patients with acute heart failure (AHF) present to a United States emergency department (ED). The vast majority are hospitalized for further management. The length of stay and high postdischarge event rate in this cohort have changed little over the past decade. Read More

    Excited Delirium: A Systematic Review.
    Acad Emerg Med 2017 Oct 9. Epub 2017 Oct 9.
    Emergency Department, Lausanne University Hospital CHUV, CH-1011, Lausanne, Switzerland.
    Study Objective: We aimed to clarify the definition, epidemiology, and pathophysiology of excited delirium syndrome (ExDS) and to summarize evidence-based treatment recommendations.

    Methods: We conducted a systematic literature search of MEDLINE, Ovid, Web of Knowledge, and Cochrane Library for articles published to March 18, 2017. We also searched the grey literature (Google Scholar) and official police or medical expert reports to complete specific epidemiological data. Read More


    A Collaborative In Situ Simulation-based Pediatric Readiness Improvement Program for Community Emergency Departments.
    Acad Emerg Med 2017 Oct 4. Epub 2017 Oct 4.
    Division of Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, CT.
    Background: More than 30 million children are cared for across 5,000 U.S. emergency departments (EDs) each year. Read More

    An Emergency Department Observation Unit is a feasible setting for Multidisciplinary Geriatric Assessments in compliance with the Geriatric Emergency Department Guidelines.
    Acad Emerg Med 2017 Oct 4. Epub 2017 Oct 4.
    Department of Emergency Medicine, The Ohio State University, Columbus, OH, USA.
    Background: The Geriatric Emergency Department Guidelines recommend providing multidisciplinary geriatric assessment in the Emergency Department (ED), but these assessments can be difficult to coordinate and may prolong length of stay. Patients who need longer than a typical ED stay can be placed in an ED Observation Unit (Obs Unit). We investigated the effects of offering multidisciplinary assessments for ED patients in an Obs Unit. Read More

    Communicating Value in Simulation: Cost Benefit Analysis and Return on Investment.
    Acad Emerg Med 2017 Oct 1. Epub 2017 Oct 1.
    University of Central Florida College of Medicine, National Medical Director, SimLEARN, Veteran Health Administration, 13800 Veterans Way, Building 13, Orlando, Florida, 32832.
    Value-based health care requires a balancing of medical outcomes with economic value. Administrators need to understand both the clinical and economic effects of potentially expensive simulation programs to rationalize the costs. Given the often-disparate priorities of clinical educators relative to health care administrators, justifying the value of simulation requires the use of economic analyses few physicians have been trained to conduct. Read More

    Simulation-based Education to Ensure Provider Competency Within the Health Care System.
    Acad Emerg Med 2017 Sep 30. Epub 2017 Sep 30.
    MGH Learning Laboratory and Division of Medical Simulation, Department of Emergency Medicine, Massachusetts General Hospital, and the Gilbert Program in Medical Simulation, Harvard Medical School, Boston, MA.
    The acquisition and maintenance of individual competency is a critical component of effective emergency care systems. This article summarizes consensus working group deliberations and recommendations focusing on the topic "Simulation-based education to ensure provider competency within the healthcare system." The authors presented this work for discussion and feedback at the 2017 Academic Emergency Medicine Consensus Conference on "Catalyzing System Change Through Healthcare Simulation: Systems, Competency, and Outcomes," held on May 16, 2017, in Orlando, Florida. Read More

    Point-of-care Cognitive Support Technology in Emergency Departments: A Scoping Review of Technology Acceptance by Clinicians.
    Acad Emerg Med 2017 Sep 28. Epub 2017 Sep 28.
    Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
    Objective: Cognitive support technologies that support clinical decisions and practices in the emergency department (ED) have the potential to optimize patient care. However, limited uptake by clinicians can prevent successful implementation. A better understanding of acceptance of these technologies from the clinician perspective is needed. Read More

    Return Visit Admissions May Not Indicate Quality of Emergency Department Care for Children.
    Acad Emerg Med 2017 Sep 27. Epub 2017 Sep 27.
    Division of Emergency Medicine, University of Washington, Harborview Medical Center, Seattle, WA.
    Objective: The objective was to test the hypothesis that in-hospital outcomes are worse among children admitted during a return ED visit than among those admitted during an index ED visit.

