Emergency Medicine Commons^™

Promoting Resident Emotional Health Meaningful Connections: An Evaluation Of A Wellness Game, Bruce St. Amour, William B. Dehart

Journal of Wellness

Introduction

Physician wellness is a topic of significant national interest. Physician burnout is at its highest point during residency and is linked to many negative outcomes. The Core Emotional Needs are a useful framework to guide thinking toward wellness in residents: connection and acceptance, healthy autonomy and performance, reasonable limits, and healthy responsibility and standards. We examined the efficacy of a game (“Well, For Me…”) designed to improve social connection and acceptance among residents to reduce social isolation. We hypothesized that this activity would be viewed positively by the residents as an intervention to improve resident wellness.

Methods

Participants …

Defining And Characterizing Frequent Attenders: Systematic Literature Review And Recommendations, Dip Shukla, Erik Faber, Brian Sick

Journal of Patient-Centered Research and Reviews

Purpose: To decrease cost and improve efficiency, health care organizations have focused on frequent attenders — patients with high health care utilization. Prior studies have investigated singular health care settings, used varying definitions of frequent attendance, and inconsistently identified factors correlated with frequent attendance. The purpose of this article is to suggest a uniform definition of frequent attenders for different health care settings and to determine factors correlated with frequent attendance.

Methods: This systematic review of three databases identified 2761 unique articles; 174 met inclusion criteria. Studies were analyzed for their definition of frequent attenders and factors associated with frequent …

A Spontaneous Isolated Superior Mesenteric Artery Dissection Associated With Cocaine Abuse: A Pathomechanistic Association., Rayan S El-Zein, Jeffrey Sobecki, Roy Greenberg, Michael Keleher, Robert A Palma

Ambulatory and Primary Care Articles

Spontaneous isolated superior mesenteric artery dissection (SISMAD) is a rare potentially fatal disease. We present a case of cocaine-related SISMAD in a patient with abdominal pain. A 38-year-old African American male with hypertension and alcohol, cocaine, and tobacco abuse presented with abdominal pain and recent cocaine use. A CT angiogram revealed SISMAD; he was treated with conservative management. Cocaine and SISMAD share similar pathophysiologic mechanisms pertaining to vascular smooth muscle cell apoptosis and increased shear stress at fixed vascular positions. Our report emphasizes the need to consider cocaine abuse in SISMAD pathophysiology, risk stratification, and treatment algorithms in future studies.

Two Resident Wellness Exercises And Their Impact, Nick J. Mccauley

Emergency Medicine

How program leaders in the CORD community are implementing innovations to improve residency wellness and resident resilience.

• Define resilience and describe how it can prevent burnout.
• Discuss ways that residency programs can work to promote resilience amongst residents COURSE DESCRIPTIONS #CORDAA20 35
• Introduce ‘Resilience Rounds’ as a didactic intervention, and the literature upon which this innovation is based
• Introduce art as a tool to overcome trauma and prevent burnout
• Demonstrate how conference/didactic time can help residents combat the perceived “culture of perfection” by sharing meaningful or successful moments with each other to improve one’s general outlook on their own practice

Post-Overdose Interventions Triggered By Calling 911: Centering The Perspectives Of People Who Use Drugs (Pwuds), Karla D. Wagner, Robert W. Harding, Richard Kelley, Brian Labus, Silvia R. Verdugo, Elizabeth Copulsky, Jeanette M. Bowles, Maria Luisa Mittal, Peter J. Davidson

Environmental & Global Health Faculty Research

Background Opioid overdose deaths have increased exponentially in the United States. Bystander response to opioid overdose ideally involves administering naloxone, providing rescue breathing, and calling 911 to summon emergency medical assistance. Recently in the US, public health and public safety agencies have begun seeking to use 911 calls as a method to identify and deliver post-overdose interventions to opioid overdose patients. Little is known about the opinions of PWUDs about the barriers, benefits, or potential harms of post-overdose interventions linked to the 911 system. We sought to understand the perspectives of PWUDs about a method for using 911 data to …

Reducing Length Of Stay For Mental Health Patients, Faye Collins, Nancijean Goudey

MaineHealth Maine Medical Center

Background:

Our facility sees an average of over 200 mental health patients every month, with limited community resources. The length of stay (LOS) for these patients had slowly risen to unacceptable levels; the number of patients whose LOS was greater than 24 hours increased in fiscal year (FY) 2017, from 633 patients to 1145. Patients in crisis require expedited transfer to appropriate care locations. Our goal was to decrease the overall length of stay for mental health patients in the Emergency Department.

