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Articles 1 - 22 of 22
Full-Text Articles in Emergency Medicine
Caring For Older Adults In The Hallway Of A Crowded Emergency Department, Rebecca Weeks, Kathy Sawasky, Michael Malone
Caring For Older Adults In The Hallway Of A Crowded Emergency Department, Rebecca Weeks, Kathy Sawasky, Michael Malone
Journal of Geriatric Emergency Medicine
This paper describes strategies for emergency department providers to address the needs of older adults when facilities are overcrowded and care extends into the hallway.
A Survey Of Delirium Self-Reported Knowledge And Practices Among Emergency Physicians In The United States, Anita N. Chary, Adriane Lesser, Sharon K. Inouye, Christopher R. Carpenter Md, Msc, Amy R. Stuck, Maura Kennedy
A Survey Of Delirium Self-Reported Knowledge And Practices Among Emergency Physicians In The United States, Anita N. Chary, Adriane Lesser, Sharon K. Inouye, Christopher R. Carpenter Md, Msc, Amy R. Stuck, Maura Kennedy
Journal of Geriatric Emergency Medicine
Objective: This study aimed to evaluate United States emergency physicians’ self-reported knowledge and practices regarding the detection, prevention, and management of delirium, a common and deadly syndrome that disproportionately affects older emergency department (ED) patients. Knowledge and practices of the broader emergency physician community about these priority topics in geriatric emergency medicine are understudied.
Design: Electronic self-administered online survey
Setting: United States
Participants: One-hundred ninety-seven emergency physicians of the American College of Emergency Physicians Emergency Medicine Practice Research Network
Measures: Descriptive statistics were generated from survey responses.
Results: Of 734 physicians in the research network who were sent the …
It Takes Courage To Pause: Rapid Goals-Of-Care Conversations In The Emergency Department, Anita N. Chary, Aanand D. Naik, Kei Ouchi
It Takes Courage To Pause: Rapid Goals-Of-Care Conversations In The Emergency Department, Anita N. Chary, Aanand D. Naik, Kei Ouchi
Journal of Geriatric Emergency Medicine
n/a
Polypharmacy And High-Risk Medications In Older Veterans Presenting For Emergency Care, Paige Morizio, Vinita Mistry, Ashley Mcknight, Marc Pepin, William Bryan, Ryan Owenby, Laura Previll, Luna Ragsdale
Polypharmacy And High-Risk Medications In Older Veterans Presenting For Emergency Care, Paige Morizio, Vinita Mistry, Ashley Mcknight, Marc Pepin, William Bryan, Ryan Owenby, Laura Previll, Luna Ragsdale
Journal of Geriatric Emergency Medicine
Background: Guidelines suggest screening for polypharmacy and documentation of high-risk medications in the geriatric Emergency Department (ED) setting. The purpose of this quality improvement initiative was to describe high-risk medications and polypharmacy in older Veterans presenting to the ED in order to inform the workflow of a Geriatric ED pharmacist.
Methods: This was a retrospective, quality improvement project that included patients age 65 years or older who presented to the ED between 10/1/2017 and 9/30/2019. The endpoints included the number of patients with at least one high-risk medication and the mean number of medications on the outpatient medication list. The …
Intermediate Care Technicians-A Novel Workforce For Veterans Affairs Geriatric Emergency Departments, Kristina T. Snell, Thomas Edes, Colleen M. Mcquown
Intermediate Care Technicians-A Novel Workforce For Veterans Affairs Geriatric Emergency Departments, Kristina T. Snell, Thomas Edes, Colleen M. Mcquown
Journal of Geriatric Emergency Medicine
No abstract provided.
Improving Patient Flow In The Urgent Care Setting, Stephanie Carpenter
Improving Patient Flow In The Urgent Care Setting, Stephanie Carpenter
Student Scholarly Projects
Practice Problem: Urgent care clinics provide care to patients with non-life-threatening illnesses or injuries and are found to be less expensive and more convenient than emergency departments. As urgent care clinics are growing in popularity so are the patient wait times and overall length of stay times.
PICOT: The PICOT question that guided this project was in urgent care clinic patients (P), how does utilizing the Emergency Severity Index (ESI) as a patient triage tool (I) compared to using no patient triage tool (C) affect the patient flow and patient wait times (O) within 13 weeks.
