Emergency Medicine Commons^™

Investigating Markers For Intracranial Hemorrhage Severity: Insights From Cbc Changes And Beyond, Mckenzie Locker, Kasey Chelemedos, Nataly Apollonsky

Tower Health Research Day

No abstract provided.

Opioid Prescribing Habits Of Emergency Department Providers In Response To An Educational Intervention, Tory A. Makela, Benjamin Aaker

Aesculapius Journal (Health Sciences & Medicine)

Opioid prescribing habits of Emergency Department providers in response to an educational intervention

Tory Makela, MS4; Benjamin Aaker, MD

Introduction: Prescription opioid misuse and dependency has been a rising cause for concern in the United States in recent years, and many of these cases began with an initial prescription in the Emergency Department (ED). Prior studies found that patients seen by “high intensity” prescribers, who prescribe greater quantities of opioids than 75% of other ED physicians within the same hospital, are significantly more likely to suffer from long-term opioid use. Other studies have shown that educational interventions on appropriate opioid …

Preventing And Responding To Workplace Violence In The Emergency Department, Janina La Porte, Stefanie Lai, Alicia Rodriguez

Articles, Abstracts, and Reports

No abstract provided.

Improving Emergency Department Belongings Inventory Electronic Medical Record Documentation, Shanekia Garrett, Stefanie Lai, Jairo Pagan, Wendy Lu, Katie Whitehead

Articles, Abstracts, and Reports

No abstract provided.

S100a8/A9 As A Prognostic Biomarker With Causal Effects For Post-Acute Myocardial Infarction Heart Failure, Jie Ma, Yang Li, Ping Li, Xinying Yang, Shuolin Zhu, Ke Ma, Fei Gao, Hai Gao, Hui Zhang, Xin-Liang Ma, Jie Du, Yulin Li

Department of Emergency Medicine Faculty Papers

Heart failure is the prevalent complication of acute myocardial infarction. We aim to identify a biomarker for heart failure post-acute myocardial infarction. This observational study includes 1062 and 1043 patients with acute myocardial infarction in the discovery and validation cohorts, respectively. The outcomes are in-hospital and long-term heart failure events. S100A8/A9 is screened out through proteomic analysis, and elevated circulating S100A8/A9 is independently associated with heart failure in discovery and validation cohorts. Furthermore, the predictive value of S100A8/A9 is superior to the traditional biomarkers, and the addition of S100A8/A9 improves the risk estimation using traditional risk factors. We finally report …

Improving Emergency Department Belongings Inventory Electronic Medical Record Documentation Rates, Stefanie Lai

Providence Nursing Research Conference 2023 – Present

Background: Electronic Medical Record (EMR) education and training for RNs should be multifaceted and targeted to the RN clinical workflow. Input from direct care RNs is essential to ensure EMR education is relevant and effective. Shared Governance at a community hospital identified quality and safety concerns among inpatient RNs. RNs reported that belongings inventories were not consistently documented in the EMR for Emergency Department (ED) admissions. Hospital policy requires belongings inventory EMR documentation for all admitted patients. An audit of charts for ED admissions over three months revealed only 5% compliance with this policy.

Purpose: The purpose of this project …

The Utility Of Non-Specific Ecg Findings In The Setting Of Low High-Sensitivity Cardiac Troponin Levels, Arqam Husain, Nathan Klausner, Emily Schwab, Joseph Miller, Kaab Husain

Medical Student Research Symposium

Objective: Our objective was to assess the relationship between non-specific ischemic electrocardiogram (nsi-ECG) findings and the occurrence of major adverse cardiac events (MACE) within a 30-day timeframe among patients in the Emergency Department (ED) with low high-sensitivity cardiac troponin (hs-cTnI) levels.

