Emergency Medicine Commons^™

Near Misses And Unsafe Conditions Reported In A Pediatric Emergency Research Network, Richard M. Ruddy, James M. Chamberlain, Prashant V. Mahajan, Tomohiko Funai, Karen J. O'Connell, Et Al.

Emergency Medicine Faculty Publications

Objective Patient safety may be enhanced by using reports from front-line staff of near misses and unsafe conditions to identify latent safety events. We describe paediatric emergency department (ED) near-miss events and unsafe conditions from hospital reporting systems in a 1-year observational study from hospitals participating in the Pediatric Emergency Care Applied Research Network (PECARN).

Design This is a secondary analysis of 1 year of incident reports (IRs) from 18 EDs in 2007–2008. Using a prior taxonomy and established method, this analysis is of all reports classified as near-miss (events not reaching the patient) or unsafe condition. Classification included type, …

Prospective Study Of Recovery From Copperhead Snake Envenomation: An Observational Study, Eric J. Lavonas, Charles J. Gerardo, Rebecca C. Bowers, Joann Short, Copperhead Snakebite Recovery Outcome Group

Emergency Medicine Faculty Publications

BACKGROUND: Although much is known about signs, symptoms, and management in the acute phase of crotaline snake envenomation, little is known about signs, symptoms, function, and quality of life during the recovery phase. The purpose of this observational pilot investigation is to evaluate the utility of several clinical outcome instruments in the setting of copperhead snakebite, and to characterize the clinical course of recovery.

METHODS: This is a multi-center prospective, open-label, observational study of patients envenomated by copperhead snakes. We administered the Disabilities of the Arm, Shoulder, and Hand (DASH), Lower Extremity Functional Scale (LEFS), Patient-Specific Functional Scale …

Do Emergency Department Patients Receive A Pathological Diagnosis? A Nationally-Representative Sample, Leana Wen, Janice A. Espinola, Joshua M. Mosowsky, Carlos A. Camargo

Emergency Medicine Faculty Publications

Introduction: Understanding the cause of patients’ symptoms often requires identifying a pathological diagnosis. A single-center study found that many patients discharged from the emergency department (ED) do not receive a pathological diagnosis. We analyzed 17 years of data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) to identify the proportion of patients who received a pathological diagnosis at ED discharge. We hypothesized that many patients do not receive a pathological diagnosis, and that the proportion of pathological diagnoses increased between 1993 and 2009.

Methods:Using the NHAMCS data from 1993-2009, we analyzed visits of patients age ≥18 years, …

Emergency Department Ultrasound Probe Infection Control: Challenges And Solutions, Hamid A. Shokoohi, Paige Armstrong, Ryan Tansek

Emergency Medicine Faculty Publications

Point-of-care ultrasound (US) has become a cornerstone in the diagnosis and treatment of patients in the emergency department (ED). Despite the beneficial impact on patient care, concern exists over repeat use of probes and the role as a vector for pathogen transmission. US probes are used for various applications, with the level of infection risk, based on the Spaulding Classification, ranging from noncritical with common practice to semicritical with endocavitary probes. To date, the most closely studied organisms are Staphylococcus aureus and human papilloma virus. Current evidence does confirm probe colonization but has not established a causative role in human …

Educational Technology Improves Ecg Interpretation Of Acute Myocardial Infarction For Medical Students And Emergency Medicine Residents, Ali Pourmand, Mary Tanski, Steven Davis, Hamid A. Shokoohi, Raymond Lucas, Fareen Zaver

Emergency Medicine Faculty Publications

Introduction: Asynchronous online training has become an increasingly popular educational format in the new era of technology-based professional development. We sought to evaluate the impact of an online asynchronous training module on the ability of medical students and emergency medicine (EM) residents to detect electrocardiogram (ECG) abnormalities of an acute myocardial infarction (AMI).