Evidence: Evidence search with …
Geriatric Emergency Medicine Fellowship Journal Club: Frailty, Sarah Keene, Rebecca Fisher, Lauren Cameron-Comasco
Geriatric Emergency Medicine Fellowship Journal Club: Frailty, Sarah Keene, Rebecca Fisher, Lauren Cameron-Comasco
Journal of Geriatric Emergency Medicine
No abstract provided.
Ten Clinical Tips In The Assessment Of Genitourinary Emergencies Of An Older Adult, Nicole Soria, Danya Khoujah
Ten Clinical Tips In The Assessment Of Genitourinary Emergencies Of An Older Adult, Nicole Soria, Danya Khoujah
Journal of Geriatric Emergency Medicine
The Influence Of Hospital Site On Emergency Physician Press Ganey Scores, Dietrich Jehle, Brian Doherty, Lexus Dickson, Melville C. O'Brien, Casey Wilson, Scott Gutovitz
The Influence Of Hospital Site On Emergency Physician Press Ganey Scores, Dietrich Jehle, Brian Doherty, Lexus Dickson, Melville C. O'Brien, Casey Wilson, Scott Gutovitz
HCA Healthcare Journal of Medicine
Background
The use of physician satisfaction scores to evaluate emergency medicine physicians’ performance and compensation is controversial. Prior studies have shown that the clinical environment may influence scores. This study compared satisfaction scores for the same physician at different emergency departments (ED). Differences in their individual score may indicate the ED environment could be as important as the physician’s interaction.
Methods
Press Ganey satisfaction scores were obtained for physicians at three EDs—Grand Strand, South Strand and North Strand—between July 2018 and June 2019. Included physicians worked at all 3 facilities and had at least 6 patient satisfaction surveys at each …
Sentinel Paper Review: Exploring Care Transitions From Patient, Caregiver, And Health-Care Provider Perspectives, Kevin T. Fuji, Aaron Malsch, Pamela Martin
Sentinel Paper Review: Exploring Care Transitions From Patient, Caregiver, And Health-Care Provider Perspectives, Kevin T. Fuji, Aaron Malsch, Pamela Martin
Journal of Geriatric Emergency Medicine
No abstract provided.
Emergency Medicine Shift Factors Causing The Most Stress Among Emergency Medicine Residents, Mohamad Moussa, Kristen Hayden, Chia-Hao Shih, Sadik Khuder, Zayd Safadi, Connor Parsell
Emergency Medicine Shift Factors Causing The Most Stress Among Emergency Medicine Residents, Mohamad Moussa, Kristen Hayden, Chia-Hao Shih, Sadik Khuder, Zayd Safadi, Connor Parsell
Journal of Wellness
Introduction: Past studies demonstrate that stress and anxiety affect emergency medicine physicians, but the causal factors identified are usually from sources outside the work shift. We attempt to show the relationship between intrinsic factors of a work shift and anxiety perceived by residents, while also examining differing gender responses.
Methods: In 2018, a cross-sectional survey of emergency medicine residents in the United States was distributed anonymously through the Emergency Medicine Residents Association. The survey consisted of demographic questions, novel questions identifying intrinsic factors, and the Generalized Anxiety Disorder 7-item (GAD-7) scale. Spearman correlation, independent t-test, and multivariate analysis of variance …
Can An Emergency Department Adequately Address An Older Adult Who Has Complex Needs?, Rami Tarabay, Adam Perry, Riwa Al Aridi, Michael Malone
Can An Emergency Department Adequately Address An Older Adult Who Has Complex Needs?, Rami Tarabay, Adam Perry, Riwa Al Aridi, Michael Malone
Journal of Geriatric Emergency Medicine
Older adults account for a considerable percentage of all emergency departments (ED) patient encounters. Those with very complex needs or multiple co-morbid conditions often have lengthy ED evaluations culminating in admission, many of which are considered potentially avoidable. Provider and process elements can evolve to create efficient and more comprehensive geriatric assessments in ED. This paper describes an older adult with acute on chronic symptoms admitted through the ED to the Acute Care for Elders (ACE) inpatient unit. We illustrate how elements of the ACE model, when applied in the ED, may avoid hospitalization. We review the Domain Management Model …
Caregiver Support In The Emergency Department, Candace Kim, Dawn Butler, Todd C. James
Caregiver Support In The Emergency Department, Candace Kim, Dawn Butler, Todd C. James
Journal of Geriatric Emergency Medicine
Caregiver support in the emergency department can lead to improved patient care, decreased suffering and lower costs. Identifying caregivers and inviting them onto the healthcare team enhances care. It is useful to document risk factors for caregiver stress and provide resources. The Kingston Caregiver Stress Scale is a tool suitable for assessing needs of caregivers. Multiple health professionals in the emergency department can be utilized to support caregivers.