Methods: We conducted a secondary analysis of the RACE-IT trial, a randomized trial performed across 9 EDs from July 2020 through March 2021 that looked at the effectiveness of hs-cTnI in evaluating the risk for acute myocardial infarction (AMI). Our study assessed the association between nsi-ECG findings (left bundle branch block, ST-segment changes, or T-wave inversions) and 30-day MACE …

Characterizing Cold Water Drownings In The Great Lakes, Elizabeth T. Helfrich, Anthony Lagina

Medical Student Research Symposium

Since the COVID-19 outbreak in 2020, Great Lakes drownings have increased. The Great Lakes are a unique and understudied environment due to being cold, fresh water, and resuscitation protocols and guidelines being derived from warm, primarily salt water environments. We analyzed open sources materials to find records of Great Lakes drownings from 2021-2023 and analyze the data looking for trends in cold and warm water drownings.

We found 80.0-85.0% of the included drowning victims were male and had an average age of 38.0-39.0 years old. 40.0%-57.7% of Great Lakes drowning deaths were in cold water; of those, Lake Michigan had …

Preventing And Responding To Workplace Violence In The Emergency Department, Stefanie Lai, Alicia Rodriguez

Providence Nursing Research Conference 2023 – Present

Background: Workplace violence (WPV) is defined as physical violence or verbal threats of physical violence, regardless of whether an employee sustains an injury. Emergency department (ED) staff are at high risk of exposure to WPV, which can lead to burnout, job dissatisfaction, and secondary stress. Effective preparation for and response to WPV incidents can help mitigate these negative effects. Multicomponent interventions, including education, safety huddles, behavioral health rapid response teams, and environmental modifications, have been shown to reduce WPV incidents and increase staff perceptions of safety.

Purpose: The purpose of this evidence informed-quality improvement project was to increase knowledge of …

An Educational Intervention Differentiating Pressure Injuries From End-Of-Life Wounds, Alicia Perez Varela, Annette Callis

Providence Nursing Research Conference 2023 – Present

Background

End-of-life (EOL) wounds are identified in the literature as Kennedy Terminal Ulcers (KTU), Skin Failure (SF), Trombley-Brennan Terminal Tissue Injury (TB-TTI), and SCALE (Skin Changes at Life’s End). EOL wounds have a similar appearance to pressure injuries (PIs) with a fundamentally different etiology. The misclassification of EOL wounds as PIs results in increased Hospital Acquired Pressure Injuries (HAPI), hospital fines, and less-than-optimal EOL wound management.

Purpose

To examine the effectiveness of an educational intervention on EOL wounds in increasing nurse confidence in providing End-of-Life Care (EOLC) and differentiating PIs from EOL wounds.

Methods

This quasi-experimental study used the 28-item …

A Better Tool For Ed Fall Risk Assessments: The Monego-Barra Ed Fall Risk Assessment Tool (Moba), Roxanne Barra, Mary Waldo, Angela Graves, Jessica Monego

Providence Nursing Research Conference 2023 – Present

Background

The incidence of falls has been increasing in emergency departments (EDs), with some resulting in harm. In a large health care system in the Western United States, the Morse Fall Risk Assessment Tool (Morse) is used across care settings, despite not being validated in the ED. Other ED tools in the literature are the Memorial ED Fall Risk Assessment Tool (Memorial) and Kinder 1 Fall Risk Assessment Tool (Kinder). These three tools contain risk factors that may not be specific to EDs or are missing relevant factors. This led the researchers to create the Monego-Barra ED Fall Risk Assessment …

Adherence To Sb5195 Naloxone Distribution Requirements At Discharge From The Emergency Department, E Stewart, J Delfeld, J Mckay, J Corhei, Kailyn Elliot

