AEMEarlyAccess's podcast: Recent Episodes
Brown University Emergency Medicine, Academic Emergency Medicine/SAEM
This is a collaboration between the editors of Academic Emergency Medicine and the Brown University Emergency Medicine Residency Program. Each podcast offers a pre-publication look at a chosen article, with an interview with its corresponding author. Visit www.brownemblog.com (AEM Early Access section) to find the links to each article and other related educational materials.
AEM E&T Podcast host Resa E. Lewiss, MD, interviews author Matthew E. Kelleher, MD, MEd.
Dr. John Dickens talks with Dr. Lance Becker about effective strategies for maintaining a strong and cohesive department culture, how mentors have shaped his leadership style, exciting research surrounding mitochondrial transplantation, and more.
Failure rate of D-dimer testing in patients with high clinical probability of pulmonary embolism: Ancillary analysis of three European studies by SAEM
Dr. Daniel Jose Artiga talks with Dr. Michael Brown about cultivating meaning in different phases of your career, the benefits of joining national emergency medicine organizations, the value in having mentors and being a mentor, and more.
“Ardor and diligence”: Quantifying the faculty effort needed in emergency medicine graduate medical education by SAEM
Study of pediatric appendicitis scores and management strategies: A prospective observational feasibility study by SAEM
Low-dose ketamine as an adjunct to morphine: A randomized controlled trial among patients with and without current opioid use by SAEM
Paths to learning: How residents navigate transience in supervisory relationships in the emergency department by SAEM
Decoding competitiveness: Exploring how EM faculty interpret standardized letters of evaluation by SAEM
Headpulse measurement can reliably ID LVO stroke in prehospital suspected stroke patients by SAEM
Full-dose challenge of moderate, severe, and unknown beta-lactam allergies in the ED by SAEM
Funding for this initiative was made possible (in part) by grant no. 1H79TI086770 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.
Patient perceptions of behavioral flags in the emergency department: A qualitative analysis by SAEM
Alcohol use disorder and cannabinoid hyperemesis syndrome management in the emergency department by SAEM
Efficacy & Safety of US-guided ESP Block vs. Sham in Adults with Rib Fractures in ED by SAEM
Mortality in adolescents and young adults following a first presentation to the ED for alcohol by SAEM
The sonographic protocol for the emergent evaluation of aortic dissections (SPEED protocol) by SAEM
Correlation of vital sign centiles with in-hospital outcomes among adults encountered by EMS by SAEM
Christopher McDowell, MD, MBA, MEd, Southern Illinois University School of Medicine by SAEM
In this study, the authors first sought to empirically derive centiles for heart rate (HR), respiratory rate (RR), and systolic blood pressure (SBP) for adults with out-of-hospital emergencies who were transported to an ED. Second, they aimed to evaluate the impact of adjusting for age in the evaluation of centile curves for vital signs to identify practical targets for adjustment of vital signs classification in adult patients based on age categories. Third, they examined the association of both unadjusted and age-adjusted vital signs with hospital admission and in-hospital mortality.
Timely reperfusion is necessary to reduce morbidity and mortality in patients with ST-elevation myocardial infarction (STEMI). Initial care by facilities with percutaneous coronary intervention (PCI) capabilities reduces time to reperfusion. The authors sought to examine whether insurance status was associated with initial care at EDs with PCI capabilities amongst adult patients with STEMI.
Dr. Sally Santen and Dr. Martin Pusic discuss their team's new commentary and perspective piece in AEM Education and Training entitled, "Our responsibility to patients: Maintain competency or ... stop practicing."
The use of generative artificial intelligence (AI) tools, such as ChatGPT, are gaining popularity for a variety of academic writing tasks and offer an innovative solution to relieve the burden of letter writing. The authors conducted a study aimed at determining whether academic physicians can distinguish between AI and human-generated letters of recommendation.
In the podcast the author references a gendered language calculator, which can be found here:
https://slowe.github.io/genderbias/
Conversations about code status in seriously ill patients at end of life is unfortunately a frequent event in the emergency department. Today we are discussing a paper in AEM entitled The differences in code status conversation approaches reported by emergency medicine and palliative care clinicians: a mixed method study. Lead author Dr. Kei Ouchi is here to discuss it with us.
We discuss this new article, A Qualitative Analysis of Patients’ Experiences with an ED Diagnosis of GI Cancer, with senior author Dr. Haejin In.
Today we are speaking to senior author Dr. Dmitri Papanagnou about his team’s new paper in AEM Education and Training entitled Making decisions “in the dark”: Learning through uncertainty in clinical practice during Covid-19.
Patients with (LEP) have been shown to experience disparities in (ED) care. The objectives of this study were to examine the LEP and irregular ED departures and return ED visits. We interview senior author Dr. Derick Jones about this new AEM paper.
Emergency care workforce concerns have gained national prominence given recent data suggesting higher than previously estimated attrition. With little known regarding characteristics of physicians leaving the workforce, this paper sought to investigate the age and number of years since residency graduation at which male and female EM physicians exhibited workforce attrition. We speak with primary author Dr. Cameron Gettel.
General emergency physicians provide most pediatric emergency care in the United States yet report more challenges managing emergencies in children than adults. Recommendations for standardized pediatric emergency medicine (PEM) curricula to address educational gaps due to variations in pediatric exposure during emergency medicine (EM) training lack learner input. This study surveyed senior EM residents and recent graduates about their perceived preparedness to manage pedi- atric emergencies to better inform PEM curricula design.
