Emergency Medicine Commons^™

Analyzing The Effect Of Interview Time And Day On Emergency Medicine Residency Interview Scores, Alanna O'Connell, Sean Greco, Tingting Zhan, Tracy Brader, Megan Crossman, Robin Naples, Anthony Sielicki, Megan Stobart Gallagher, Peter Tomaselli, Dimitrios Papanagnou

Department of Medicine Faculty Papers

Background: When it comes to scheduling interviews, medical students may wonder if they need a strategy to increase their likelihood of matching. Previous studies examined the temporal effects of the residency interview on overall match rate; however, there are additional factors that affect the match process, including board examination scores and letters of recommendation. Only few studies have examined the effect interview time of day has on match success. The current study examines the impact date and time of interview during the interview season have on candidates' respective interview scores.

Methods: Interview data over a three-year period (i.e., three interview …

Level Of Comfort In Evaluating Older Patients Amongst Medical Students And Emergency Medicine Residents, Lily L. Berrin, Phraewa Thatphet, Anita N. Chary, Surriya C. Ahmad, Don Melady, Shan W. Liu

Journal of Geriatric Emergency Medicine

Introduction

As the population ages, emergency physicians must be better equipped to manage the complex needs of older patients. While geriatric core competencies have been developed for medical students and emergency medicine (EM) residents, little work has been done to evaluate EM trainees’ comfort with these competencies, or their interest in and barriers to learning more about Geriatric Emergency Medicine (GEM).

Methods

We conducted a cross-sectional study of EM residents and medical students in their clinical years of training with interest in EM. We used an online self-administered survey to evaluate trainees’ self-reported comfort with previously reported geriatric competency domains, …

Goals-Of-Care Course For Emergency Physicians During The Covid-19 Pandemic., Mari Siegel, Erica Westlake

Department of Emergency Medicine Faculty Papers

BACKGROUND

COVID-19 increased the need for goals of care (GOC) discussions in the Emergency Department (ED). Many Emergency Physicians (EPs) report no formal training in holding GOC discussions. COVID-19 created unique teaching challenges given social distancing requirements.

METHODS

Eight teaching sessions were held using Zoom in March and April at an urban institution in the United States. Sessions were limited to 4-8 participants. They were comprised of a 30-minute lecture and 15 minutes of role-playing, in which providers read scripts to practice communication skills. The lecture introduced vocabulary and models to shape GOC discussions. Participants were invited to complete an …

Reorganizing Emergency Department Information Systems To Reduce Physician Cognitive Load, James C. Mcclay, Jeffery Nielson, Benjamin Slovis

Posters and Presentations: Emergency Medicine

No abstract provided.

Zooming-Out Covid-19: Virtual Clinical Experiences In An Emergency Medicine Clerkship., Shruti Chandra, Chaiya Laoteppitaks, Nina Mingioni, Dimitrios Papanagnou

Department of Emergency Medicine Faculty Papers

In the setting of the novel 2019 coronavirus (COVID‐19) pandemic, it has been challenging to provide medical students in the Emergency Medicine (EM) clerkship meaningful clinical experiences that would meet clinical course goals and objectives, as well as satisfy Liaison Committee for Medical Education (LCME) requirements. During the EM clerkship, students play an integral role in interviewing patients, formulating treatment plans, facilitating patient discharges, and counseling patients. Immediately available direct and indirect supervision are paramount to ensure student learning and safe patient care. The authors present a novel clinical educational experience for senior medical students in an EM clerkship that …

Telemedicine Certified Recovery Specialists For Patients With Opioid Use Disorders In The Emergency Department In Covid-19, Kory S. London, Md

Health Equity and Quality Improvement (HEQI) Summit

COVID-19 is a staggering tragedy in a number of manners, but the lack of available access points to healthcare services due to federal, state, local and institutional regulations and decisions creates higher levels of patient vulnerability.

Patients with opioid use disorders (OUD) are especially vulnerable given high levels of coexistent housing insecurity, food insecurity and lack of primary care at baseline. These patients frequently utilize the emergency department for both medical and non-medical concerns.