Providence Nursing Research Conference 2023 – Present

Background: Washington State, mirroring a national crisis, experienced a surge in opioid-related deaths, with 17,502 fatalities from 2007 to 2021. This trend aligns with the U.S.'s broader opioid epidemic, marked by 70,000 drug overdose deaths in 2017, data show overdose deaths involving opioids increased from an estimated 70,029 in 2020 to 80,816 in 2021. Overdose deaths were from synthetic opioids, primarily fentanyl. In response, empowering registered nurses (RNs) in emergency departments (EDs) to issue Nurse-Initiated Orders (NIO) for patients to discharge from the hospital with physical naloxone pre-pack kits to be used in the community, an opioid antagonist, has …

Relationship Between On-Demand Telehealth Visits And Emergency Department And Hospital Surge During The Covid-19 Pandemic, B. H. Slovis, Xin Ji, Anna Marie Chang, John C. Kairys, Judd Hollander

Department of Emergency Medicine Faculty Papers

OBJECTIVES: The relationship between COVID-19-related telehealth calls could be used to predict emergency department visits and hospital surges 3 days later potentially facilitating staffing adjustments in advance of patient arrivals. The purpose of this research was to study the temporal association between frequencies of on demand telehealth calls and emergency department surges during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic.

METHODS: This cohort study examined patients who self-initiated synchronous audio-video on-demand telehealth calls between January 1, 2020 and June 30, 2022, and compared these to emergency department arrivals. The exposure in question was a synchronous audio-video on-demand telehealth …

" Does Educational Level Affect The Outcome Of Myocardial Infarction? ", Ahmed Magdy Ahmed Elsayed

Theses and Dissertations

Background: Heath awareness plays a major role in determining the outcomes of serious medical conditions specially when response time is crucial. STEMI patients are prone to serious compilations if they didn’t receive the appropriate treatment on time. Raising the health awareness of the community would result in seeking medical help at earlier stage of the disease. Earlier presentation to the medical center would result in better health outcomes. Certain factors form the health awareness of the community. This includes educational level, previous exposure to similar situations, and exposure to health awareness materials.

Methods: This is a cohort study in …

Medication Errors Among Als Providers In The Prehospital Setting, Cody Vaughn Gibson, Victor Jimenez Jr

Annual Research Symposium

EMS providers administer a variety of medications to patients in the prehospital environment, and while there are numerous published studies on medication errors pertaining to the hospital environment, there are comparatively fewer studies which focus on the prehospital environment. Therefore, the purpose of this survey is to investigate the type and frequency of medication errors occurring in the prehospital environment.

Validation Of A Novel, Rapid Sepsis Diagnostic For Emergency Department Use, Hollis R. O'Neal, Roya Sheybani, David R. Janz, Robert Scoggins, Tonya Jagneaux, James E. Walker, Daniel J. Henning, Elizabeth Rosenman, Simon A. Mahler, Hariharan Regunath, Christopher S. Sampson, D. Clark Files, Richard D. Fremont, Michael J. Noto, Erica E. Schneider, Wesley R. Shealey, Matthew S. Berlinger, Thomas C. Carver, Morgan K. Walker, Nathan A. Ledeboer, Ajay M. Shah, Henry T.K. Tse, Dino Dicarlo, Todd W. Rice, Christopher B. Thomas

School of Medicine Faculty Publications

OBJECTIVES: To assess the in vitro IntelliSep test, a microfluidic assay that quantifies the state of immune activation by evaluating the biophysical properties of leukocytes, as a rapid diagnostic for sepsis. DESIGN: Prospective cohort study. SETTING: Five emergency departments (EDs) in Louisiana, Missouri, North Carolina, and Washington. PATIENTS: Adult patients presenting to the ED with signs (two of four Systemic Inflammatory Response Syndrome criteria, where one must be temperature or WBC count) or suspicion (provider-ordered culture) of infection. INTERVENTIONS: All patients underwent testing with the IntelliSep using ethylene diamine tetraacetic acid-anticoagulated whole blood followed by retrospective adjudication for sepsis by …

Analysis Of Anonymous Student Narratives About Experiences With Emergency Medicine Residency Programs, Molly Estes, Jacob Garcia, Ronnie Ren, Mark Olaf, Shannon Moffett, Michael Galuska, Xiao C. Zhang