Dr. Pensa interviews author Dr. Michelle Suh about her teams recent E&T publication, “I’d rather see action”: Application and recruitment experiences of underrepresented in emergency medicine trainees."
Amiodarone and lidocaine have not been shown to have a clear survival benefit
compared to placebo for out-of-hospital cardiac arrest (OHCA). However, randomized trials may have been impacted by delayed administration of the study drugs. Today we’re talking with Dr. Joshua Lupton, first author on a new AEM paper entitled “ Survival by Time-to-Administration of Amiodarone, Lidocaine, or Placebo in Shock-Refractory Out-of-Hospital Cardiac Arrest.”
Demographic differences in opioid prescribing by patient race and ethnicity have been widely reported; Black and Hispanic patients receive lower rates and dosages of opioid prescriptions for the same conditions and reported pain level as white patients. At the same time, higher dosage opioid prescriptions have been associated with higher rates of new long-term opioid use and high-risk use, and opioid stewardship is being increasingly emphasized. Today we’re talking aout a new study in this area with lead author Aidan Crowley: Disparities in Emergency Department and Urgent Care Opioid Prescribing Before and After Randomized Clinician Feedback Interventions.
We speak with lead author Dr. Murdoc Leeies about his team's new AEM paper, "Equity-Relevant Sociodemographic Variable Collection in Emergency Medicine: A Systematic Review, Qualitative Evidence Synthesis & Recommendations for Practice."
Delirium, altered mental status or confusion among older adults are common presentations to the emergency department (ED). We discuss this new AEM paper with author Dr. Shan Liu, whose team aimed to report the proportion of older ED patients presenting with delirium who have acute abnormal findings on head imaging. We also assessed whether anticoagulation, neurological deficits, trauma or headache were associated with head imaging abnormalities in these patients.
Dr. Pensa and author Summer Ghaith discuss her team's new research in AEM entitled "Dizziness as a Missed Symptom of Central Nervous System Pathology: A Review of Malpractice Cases."
Dr. Jaime Jordan joins the podcast to discuss her team's new AEM Education and Training paper, "Development of a lecture evaluation tool rooted in cognitive load theory: A modified Delphi study."
Dr. Jonathan Pirie discusses his recent AEM Education and Training paper, "Impact and effectiveness of a mandatory competency-based simulation program for pediatric emergency medicine faculty."
Dr. Jin Han joins the podcast to discuss his recent paper in AEM on telemental health care in the VA system.
Paper abstract: Point-of-care ultrasound (US) has been suggested as the primary imaging in evaluating patients with suspected diverticulitis. Discrimination between simple and complicated diverticulitis may help to expedite emergent surgical consults and determine the risk of complications. This study aimed to: (1) determine the accuracy of an US protocol (TICS) for diagnosing diverticulitis in the Emergency Department (ED) setting and (2) assess the ability of TICS to distinguish between simple and complicated diverticulitis.
The Master Adaptive Learner (MAL) model was developed as an educational framework that teaches learners how to develop adaptive expertise. Dr. Guy Carmelli discusses his recent paper in AEM Education and Training on adapting the EM clerkship to create master adaptive learners.
The strengths and weaknesses of virtual and in-person formats within continuing professional development (CPD) are incompletely understood. This study sought to explore attendees’ perspectives across multiple specialties regarding benefits and limitations of conference formats, and strategies for successful virtual and hybrid (i.e., in-person conferences with a virtual option) conferences.
Cocaine use results in over 500,000 emergency department (ED) visits annually across the U.S. and ethanol co-ingestion is reported in 34% of these. Commingling cocaine with ethanol results in the metabolite cocaethylene (CE), which is metabolically active for longer than cocaine alone. Current literature on the cardiotoxicity of CE compared to cocaine alone is limited and lacks consensus. The present study aims to fill this gap in the literature and examine cardiovascular events in cocaine use as confirmed by urine toxicology versus CE exposure.
Dr. Pensa interviews Dr. Margaret Samuels-Kalow about her new paper in AEM, "Post-Roe Emergency Medicine: Policy, clinical, training, and individual implications for emergency clinicians."
Dr. Pensa discusses the new paper "A Consensus List of Ultrasound Competencies for Graduating Emergency Medicine Residents" with lead author Dr. David Haidar.
Dr. Pensa speaks to Dr. Holly Caretta-Weyer about her new AEM Education and Training Journal paper, "Bridging the Gap: Development of an Experiential Learning- Based Health Disparities Curriculum."
We discuss the new AEM article, "Increased Identification of Cannabis Users Drivers Involved in Motor
Vehicle Collisions Using an Expanded Cannabis Inventory" with author Dr. Esther Choo.
Author Dr. Coughlin and Dr. Pensa discuss his team's AEM Education and Training article, "Differences in Faculty Feedback for High, Expected, and Below-Expected Clinically Performing Emergency Medicine Residents."
We speak to first author Dr. Marie Jessen about a new paper in AEM entitled "Restrictive Fluids Versus Standard Care in Adults with Sepsis in the Emergency Department (REFACED) – a Multicenter, Randomized Feasibility Trial."
We discuss a new article in AEM Education and Training called “Coaching models, theories, and structures: an overview for teaching faculty in the emergency department and educators in the offices” with lead author Dr. Nicole Deiorio.
Appropriate triage of patients in the ED is sometimes challenging, and today we’re discussing a new article in AEM entitled “Physician Gestalt for Emergency Department Triage: A Prospective Videotaped Study.” This paper from an academic ED in Taiwan compared physician gestalt versus the Taiwan Triage and Acuity Scale (TTAS), which is standard computerized triaging software used in Taiwan.
