Emergency Medicine Commons^™

Improving Cpr Quality In The Emergency Department By Implementing Data Driven Debriefs, Alyssa M. Hughes

Doctor of Nursing Practice Final Project Abstract

Purpose

The purpose of the quality improvement project was to evaluate the effectiveness of implementing a data driven debrief tool to improve the average compressions in target in adult cardio-pulmonary resuscitation (CPR) events.

Results

In FY23 prior to implementation the average compressions in target was only 1.65%. During the implementation phase of the project the average compressions in target reached 41% (n=3). In addition, the staff provided positive feedback regarding the tool and the integration in the workflow.

Background

The project was completed in a tertiary academic medical center emergency room. All adult CPR events within the emergency department utilizing …

Rural Emergency Department Perspectives On Telemedicine Consultation For Pediatric Emergencies, Caroline Nemechek, Kimberly Randell, Romina Barral, Michelle K. Arzubi-Hughes

Posters

No abstract provided.

Drivers Of Professional Satisfaction In Emergency Medicine Residency Training In The Us, Arvin Radfar Akhavan, Kirstin Woody Scott, Patrick Hewes, Erin Kinney, Boris Pavic, Josh Simmons, Michelle Lall, Michael Gottlieb, Yvette Calderon, Dave Lu

Department of Emergency Medicine Faculty Papers

BACKGROUND: Physician wellness discussions often center on burnout and negative aspects of clinical practice. Less is known about what brings professional satisfaction to physicians, particularly among emergency medicine (EM) residents. Understanding drivers of professional satisfaction is important for the future of the specialty as they may influence residents' career decisions. This study aimed to identify drivers of professional satisfaction among a national cohort of EM residents.

METHODS: We conducted a mixed methods study using a survey administered following the 2024 ABEM In-Training Examination to EM residents in ACGME-accredited programs. The single-item, free-text survey question asked: "List the top 3 drivers …

Explosive Weapons Trauma Care Collective (Extracct) Clinical Practice Guideline: Transfer Of Critically Injured Casualties, Emma Butterfield, Gavin Wooldridge, Solomon Asfaw, Mervat Alhilal, Mardi Steere, Benjamin Wachira, Paul Reavley, Roman Shtybel, Marius Rehn

Emergency Medicine, East Africa

Introduction Blast-injured patients often present to healthcare facilities which cannot definitively meet their clinical needs. This clinical practice guideline (CPG) reviews and describes best practice for inter-facility transfer of casualties in resource limited and conflict-afflicted contexts where there may not be a formal referral pathway or specialized inter-facility transfer service.

Methods A narrative literature review and synthesis of expert opinion were used to develop this CPG.

Results The guideline describes current standards and best practice in inter-facility transfer in a low resource context—particularly during conflict when referral and transfer pathways may be overwhelmed—and advises on the selection and preparation of …

Unveiling Unwritten Curricula: Enhancing Junior Faculty Development In Academic Emergency Medicine, Abagayle Bierowski, Casey Morrone, Erin Hoag, Ridhima Ghei, Michael Pasirstein, Julie Blaszczak, Dimitrios Papanagnou

Department of Emergency Medicine Faculty Papers

INTRODUCTION: The transition from resident to junior faculty in academic emergency medicine (EM) may be shaped not only by formal training and institutional policies but also by the "unwritten curriculum," a set of norms and expectations embedded in institutional culture. However, the unwritten curriculum and its potential to impact junior faculty development remains largely unexplored. Little is known about how junior faculty perceive, experience, and navigate these informal expectations, or the formal and informal structures that influence this process. In this study we aimed to explore junior faculty members' experiences with the unwritten curriculum in academic EM, with a focus …

From Fly On The Wall To Future Colleagues: Best Practice Recommendations For Medical Student Shadowing Programs, Molly Estes, Danielle Matonis, Mckenna Knych, Brian Barbas, Ronnie Ren, William Dixon, Michael Pasirstein, Xiao C. Zhang, Kaitlin Bowers, Ravi R. Chauhan, Laryssa A. Patti

