Emergency Medicine Commons^™

Acute Exacerbations Of Chronic Obstructive Pulmonary Disease: A Primer For Emergency Physicians, Randy Sorge, Peter Deblieux

School of Medicine Faculty Publications

Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) impose a significant burden on patients and the emergency health care system. Patients with COPD who present to the emergency department (ED) often have comorbidities that can complicate their management. Objective: To discuss strategies for the management of acute exacerbations in the ED, from initial assessment through disposition, to enable effective patient care and minimize the risk of treatment failure and prevent hospital readmissions. Discussion: Establishing a correct diagnosis early on is critical; therefore, initial evaluations should be aimed at differentiating COPD exacerbations from other life-threatening conditions. Disposition decisions are based …

Etiology Of Acute Undifferentiated Fever In Patients Presenting To The Emergency Department Of A Tertiary Care Center In Karachi, Pakistan, Noman Ali, Nadeem Ullah Khan, Shahid Shahid, Syed Mustahsan

Department of Emergency Medicine

Objective: Our study aimed at identifying the characteristics and etiology of various causes of acute undifferentiated fever in patients presenting to the emergency department of a tertiary care hospital.
Methods: This was a retrospective study conducted at the department of emergency medicine, Aga Khan University Hospital from January to June 2016. Adult patients presenting to Emergency department with acute undifferentiated fever were enrolled. Descriptive statistics were calculated in terms of mean±SD for continuous variables like age of the patients and duration of fever, whereas frequency and percentage were computed for categorical variables like gender and causes of fever.
Results: A …

A Multicenter Mixed-Effects Model For Inference And Prediction Of 72-H Return Visits To The Emergency Department For Adult Patients With Trauma-Related Diagnoses, Ehsan Yaghmaei, Louis Ehwerhemuepha, William Feaster, David Gibbs, Cyril Rakovski

Mathematics, Physics, and Computer Science Faculty Articles and Research

Objective

Emergency department (ED) return visits within 72 h may be a sign of poor quality of care and entail unnecessary use of healthcare resources. In this study, we compare the performance of two leading statistical and machine learning classification algorithms, and we use the best performing approach to identify novel risk factors of ED return visits.

Methods

We analyzed 3.2 million ED encounters with at least one diagnosis under “injury, poisoning and certain other consequences of external causes” and “external causes of morbidity.” These encounters included patients 18 years or older from across 128 emergency room facilities in the …

Telemedicine In The Emergency Department In The Era Of Covid-19: Front-Line Experiences From 2 Institutions, Joel M. Hamm, Chris Greene, Michael T. Sweeney, Setareh Mohammadie, Linda B. Thompson, Eric Wallace, Walter Schrading

Emergency Medicine Faculty Publications

During the COVID-19 pandemic, one of the major changes that has occurred in emergency medicine is the evolution of telemedicine. With relaxation of regulatory and administrative barriers, the use of this already available technology has rapidly expanded. Telemedicine provides opportunity to markedly decrease personal protective equipment (PPE) and reduce healthcare worker exposures. Moreover, with the convenience and availability of access to medical care via telemedicine, a more fundamental change in healthcare delivery in the United States is likely. The implementation of telemedicine in the emergency department (ED) in particular has great potential to prevent the iatrogenic spread of COVID-19 and …

Emergency Department Admissions During Covid-19: Implications From The 2002-2004 Sars Epidemic, Muhammad Musaab Munir, Russell S. Martins, Asad Mian

Medical College Documents

No abstract provided.

Emergency Preparedness And Response To The Covid-19 Pandemic: Our Experience From The Emergency Department Of A Tertiary Care Hospital In Pakistan, Badar Afzal Khan, Noman Ali, Asad Mian

Department of Emergency Medicine

No abstract provided.