Dr. Korie Zink discusses this new qualitative study in AEM Education and Training on fears and hopes at the start of EM orientation.
Although more guideline-adherent care has been described in pediatric compared to adult trauma centers, we aimed to provide a more detailed characterization of management and resource utilization of children with intra-abdominal injury (IAI) within pediatric centers. Our primary
objective was to describe the epidemiology, diagnostic evaluation, and management of children with IAI across U.S. children’s hospitals. Our secondary objective was to describe the inter-hospital variation in surgical management of children with IAI.
Competency-based medical education (CBME) is a topic we have discussed often on this podcast series, and today we are discussing a critical part of it; direct observation of trainees. But as most of us know, direct observation also has its challenges in a busy ED. Today we’re discussing a new paper in AEM Education and Training entitled "Does direct observation influence the quality of workplace-based assessment documentation?" First author Dr. Jeffrey Landreville is here to discuss it with us.
We talk to Dr. Jaron Raper about a new article in AEM entitled "Can right ventricular assessments improve triaging of low risk pulmonary embolism?"
We discuss this paper with first author Dr Joyce Li. They sought to evaluate racial and ethnic differences in pediatric patients across a broad range of low-value imaging studies in the general ED setting.
Most emergency medicine educators are familiar with the Milestones, the current evaluation system for emergency medicine residents, and these have been shown to be imperfect and highly subjective. Ath the same time, EM residents need to achieve competency in patient safety and quality improvement processes, Today we’re talking about a recent paper in AEM Education and training journal, “Implementation of a Pilot Novel Objective Peer comparison evaluation system in an emergency medicine residency program.” First author Dr Kraftin Schreyer, MD MBA is here to discuss it with us.
The ACGME requires residents to participate in scholarship, and programs are required to provide an environment conducive to the production of scholarship and acquiring the necessary skills involved. Today we are talking to Dr Kraftin Schreyer about a recent paper in AEM Education and Training entitled “The Content Expert Program: A Structured Approach to Increase Emergency Medicine Resident Scholarly Activity.”
The American College of Surgeons requires trauma centers to use six minimum criteria (ACS-6) for full trauma team activation: hypotension, gunshot wound to the neck or torso, Glasgow Coma Scale (GCS) score < 9, respiratory compromise, transfers receiving blood transfusion, or physician discretion. Our goal was to evaluate the effect of adding varying shock index (SI) thresholds to the ACS-6 in an adult trauma population with the hypothesis that SI would significantly improve sensitivity at the expense of an acceptable decrease in specificity
Gender disparities in medicine are well documented; however, little qualitative data exist. This study sought to provide a qualitative assessment of harassment and discrimination experienced by female physicians in emergency medicine (EM) specifically by colleagues or supervisors.
The journal club is a ubiquitous and time-honored tradition within medical education. However, in recent years, open educational resources (OERs) have become increasingly influential in how physicians interact with the medical literature across multiple specialties. The authors sought to explore how emergency medicine (EM) resident physicians reconcile different perspectives across OERs into their educational experience at the journal club.
Tracheal intubation (TI) practice across pediatric emergency departments (EDs) has not been comprehensively reported. We aim to describe TI practice and outcomes in pediatric EDs in contrast to those in intensive are units (ICUs) and use the data to identify quality improvement targets.
Patient-centered care is concordant with patient values and preferences. There is a lack of research on patient values and preferences for pulmonary embolism (PE) testing in the emergency department (ED), and a poor physician understanding of patient-specific goals. Our aim was to map patient-specific values, preferences, and expectations regarding PE testing in the ED.
The objective was to evaluate the efficacy and safety of single-dose ketamine infusion in adults with sickle cell disease (SCD) who presented with acute sickle vasoocclusive crisis (VOC).
In 2017, the Accreditation Council for Graduate Medical Education (ACGME) revised its Common Program Requirements to support trainees and faculty by mandating programs to provide dedicated wellness resources and education. Emergency medicine may benefit from this change due to high burnout rates within the specialty. However, the current state of wellness interventions in emergency medicine (EM) residency programs has not yet been well described. Understanding current practices is necessary to assess unmet needs and inform the development and evaluation of future interventions that aim to improve trainee wellness.
Prior studies have demonstrated that EM applicants consider geography as well as modifiable/non- modifiable program factors. Less attention, however, has been paid to underrepresented groups. Additionally, the prevalence and characteristics of “red flags,” or factors that may lead an applicant to lower a program’s rank or not rank it at all, remains unknown in EM.
Delayed diagnosis of cerebrovascular disease (CVD) among patients can result in substantial harm. If diagnostic process failures can be identified at emergency department (ED) visits that precede CVD hospitalization, interventions to improve diagnostic accuracy can be developed.
Emergency medicine clinicians are excellent at identifying and treating physical trauma as a chief complaint, but are often unaware of patients’ previous experiences of trauma. The purpose of this study was to describe emergency department (ED) patients’ lifetime experiences of trauma.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-line medication for acute low back pain (LBP). It is unclear if the choice of NSAID impacts outcomes. We compared ibuprofen, ketorolac, and diclofenac for the treatment of acute, nonradicular LBP.
Increasing the diversity of the emergency medicine (EM) workforce is imperative, with more diverse teams showing improved patient care and increased innovation. Holistic review, adapted from the Association of American Medical Colleges (AAMC), focuses on screening applicants with a balanced method, valuing their experiences, attributes, and academic metrics equally. A core tenet to holistic review is that diversity is essential to excellence.