Department of Emergency Medicine Faculty Papers

Background: Academic emergency medicine (EM) communities have viewed anonymous online communities (AOC) such as Reddit or specialty-specific “applicant spreadsheets” as poor advising resources. Despite this, robust EM AOCs exist, with large user bases and heavy readership. Insights about applicants’ authentic experiences can be critical for applicants and program leadership decision-making. To date, there are no EM studies to qualitatively assess EM AOC narratives during the application cycle. Our goal was to perform a qualitative analysis of students’ EM program experiences through a publicly available AOC. Methods: This was a qualitative analysis of a publicly available, time-stamped, user-locked AOC dataset: “Official …

Elderly Female With Abdominal Pain And Hypotension, Michael Fareri, Arthur K Au, Kelly Goodsell, M. Fields

Department of Emergency Medicine Faculty Papers

No abstract provided.

The Interrai Ed Tool For Screening Older Patients In The Emergency Department: “What Am I Supposed To Do With This?”, Michael L. Malone

Journal of Geriatric Emergency Medicine

not applicable for Collective Wisdom/ Editorial per JGEM author guidelines.

Effectiveness Of Antibiotic Stewardship For Healthcare Providers At Urgent Care Clinics, Helen T. Adewole

Electronic Theses and Dissertations

Antibiotics have revolutionized modern medicine; however, the overuse in urgent care and primary care significantly contributes to the global burden of infections resistant to available antimicrobial medicines. Approximately 30% of the antimicrobials prescribed in acute care settings are unnecessary. Patient demand for antibiotics has seemingly skyrocketed following the recent COVID-19 pandemic. Practitioners must be knowledgeable about antibiotic stewardship initiatives, such as the wait-and-see approach, to reduce antibiotic overuse and improve the trajectory of antibiotic resistance and patient health outcomes. The gap in practice was the limited awareness of scientific evidence-based tools to partner with patients and improve antibiotic prescription patterns. …

Boarding Of Older Adults: A Concerning Trend In The Emergency Department, Julie Van Baardwijk, Eric Tharmathurai, Ariba Khan

Journal of Geriatric Emergency Medicine

Emergency department (ED) boarding (EDB) is the practice of holding admitted patients in the ED due to a lack of hospital beds. We identified one ED in our health system with a high rate of EDB. We sought to identify factors associated with EDB in this hospital by comparing it to a similar hospital in our health care system.

Methods: We conducted a retrospective study comparing two community hospitals in our healthcare system. Boarding was defined as a patient waiting ≥8 hours in ED for disposition. One hospital, located in a rural area with 55beds was chosen as it was …

Recommendations From People Who Use Drugs In Philadelphia, Pa About Structuring Point-Of-Care Drug Checking, Megan K. Reed, Elias Borne, Tracy Esteves Camacho, Morgan Kelly, Kristin L. Rising

Department of Emergency Medicine Faculty Papers

Background

Adulterants, such as fentanyl and xylazine, among others, are present in a high percentage of the illicit drug supply, increasing the risk for overdose and other adverse health events among people who use drugs (PWUD). Point-of-care drug checking identifes components of a drug sample and delivers results consumers. To successfully meet the diverse needs of PWUD, more information is needed about the utility of drug checking, motivations for using services contextualized in broader comments on the drug supply, hypothesized actions to be taken after receiving drug checking results, and the ideal structure of a program.