Department of Emergency Medicine Faculty Papers

BACKGROUND: Physician shadowing is a common component of early medical education and frequently represents students' first exposure to clinical practice. Despite its prevalence, existing guidance primarily targets learners rather than physicians supervising shadowing experiences. This gap is especially relevant in the emergency department (ED), where high patient acuity, workflow demands, and complex clinical environments create challenges for providing safe and meaningful observational learning. We sought to develop consensus-based best practice recommendations for ED faculty supervising medical student shadowing.

METHODS: We conducted a modified Delphi study using an online survey platform to achieve panelist consensus. Ten emergency medicine educators with a …

Where Evidence-Based Medicine Meets Ai: Promise, Pitfalls, And Practice, Sangil Lee, Joshua Davis, Ken Milne, Christina Shenvi, Lars K. Beattie, Martin Wegman, Laura Melville, Richard D. Shih, Bryan Kane

Department of Emergency Medicine Faculty Papers

No abstract provided.

Nurses’ Knowledge Regarding Ventilator-Associated Pneumonia Prevention Bundle In Adult Cardiac Care Units, Marwa Abdo

Nursing

Ventilator-associated pneumonia (VAP) is among the most common ICU infections for ventilated patients, associated with increased mortality (20-50%), morbidity, and health care costs. Nurses' knowledge of VAP prevention bundles is vital to reducing its incidence in critical care areas. Aim: To assess Nurses’ knowledge regarding the ventilator-associated pneumonia prevention bundle in Adult Cardiac Care Units. Study design: A cross-sectional study design was used. Setting: This study was conducted in both the adult cardiac intensive care unit and the cardiac care unit at Aswan Heart Centre–Magdy Yacoub Foundation, Egypt. Subject: A convenience sample of 67 nurses was selected. Data collection tool: …

Identifying Social Determinants Of Health Subgroups And Their Associations With Health Outcomes In A Prospective Us Adult Covid-19 Cohort: An Analysis Of The Inspire Registry, Yohali Burrola-Mendez, Eugene Lin, Canada Parrish, Chialing Hsu, Mandy J. Hill, Michael Gottlieb, Kristin L. Rising, Lauren E. Wisk, Nicole L. Gentile, Rachel E. Geyer, Robert A. Weinstein, Michelle Santangelo, Kristyn Gatling, Jonathan W. Dyal, Joann G. Elmore, Robert M. Rodriguez, Phillip Watts, Ji Chen, Zihan Diao, Erica S. Spatz, Kwun Cg Chan, K A. Stephens, Kelli N. O'Laughlin, Inspire Group

Department of Emergency Medicine Faculty Papers

OBJECTIVE: To identify subgroups with similar social determinants of health (SDOH) characteristics using latent class analysis (LCA) and examine their associations with physical and mental health, cognitive function and missed workdays at 3 and 6 months post-SARS-CoV-2 infection. We hypothesised that intersecting SDOH factors would differentially influence COVID-19-related health outcomes across subgroups.

DESIGN: Prospective cohort study from the Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE), with longitudinal data collection and cross-sectional analyses at baseline, 3-month and 6-month follow-ups.

SETTING: Multicentre registry across eight US academic medical centres (Chicago, Dallas, Houston, Los Angeles, New Haven, Philadelphia, San Francisco and …

Young Man With Neck Pain, Sejal Patel, Steven Graver, Megan Daniels, Kelly Goodsell, Arthur K. Au

Department of Emergency Medicine Faculty Papers

No abstract provided.

Where Housing And Healthcare Meet: Ed Utilization Through On-Site Nursing And Fmr Collaboration, Bennett Gosiker, Tara Ahmadi, Bessie Liu, Naeemah Munir, Viet Nguyen, Carrie B Rubenstein

All Poster Presentations

No abstract provided.