The authors developed a series of five virtual workshop sessions in 2019 that were held over Zoom in June and July 2020 in the setting of the COVID-19 pandemic. Eight learners completed the curriculum. Prior to each session, learners were provided pre-session materials including podcasts, recorded lectures, and readings. Thought-provoking questions were also provided with pre-session materials to facilitate discussion during sessions. Materials were curated to provide foundational knowledge on CRT and U.S. history as well as local history of the San Francisco Bay Area.
Effective feedback is the cornerstone of competency-based education. The emergency department (ED) is a unique learning and feedback environment. Developing our understanding of emergency medicine (EM) residents’ experiences around feedback will improve resident training and inform EM faculty development programs. This qualitative study explores the feedback culture and practices in EM and resident's experiences and attitudes toward feedback in this specific training environment.
Widespread vaccination is an essential component of the public health response to the COVID-19 pandemic, yet vaccine hesitancy remains pervasive. This prospective survey investigation aimed to measure the prevalence of vaccine hesitancy in a patient cohort at two urban Emergency Departments (EDs) and characterize underlying factors contributing to hesitancy.
Appendicitis is the most common surgical condition in pediatric emergency department (ED) patients. Prompt diagnosis can reduce morbidity, including appendiceal perforation. The goal of this study was to measure racial/ethnic differences in rates of 1) appendiceal perforation, 2) delayed diagnosis of appendicitis, and 3) diagnostic imaging during prior visit(s).
The chief resident role often includes additional administrative and educational experiences beyond those of nonchief senior residents. It is unclear to what extent these experiences influence the postresidency career path of those selected as chief residents. The objective of this study was to evaluate the association of chief resident status on immediate postresidency career characteristics relative to nonchief residents in emergency medicine (EM).
Firearm injuries are one of the leading preventable causes of morbidity and mortality among children. Limited information exists about the impact of nonfatal firearm injuries on utilization and expenditures. Our objective was to compare health care encounters and expenditures 1 year before and 1 year following a nonfatal firearm injury.
Teaching and learning in the clinical setting are vital for the training and development of emergency physicians. Increasing service provision and time pressures in the Emergency Department (ED) have led to junior trainees’ perceptions of a lack of teaching and a lack of support during clinical shifts. We sought to explore the perceptions of learners and supervisors in our emergency department regarding teaching within this diverse and challenging context.
Uniformly training physicians to provide safe, high-quality care requires reliable assessment tools to ensure learner competency. The consensus-derived National Clinical Assessment Tool in Emergency Medicine (NCAT-EM) has been adopted by clerkships across the country. Analysis of large-scale deidentified data from a consortium of users is reported.
Effective sepsis resuscitation depends on useful criteria for prompt identification of eligible patients. These criteria should reliably predict a discharge diagnosis of sepsis, ensuring that interventions are triggered for those who need it while avoiding potentially harmful interventions in those who do not. We sought to determine the proportion of patients meeting sepsis criteria in the emergency department (ED) that was ultimately diagnosed with sepsis and to quantify the subset of nonseptic patients with risk factors for harm from fluid resuscitation.
We interview Dr. Scott Simpson about his recent AEM article describing the Columbia-Suicide Severity Rating Scale (C-SSRS)-Clinical Practice Screener's ability to predict suicide and emergency department (ED) visits for self-harm in the year following an ED encounter.
Little is known about patient perspectives to effectively engage patients immediately following opioid overdose. Our objective was to explore patients’ perspectives on substance use treatment, perceived needs, and contextual factors that shape the choice of patients seen in the emergency department (ED) to engage with treatment and other patient support services in the acute post–opioid overdose period.
The COVID‐19 Evaluation of Risk in Emergency Departments (COVERED) project is a multicenter, prospective cohort surveillance project at 20 geographically diverse, high‐volume urban U.S. academic medical centers. The project's primary aim was to estimate the attributable risk of occupational acquisition of COVID‐19 in ED personnel during a 20‐week follow‐up. At completion we surveyed participants regarding receipt of vaccines, feelings of personal safety after vaccination, personal protective equipment (PPE) use and, if applicable, reasons for declining vaccination.
Previous literature demonstrates increased mortality for Traumatic Brain Injury (TBI) with transfer to a Level II versus Level I trauma center. Our objective is to determine the effect of the most recent American College of Surgeons-Committee on Trauma (ACS-COT) Resources for the Optimal Care of the Injured Patient resources manual (“The Orange Book”) on outcomes after severe TBI afterinterfacility transfer to Level I vs Level II center.
Containment of the coronavirus disease 2019 (COVID-19) pandemic requires the public to change behavior under social distancing mandates. Social media are important information dissemination platforms that can augment traditional channels communicating public health recommendations. The objective of the study is to assess the effectiveness of COVID-19 public health messaging on Twitter when delivered by emergency physicians and containing personal narratives.
As students on an emergency medicine (EM) rotation work with different faculty on a daily basis, EM clerkships often incorporate an end‐of‐shift evaluation to capture sufficient student performance data. Electronic shift evaluations have been shown to increase faculty completion compliance. This study aimed to examine learner perceptions of their individualized feedback during an EM clerkship following the adoption of an electronic evaluation tool.
In this study, we examined how the context of the emergency department (ED) shapes the ways in which emergency physicians reconcile their competing roles in patient care and clinical supervision to optimize learning and ensure patient safety.
Child abuse is a significant cause of morbidity and mortality in preverbal children who cannot explain their injuries. Fractures are among the most common injuries associated with abuse but of themselves fractures may not be recognized as abusive until a comprehensive child abuse evaluation is completed, often prompted by other signs or subjective features. We sought to determine which children presenting with rib or long‐bone fractures should undergo a routine abuse evaluation based on age.