    Methods: This was a retrospective analysis of ED visits by children age 0 to 17 to hospitals in Florida and New York in 2013. Children hospitalized during an ED return visit within 7 days were classified as "ED return admissions" (discharged at ED index visit and admitted at return visit) or "readmissions" (admission at both ED index and return visits). Read More

    Ideal Cricoid Pressure Is Biomechanically Impossible During Laryngoscopy.
    Acad Emerg Med 2017 Sep 28. Epub 2017 Sep 28.
    Pathology North, Tamworth Rural Referral Hospital, Tamworth, NSW, Australia.
    Objective: This study was a prospective, randomized controlled trial of rapid sequence intubation (RSI) with cricoid pressure (CP) within the emergency department (ED). The primary aim of the study was to examine the link between ideal CP and the incidence of aspiration.

    Method: Patients > 18 years of age undergoing RSI in the ED of two hospitals in New South Wales, Australia, were randomly assigned to receive measured CP using weighing scales to target the ideal CP range (3. Read More

    Alternative Markers of Performance in Simulation: Where We Are and Where We Need To Go.
    Acad Emerg Med 2017 Sep 26. Epub 2017 Sep 26.
    Department of Emergency Medicine, University of Michigan, Ann Arbor, MI.
    This article on alternative markers of performance in simulation is the product of a session held during the 2017 Academic Emergency Medicine Consensus Conference "Catalyzing System Change Through Health Care Simulation: Systems, Competency, and Outcomes." There is a dearth of research on the use of performance markers other than checklists, holistic ratings, and behaviorally anchored rating scales in the simulation environment. Through literature review, group discussion, and consultation with experts prior to the conference, the working group defined five topics for discussion: 1) establishing a working definition for alternative markers of performance, 2) defining goals for using alternative performance markers, 3) implications for measurement when using alternative markers, identifying practical concerns related to the use of alternative performance markers, and 5) identifying potential for alternative markers of performance to validate simulation scenarios. Read More

    Measuring Emergency Department Patient Population Acuity.
    Acad Emerg Med 2017 Sep 23. Epub 2017 Sep 23.
    Brigham and Women's Hospital, Harvard University, Department of Emergency Medicine, Boston, MA, USA.
    Background: Emergency department (ED) acuity is the general level of patient illness, urgency for clinical intervention, and intensity of resource use in an ED environment. The relative strength of commonly used measures of ED acuity is not well understood.

    Methods: We performed a retrospective cross-sectional analysis of ED-level data to evaluate the relative strength of association between commonly used proxy measures with a full spectrum measure of ED acuity. Read More

    Randomized Controlled Feasibility Trial of Intranasal Ketamine Compared to Intranasal Fentanyl for Analgesia in Children with Suspected Extremity Fractures.
    Acad Emerg Med 2017 Sep 19. Epub 2017 Sep 19.
    Department of Emergency Medicine, Carolinas Medical Center.
    Objectives: We compared the tolerability and efficacy of intranasal subdissociative ketamine to intranasal fentanyl for analgesia of children with acute traumatic pain and investigated the feasibility of a larger noninferiority trial that could investigate the potential opioid-sparing effects of intranasal ketamine.

    Methods: This randomized controlled trial compared 1 mg/kg intranasal ketamine to 1.5 μg/kg intranasal fentanyl in children 4 to 17 years old with acute pain from suspected isolated extremity fractures presenting to an urban Level II pediatric trauma center from December 2015 to November 2016. Read More

    Lessons Learned From the Development and Parameterization of a Computer Simulation Model to Evaluate Task Modification for Health Care Providers.
    Acad Emerg Med 2017 Sep 19. Epub 2017 Sep 19.
    Department of Emergency Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH.
    Computer simulation is a highly advantageous method for understanding and improving health care operations with a wide variety of possible applications. Most computer simulation studies in emergency medicine have sought to improve allocation of resources to meet demand or to assess the impact of hospital and other system policies on emergency department (ED) throughput. These models have enabled essential discoveries that can be used to improve the general structure and functioning of EDs. Read More

    Human Factors and Simulation in Emergency Medicine.
    Acad Emerg Med 2017 Sep 19. Epub 2017 Sep 19.
    Department of Psychology, Old Dominion University, Norfolk, VA.
    This consensus group from the 2017 Academic Emergency Medicine Consensus Conference "Catalyzing System Change through Health Care Simulation: Systems, Competency, and Outcomes" held in Orlando, Florida, on May 16, 2017, focused on the use of human factors (HF) and simulation in the field of emergency medicine (EM). The HF discipline is often underutilized within EM but has significant potential in improving the interface between technologies and individuals in the field. The discussion explored the domain of HF, its benefits in medicine, how simulation can be a catalyst for HF work in EM, and how EM can collaborate with HF professionals to effect change. Read More

    Implementation and preliminary clinical outcomes of a pharmacist-managed venous thromboembolism clinic for patients treated with rivaroxaban post emergency department discharge.
    Acad Emerg Med 2017 Sep 16. Epub 2017 Sep 16.
    Clinical Services Clinical Pharmacy Specialist - Burn Intensive Care Unit.
    Objective: To describe the implementation, work flow, and differences in outcomes between a pharmacist-managed clinic for the outpatient treatment of venous thromboembolism (VTE) using rivaroxaban versus care by a primary care provider.