Existing pathways to assist these patients utilize in person certified (peer) recovery specialists (CRS) who are not employed by the enterprise. Given the need to limit …

Progression Of Patient Cohorting In Response To Covid-19 At The Jefferson Methodist Emergency Department, Kory S. London, Md, Efrat Kean, Md

Health Equity and Quality Improvement (HEQI) Summit

While COVID-19 and it’s various complications are a source of a substantial number of Emergency Department (ED) visits, many patients still arrive to the ED for non-COVID-19 indications.

Due to pre-existing construction which was halted by the pandemic, external space for a tent configuration was unavailable.

In effort to decrease patient, staff and nurse exposure to COVID, a system of cohorting was created to assure uninterrupted service in a manner as safe as possible for all involved.

Given the uncertainty of patient volumes and the potential for a high burden of disease similar to our colleagues in New York and …

Progression Of Patient Cohorting In Response To Covid-19 At The Jefferson Methodist Emergency Department, Kory S. London, Md, Efrat Kean, Md

Health Equity and Quality Improvement (HEQI) Summit

COVID-19 is a predominantly respiratory disease and Philadelphia is a city with a myriad of pulmonary comorbidities such as asthma and COPD.

Use of bronchodilator medications through a nebulizer machine is considered an 'Aerosol Generating Procedure' (AGP), and increases risks to staff who and complicates the cleaning and processing of rooms and equipment where AGPs are performed. Additionally, there is a severe limitation in availability of negative pressure rooms, which mitigate these AGPs.

With the COVID pandemic causing supply chain problems across the country, a multidisciplinary approach was required to appropriately ration available inhalers (MDI), the alternatives to nebulized treatments, …

Intraosseous (Io) Vs Intravenous (Iv) Vascular Access For Out Of Hospital Cardiac Arrest., Syed Tariq Nabi, Megan Mackenzie, Monica Prasad, Mustapha Choucair, Peyton Johnston, Reba John, Sarah Meram, James Paxton

Medical Student Research Symposium

Over 300,000 Americans every year experience an out-of-hospital cardiac arrest (OHCA) (Benjamin EJ 2019). Of these 300,000+ patients only 10.6% of them survive to hospital discharge. Advanced Cardiac Life Support (ACLS) has been suggested to improve survival following an OHCA (Neumar, Otto et al. 2010). Current ACLS guidelines recommend obtaining vascular access, however, offer little suggestion as to which type of access device should be used. It is our belief that using an Intraosseous vascular access device will lead to shorter time to medication delivery and increased rates of return of spontaneous circulation (ROSC) compared to Intravenous vascular access. We …

Sex-Based Differences In Depth Of Soft Tissue At The Proximal Tibia Intraosseous Catheter Insertion Site, Tristan Lemon Bs, Revelle Gappy Bs, Ryan Kelly Bs, Kenneth Kutschman Bs, Sarah Meram Ms, James Paxton Md, Mba

Medical Student Research Symposium

Background

Intraosseous (IO) catheters are commonly used to rapidly obtain vascular access for critically-ill patients in the emergency department (ED). Although the proximal tibia (PT) is a standard IO insertion site for adult subjects, little is known about sex-based variation in the proper depth of insertion.

Methods

A retrospective cohort study was performed, utilizing CT scans obtained from DMC over a ten-year period (2009-2018) to estimate soft tissue depth overlying the recommended PT-IO insertion site. Depths of soft tissue from skin surface to bone surface (Measurement A) and from skin surface to the opposite bony cortex (Measurement B) were measured …

Intention To Leave Emergency Medicine: Mid-Career Women Are At Increased Risk, M. D. Lall, S. M. Perman, N. Garg, N. Kohn, K. Whyte, A. Gips, T. Madsen, J. M. Baren, J. Linden

Journal Articles

No abstract provided.