The risk factors for peri‐intubation cardiac arrest in critically ill children are incompletely understood. The study objective was to derive physiologic risk factors for deterioration during tracheal intubation in a pediatric emergency department (PED).
Communication and interpersonal skills are important for effective patient care but are difficult to measure. Unannounced standardized patient encounters (USPEs) have the benefit of providing a standardized situation and provide a representation of usual care rather than best behavior, while also allowing for video recording without violating patient privacy. We conducted a feasibility pilot study to examine the use of videotaped USPEs in resident education of interpersonal and communication skills and specifically empathy.
Parenteral opioids are commonly used to treat acute severe pain. We measured pleasurable sensations in patients administered intravenous analgesics to determine if these sensations were associated with receipt of an opioid, after controlling for relief of pain. Pleasurable sensations not accounted for by relief of pain were considered opioid-induced euphoria.
People with disabilities constitute a marginalized population who experience significant health care disparities resulting from structural, socioeconomic, and attitudinal barriers to accessing health care. It has been reported that education on the care of marginalized groups helps to improve awareness, patient-provider rapport, and patient satisfaction. Yet, emergency medicine (EM) residency education on care for people with disabilities may be lacking.
Race‐based bias in health care occurs at organizational, structural, and clinical levels and impacts emergency medical care. Limited literature exists on the role of race on patient restraint in the emergency setting. This study sought to examine the role of race in physical restraint in an emergency department (ED) at a major academic medical center.
Pediatric appendicitis remains a challenging diagnosis in the emergency department (ED). Available risk prediction algorithms may contribute to excessive ED imaging studies. Incorporation of physician gestalt assessment could help refine predictive tools and improve diagnostic imaging decisions.
The Accreditation Council for Graduate Medical Education (ACGME), which regulates residency and fellowship training in the United States, recently revised the minimum standards for all training programs. These standards are codified and published as the Common Program Requirements. Recent specific revisions, particularly removing the requirement ensuring protected time for core faculty, are poised to have a substantial impact on emergency medicine training programs.
The accuracy and speed by which acute myocardial infarction (AMI) is excluded are an important determinant of emergency department (ED) length of stay and resource utilization. While high‐sensitivity troponin I (hsTnI) >99th percentile (upper reference level ) represents a “rule‐in” cutpoint, our purpose was to evaluate the ability of the Beckman Coulter hsTnI assay, using various level‐of‐quantification (LoQ) cutpoints, to rule out AMI within 3 hours of ED presentation in suspected acute coronary syndrome (ACS) patients.
The objective of this study was to develop a decision aid (DA) to facilitate shared decision making (SDM) around whether to obtain computed tomography (CT) imaging in patients presenting to the emergency department (ED) with suspected uncomplicated ureterolithiasis.
Early access to specialized stroke care is critically important in the treatment of suspected acute stroke, but access to dedicated stroke centers is unequal and varies geographically. Among the different levels of hospitals providing stroke care, the comprehensive stroke center (CSC) is the highest designation. In many systems of stroke care, if transport to a CSC is expected to take less than a certain number of minutes, the patient is taken to the CSC even if a non-CSC hospital is closer. Transport time–based decisions like these, however, could be significantly impacted during times of heavy traffic. This study examines this potential in LA County.
Translational research in medical education requires the ability to rigorously measure learner performance in actual clinical settings; however, current measurement systems cannot accommodate the variability inherent in many patient care environments. This is especially problematic in emergency medicine, where patients represent a wide spectrum of severity for a single clinical presentation. Our objective is to describe and implement EBAM, an event‐based approach to measurement that can be applied to actual emergency medicine clinical events.
While emergency medical services (EMS) often use endotracheal intubation (ETI) or supraglottic airways (SGA), some patients receive only bag–valve–mask (BVM) ventilation during out‐of‐hospital cardiac arrests (OHCA). Our objective was to compare patient characteristics and outcomes for BVM ventilation to advanced airway management (AAM) in adults with OHCA.
The Accreditation Council for Graduate Medical Education Common Program Requirements effective 2017 state that programs and sponsoring institutions have the same responsibility to address well‐being as they do other aspects of resident competence. The authors sought to determine if the implementation of a multifaceted wellness curriculum improved resident burnout as measured by the Maslach Burnout Inventory (MBI).
The COVID-19 pandemic requires a substantial change to the traditional approach to conference didactics. Switching to a virtual medium for conference sessions presents several challenges, particularly with regard to aspects that rely heavily upon in-person components (e.g., simulation, ultrasound). We interview Dr. Michael Gottlieb about this paper, discussing the challenges and strategies to address them for conference planning in the era of COVID-19.
The White House “Stop the Bleed” campaign has renewed interest in public‐access bleeding kits and the use of tourniquets by the lay public. The objective of this study was to determine which type of tourniquet could be applied most effectively by the lay public using only manufacturer instructions included with each tourniquet.
Emergency providers (EPs) are uniquely placed to advocate for firearm safety and have been shown to be at risk of exposure to firearms in the emergency department (ED). We sought to characterize EPs’ knowledge of firearms, frequency of encountering firearms in the ED and level of confidence with safely removing firearms from patient care settings.
Academic emergency medicine is a constant balance between efficiency and education. The authors developed a new model called swarming, where the bedside nurse, resident, and attending/fellow simultaneously evaluate the patient, including initial vital signs, bedside triage, focused history and physical examination, and discussion of the treatment plan, thus creating a shared mental model.