Methods

In December 2021, …

Whole Blood In Trauma, Jason P. Prevelige

Pacific Journal of Health

Abstract: Hemorrhage is a leading cause of death in trauma patients. Whole blood administration in trauma has gained a renewed interest in recent years, however the concept is not new at all, with its origins spanning over 100 years. Field experience in United States’ military conflicts has provided important data on the efficacy of whole blood in reducing mortality and amount of blood product administration. Civilian trials however have not necessarily shown similar results. The safety of whole blood however does not seem to be in question given the available data, and is an acceptable option for blood replacement in …

The Challenges Of Implementing And Documenting Ottawa Ankle Rules In The Pediatric Emergency Department: A Retrospective Study, Emmalee M. Kugler, Michael Gillman, Olivia Toner

Cooper Rowan Medical Journal

INTRODUCTION
Acute ankle sprains account for nearly 2% of visits to the pediatric emergency department (PED). The Ottawa Ankle Rules (OAR) were developed as a safe and effective clinical decision-making tool for detecting the need for radiographs in adults with acute ankle pain. OAR state radiographs are required with at least one of the following:

1. Inability to bear weight immediately following the injury and for four steps in the ED 2. Bony tenderness at the posterior edge of the lateral or medial malleolus

OBJECTIVE
Few prospective cohort studies have attempted to assess OAR pediatric populations. This study investigates the …

Non-Ketotic Hyperglycemia Unmasks Hemichorea - A Reply, Ezhilkugan Ganessane, Sasikumar Mahalingam, Selva Ganesan

Journal of Community Hospital Internal Medicine Perspectives

No abstract for this article type

De-Implementation Of Fecal Occult Blood Testing In The Emergency Department And Hospital Units: A Quality Improvement Project, Adewale Ajumobi, Joline De Castro, Ammar Qureshi

Journal of Community Hospital Internal Medicine Perspectives

Background: Fecal occult blood tests (FOBT) are inappropriately used in patients with melena, hematochezia, coffee ground emesis, iron deficiency anemia, and diarrhea. The use of FOBT for reasons other than screening for colorectal cancer is considered low-value and unnecessary. Methods: Quality Improvement Project that utilized education, Best Practice Advisory (BPA) and modification of order sets in the electronic health record (EHR). The interventions were done in a sequential order based on the Plan-Do-Study-Act (PDSA) method. An annotated run chart was used to analyze the collected data. Results: Education and Best Practice Advisory within the EHR led to significant reduction in …

Prediction Of Major Adverse Cardiac Events In The Emergency Department Using An Artificial Neural Network With A Systematic Grid Search, Ahmed Raheem Buksh, Nadeem Ullah Khan, Rida Jawed, Shahan Waheed, Musa Karim

Department of Emergency Medicine

Background: The aim of our research was to design and evaluate an Artificial Neural Network (ANN) model using a systemic grid search for the early prediction of major adverse cardiac events (MACE) among patients presenting to the triage of an emergency department.
Methods: This is a single-center, cross-sectional study using electronic health records from January 2017 to December 2020. The research population consists of adults coming to our emergency department triage at Aga Khan University Hospital. The MACE during hospitalization was the main outcome. To enhance the architecture of an ANN using triage data, we used a systematic grid search …

A Case Of Sore Throat And Dizziness, Victoria Gordon, Anita Datta

Gulf Coast Division Research Symposium 2024

No abstract provided.

A Case To Cause Pause, Kai Tubb, Stevley Koshy

Gulf Coast Division Research Symposium 2024

No abstract provided.

Veterans Direct Admission Reassessment Tool Validation For The Reduction Of Rapid Response Code Blue, And Code Stroke Team Activations In Newly Arrived Direct Admission Veterans, Joshua Monroe Wells

DNP Projects

Abstract

Purpose: Rapid clinical assessment of newly arriving direct admission veteran patients to the Department of Veterans Affairs Health Care System (VAHCS) Lexington is of the utmost importance to determine current patient condition, alteration from previously known condition at time of provider acceptance or time of report, and appropriate level of care for these veterans. The facility has seen an increase in the number of unexpected patient declines by direct admission patients presenting to medical surgical units at the VA Health Care System Lexington KY. This recurrent decline resulted in the facility performing a Root Cause Analysis (RCA), which identified …