Comparative Analysis Of Emergency Department Pain Medications Given For Treatment Of Sickle Cell Pain Crisis, Christo Mitchell, Kristian Campbell, Brittanii Prahl, Jack Huber

All Poster Presentations

No abstract provided.

Enhancing Emergency Department Preparedness For Amniotic Fluid Embolism Through Evidence-Based Simulation Training, Olivia M. Smoak

Doctor of Nursing Practice Final Manuscripts

Maternal mortality in the United States remains a significant and worsening public health concern, with increasing reliance on emergency departments (EDs) as access points for maternal care. Emergency clinicians are therefore more likely to encounter high-acuity obstetric emergencies, including maternal cardiac arrest and amniotic fluid embolism (AFE), yet often receive limited formal training in these conditions. Simulation-based education, interdisciplinary training, and cognitive aids have been identified as effective strategies to improve performance in high-risk, low-frequency events.

The purpose of the evidence-based practice project was to evaluate whether an interdisciplinary simulation with obstetric-led debrief and introduction of the AFE checklist improves …

Richmond Agitation-Sedation Scoring Implementation In A Critical Access Hospital, Jasmine A. Hobbs

Doctor of Nursing Practice Posters and Presentations

Mechanically ventilated patients who are boarding in rural emergency departments face an increased risk of inconsistent sedation management due to the lack of standardized protocols and the extended transfer times to higher levels of care. The variability in sedation practices can lead to both under- and over-sedation, which negatively affects patient comfort, safety, and clinical outcomes. Research suggests that sedation protocols incorporating the Richmond Agitation-Sedation Scale (RASS) can shorten mechanical ventilation duration and improve clinical outcomes. The purpose of this project was to evaluate the effectiveness of a targeted educational intervention on improving nursing knowledge and comfort with the RASS …

Richmond Agitation-Sedation Scoring Implementation In A Critical Access Hospital, Jasmine A. Hobbs

Doctor of Nursing Practice Scholarly Projects

Mechanically ventilated patients who are boarding in rural emergency departments face an increased risk of inconsistent sedation management due to the lack of standardized protocols and the extended transfer times to higher levels of care. The variability in sedation practices can lead to both under- and over-sedation, which negatively affects patient comfort, safety, and clinical outcomes. Research suggests that sedation protocols incorporating the Richmond Agitation-Sedation Scale (RASS) can shorten mechanical ventilation duration and improve clinical outcomes. The purpose of this project was to evaluate the effectiveness of a targeted educational intervention on improving nursing knowledge and comfort with the RASS …

From Learners To Leaders: A Peer-Led Simulation Program For Anesthesia Procedural Skills Training In Medical Students, Noah S. Kos, Ryan Beyers, Chloe Sutlick, Benjamin Sun, Tochi Mbagwu, Dr. John D. Mitchell Md

Medical Student Research Symposium

Title: From Learners to Leaders: A Peer-Led Simulation Program for Anesthesia Procedural Skills Training in Medical Students

Authors: Noah Kos, Ryan Beyers, Chloe Sutlick, Benjamin Sun, Tochi Mbagwu, John D. Mitchell, M.D.

Background: Procedural skill competency is vital in medical education, but limited faculty availability poses challenges. We implemented a peer-led simulation program teaching peripheral IV insertion (PIV) and endotracheal intubation, with a focus on student leadership.

Methods: Sixteen peer educators, trained by attendings, conducted monthly workshops from July-October 2025. Students practiced at PIV and intubation stations, assessed via validated rubrics (17 items for PIV, 21 for intubation; 5-point scale). …