This study compared first attempt intubation success using direct laryngoscopy augmented by laryngeal manipulation, ramped patient positioning and use of a bougie (A-DL) with unaided video laryngoscopy (VL) in adult emergency department intubations.
Video laryngoscopy used without any augmenting maneuver, device or technique resulted in higher first attempt success than does direct laryngoscopy that is augmented by use of a bougie, external laryngeal manipulation, ramping, or combinations thereof.
This was a one-year prospective, multicenter trial involving ten EM residencies from 2017 to 2018. Subjects were PGY 1-4 EM residents. Grit-S scores, MCAT percentile, remediation rates,
ITE scores, and the ITE score’s prediction of passing the ABEM Qualifying Examination were collected. Correlation coefficients were computed to assess the relationship between residents’ grit and achievement.
Arrhythmia is one of the most worrisome causes of syncope. Electrocardiographic (ECG) monitoring is crucial for the management of non–low risk patients in the emergency department (ED). However, its diagnostic accuracy and optimal duration are unknown. We aimed to assess the diagnostic accuracy of ECG monitoring in non–low risk patients with syncope in the ED.
Despite increased focus on opioid prescribing, little is known about the influence of prescription opioid medication information given to patients in the emergency department (ED). The study objective was to evaluate the effect of an Electronic Medication Complete Communication (EMC 2 ) Opioid Strategy on patients’ safe use of opioids and knowledge about opioids.
Graduate medical education (GME) bodies are beginning to mandate coaching as an integral part of the learning process, in addition to current requirements for mentorship. Once an Emergency Medicine physician transitions beyond graduate training, there is no requirement and little focus on coaching as a method of improving or maintaining clinical practice. Our objective was to understand and describe the current state of the published literature with regards to the use of coaching and mentorship for both GME and practicing physicians.
The American Board of Emergency Medicine Model of the Clinical Practice of Emergency Medicine (ABEM Model) serves as a guide for resident education and the basis for the resident In-training Examination (ITE) and the Emergency Medicine Board Qualification Examinations. The purpose of this study was to determine how closely resident–patient encounters in the authors' emergency departments (EDs) matched the ABEM Model as presented in the specifications of the content outline for the ITE.
Freestanding emergency departments (FrEDs) could reduce wait times in overcrowded emergency departments, but they might also increase usage and overall spending for emergency care. We investigate the relationship between the number of FrEDs entering a local market and overall spending on emergency care.
The ED imaging h‐index allows identification of patients who undergo significant ED imaging, based on a single‐digit patient‐specific metric that incorporates both annual ED visit number and medical imaging resource intensity per visit. While ED patients with an ED imaging h‐index ≥ 2 represented a minuscule fraction of privately insured individuals, they were associated with one‐fifth of all ED imaging resources.
Emergency departments (EDs) frequently care for patients who are homeless or unstably housed. One promising approach taken by the homeless services system is to provide interventions that attempt to prevent homelessness before it occurs. Experts have suggested that health care settings may be ideal locations to identify and intervene with patients at risk for homelessness, yet little is known even about the basic characteristics of patients who might benefit from such interventions. This qualitative study examines themes that may lead to homelessness.
We describe a novel GME fellowship in climate and health science policy, designed to train a new generation of clinicians to provide the necessary perspective and skills for effective leadership in this field.
Provider efficiency has been reported in the literature but there is a lack of efficiency analysis among EM residents. This paper aims to compare efficiency of EM residents of different training levels and determine if EM resident efficiency is affected by ED overcrowding.
Pay-for-performance (P4P) programs have been implemented in various forms to reduce emergency department (ED) patient length of stay (LOS). This retrospective study investigated to what extent the timing of patient disposition in Metro Vancouver EDs was influenced by a LOS-based P4P program.
Discussing: "A cross-sectional analysis of compassion fatigue, burnout and compassion satisfaction in pediatric emergency medicine physicians in the US"
This study examined the prevalence of compassion fatigue, burnout, and compassion satisfaction, and sought to identify potential personal and professional predictors of these phenomena in pediatric critical care providers. Dr. Gita Pensa interviews authors Dr. Andrea Weintraub and Jeanie Gribben.
Although lesbian, gay, bisexual, and transgender (LGBT) patients are ubiquitous in emergency medicine (EM), little education is provided to EM physicians on LGBT health care needs and disparities. There is also limited information on EM physician behavior, comfort, and attitudes toward LGBT patients. The objective of this study was to assess EM residents behavior, comfort, and attitudes in LGBT health.
Capturing Emergency Department Discharge Quality With the Care Transitions Measure: A Pilot Study
Dr. Chana Rich interviews Dr. Amber Sabbatini about this pilot study in the June issue of Academic Emergency Medicine.
Increased empathy may improve patient perceptions and outcomes. No training tool has been derived to teach empathy to emergency care providers. Dr. Pettit and her team engaged patients to assist in creating a concept map to teach empathy to emergency care providers.
Overuse of head computed tomography (CT) for syncope has been reported. However, there is no literature synthesis on this overuse. The authors undertook a systematic review to determine the use and yield of head CT and risk factors for serious intracranial conditions among syncope patients. Dr. Gabe Gao interviews Drs. Viau and Thiruganasambandamoorthy about their work.
The objective of this study was to determine if there is a difference in procedural amnesia and adverse respiratory events (AREs) between the target sedation levels of moderate (MS) and deep (DS) procedural sedation. We discuss with lead author, Dr. Alexandra Schick, currently of Brown Emergency Medicine; study conducted at Hennepin County Medical Center (MN).