Evaluating The Impact Of An Intervention To Promote Empathy For Patients With Substance Use Disorder In A Rural Emergency Department, Theresa Poling

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background

Negative attitudes of health professionals towards patients with SUD are common and contribute to suboptimal health care for this marginalized group of patients (Van-Boekel, Brouwers, Van-Weeghel & Garretson, 2013).

Objectives

Promoting empathy in the Emergency Department (ED) has the potential to increase nursing staff’s awareness of their attitudes and perceptions toward patients with SUD, thereby decreasing the stigma associated with addiction and improving patient care and patient outcomes. The rationale for implementing this project was to evaluate a tool to promote empathy. This tool was developed by the student researcher based on a literature search and analysis.

Design

This …

The Effects Of Reentry Programs On Healthcare Accessibility And Resulting Emergency Department Strain By Ex-Inmates: An Integrative Literature Review, Kaitlyn Muratori

Grace Peterson Nursing Research Colloquium

THE EFFECTS OF REENTRY PROGRAMS ON HEALTHCARE ACCESSIBILITY AND RESULTING EMERGENCY DEPARTMENT STRAIN BY EX-INMATES

Kaitlyn Muratori

Faculty Sponsor: Dr. Christina Lattner

Background: Ex-inmates are significantly more likely to use emergency rooms to seek treatment for substance abuse, mental health disorders, or poor management of chronic conditions which, if not treated on a community level, ultimately contributes to overboarding in the emergency department.

Objectives: The purpose of this literature review is to use current research to examine the relationship between reentry programs across the US and healthcare accessibility, as well as the resulting strain of emergency room misuse by ex-inmates. …

Discerning Suicide In Drug Intoxication Deaths: Paucity And Primacy Of Suicide Notes And Psychiatric History, Ian Rh Rockett, Eric D. Caine, Hilary S. Connery, Gail D'Onofrio, David J. Gunnell, Ted R. Miller, Kurt B. Nolte, Mark S. Kaplan, Nestor D. Kapusta, Christa L. Lilly, Lewis S. Nelson, Sandra L. Putnam, Steven Stack, Peeter Varnik, Lynne R. Webster, Haomiao Jia

Faculty & Staff Scholarship

Objective

A paucity of corroborative psychological and psychiatric evidence may be inhibiting detec- tion of drug intoxication suicides in the United States. We evaluated the relative importance of suicide notes and psychiatric history in the classification of suicide by drug intoxication versus firearm (gunshot wound) plus hanging/suffocation—the other two major, but overtly violent methods.

Methods

This observational multilevel (individual/county), multivariable study employed a general- ized linear mixed model (GLMM) to analyze pooled suicides and undetermined intent deaths, as possible suicides, among the population aged 15 years and older in the 17 states participating in the National Violent Death Reporting System …

Education And Prevention Of Stress And Ptsd In Prehospital Care Providers, Adriana Goad

A with Honors Projects

The field of prehospital emergency care is one full of unpredictability, high physical demand, and mental stress. EMTs and Paramedics are called to the unknown to treat whatever they come upon with the limited supplies and equipment that can be found in their trauma bag and ambulances. Some calls may be rewarding as they save the life of a patient, or they can be run of the mill as they get a call for a person not feeling well. Some calls, though, do not end in a relaxed drop off at the ED and back to the station for the …

Does Mental Status Impact Therapist And Patient Communication In Emergency Department Brief Interventions Addressing Alcohol Use?, Brian Borsari, Timothy R. Apodaca, Ali Yurasek, Peter M. Monti

Manuscripts, Articles, Book Chapters and Other Papers

Motivational interviewing (MI) is often incorporated into screening, brief intervention, and referral to treatment (SBIRT) interventions in critical care settings to address alcohol and other drug use. However, cognitive status has been linked to differential response to MI sessions in emergency department (ED) settings. The current study examined one possible explanation for this differential response: whether higher versus lower mental status impacts patient response to clinician statements during MI sessions conducted in an ED. Participants were 126 patients receiving an MI-based single-session alcohol brief intervention, and 13 therapists who provided treatment. Participants completed a mental status exam (MSE) as part …

Academic Medicine Responds To The Opioid Crisis, John Prescott

Marshall Journal of Medicine

Opioid dependence has devastated communities across the nation particularly in rural states and academic medicine has responded in a variety of ways. Through its tripartite mission of education, research, and clinical care, creative solutions are being implanted. Medical schools and teaching hospitals are partnering with public health and law enforcement agencies, as well as local healthcare providers to address the clinical, social, and rehabilitative challenges. Academic medicine continues to adapt to the needs of the nation and teach, train, and prepare the next generation of physicians to be at their best when things are at their worst.