Inflammatory Markers In The Emergency Department And Ptsd Symptoms In The Aurora Study: A Longitudinal Cohort Study, Kristen Nishimi, Sarah Linnstaedt, Thomas Neylan, Lauren Mckibben, Liz Marie Albertorio-Sáez, Ying Zhao, Stacey House, Francesca Beaudoin, Xinming An, Jennifer Stevens, Gari Clifford, Tanja Jovanovic, Laura Germine, Scott Rauch, John Haran, Alan Storrow, Paul Musey, Phyllis Hendry, Sophia Sheikh, Brittany Punches, Robert Swor, Jose Pascual, Mark Seamon, Elizabeth M Datner, Claire Pearson, David Peak, Roland Merchant, Robert Domeier, Niels Rathlev, Brian O'Neil, Paulina Sergot, Leon Sanchez, Steven Bruce, Steven Harte, Ronald Kessler, Karestan Koenen, Kerry Ressler, Samuel Mclean, Aoife O'Donovan

Department of Emergency Medicine Faculty Papers

BACKGROUND: Systemic inflammation is hypothesized to contribute to post-traumatic stress disorder (PTSD) vulnerability. Few studies have examined inflammation shortly after trauma as a predictor of later PTSD symptoms. We examined whether inflammation from the emergency department (ED) post-trauma is associated with PTSD symptom severity over the following 6 months.

METHODS: Our sample included 742 AURORA participants, a longitudinal cohort of patients in 29 EDs across the United States after a traumatic stressor, followed up to 6 months. Plasma cytokines were assessed from a study blood draw in the ED: an inflammatory index (standardized sum of generally pro-inflammatory markers interleukin [IL]-6, …

From Clinical Observation To Scholarly Question Academic Curiosity As A Professional Virtue In Emergency Medicine Introducing The Mindful Observation → Curious Inquiry → Clinical Structuring → Scholarly Sharing (Moccs) Model, James Espinosa, Alan A. Lucerna

Rowan-Virtua Research Day

Emergency Medicine generates continuous clinical observations, yet many potentially meaningful insights never progress beyond informal reflection. This poster reframes every day shift observations as the ecological foundation of scholarly inquiry. Conceptual Framework: We propose a simple, repeatable process to lower the activation energy for academic engagement The Mindful Observation → Curious Inquiry → Clinical Structuring → Scholarly Sharing (MOCCS) Model. This model centers disciplined noticing as a professional virtue. By naming and normalizing the “hmmm” and “huh?” moments, this approach validates frontline clinical wisdom, democratizes scholarly participation, and restores intellectual joy within high-stress clinical environments. Conclusion: Curiosity is not hierarchical. …

The Neurobiology Of Interruptions In Emergency Medicine: The Case For Informed Interruption Management In Support Of Cognitive Stability In High-Reliability Clinical Environments, James Espinosa, Henry Schuitema, Alan Lucerna

Rowan-Virtua Research Day

Background: Interruptions are ubiquitous in Emergency Departments (EDs) and have been associated with task delay, multitasking, and increased error risk. While operational and human-factors impacts are well described, the underlying neurocognitive mechanisms remain underexplored. Not all interruptions are avoidable.  However,  interruptions in emergency medicine represent neurocognitive destabilization events that can degrade task representation and increase vulnerability to error during task resumption. Recognizing the neural mechanisms underlying interruptions reframes their management as a systems-level patient safety priority. The aim is not elimination of clinically necessary communication, but thoughtful reduction, prioritization, and design that protects cognitive stability.

Objective: To synthesize cognitive neuroscience …

Protecting The Protectors: Supporting Emergency Department Security Officer Wellness: A Brief Conceptual Review And Research Agenda, James A. Espinosa Md, Paul Sarnese, Alan Lucerna

Rowan-Virtua Research Day

Background: Workplace violence in emergency departments (EDs) has been widely studied, yet the occupational wellness of ED security officers has received comparatively limited focused attention in emergency medicine literature.

Objective: To conceptually examine the role of ED security personnel within the emergency care environment and outline a research agenda addressing their wellness.

