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ED. SPOED

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17 papers 0 to 25 followers
By Johan Boie ED. PULMONARY
https://www.readbyqxmd.com/read/25754936/structural-quality-indicators-to-support-quality-of-care-for-older-people-with-cognitive-impairment-in-emergency-departments
#1
Linda M Schnitker, Melinda Martin-Khan, Ellen Burkett, Caroline A Brand, Elizabeth R A Beattie, Richard N Jones, Len C Gray
OBJECTIVES: The purpose of this study was to identify the structural quality of care domains and to establish a set of structural quality indicators (SQIs) for the assessment of care of older people with cognitive impairment in emergency departments (EDs). METHODS: A structured approach to SQI development was undertaken including: 1) a comprehensive search of peer-reviewed and gray literature focusing on identification of evidence-based interventions targeting structure of care of older patients with cognitive impairment and existing SQIs; 2) a consultative process engaging experts in the care of older people and epidemiologic methods (i...
March 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/25731864/optimizing-diagnostic-imaging-in-the-emergency-department
#2
Angela M Mills, Ali S Raja, Jennifer R Marin
While emergency diagnostic imaging use has increased significantly, there is a lack of evidence for corresponding improvements in patient outcomes. Optimizing emergency department (ED) diagnostic imaging has the potential to improve the quality, safety, and outcomes of ED patients, but to date, there have not been any coordinated efforts to further our evidence-based knowledge in this area. The objective of this article is to discuss six aspects of diagnostic imaging to provide background information on the underlying framework for the 2015 Academic Emergency Medicine consensus conference, "Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization...
May 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/25754937/process-quality-indicators-targeting-cognitive-impairment-to-support-quality-of-care-for-older-people-with-cognitive-impairment-in-emergency-departments
#3
MULTICENTER STUDY
Linda M Schnitker, Melinda Martin-Khan, Ellen Burkett, Elizabeth R A Beattie, Richard N Jones, Len C Gray
OBJECTIVES: The objective of this study was to develop process quality indicators (PQIs) to support the improvement of care services for older people with cognitive impairment in emergency departments (ED). METHODS: A structured research approach was taken for the development of PQIs for the care of older people with cognitive impairment in EDs, including combining available evidence with expert opinion (phase 1), a field study (phase 2), and formal voting (phase 3)...
March 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/25773461/clinically-significant-differences-in-acute-pain-measured-on-self-report-pain-scales-in-children
#4
Daniel S Tsze, Gerrit Hirschfeld, Carl L von Baeyer, Blake Bulloch, Peter S Dayan
OBJECTIVES: The objective was to determine the minimum and ideal clinically significant differences (MCSD, ICSD) in pain intensity in children for the Faces Pain Scale-Revised (FPS-R) and the Color Analog Scale (CAS) and to identify any differences in these estimates based on patient characteristics. METHODS: This was a prospective study of children aged 4 to 17 years with acute pain presenting to two urban pediatric emergency departments. Participants self-reported their pain intensity using the FPS-R and CAS and qualitatively described their changes in pain...
April 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/25773604/trends-in-observation-prone-emergency-department-visits-among-michigan-children-2007-2011
#5
Michelle L Macy, Lisa Cohn, Sarah J Clark
OBJECTIVES: To the best of the authors' knowledge, admission of children under observation status in community hospitals has not been examined. The hypothesis of this study was that there has been an increase in observation charge code use over time and variations in the application of observation charge codes across hospital types. METHODS: This was a cross-sectional analysis of 5 years (2007 through 2011) of administrative claims data from Michigan residents enrolled in Medicaid, Blue Cross/Blue Shield of Michigan preferred provider organization, and Blue Cross Network health maintenance organization compiled into a single data set...
April 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/25778743/the-prevalence-and-diagnostic-utility-of-systemic-inflammatory-response-syndrome-vital-signs-in-a-pediatric-emergency-department
#6
Halden F Scott, Sara J Deakyne, Jason M Woods, Lalit Bajaj
OBJECTIVES: This study sought to determine the prevalence, test characteristics, and severity of illness of pediatric patients with systemic inflammatory response syndrome (SIRS) vital signs among pediatric emergency department (ED) visits. METHODS: This was a retrospective descriptive cohort study of all visits to the ED of a tertiary academic free-standing pediatric hospital over 1 year. Visits were included if the patient was <18 years of age and did not leave before full evaluation or against medical advice...