Helping Navigate The Complex Web Of Community Medicine: How Dedicated Social Services Support In The Ed Can Prevent Unnecessary Ed Visits And Hospital Readmissions, Adam Kennah

Learning Showcase 2016: A Celebration of Discovery, Transformation and Success

A hospital's Emergency Department (ED) serves as its front door to the community. The vast majority of admitted patients present initially to the ED, and even more still begin and end their hospital visit in the ED. A hospital's ED will deal with every societal ill facing that community. However, most hospitals reserve dedicated Social Service resources to admitted patients who have had prolonged inpatient hospital stays. EDs around the country are being overburdened with patients who present to the ED for non-emergent conditions. Access to community based healthcare is daunting even for well-connected individuals. It can be downright impenetrable …

Psychiatric Boarding In New Hampshire: Violation Of A Statutory Right To Treatment, James A. Mcclure

The University of New Hampshire Law Review

[Excerpt] "New Hampshire law provides for the involuntary commitment of a patient such as Jane when she is a danger to herself or others as a result of mental illness. The patient has a right to treatment under N.H. Rev. Stat. Ann. § 135-C:1, et seq. Specifically, the patient should receive "adequate and humane treatment" pursuant to an "individual service plan" and "in the least restrictive environment necessary." However, appropriate facilities often are not available for patients waiting in emergency rooms, and patients can become trapped for hours or even days. This phenomenon is called "psychiatric boarding."

New Hampshire is …

794 Evaluating Disability In Adult Burn Injury Patients Treated At A Tertiary-Care Burn Unit In Karachi, Pakistan: A Longitudinal Study Using Who Disability Assessment Schedule Ii, Nukhba Zia, Asim Durrani, Safia Awan, Madiha Hashmi, Mazhar Nizam, Asad Latif

Department of Anaesthesia

Background: Disability after burn injury is not assessed in the context of Pakistan. This study assesses disability among adult burn injury patients presenting to a burn unit in Karachi, Pakistan.
Methods: This longitudinal study was conducted at a burn centre is Karachi, Pakistan. Adult patients(>18 years) who were discharge after 24-hour admission were enrolled from August 2014–March 2015. Baseline assessment before discharge and follow-up at 2,6 and 12 weeks after discharge via telephone was done using 12-item WHODAS 2.0 (5 -point likert-scale; 1 = none; 2 = mild; 3 = moderate; 4 = severe; and 5 = extreme) related …

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 …

Geropsychiatric Medical Problems, Daniel Giorgio

Williams Honors College, Honors Research Projects

With a growing elderly population in the United States, the development of

efficient methods to ensure high-quality care for geriatric patients is more important than

ever. In the emergency department (ED), geriatric patients account for up to 24% of

stays. Many of these patients come to the ED for neuropsychiatric reasons and some are

admitted to geropsychiatric units. These patients require medical screening to identify

issues that may in part account for their mental state. The purpose of this study was to

characterize the patients who were admitted from the Summa Health System ED to

geropsychiatric units. It was hypothesized …

La Cesárea Y El Parto Natural: Las Opiniones De Profesionales De La Salud En La Provincia De Buenos Aires / Cesarean Section And Natural Birth: The Opinions Of Health Provinces In The Province Of Buenos Aires, Jacqueline Chipkin

Independent Study Project (ISP) Collection

Introduction: The ways in which women of society give birth have the power to influence maternal-infant health and shape the economy of the healthcare system. Today, the rates of cesarean sections are increasing throughout the world. In Argentina, on average, more than 35% of pregnant women received cesarean sections in 2008, with large differences observed in the rates between the public and private health sectors. The World Health Organization (WHO) has established that healthcare systems should only employ a cesarean section if labor cannot progress safely. According to this standard, the organization estimates that cesarean sections should only be utilized …

The Closure Of New Orleans' Charity Hospital After Hurricane Katrina: A Case Of Disaster Capitalism, Kenneth Brad Ott

University of New Orleans Theses and Dissertations

Abstract

Amidst the worst disaster to impact a major U.S. city in one hundred years, New Orleans’ main trauma and safety net medical center, the Reverend Avery C. Alexander Charity Hospital, was permanently closed. Charity’s administrative operator, Louisiana State University (LSU), ordered an end to its attempted reopening by its workers and U.S. military personnel in the weeks following the August 29, 2005 storm. Drawing upon rigorous review of literature and an exhaustive analysis of primary and secondary data, this case study found that Charity Hospital was closed as a result of disaster capitalism. LSU, backed by Louisiana state officials, …

Quitline Fax Referrals – Increasing Enrollment And Outcomes, Alice Dalla-Palu Mpa, Ctts-M, Cac, Jeanne Fignar Aas, Patricia Lavan Rdh, Ba, Kayshin Chan Mph

Department of Emergency Medicine

No abstract provided.