Discussion: Security officers frequently respond to behavioral crises, assist with restraint events, and help maintain safety for patients, visitors, and staff. These duties include vigilance between events, sudden physical exertion, and exposure to aggression. ED security work often follows a recognizable rhythm: baseline vigilance, rapid escalation response, physical …

Wildfires And Emergency Department Respiratory Surge: Brief Review, Systems Forecasting Implications And Recommendations For Research, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background: Wildfire smoke produces abrupt increases in PM2.5 and Air Quality Index (AQI) levels. Event-based and multi-season studies demonstrate short-term increases in asthma-related Emergency Department (ED) visits, with additional evidence supporting increased utilization for broader respiratory disease and chronic lower respiratory disease (including COPD) (Reid et al., 2016; Liu et al., 2015; Stowell et al., 2025; CDC, 2023).

Objective: To synthesize current evidence linking wildfire smoke to ED respiratory surge and to propose a systems forecasting model that translates environmental signals into structured operational stabilization within a complex adaptive system (CAS).

Methods (Review & Model Development): Narrative synthesis of event-based …

Soundscapes (Ambient Sound, Noise, Music And Other Background Sound) In The Emergency Department: An Under-Theorized Environmental Modifier In A Complex Adaptive System, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background:

Music and ambient sound (including noise and other sounds) are frequently present in emergency departments (EDs), yet their role as environmental modifiers remains under-theorized. Existing literature largely examines background music, for example,  in procedural or perioperative contexts, with limited attention to open, high-density, multi-agent acute care systems.

Objective:

To conceptualize auditory input as a dynamic environmental variable within the ED viewed as a Complex Adaptive System (CAS), integrating neurobiological mechanisms with systems-level implications.

Methods/Conceptual Approach: Narrative conceptual synthesis integrating neurobiology of auditory processing, affective neuroscience, cognitive load theory, and complexity science.

Results:

Conceptual Insights: Auditory stimuli engage distributed neural …

Identifying And Generalizing Best Attending Teaching Practices: A Proposal For The Use Of Appreciative Inquiry To Enhance Emergency Medicine Residency Teaching Practices, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background

Teaching in the Emergency Department (ED) occurs within a complex adaptive system characterized by time pressure, interruptions, and high cognitive load. Studying what works well in clinical teaching , even in such a challenging  environment for  teaching, may reveal reproducible patterns that strengthen educational culture, enhance resident learning, and accelerate the development of teaching expertise. In complex clinical environments, excellence is often present but under-recognized; An approach called Appreciative Inquiry provides a structured method for making it visible.

Conceptual Framework

Appreciative Inquiry (AI) offers an alternative approach by systematically studying successful practices rather than failures. AI explores how and …

Conceptualizing The Transition From Stable Operations To Turbulent States : Reframing Emergency Department Operations. Learning From Fluid Dynamics And Complexity Science, James Espinosa, David Ho, Alan Lucerna

Rowan-Virtua Research Day

Background: Emergency departments are frequently described using the language of patient flow, implying  smooth and predictable movement of patients through a system versus known obstructions to flow.  Clinicians, however, often observe abrupt shifts in operational stability.

Objective: To explore whether concepts from fluid dynamics and complexity science offer a useful framework for understanding these transitions.

Methods: Conceptual synthesis drawing on emergency medicine operations research, human factors, systems science, and fluid mechanics.

Results (Conceptual): Emergency departments exhibit behaviors analogous to systems approaching turbulence, including sensitivity to perturbation, amplification of delays, and nonlinear responses.

Conclusion: Viewing ED operations through the lens of …

A Systems Perspective On Workstation Ergonomic Principles And Their Application In Emergency Care Environments, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background: Workstation ergonomic principles are commonly included in mandatory healthcare training programs. These recommendations—monitor height relative to eye level, neutral arm positioning, and adjustable seating—derive largely from occupational ergonomics literature designed to reduce musculoskeletal strain and improve comfort during computer work. Emergency Departments (EDs), however, represent dynamic environments with shared workstations and workflow interruptions that may influence the implementation of these recommendations.

Objective: To summarize the evidence supporting commonly taught workstation ergonomic principles and frame them within a systems perspective of ED work environments.