The purpose of this study was to complete a comprehensive analysis of gender differences in faculty rank among U.S. emergency physicians that reflected all academic emergency physicians. Female academic EM physicians are less likely to hold the rank of associate or full professor compared to male physicians even after detailed adjustment for other factors that may influence faculty rank.
Dr Nathan Olson discusses his team's article in the January 2019 AEM E&T issue, "Faculty Assessment of Emergency Medicine Resident Grit." We subsequently hear from Dr Annahieta Kalantari, who wrote the accompanying commentary piece in the same issue.
Two to five percent of patients with ACS are inappropriately discharged from the ED each year, despite our best efforts, which showcases the need for clinical decision tools that work. Dr Zack Lipsman interviews first author Dr Shannon Fernando about his recent meta-analysis in AEM, "Prognostic Accuracy of the HEART Score for Prediction of Major Adverse Cardiac Events in Patients Presenting with Chest Pain." Thirty studies are included in this meta-analysis.
Education research and scholarship are essential for promotion of faculty as well as dissemination of new educational practices. Educational faculty frequently spend the majority of their time on administrative and educational commitments and, as a result, educators often fall behind on scholarship and research. Dr Sally Santen talks with Dr Rory Merritt about helpful strategies to increase your scholarly productivity.
Previous studies of point‐of‐care ultrasound (POCUS) have reported high sensitivities and specificities for retinal detachment (RD). This study's primary objective was to assess the test characteristics of POCUS performed by a large heterogeneous group of emergency physicians (EPs) for the diagnosis of RD.
Dr Rory Merritt interviews Dr Angela Jarman on her team's recent AEM E&T publication, "Looking Through the Prism: Comprehensive Care of Sexual Minority and Gender Non-Conforming Patients in the Acute Care Setting," a Perspective and Commentary piece.
In the first decade of the 21st century, 20,000 children died from firearm violence. For survivors, evidence shows an increased risk in mortality in the first few years post injury but long term data is lacking. Dr. Shaahinfar discusses his team's new AEM publication, "Long-term mortality in pediatric firearm assault survivors: a multi-center, retrospective, comparative cohort study. "
Jessica Roche, managing director of the CDC-funded University of Michigan Injury Prevention Center, discusses her team's recent AEM article, "Tracking Assault-Injured, Drug-Using Youth in Longitudinal Research: Follow Up Methods." She is being interviewed by Dr. Ashley Gray of Brown Emergency Medicine.
Dr Jesse Pines is interviewed by Dr Rory Merritt on a recent AEM Education and Training article in which Dr Pines and his team explore attributes, traits, background, skills, and behavioral factors important to top clinical performance in emergency medicine (EM) residency.
Threat perceptions in the ED (patients’ subjective feelings of helplessness or lack of control) during evaluation for an acute coronary syndrome (ACS) are associated with the development of PTSD, and PTSD has been associated with medication nonadherence, cardiac event recurrence, and mortality. This study reports the development and validation of a 7-item measure of ED Threat Perceptions in English- and Spanish-speaking patients evaluated for ACS.
Dr Scott Crawford discusses his recent AEM E&T article and describes a novel interview technique at his program, where applicants are observed while working in teams in a virtual reality game called "Keep Talking and Nobody Explodes."
Dr Christopher Kabrhel discusses evaluating patients for pulmonary embolism using the YEARS criteria in an independent population. It may be possible to safely rule out PE in patients with low pre-test probability using a higher-than-standard D dimer threshold.
Quality of online educational resources can vary, and learners' gestalt may not be an indicator of quality. The development of tools to guide clinicians and learners in the selection of blogs and podcasts is a growing area of interest. This article focuses on editorial processes in online EM resources and whether they can be reliably integrated into a critical appraisal tool.
Psychosocial factors and responses to injury modify the transition from acute to chronic pain. Specifically, posttraumatic stress disorder symptoms exacerbate and co‐occur with chronic pain. Yet no study has prospectively considered the associations among these psychological processes and pain reports using experience sampling methods (ESM) during the acute aftermath of injury. This study applied ESM via daily text messaging to monitor and detect relationships among psychosocial factors and post‐injury pain across the first 14‐days after emergency department (ED) discharge.
Dr. Rory Merritt interviews Dr. Catherine Patocka, lead author of AEM E&T's recent article, "Point of Care Resource Use in the ED: A Developmental Model."
Despite increasing attention to the use of shared decision making (SDM) in the emergency department (ED), little is known about ED patients’ perspectives regarding this practice. Dr. Schoenfeld and her colleagues sought to explore the use of SDM from the perspectives of ED patients, focusing on what affects patients’ desired level of involvement and what barriers and facilitators patients find most relevant to their experience.
We discuss with Dr Margaret Samuels-Kalow her recent AEM paper, 'Comparing Statewide and Single Center Data to Predict High Frequency ED Utilization Among Patients With Asthma Exacerbation.
Previous studies examining high-frequency emergency department (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 statewide versus single-center data.
Since legalization in Colorado, providers have noted increased healthcare utilization associated with acute and chronic marijuana use. It is currently unknown if cannabis use is associated with increased ED visits in patients with mental illness. The primary objective of this study was to determine the prevalence ratios of mental health diagnoses among ED visits with cannabis-associated diagnosis compared to those without cannabis-associated diagnoses in Colorado. Dr Adam Haag interviews corresponding author Dr Andrew Monte.