Reaching Smokers Via Email Blasts - Cost Effective Blast To The Future, Alice Dalla-Palu Mpa, Ctts-M, Cac, Jeanne Fignar Aas, Edward Frack Ba

Department of Emergency Medicine

No abstract provided.

Survey Of Emergency Department Patients' Perceived Barriers To Accessing Services And Community Resource Utilization, Kelsey Ann Wilke

All Graduate Theses, Dissertations, and Other Capstone Projects

The purpose of this project is to describe the patients being served by Avera McKennan’s emergency department (ED) and to explore perceived barriers to accessing services and current community resource utilization in order to prevent further non-emergent visits.

Research Questions: 1) What are the demographic characteristics of emergency department patients that are referred to the emergency department social worker? 2) What are the perceived barriers that emergency department patient’s encounter when trying to access services and community resources?

Needs Assessment Of Emergency Department Social Workers In Southwestern Minnesota In Relation To Emergency Department Expansion, Gina Marie Njugunah

All Graduate Theses, Dissertations, and Other Capstone Projects

Expansion of a hospital emergency department will affect the role of the emergency department social worker. This research project was conducted to assess the needs, concerns, and strengths of the social workers working in the emergency department of a regional medical center. The study included 13 participants who completed an on-line survey. Results showed that participants were concerned with the increase in patient volume as well as the possible increase in wait time for patients. Participants also expressed how concerns could be addressed. The most common solution was to track information about the cases, including wait times for patients, in …

Characteristics Of Patients Admitted With Alcohol Related Traumatic Injuries, Jessica Wolf

All Graduate Theses, Dissertations, and Other Capstone Projects

Alcohol use is well recognized as a contributor to traumatic injury. The purpose of this review was to describe the demographics of patients admitted to a regional trauma center with alcohol related traumatic injuries in order to improve service to this population and provide injury prevention programs directed towards this population.

Research Question: What are the characteristics of patients admitted to St. Marys Hospital with an alcohol related traumatic injury?

Social Work Involvement In Supporting Survivors Of An Unexpected Death In An Emergency Department, Jennifer E. Buchanan

All Graduate Theses, Dissertations, and Other Capstone Projects

People occasionally present to a hospital’s emergency department (ED) after an event such as a heart attack or a motor vehicle accident that results in their sudden and unexpected death. Although members of the ED attempt to support the survivors as much as possible, due to the fast pace of the environment and responsibilities to other patients, the survivors may not always be provided with the necessary resources and support. This can leave survivors feeling isolated and confused about the appropriate course of action after this type of experience. A planned, organized approach delivered by educated and sensitive staff can …

Characteristics And Outcome Of Patients With Drug Overdose At A Tertiary Care Hospital In Karachi., Muhammad Shahid, Junaid Patel, Haider Naqvi Aga Khan University, Muhammad Shoaib Khan

Department of Emergency Medicine

No abstract provided.

Predicting Work Stress Burnout In Rural And Urban Emergency Medical Technicians Through The Use Of Early Recollections, Susan M. Vettor

Dissertations

Problem . Literature on work-stress burnout among emergency medical technicians (EMTs) suggests that they have maintained the same levels of burnout and attrition rates for the past 20 years. The purpose of this study was to investigate the relationship between early recollections and burnout in EMTs working in urban and rural locations.

Method . A demographic questionnaire, the Staff Burnout Scale for Health Professionals (SBS-HP), and two early recollections, were used to survey 120 emergency medical technicians in Toronto, Ontario and Mojave County, Arizona to assess their level of burnout and to identify various themes in early recollections.

Results . …

Retrospective Analysis Of Youth Evaluated For Suicide Attempt Or Suicidal Ideation In An Emergency Room Setting, Julie Hagedorn, Hatim A. Omar

Pediatrics Faculty Publications

Suicide is the third leading cause of death in adolescents and a major contributor to morbidity in this age group. The objective of this study was to look at the demographics, major stressors and factors leading to attempting suicide as well as the methods of attempted suicide in adolescents admitted to two hospitals in a medium size city. Medical records were reviewed of adolescents admitted to two area hospitals for attempted suicide between 7/1/97-12/31/99. Coroner's data on completed suicide were also reviewed. In the study period a total of 287 persons aged 21 years or under were admitted for attempted …