    Interventions: Patients in the studied health system that are diagnosed with low-risk VTE in the emergency department are often discharged without hospital admission. These patients are treated with rivaroxban and follow up either in a pharmacist-managed VTE clinic or with their primary care provider. Read More

    Interobserver Agreement in Pediatric Cervical Spine Injury Assessment Between Prehospital and Emergency Department Providers.
    Acad Emerg Med 2017 Sep 18. Epub 2017 Sep 18.
    Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH.
    Background: Investigators have derived cervical spine injury (CSI) decision support tools from physician observations. There is a need to demonstrate that prehospital emergency medical services (EMS) providers can use these tools to appropriately determine the need for spinal motion restrictions and make field disposition decisions.

    Objectives: The objective was to determine the interobserver agreement between EMS and emergency department (ED) providers for CSI risk assessment variables and overall gestalt for CSI in children after blunt trauma. Read More

    Hot off the Press: Embedded Clinical Decision Support in Electronic Health Record Decreases Use of High-cost Imaging in the Emergency Department: EmbED Study.
    Acad Emerg Med 2017 Sep 15. Epub 2017 Sep 15.
    University of Western Ontario, Goderich, Ontario, Canada.
    This longitudinal before/after study of embedded clinical decision rules assessed the effects of clinical decision support on use of common imaging studies. Among high users, rates of computed tomograhy (CT) scan of the brain and CT of the cervical spine were reduced after implementation of embedded clinical decision instruments, while in low users, rates increased. This article summarizes the manuscript and the Skeptics Guide to Emergency Medicine podcast, as well as the ensuing social media/online discussion. Read More

    Improved Survival for Rural Trauma Patients Transported by Helicopter to a Verified Trauma Center: A Propensity Score Analysis.
    Acad Emerg Med 2017 Sep 12. Epub 2017 Sep 12.
    Department of Anesthesiology and the Program in Trauma, R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD.
    Objectives: Recent studies using advanced statistical methods to control for confounders have demonstrated an association between helicopter transport (HT) versus ground ambulance transport (GT) in terms of improved survival for adult trauma patients. The aim of this study was to apply a methodologically vigorous approach to determine if HT is associated with a survival benefit for when trauma patients are transported to a verified trauma center in a rural setting.

    Methods: The ascertainment of trauma patients age ≥ 15 years (n = 469 cases) by HT and (n = 580 cases) by GT between 1999 and 2012 was restricted to the scene of injury in a rural area of 10 to 35 miles from the trauma center. Read More

    Prehospital Supraglottic Airway Was Associated With Good Neurologic Outcome in Cardiac Arrest Victims Especially Those Who Received Prolonged Cardiopulmonary Resuscitation.
    Acad Emerg Med 2017 Sep 12. Epub 2017 Sep 12.
    Department of Emergency Medicine, Kangwon National University Hospital, Chuncheon-si, Gangwon-do, Republic of Korea.
    Objectives: We performed this study to investigate the association of prehospital supraglottic airway (SGA) on neurologic outcome in cardiac arrest victims with adjustment of postresuscitation variables as well as prehospital and resuscitation variables.

    Methods: This study was a retrospective study based on a multicenter prospective cohort registry from December 2013 to April 2016. According to the 28-day cerebral performance categories (CPCs) scale, patients were divided into the good-outcome group (CPC 1-2) and the poor-outcome group (CPC 3-5). Read More

    Using Virtual Reality Simulation Environments to Assess Competence for Emergency Medicine Learners.
    Acad Emerg Med 2017 Sep 9. Epub 2017 Sep 9.
    OSF Healthcare, Jump Simulation, Peoria, IL.
    Immersive learning environments that use virtual simulation (VS) technology are increasingly relevant as medical learners train in an environment of restricted clinical training hours and a heightened focus on patient safety. We conducted a consensus process with a breakout group of the 2017 Academic Emergency Medicine Consensus Conference "Catalyzing System Change Through Health Care Simulation: Systems, Competency, and Outcomes." This group examined the current uses of VS in training and assessment, including limitations and challenges in implementing VS into medical education curricula. Read More