Unmet Needs And Social Challenges For Older Adults During And After The Covid-19 Pandemic: An Opportunity To Improve Care, Alyssa Elman, Daniel Baek, Elaine Gottesman, Michael E. Stern, Mary R. Mulcare, Amy Shaw, Morgan Pearman, Michelle Sullivan, Sunday Clark, Timothy F. Platts-Mills, Rahul Sharma, Tony Rosen
Unmet Needs And Social Challenges For Older Adults During And After The Covid-19 Pandemic: An Opportunity To Improve Care, Alyssa Elman, Daniel Baek, Elaine Gottesman, Michael E. Stern, Mary R. Mulcare, Amy Shaw, Morgan Pearman, Michelle Sullivan, Sunday Clark, Timothy F. Platts-Mills, Rahul Sharma, Tony Rosen
Journal of Geriatric Emergency Medicine
Many older adults have unmet needs and social challenges that can negatively impact their health and well-being, particularly during and after the COVID pandemic. These include social isolation, inadequate care or assistance with their daily activities, food insecurity, housing insecurity, poverty, and abuse/neglect/exploitation. An ED visit provides a unique and critical opportunity to identify these issues and initiate intervention for these vulnerable older adults. By assessing for unmet needs and social challenges, considering a team-based approach as to how they may be ameliorated, using online tools, and integrating telehealth and EMS, ED providers have the potential to dramatically improve …
Management Of Fall Patients – What Should Be Done For Emergency Department Fall Patients?, Katherine Selman, Christine Binkley, Katherine Davenport, Shan W. Lliu, Maura Kennedy
Management Of Fall Patients – What Should Be Done For Emergency Department Fall Patients?, Katherine Selman, Christine Binkley, Katherine Davenport, Shan W. Lliu, Maura Kennedy
Journal of Geriatric Emergency Medicine
Falls are the leading cause of injury-related emergency visits in older adults, translating into an estimated 3 million ED visits and 32,000 deaths from fall-related injuries annually in the United States. Falls subsequently result in diminished functional ability and higher risk for future falls and mortality. Despite this, ED clinicians focus primarily on injuries that result from a fall and often defer the modifiable causes of the fall and future fall prevention to outpatient providers. We review two articles that address the feasibility of performing interventions from the ED and the efficacy of a multifactorial fall intervention program.
Using The 4m Model To Screen Geriatric Patients In The Emergency Department, Martinus Megalla, Roopa Avula, Christopher Manners, Portia Chinnery, Lindsey Perrella, Douglas Finefrock
Using The 4m Model To Screen Geriatric Patients In The Emergency Department, Martinus Megalla, Roopa Avula, Christopher Manners, Portia Chinnery, Lindsey Perrella, Douglas Finefrock
Journal of Geriatric Emergency Medicine
Several models of specialized geriatric care in the Emergency Department (ED) have been developed since the American College of Emergency Physicians (ACEP) began accrediting geriatric EDs in 2018. There is considerable variability in terms of both design and efficacy in regard to screening older patients in the ED and determining proper interventions The John A. Hartford Foundation and Institute for Healthcare Improvement (IHI) have developed the 4M Model for Creating Age-Friendly Health Systems which aims to provide high quality care to older patients by addressing four critical elements: Mentation, Mobility, Medication, What Matters. This article describes a screening tool for …
“I’M Not Staying In The Hospital Tonight”: How Emergency Departments Can Leverage Health And Social Services At Home To Support Care Transitions For Older Patients, Emily Franzosa, Ula Hwang, Maya Genovesi, Orna Intrator, Thomas Edes, Michael Malone
“I’M Not Staying In The Hospital Tonight”: How Emergency Departments Can Leverage Health And Social Services At Home To Support Care Transitions For Older Patients, Emily Franzosa, Ula Hwang, Maya Genovesi, Orna Intrator, Thomas Edes, Michael Malone
Journal of Geriatric Emergency Medicine
When hospital admission is less than desirable and sending a patient home alone feels unsafe, connecting patients to health and social services at home are a valuable third option for emergency providers. Coordinating home support services from the ED is effective care delivery and aligns with health systems’ goals of decreasing avoidable admissions, and developing capacity to assess and refer patients to home support from the ED is part of good emergency care. Change also doesn’t have to happen overnight. Taking small steps now to improve older patients' transitions to home can help EDs build toward high-quality, patient-centered care for …
Emergency Department - Community Partnership To Coordinate Older Adults Falls Prevention Programs, Suzanne Ryer, Ann Gallo, Adam Perry, Michael Malone