Refusal Of Care In The Emergency Department: Self-Reported Reasons For Leaving Without Completing Treatment, Brenden Drerup

Scholarship in Medicine - All Papers

Objective: Emergency department (ED) patients may choose to leave prior to physician evaluation, elope during treatment, or leave against medical advice during treatment. This study was performed to identify the reasons why patients left the ED before completing treatment. Methods: This prospective study was conducted at Miami Valley Hospital, an urban level 1 trauma center. This study identified ED patients who left before completing treatment, including those who left without being seen (LWBS), eloped during treatment, or left against medical advice (AMA), from September to December of 2018. This project included a chart review and a prospective patient telephone survey. …

Burnout Among Emergency Physicians Working At A Large Tertiary Centre In Ontario, Rushika Perera, Kristine Van Aarsen, Laura Foxcroft, Rodrick Lim

Journal of Wellness

BACKGROUND: Emergency medicine (EM) is a high-stress specialty. Work related stress and burnout have been reported to negatively impact physician-patient interactions, overall physician mental and physical health, and most importantly, patient outcomes. We assessed the rates of burnout among emergency physicians (EPs) at our centre.

METHODS: A local cross-sectional study to assess burnout among adult and pediatric EPs, fellows and residents was conducted at three Emergency Departments (EDs) at a single institution in Canada. The anonymous online survey encompassed demographics, the validated MBI tool (Maslach Burnout Inventory) and additional questions aimed at identifying determinants of EP burnout. Each respondent’s three …

Outpatient Treatment Of Pulmonary Embolism: A Single-Center Case Series, Annie Huyler, Casey Z. Macvane, Andrew Perron, Tania D Strout

MaineHealth Maine Medical Center

Background: Pulmonary embolus (PE) is associated with significant utilization of health care resources and financial burden Several additions that have allowed us to look at safely treating patients with PEs as outpatients:

• Simplified Pulmonary Embolism Severity Index (sPESI) -Risk stratifies patients based on their age, vital signs, and past medical history

• Novel oral anticoagulants

Primary Objective: To describe the population, treatment strategies, short-term complications and outcomes associated with outpatient management of PE following treatment in the ED.

An Assessment Of Emotional Intelligence In Emergency Medicine Resident Physicians., Dimitrios Papanagnou, Kathryn M Linder, Anuh Shah, Kory Scott London, Shruti Chandra, Robin Naples

Department of Emergency Medicine Faculty Papers

Objectives: To define the emotional intelligence (EI) profile of emergency medicine (EM) residents, and identify resident EI strengths and weaknesses.

Methods: First-, second-, and third-year residents (post-graduate years [PGY] 1, 2, and 3, respectively) of Thomas Jefferson University Hospital's EM Program completed the Emotional Quotient Inventory (EQ-i 2.0), a validated instrument offered by Multi-Health Systems. Reported scores included total mean EI, 5 composite scores, and 15 subscales of EI. Scores are reported as means with 95% CIs. The unpaired, two-sample t-test was used to evaluate differences in means.

Results: Thirty-five residents completed the assessment (response rate 97.2%). Scores were normed …

An Assessment Of Emotional Intelligence In Emergency Medicine Resident Physicians., Dimitrios Papanagnou, Kathryn Linder, Anuj Shah, Kory Scott London, Shruti Chandra, Robin Naples

Department of Emergency Medicine Faculty Papers

OBJECTIVES: To define the emotional intelligence (EI) profile of emergency medicine (EM) residents, and identify resident EI strengths and weaknesses.

METHODS: First-, second-, and third-year residents (post-graduate years [PGY] 1, 2, and 3, respectively) of Thomas Jefferson University Hospital's EM Program completed the Emotional Quotient Inventory (EQ-i 2.0), a validated instrument offered by Multi-Health Systems. Reported scores included total mean EI, 5 composite scores, and 15 subscales of EI. Scores are reported as means with 95% CIs. The unpaired, two-sample t-test was used to evaluate differences in means.