We speak to lead author Dr. Christian Toarta and final/senior author Dr. Venkatesh Thiurganasambandamoorthy about their upcoming Academic Emergency Medicine article entitled "Syncope Prognosis Based on Emergency Department Diagnosis: A Prospective Cohort Study." They are interviewed by Dr Tess Wiskel, a PGY-4 in Emergency Medicine at Brown.
Dr Rory Merritt interviews Dr Teresa Chan about her upcoming Education and Training article, "Learning Analytics in Medical Education Assessment." The authors situate medical learning analytics within the context of competency-based education while providing suggestions for potential areas for implementation of these techniques into resident evaluation. Authors are careful to note the data inputs, database creation and data analysis potentially performed by learning analytic techniques “should be driven by both evidence and theory.”
Post-anesthesia negative behavioral changes in children are well documented in surgical and anesthesia literature, and these changes can last for days to weeks. It is not known if this is true for children receiving procedural sedation in the emergency department. We speak with Dr Jean Pearce about her her study was to evaluate the proportion of pediatric patients who experience negative post-discharge behaviors in the 1-2 weeks after procedural sedation for fracture reduction in the emergency department, and to determine predictors of negative post-discharge behaviors among study subjects.
Human Factors (HF) is a scientific discipline that examines how human characteristics affect the utility of tools, technologies, and work environments. Patient simulation has been used extensively in health care training, but simulation also plays a large role in HF research and design -- perhaps it's time for clinicians working with simulation to have more interaction with HF designers to create better, clinician-friendly technologies. We interview Dr. Emily Hayden, lead author of "Human Factors and Simulation in Emergency Medicine", a product of the 2017 AEM Consensus Conference, "Catalyzing System Change Through Health Care Simulation: Systems, Competency, Outcomes."
Bedside teaching in a busy emergency department is a challenge for all academic emergency physicians. In this podcast, Dr Rory Merritt interviews Dr Chris Merritt (no relation!) about his recent AEM Education and Training publication, "Not Another Bedside Lecture: Active Learning Techniques for Bedside Instruction." Learn three quick and easy-to-implement techniques to facilitate more active learning in a time-pressured environment.
In rural critical access hospitals, the presentation of an anticoagulated patient with significant hemorrhage poses numerous difficulties, including the fact that reversal agents 4-factor PCC and FFP are often not stocked. This month's selected paper presents a unique protocol for delivering and administering 4-factor PCC via air ambulance when transferring the patient from the rural setting to tertiary care.
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).
Over 35 million alcohol-impaired (AI) patients are cared for in emergency departments (EDs) annually. Emergency physicians are charged with ensuring AI patients’ safety by identifying resolution of alcohol induced impairment. Dr Eric Lee interviews Dr Jason Hack about his recent article in AEM and the Hack's Impairment Index Score.
Unintentional submersion is a leading cause of death in kids under 14 in the US. A question for the emergency physician is what cohort of 'near drowning' patients can be safely sent home from the emergency department following a period of observation.
In this episode of AEM Early Access Dr Eric Lee speaks with Dr Rohit Shenoi about his recent AEM Article entitled, "The Pediatric Submersion Score Predicts Children at Low Risk for Injury Following Submersions." This article supports a simple scoring classification to identify low risk pediatric submersion victims who can be safely discharged after an eight hour observation period rather than be admitted to the hospital.
With growing attention being paid to health care costs, Dr Todd Lyons and his colleagues recently studied risk factors, patterns, and costs associated with patients whose care is fragmented across multiple emergency departments. Dr Anu Ganapathy interviews Dr Lyons about his group's findings and their recent article in Academic Emergency Medicine.
Global Health experiences are becoming more and more common in emergency medicine training programs. However, because of the diverse opportunities and experiences within global health, developing a standard curriculum and assessment tools is challenging. In this podcast, Dr Katherine Douglass discusses her recent AEM Education and Training publication, "Development of a Global Health Milestones Tool for Learners in Emergency Medicine: A Pilot Project."
Disparities in salary and rank exist among full time US academic emergency medicine faculty, even after controlling for factors such as clinical hours and training. There are also gender and minority disparities in rank and leadership positions. We discuss these findings, being published in October's Academic Emergency Medicine journal, with lead author Dr Tracy Madsen.
In this episode, Dr. Thomas Ross interviews Dr. Alexis Cournoyer about his research on BLS/ACLS outcome associations in out-of-hospital cardiac arrest in a cohort of over 7000 adults, as well as a subgroup of extracorporeal CPR candidates.
We interview Dr Patrick Carter of the University of Michigan Injury Center on his upcoming AEM Article looking at non-fatal pediatric firearm injury data from the PECARN network.
In this episode, we discuss Dr Bower's forthcoming AEM Article regarding the use of ketamine as an adjunct to opiates for the management of acute pain in the emergency department.
This podcast is a joint effort between the editors of Academic Emergency Medicine and the Brown University Emergency Medicine Residency Program. Each month, a selected article will be discussed and released online in advance of publication. The article will be available in an open access digital format for a limited period of time. Visit www.brownemblog.com for a link to this article (open access through 6/9/17), as well as an article summary and links to additional related educational content.
May 2017: Discussing "Point-of-care ultrasound for non-angulated distal forearm fractures in children: test performance characteristics and patient-centered outcomes"
Naveen Poonai MD, Frank Myslik MD, Gary Joubert MD, Josiah Fan MD et al.
Guest/Author: Dr. Naveen Poonai MSc MD FRCPC, Schulich School of Medicine and Dentistry, London, Ontario
Host: Dr. Gita Pensa, MD, Brown University Emergency Medicine Residency Program
Keywords: POCUS, Ultrasound, Pediatrics, Orthopedics, Emergency Medicine