April 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/25779540/interobserver-agreement-in-retrospective-chart-reviews-for-factors-associated-with-cervical-spine-injuries-in-children
#7
MULTICENTER STUDY
Cody S Olsen, Nathan Kuppermann, David M Jaffe, Kathleen Brown, Lynn Babcock, Prashant V Mahajan, Julie C Leonard
OBJECTIVES: The objective was to describe the interobserver agreement between trained chart reviewers and physician reviewers in a multicenter retrospective chart review study of children with cervical spine injuries (CSIs). METHODS: Medical records of children younger than 16 years old with cervical spine radiography from 17 Pediatric Emergency Care Applied Research Network (PECARN) hospitals from years 2000 through 2004 were abstracted by trained reviewers for a study aimed to identify predictors of CSIs in children...
April 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/25779695/emergency-department-revisits-for-patients-with-kidney-stones-in-california
#8
Charles D Scales, Li Lin, Christopher S Saigal, Carol J Bennett, Ninez A Ponce, Carol M Mangione, Mark S Litwin
OBJECTIVES: Kidney stones affect nearly one in 11 persons in the United States, and among those experiencing symptoms, emergency care is common. In this population, little is known about the incidence of and factors associated with repeat emergency department (ED) visits. The objective was to identify associations between potentially mutable factors and the risk of an ED revisit for patients with kidney stones in a large, all-payer cohort. METHODS: This was a retrospective cohort study of all patients in California initially treated and released from EDs for kidney stones between February 2008 and November 2009...
April 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/25779855/factors-associated-with-oxyhemoglobin-desaturation-during-rapid-sequence-intubation-in-a-pediatric-emergency-department-findings-from-multivariable-analyses-of-video-review-data
#9
Andrea S Rinderknecht, Matthew R Mittiga, Jareen Meinzen-Derr, Gary L Geis, Benjamin T Kerrey
OBJECTIVES: In a video-based study of rapid sequence intubation (RSI) in a pediatric emergency department (PED), 33% of children experienced oxyhemoglobin desaturation (SpO2 < 90%). To inform targeted improvement interventions, we planned multivariable analyses to identify patient and process variables (including time-based data around performance of key RSI process elements uniquely available from video review) associated with desaturation during pediatric RSI. METHODS: These were planned analyses of data collected during a retrospective, video-based study of RSI in a high-volume, academic PED...
April 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/25779934/age-related-differences-in-factors-associated-with-cervical-spine-injuries-in-children
#10
Julie C Leonard, David M Jaffe, Cody S Olsen, Nathan Kuppermann
OBJECTIVES: The Pediatric Emergency Care Applied Research Network (PECARN) investigators previously identified risk factors associated with cervical spine injuries (CSIs) in children. Anatomic maturation and age-related variation in mechanisms of injury suggested the need to explore factors separately for younger versus older children. The purpose of this substudy was to investigate CSI risk factors in age subgroups within the PECARN study cohort. METHODS: This was an age-stratified case-control analysis of children younger than 16 years presenting to 17 PECARN hospitals following blunt trauma between January 1, 2000 and December 31, 2004...
April 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/25807868/emergency-physician-perceptions-of-medically-unnecessary-advanced-diagnostic-imaging
#11
Hemal K Kanzaria, Jerome R Hoffman, Marc A Probst, John P Caloyeras, Sandra H Berry, Robert H Brook
OBJECTIVES: The objective was to determine emergency physician (EP) perceptions regarding 1) the extent to which they order medically unnecessary advanced diagnostic imaging, 2) factors that contribute to this behavior, and 3) proposed solutions for curbing this practice. METHODS: As part of a larger study to engage physicians in the delivery of high-value health care, two multispecialty focus groups were conducted to explore the topic of decision-making around resource utilization, after which qualitative analysis was used to generate survey questions...
April 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/25807995/emergency-physician-perceptions-of-shared-decision-making
#12
Hemal K Kanzaria, Robert H Brook, Marc A Probst, Dustin Harris, Sandra H Berry, Jerome R Hoffman
OBJECTIVES: Despite the potential benefits of shared decision-making (SDM), its integration into emergency care is challenging. Emergency physician (EP) perceptions about the frequency with which they use SDM, its potential to reduce medically unnecessary diagnostic testing, and the barriers to employing SDM in the emergency department (ED) were investigated. METHODS: As part of a larger project examining beliefs on overtesting, questions were posed to EPs about SDM...