RESULTS: Thirty-five residents completed the assessment (response rate 97.2%). Scores were normed …

Cerebrovascular Accident Survival: Strategies Of Flight Nursing And Aeromedical Transport, Alexis Caudle

Senior Honors Theses

Cerebrovascular accidents (CVA), known as strokes, are a leading cause of death worldwide. The delivery and timing of treatment for CVAs is a critical factor in restoring health to the patient. One of the variables in recovery is the method of transport used in bringing the patient to a health care facility. Aeromedical transport remains a valuable resource to achieve full recovery in stroke patients. An ongoing debate of risk versus benefit of helicopter emergency services will be included as well as examination of variables including location, time, physiology of the flight, and the patient’s condition to be scrutinized. In …

The 2016 Academic Emergency Medicine Consensus Conference, "Shared Decision Making In The Emergency Department: Development Of A Policy-Relevant Patient-Centered Research Agenda" Diagnostic Testing Breakout Session Report., Tyler W. Barrett, Kristin L. Rising, M. Fernanda Bellolio, M. Kennedy Hall, Aaron Brody, Kenneth W. Dodd, Mira Grieser, Phillip D. Levy, Ali S. Raja, Wesley H. Self, Gail Weingarten, Erik P. Hess, Judd Hollander

Department of Emergency Medicine Faculty Papers

Diagnostic testing is an integral component of patient evaluation in the emergency department (ED). Emergency clinicians frequently use diagnostic testing to more confidently exclude "worst-case" diagnoses rather than to determine the most likely etiology for a presenting complaint. Increased utilization of diagnostic testing has not been associated with reductions in disease-related mortality but has led to increased overall healthcare costs and other unintended consequences (e.g., incidental findings requiring further workup, unnecessary exposure to ionizing radiation or potentially nephrotoxic contrast). Shared decision making (SDM) presents an opportunity for clinicians to discuss the benefits and harms associated with diagnostic testing with patients …

Current Workforce Characteristics And Burnout In Pediatric Emergency Medicine., Marc H. Gorelick, Robert Schremmer, Holly Ruch-Ross, Carrie Radabaugh, Steven Selbst

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVES: Changes in health care delivery and graduate medical education have important consequences for the workforce in pediatric emergency medicine (PEM). This study compared career preparation and potential attrition of the PEM workforce with the prior assessment from 1998.

METHODS: An e-mail survey was sent to members of the American Academy of Pediatrics (AAP) Section on EM and to non-AAP members board certified in PEM. Information on demographics, practice characteristics and professional activities, career preparation, future plans, and burnout (using two validated screening questions) was analyzed using standard descriptive statistics.

RESULTS: Of 2,120 surveys mailed, 895 responses were received (40.8% …

Point-Of-Care Ultrasonography By Pediatric Emergency Medicine Physicians., Jennifer R. Marin, Resa E. Lewiss, American Academy Of Pediatrics, Committee On Pediatric Emergency Medicine, Society For Academic Emergency Medicine, Academy Of Emergency Ultrasound, American College Of Emergency Physicians, Pediatric Emergency Medicine Committee, World Interactive Network Focused On Critical Ultrasound, Gregory P. Conners

Manuscripts, Articles, Book Chapters and Other Papers

Emergency physicians have used point-of-care ultrasonography since the 1990 s. Pediatric emergency medicine physicians have more recently adopted this technology. Point-of-care ultrasonography is used for various scenarios, particularly the evaluation of soft tissue infections or blunt abdominal trauma and procedural guidance. To date, there are no published statements from national organizations specifically for pediatric emergency physicians describing the incorporation of point-of-care ultrasonography into their practice. This document outlines how pediatric emergency departments may establish a formal point-of-care ultrasonography program. This task includes appointing leaders with expertise in point-of-care ultrasonography, effectively training and credentialing physicians in the department, and providing ongoing …

Tactical Medicine: An Examination Of Medical Training In Law Enforcement, Brian J. Woods Jr.