E-Cigarette Or Vaping Product Use-Associated Lung Injury (Evali) Characterized By Pulmonary Ultrasound, Peter Sacci, Arthur Au

Department of Emergency Medicine Faculty Papers

Pulmonary ultrasound is a useful tool in the diagnosis and resuscitation of emergency department (ED) patients with dyspnea. We present the case of a patient who was diagnosed with E-cigarette or vaping product use-associated lung injury (EVALI) using pulmonary ultrasound. Many of these cases are diagnosed using x-ray, computerized tomography, or bronchoscopy and to our knowledge this is the first published case that demonstrates utility of ultrasound in diagnosing EVALI. While more investigation is needed on the use of this technique, the patient in this case was diagnosed with EVALI based on positive history, presence of normal cardiac function, non-cardiogenic …

Optimizing Evaluation And Treatment Of Patients With Nausea And Vomiting Of Pregnancy In The Emergency Department, Danielle N. Carr, Md, Angela Carracino, Do, Alisha Sangal, Md, Madeline Smith, Md

Health Equity and Quality Improvement (HEQI) Summit

Problem Definition

• Nausea and vomiting of pregnancy (NVP). Approximately 50% prevalence rate
• Pregnant patients with NVP require special considerations for treatment
• Long ER wait times
• Possibly avoidable hospital admissions

Pediatric Congenital Heart Diseases: Patterns Of Presentation To The Emergency Department Of A Tertiary Care Hospital, Surraiya Bano, Saleem Akhtar, Uzma R. Khan

Department of Emergency Medicine

Objective: To observe presentation of Pediatric congenital cardiac defects to the Emergency Department (ED) of a tertiary care hospital in Pakistan.
Methods: This is a retrospective chart review of patients under the age of 16 years with congenital cardiac defects presenting to the Emergency Department of Aga Khan University Hospital over a period of eighteen months, from January 2012 to June 2013. Study population was divided into two groups; first group constituted children with undiagnosed congenital cardiac defects, whereas second group constituted children with diagnosed congenial cardiac defects presented to ED. In previously diagnose cases each visit was counted as …

Simulation-Based Mastery Learning Compared To Standard Education For Discussing Diagnostic Uncertainty With Patients In The Emergency Department: A Randomized Controlled Trial., Danielle M. Mccarthy, Rhea E. Powell, Kenzie A. Cameron, David H. Salzman, Dimitrios Papanagnou, Amanda Doty, Benjamin E. Leiby, Katherine Piserchia, Matthew R. Klein, Xiao C. Zhang, William C. Mcgaghie, Kristin L. Rising

Department of Pharmacology and Experimental Therapeutics Faculty Papers

BACKGROUND: Diagnostic uncertainty occurs frequently in emergency medical care, with more than one-third of patients leaving the emergency department (ED) without a clear diagnosis. Despite this frequency, ED providers are not adequately trained on how to discuss diagnostic uncertainty with these patients, who often leave the ED confused and concerned. To address this training need, we developed the Uncertainty Communication Education Module (UCEM) to teach physicians how to discuss diagnostic uncertainty. The purpose of the study is to evaluate the effectiveness of the UCEM in improving physician communications.

METHODS: The trial is a multicenter, two-arm randomized controlled trial designed to …

Mechanical, Team-Focused, Video-Reviewed Cardiopulmonary Resuscitation Improves Return Of Spontaneous Circulation After Emergency Department Implementation, D. M. Rolston, T. Li, C. Owens, G. Haddad, T. J. Palmieri, V. Blinder, J. L. Wolff, M. Cassara, Q. Zhou, L. B. Becker

Journal Articles

No abstract provided.

A Module Based Method Of Teaching A Novel Approach To Electrocardiogram Interpretation, Emily Fishbein, Alexandra Koutsoubis, Jennifer White, Md, Dimitrios Papanagnou, Md

Phase 1

Purpose: The traditional approach to 12-lead electrocardiogram interpretation has limitations in the ED setting because it is tedious and does not emphasize pattern recognition for potentially fatal conditions that ED physicians must recognize. Additionally, while lecture-based learning is necessary, learning modules can help learners gain a better understanding of the material. The purpose of this study was to create and implement a self-paced learning module that teaches a novel way of ECG interpretation through the following steps: is it sinus? is it wide? is there ischemia? and does this herald sudden death?