    A Decision Instrument to Identify Isolated Traumatic Subdural Hematomas at Low Risk of Neurologic Deterioration, Surgical Intervention, or Radiographic Worsening.
    Acad Emerg Med 2017 Nov 23;24(11):1377-1386. Epub 2017 Oct 23.
    Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA.
    Objectives: Subdural hematoma (SDH) is the most common form of traumatic intracranial hemorrhage. Severity of disease in patients with SDH varies widely. It was hypothesized that a decision rule could identify patients with SDH who are at very low risk for neurologic decline, neurosurgical intervention, or radiographic worsening. Read More

    Patients Visiting Multiple Emergency Departments: Patterns, Costs, and Risk Factors.
    Acad Emerg Med 2017 Nov 23;24(11):1349-1357. Epub 2017 Oct 23.
    Division of Emergency Medicine, Boston Children's Hospital, Boston, MA.
    Objectives: We sought to characterize the population of patients seeking care at multiple emergency departments (EDs) and to quantify the proportion of all ED visits and costs accounted for by these patients.

    Methods: We performed a retrospective, cohort study of deidentified insurance claims for privately insured patients with one of more ED visits between 2010 and 2016. We measured the number of EDs visited by each patient and determined the overall proportion of all ED visits and ED costs accounted for by patients who visit multiple EDs. Read More

    Critical Appraisal of Emergency Medicine Educational Research: The Best Publications of 2015.
    Acad Emerg Med 2017 Oct;24(10):1212-1225
    Oregon Health & Science University, Portland, OR.
    Objective: The objectives were to critically appraise the medical education research literature of 2015 and review the highest-quality quantitative and qualitative examples.

    Methods: A total of 434 emergency medicine (EM)-related articles were discovered upon a search of ERIC, PsychINFO, PubMED, and SCOPUS. These were both quantitative and qualitative in nature. Read More

    Rate Control With Beta-blockers Versus Calcium Channel Blockers in the Emergency Setting: Predictors of Medication Class Choice and Associated Hospitalization.
    Acad Emerg Med 2017 Nov;24(11):1334-1348
    Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
    Objectives: Rate control is an important component of the management of patients with atrial fibrillation (AF). Previous studies of emergency department (ED) rate control have been limited by relatively small sample sizes. We examined the use of beta-blockers (BBs) versus nondihydropyridine calcium channel blockers (CCBs) in ED patients from 24 sites and the associated hospital admission rates. Read More

    The 2017 Academic Emergency Medicine Consensus Conference: Catalyzing System Change Through Healthcare Simulation: Systems, Competency, and Outcomes.
    Acad Emerg Med 2017 Aug 29. Epub 2017 Aug 29.
    Division of Emergency Medicine, University of Washington, Seattle, WA.
    Over the past decade, emergency medicine (EM) took a lead role in healthcare simulation in part due to its demands for successful interprofessional and multidisciplinary collaboration, along with educational needs in a diverse array of cognitive and procedural skills. Simulation-based methodologies have the capacity to support training and research platforms that model micro-, meso-, and macrosystems of healthcare. To fully capitalize on the potential of simulation-based research to improve emergency healthcare delivery will require the application of rigorous methods from engineering, social science, and basic science disciplines. Read More

    "What Do People Do If They Don't Have Insurance?": ED-to-ED Referrals.
    Acad Emerg Med 2017 Aug 28. Epub 2017 Aug 28.
    The Office of Population Health Management, Northwell Health/Hofstra Medical School, Great Neck, NY.
    Objective: Up to 20% of patients seen in public emergency departments (EDs) have already been seen for the same complaint at another ED, but little is known about the origin or impact of these duplicate ED visits. The goals of this investigation were to explore 1) whether patients making a repeat ED visit are self-referred or indirectly referred from the other ED and 2) gather the perspective of affected patients on the health, social, and financial consequences of these duplicate ED visits.

    Methods: This mixed-methods study conducted over a 10-week period during 2016 in a large public hospital ED in Texas prospectively surveyed patients seen in another ED for the same chief complaint. Read More

    Mannequin-based Telesimulation: Increasing Access to Simulation-based Education.
    Acad Emerg Med 2017 Aug 28. Epub 2017 Aug 28.
    MGH Learning Laboratory, Massachusetts General Hospital, Boston, MA.
    A telesimulation platform utilizes communications technology to provide mannequin-based simulation education between learners and instructors located remotely from one another. Specifically, the instructor controls the mannequin and moderates the debriefing remotely. During these sessions, the instructor observes the learners in real time and provides immediate feedback during the debriefing. Read More

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