Methods: Narrative review of occupational ergonomics guidelines, ergonomic intervention studies, and human factors literature relevant to …

The Ed Is Inherently Interleaved: The Learning Theory Case For Hybrid Resident Conference Curriculum Design In Emergency Medicine: Block For Onboarding And For Specialized Topics With Predominant Interleaving For Intermediate And Advanced Residents, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background

Emergency medicine (EM) training occurs within a clinical environment characterized by rapid context switching, diagnostic uncertainty, and frequent transitions between unrelated clinical problems. Didactic curricula that rely only on block-based topic organization may not fully reflect the cognitive demands of real emergency department practice.

Objective

To propose a developmentally adaptive hybrid model of EM curricular design that integrates early block learning during the onboarding phase of new residents, progressing to a general approach of interleaved learning. Specialized topics,  can be introduced using block learning at any time during the residency years.

Methods / Conceptual Approach

This conceptual educational model …

Reframing Emergency Medicine (And Healthcare) Wellness Measures: The Case For Adding Measures Of Physiological Sustainability, Exercise, Restoration, And Meaning, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background

Physician wellness measurement in Emergency Medicine (EM) in particular and in healthcare in general has largely focused on identifying distress states such as emotional exhaustion and depersonalization. Instruments such as the Maslach Burnout Inventory and related derivative surveys have been well-validated and  have played a central role in identifying the scope of burnout across healthcare systems.

Conceptual Framing

While current measures of distress are essential, they may not fully characterize the spectrum of clinician health. In many fields outside healthcare—including occupational health, resilience research, and positive psychology—assessment of well-being includes behaviors and experiences associated with sustained health, such as …

Reframing The Ed–Hospitalist Admission As A Clinical Handoff: The Ed To Hospital Admission As A Cross-System Handoff In A Complex Adaptive Clinical Environment. The Case For Systems Approaches To Enhance Safe And Effective Transitions Across A True System Interface, James Espinosa, Alan Lucerna, Henry Schuitema

Rowan-Virtua Research Day

Background

Transitions from the Emergency Department (ED) to hospital medicine represent a high-stakes clinical handoff across systems. While often experienced as challenging, these interactions are better understood as occurring between services operating under different cognitive loads, operational priorities, and time horizons. Reframing the ED–hospitalist admission as a structured handoff aligns this process with broader patient safety efforts.

Objective

To characterize the ED–hospitalist admission as a cross-system clinical handoff and to identify practical strategies that enhance safety, clarity, and alignment during this transition.

Methods

Conceptual analysis informed by clinical experience, systems theory, and teaching observations. Key domains of potential misalignment were …

Mental Health Vs Substance Misuse: Predicting Restraint Use In The Emergency Department, Chloe Lafosse Bs, Michael Witt Md, Mph

Rowan-Virtua Research Day

Introduction: Violence in the emergency department affects approximately 30% of hospital staff every 6 months. Presenting complaints may contribute to violence risk, particularly in those with mental health or substance misuse issue where there are heightened risks of cognitive impairment and involuntary holds.

Methods: We conducted a systematic review of literature published between 1957-2025 using multiple databases, identifying studies that observed physical restraint use on adult emergency department patients. All relevant data was recorded and imputed into SPSS for a chi-square test.

Results: Thirteen studies (2019-2025) met inclusion criteria, with sample sizes ranging from 58 to 1,035,522 participants. All studies …

Myxedema Coma: Recognizing A Silent But Potentially Fatal Emergency, Aashna Chaudhry, Robin Lahr, James Espinosa, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Myxedema coma is an endocrinologic emergency that requires prompt recognition and treatment. It is described as severe hypothyroidism characterized by life-threatening slowing of metabolic processes, often occurring in the setting of precipitating factors such as trauma, infection, medications, or cold exposure. This case report presents a clinical case in which early suspicion of myxedema coma in an elderly female patient led to prompt treatment and life-saving measures.