Williams Honors College, Honors Research Projects

In recent years, there has been a trend towards making law enforcement officers more well-rounded first responders by increasing their required medical competencies. The required medical competencies of six law enforcement agencies of varying sizes in Northeast Ohio were examined by interviews conducted with a representative from each agency. Interview question topics included information on current training requirements and the types of medical equipment issued to officers. The study found that all six of the agencies surveyed offered medical training to officers as part of required continuing education, and all six agencies currently issued, or planned to issue in the …

Ethical Dilemmas Posed In The Care Of Obese Patients In The Emergency Department, Arvind Venkat, Gregory Luke Larkin

Journal of Health Ethics

The rising prevalence of obesity represents a health care crisis. As the gateway to the health care system, the emergency department is the clinical setting where the difficulties posed by the care of obese patients are heightened. These difficulties include the increasing burden of obesity-related illnesses, the challenges posed in diagnostic evaluation and treatment and the known barriers to access to care seen in this patient population. The limitations posed by obesity on care in the emergency department, the one guaranteed access point for medical treatment, creates a series of ethical dilemmas for emergency physicians and the facilities in which …

Emergency Physicians' Perspectives On The Usability Of Health Information Exchange, Shirley A. Thorn

Theses and Dissertations (ETD)

Emergency physicians are key users of health information exchanges (HIE). Understanding their perspectives on the usability of HIE is important if the full potential of the HIE is to be achieved. The literature identified that emergency physician experiences with HIEs are unexplored areas requiring further studies. The purpose of this study using grounded theory methods was to understand the perspectives of emergency physicians concerning the usability of HIEs. The fundamental question was how do emergency physicians use the HIE in making clinical decisions?

Rich and thick data were collected from 15 emergency physicians in four urban hospitals in the mid-south …

Resident Efficiency In A Pediatric Emergency Department., M Denise Dowd, Celeste Tarantino, Theodore M. Barnett, Laura Fitzmaurice, Jane F. Knapp

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVES: To measure the hourly rate of patients evaluated and treated by resident physicians in an academic pediatric emergency department (PED) and examine differences in the rate by subspecialty and year of training.

METHODS: For all residents rotating in an academic, urban children's hospital PED, the rate of patients seen per hour over the course of their rotation was calculated using an electronic tracking system, EmSTAT, for calendar year 2000. Rates are reported as the mean number of patients seen per resident hour worked. Mean differences are reported for resident subspecialties (emergency medicine, pediatrics, and family practice) and postgraduate year …

Emergency Physicians' Practices And Attitudes Regarding Procedural Anaesthesia For Nasogastric Tube Insertion., G A. Juhl, Gregory P. Conners

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: To determine practice and attitudes of emergency physicians regarding procedural anaesthesia for nasogastric tube insertion (NGT).

METHODS: Survey of resident/attending emergency physicians working in a tertiary care medical centre.

RESULTS: Of 68 physicians, 46 responded: 98% believed that awake and alert patients find NGT insertion uncomfortable/painful; 93% used measures to reduce this, most commonly lubricant gel, topical anaesthetic spray, lidocaine gel, and distraction/use of a child life worker; 28% believed these provided adequate pain control and 37% believed they were inadequate. Topical anaesthetic spray, lidocaine gel, and nebulised/atomised anaesthetics were believed the most practical to administer and 44% actually …

Identifying Inaccuracies On Emergency Medicine Residency Applications., Eric D Katz, Lee Shockley, Lawrence Kass, David Howes, Janis P Tupesis, Christopher Weaver, Osman R Sayan, Victoria Hogan, Jason Begue, Diamond Vrocher, Jackie Frazer, Timothy Evans, Gene Hern, Ralph Riviello, Antonio Rivera, Keith Kinoshita, Edward Ferguson

Department of Emergency Medicine Faculty Papers

BACKGROUND: Previous trials have showed a 10-30% rate of inaccuracies on applications to individual residency programs. No studies have attempted to corroborate this on a national level. Attempts by residency programs to diminish the frequency of inaccuracies on applications have not been reported. We seek to clarify the national incidence of inaccuracies on applications to emergency medicine residency programs. METHODS: This is a multi-center, single-blinded, randomized, cohort study of all applicants from LCME accredited schools to involved EM residency programs. Applications were randomly selected to investigate claims of AOA election, advanced degrees and publications. Errors were reported to applicants' deans …

Emergency Medicine: A Relatively New Specialty, Rifat Rehmani

Department of Emergency Medicine

No abstract provided.