Methods: We developed an online ECG training and testing module on AMI, with emphasis on recognizing ST elevation myocardial infarction (MI) and early activation of cardiac catheterization resources. Study participants included senior medical students and EM residents at all postgraduate levels rotating in our emergency department (ED). …

Do Emergency Department Patients Receive A Pathological Diagnosis? A Nationally-Representative Sample., Leana S. Wen, Janice A. Espinola, Joshua M. Mosowsky, Carlos A. Camargo

Emergency Medicine Faculty Publications

Introduction

Understanding the cause of patients’ symptoms often requires identifying a pathological diagnosis. A single-center study found that many patients discharged from the emergency department (ED) do not receive a pathological diagnosis. We analyzed 17 years of data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) to identify the proportion of patients who received a pathological diagnosis at ED discharge. We hypothesized that many patients do not receive a pathological diagnosis, and that the proportion of pathological diagnoses increased between 1993 and 2009.

Methods

Using the NHAMCS data from 1993–2009, we analyzed visits of patients age ≥18 years, discharged …

Solving The Worldwide Emergency Department Crowding Problem - What Can We Learn From An Israeli Ed?, Jesse M Pines, Steven L Bernstein

Emergency Medicine Faculty Publications

ED crowding is a prevalent and important issue facing hospitals in Israel and around the world, including North and South America, Europe, Australia, Asia and Africa. ED crowding is associated with poorer quality of care and poorer health outcomes, along with extended waits for care. Crowding is caused by a periodic mismatch between the supply of ED and hospital resources and the demand for patient care. In a recent article in the Israel Journal of Health Policy Research, Bashkin et al. present an Ishikawa diagram describing several factors related to longer length of stay (LOS), and higher levels of ED …

Treatment Failure Outcomes For Emergency Department Patients With Skin And Soft Tissue Infections, Larissa S. May, Mark S. Zocchi, Catherine Zatorski, Jeanne A. Jordan, Richard E. Rothman, Chelsea Ware

Emergency Medicine Faculty Publications

Introduction: Skin and soft tissue infections (SSTIs) are commonly evaluated in the emergency department (ED). Our objectives were to identify predictors of SSTI treatment failure within one week post-discharge in patients with cutaneous abscesses, as well as to identify predictors of recurrence within three months in that proportion of participants. Methods: This was a sub-analysis of a parent study, conducted at two EDs, evaluating a new, nucleic acid amplification test (NAAT) for Staphylococcus aureus in ED patients. Patients≥18 years receiving incision and drainage (I and D) were eligible. Patient-reported outcome data on improvement of fever, swelling, erythema, drainage, and pain …

Mental Health Disorders In Child And Adolescent Survivors Of Post-War Landmine Explosions., Mohammad Ali Hemmati, Hamid Shokoohi, Mehdi Masoumi, Shahriar Khateri, Mohammadreza Soroush, Ehsan Modirian, Mahtab Poor Zamany Nejat Kermany, Maryam Hosseini, Batool Mousavi

Emergency Medicine Faculty Publications

BACKGROUND: To describe the mental health status of 78 child and adolescent survivors of post-war landmine explosions.

METHODS: Child and adolescent survivors of landmine explosions who were younger than 18 years old at the time of the study were identified and enrolled in this study. The mental health status of the participants was assessed by general health assessment and psychiatric examinations. Psychiatric assessment and diagnosis were undertaken using the Diagnostic and Statistical Manual for mental disorders (DSM-IV) criteria. A psychiatrist visited and interviewed each survivor and identified psychiatric disorders.

RESULTS: Seventy-eight child and adolescent survivors with a mean age of …

Telepsychiatric Assessment Of A Mariner Expressing Suicidal Ideation., Alexander Lee, Neal Sikka, Francis O'Connell, Allen Dyer, Keith Boniface, James Betz

Emergency Medicine Faculty Publications

This case report highlights the successful use of telepsychiatric consultation by secure video chat to remotely assess a mariner expressing suicidal ideation. As a result of this intervention, telemedicine providers initiated psychiatric stabilisation while the mariner was still aboard the vessel, determined that he was safe for repatriation under the care of qualified medical escorts, and facilitated admission to a psychiatric facility near his home in the United States. Mental health emergencies are a significant cause of morbidity and mortality among mariners. Telepsychiatry is a validated method of establishing a psychiatric diagnosis and disposition as well as assessing risk of …