Emergency Department - Community Partnership To Coordinate Older Adults Falls Prevention Programs, Suzanne Ryer, Ann Gallo, Adam Perry, Michael Malone
Journal of Geriatric Emergency Medicine
Abstract
Falls and injurious falls are common causes for emergency department visits in older adults. Prior literature describing ED care of older adults has focused on the patients' injuries and their ED care. There is a gap in the literature describing community- based falls prevention strategies and interventions deployed by community organizations, beyond health systems. We identified variation in approaches to older adults among paramedic programs from one community to the next within Milwaukee County, Wisconsin. We also noted no organized falls prevention program spanning all communities, emergency departments and health systems in the county. We describe the implementation of …
Assigning Level Of Care In Blunt Chest Trauma Patients: Applying Objective Scoring Systems, Alyssa Imperatore, Kaitlyn Oldewurtel, James Eakins
Assigning Level Of Care In Blunt Chest Trauma Patients: Applying Objective Scoring Systems, Alyssa Imperatore, Kaitlyn Oldewurtel, James Eakins
Rowan-Virtua Research Day
25% of all traumatic deaths are related to blunt chest trauma and another 50% have in-hospital morbidity and mortality. Recognizing patients with high risk of mortality is just as important as recognizing the immediate severely injured patients. Atlanticare Regional Trauma Center developed a scoring system in an attempt to properly assign these patients to an appropriate level of care. The system was developed based on a literature review but has not yet been studied to review its effectiveness in improving outcomes in chest trauma patients. Therefore, the scoring system is used as a guideline and not an official document in …
The Application Of Point-Of-Care Ultrasound In Ed Intubations And Airway Access: A Systematic Review, Frank Wheeler, James Espinosa, Alan Lucerna, Jeffrey Gardecki
The Application Of Point-Of-Care Ultrasound In Ed Intubations And Airway Access: A Systematic Review, Frank Wheeler, James Espinosa, Alan Lucerna, Jeffrey Gardecki
Rowan-Virtua Research Day
Intubation is an essential procedure performed on a routine basis in the emergency room. Unsuccessful intubations are associated with deleterious outcomes. A systematic review was performed to investigate the accuracy of point of care ultrasound (POCUS) in successful Endotracheal Tube (ET) tube confirmation, utilizing ultrasonography, identification of the cricothyroid membrane utilizing ultrasound, and dynamically during use of ultrasonography in the process of intubation. This review demonstrated high sensitivity and specificity for ultrasound confirmation of ET tube placement, high success rate in ultrasound-guided intubation, and lower than expected accuracy in identifying the cricothyroid membrane. Ultrasonography should be considered for ET tube …
Case Report: The Value Of Vigilance And Iterative Evaluations With An Uncooperative Patient In The Emergency Department, Duwayne Campbell
Case Report: The Value Of Vigilance And Iterative Evaluations With An Uncooperative Patient In The Emergency Department, Duwayne Campbell
Rowan-Virtua Research Day
Discussion
A Flexible and Vigilant Approach: The initial presenting information from EMS could have led to anchoring bias. A flexible approach led to new information, which led to interative testing.
Iterative physical examination. There are cases, as seen in this case report, where the physical examination was unreliable or even impossible. Iterative evaluations ultimately led to appropriate imaging and accurate diagnosis.
Iterative testing: In the case presented, the radiologist reported a finding as being present on a prior CXR; however, given the patient’s clinical presentation, further imaging studies were necessary.
Improving Emergency Department Throughput: Using A Pull Method Of Patient Flow, Jeffrey Collins
Improving Emergency Department Throughput: Using A Pull Method Of Patient Flow, Jeffrey Collins
Student Scholarly Projects
Practice Problem: Overcrowding in the emergency department (ED) has been shown to increase the length of hospital stay, adversely impact patient outcomes, and reduce patient satisfaction. Problems with overcrowding and throughput are often thought of as an ED-specific inefficiency; however, the issue is indicative of hospital-wide inefficiencies.
PICOT: The PICOT question that guided this project was “For ED patients admitted to the medical-surgical unit at an acute medical center, will the implementation of a pull model for patient flow, when compared to the current push model, reduce admission delay and length of stay (LOS) within six weeks of implementation?
Evidence: …