April 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/25810343/performance-of-the-2-hour-accelerated-diagnostic-protocol-within-the-american-college-of-radiology-imaging-network-pa-4005-cohort
#13
Simon A Mahler, Chadwick D Miller, Harold I Litt, Constantine A Gatsonis, Bradley S Snyder, Judd E Hollander
OBJECTIVES: The 2-hour accelerated diagnostic protocol (ADAPT) is a decision rule designed to identify emergency department (ED) patients with chest pain for early discharge. Previous studies in the Asia-Pacific region demonstrated high sensitivity (97.9% to 99.7%) for major adverse cardiac events (MACE) at 30 days. The objective of this study was to determine the validity of ADAPT for risk stratification in a cohort of U.S. ED patients with suspected acute coronary syndrome (ACS). METHODS: A secondary analysis of participants enrolled in the American College of Radiology Imaging Network (ACRIN) PA 4005 trial was conducted...
April 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/25808065/properties-of-serial-ultrasound-clinical-diagnostic-pathway-in-suspected-appendicitis-and-related-computed-tomography-use
#14
Suzanne Schuh, Kevin Chan, Jacob C Langer, Dina Kulik, Marcela Preto-Zamperlini, Nadine Al Aswad, Carina Man, Arun Mohanta, Derek Stephens, Andrea S Doria
OBJECTIVES: The primary objective was to determine the diagnostic accuracy of a serial ultrasound (US) clinical diagnostic pathway to detect appendicitis in children presenting to the emergency department (ED). The secondary objective was to examine the diagnostic performance of the initial and interval US and to compare the accuracy of the pathway to that of the initial US. METHODS: This was a prospective cohort study of 294 previously healthy children 4 to 17 years old with suspected appendicitis and baseline pediatric appendicitis scores of ≥2, who were managed with the serial US clinical diagnostic pathway...
April 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/25899650/diagnostic-performance-of-focused-cardiac-ultrasound-performed-by-emergency-physicians-for-the-assessment-of-ascending-aorta-dilation-and-aneurysm
#15
Peiman Nazerian, Simone Vanni, Fulvio Morello, Matteo Castelli, Maddalena Ottaviani, Claudia Casula, Alessandra Petrioli, Maurizio Bartolucci, Stefano Grifoni
OBJECTIVES: The diagnostic performance of transthoracic focused cardiac ultrasound (FoCUS) performed by emergency physicians (EP) to estimate ascending aorta dimensions in the acute setting has not been prospectively studied. The diagnostic accuracy and the interobserver variability of EP-performed FoCUS were investigated to estimate thoracic aortic dilation and aneurysm compared with the results of computed tomography angiography (CTA). METHODS: This was a prospective single-center cohort study of a convenience sample of patients who underwent CTA in the emergency department for suspected aortic pathology...
May 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/25899550/cost-effectiveness-of-quantitative-pretest-probability-intended-to-reduce-unnecessary-medical-radiation-exposure-in-emergency-department-patients-with-chest-pain-and-dyspnea
#16
RANDOMIZED CONTROLLED TRIAL
Jennifer L Troyer, Alan E Jones, Nathan I Shapiro, Alice M Mitchell, Ian Hewer, Jeffrey A Kline
OBJECTIVES: Quantitative pretest probability (qPTP) incorporated into a decision support tool with advice can reduce unnecessary diagnostic testing among patients with symptoms suggestive of acute coronary syndrome (ACS) and pulmonary embolism (PE), reducing 30-day costs without an increase in 90-day adverse outcomes. This study estimates long-term (beyond 90-day) costs and outcomes associated with qPTP. The authors hypothesized that qPTP reduces lifetime costs and improves outcomes in low-risk patients with symptoms suggestive of ACS and PE...
May 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/25903585/the-5es-of-emergency-physician-performed-focused-cardiac-ultrasound-a-protocol-for-rapid-identification-of-effusion-ejection-equality-exit-and-entrance
#17
M Kennedy Hall, E C Coffey, Meghan Herbst, Rachel Liu, Joseph R Pare, R Andrew Taylor, Sheeja Thomas, Chris L Moore
Emergency physician (EP)-performed focused cardiac ultrasound (EP FOCUS) has been increasingly recognized as a crucial tool to help clinicians diagnose and treat potentially life-threatening conditions. The existing literature demonstrates a variety of EP FOCUS applications and protocols; however, EP FOCUS is not taught, practiced, or interpreted consistently between institutions. Drawing on over 12 years of experience in a large-volume, high-acuity academic emergency department, we have developed a protocol for teaching and performing EP FOCUS known as "The 5Es," where each E represents a specific assessment for immediately relevant clinical information...
May 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
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