Methods: The objective endpoint of this study was …

Utility Of Point Of Care Ultrasound For Identifying Dental Abscesses In Emergency Department Patients Presenting With Dental Pain, Matthew Cervantes, Kelly Goodsell, Md, Arthur Au, Md

Phase 1

Introduction: Computed tomography (CT) is the current gold standard for diagnosing dental abscesses in the Emergency Department (ED). There are limitations to using CT, including high cost, radiation exposure, and lengthy time to diagnosis. Point of Care Ultrasound (POCUS) is an alternative imaging modality that does not have these limitations, and is already used to diagnose other soft tissue abscesses. The efficacy of POCUS for diagnosing suspected dental abscesses has never been investigated. The purpose of this project is to compare the utility of POCUS to CT in diagnosing suspected dental abscesses in the ED.

Methods: A convenience …

Marijuana Use And Mental Health Among Emergency Department Patients, Megan Hanna

Scholarship in Medicine - All Papers

Background: According to the Centers for Disease Control and Prevention (CDC), marijuana is the most commonly used illicit drug in the U.S. with an increasing number of users in recent years.

Objective: This study was undertaken to identify common reasons for marijuana use and any relationship between its use and mental health among Emergency Department (ED) patients. Methods: A total of 303 ED patients participated from the Miami Valley Hospital Emergency Department. Eligible participants included those with any marijuana use. Subjects were administered a survey which identified age of first use, reasons for use, and presence of anxiety and depression …

Development Of A Hert Trained Interprofessional Student Decontamination Team For Hospital Mass Casualty Response, Ashley Wong, Claire Zurlo, Edward Jasper

Phase 1

Introduction: FEMA’s Hospital Emergency Response Training (HERT) prepares healthcare workers to decontaminate patients during a mass casualty incident. This depletes the emergency department (ED) staff when they are needed most though. Developing an interprofessional student composed HERT team to screen and decontaminate affected populations will allow ED staff to handle more medically complex situations during a mass casualty event.

Methods: Likert scale surveys were conducted among ED physicians and nurses at Jefferson Hospital and HERT trained medical and nursing students at Jefferson University. These were to evaluate the training program and ED staff opinions of utilizing a student HERT …

Oncology Hospital At Home: A Retrospective Chart Review Examining Whether Oncology Patients Placed Under Observation Status By The Ed Could Be Managed In The Home Setting, Mary Blumenfeld, Adam Binder, Md, Nathan Handley, Md

Phase 1

Introduction: Hospital at Home (HaH) programs deliver hospital-level care in the home setting rather than in the traditional inpatient unit. In the US, this model of care has focused on the general medicine population, but no such models for adult oncologic care have been described in the literature to date. The current study seeks to identify whether certain diagnoses of patients with cancer admitted to observation status are predictive for early discharge and potentially model diagnoses on which to build a HaH program.

Methods: Electronic medical records were reviewed for 130 adult cancer patients presenting to the Thomas Jefferson …

Global Health Immersive Elective In The Philippines, Lisa Godfrey

Posters

Describes her experiences working at Fabella Memorial NICU and the Philippines General Hospital.

Sepsis Education And Training In Medical School, Shayan Ghiaee, Dimitrios Papanagnou, Md, David F. Gaieski, Md

Phase 1

Purpose: According to the National Institutes of Health, severe sepsis strikes more than one million Americans every year. Despite the extensive research that has gone into creating the different risk stratification tools for sepsis, there is still a fifteen to thirty percent mortality rate among patients diagnosed with sepsis. We believe this is due to a lack of robust education and training of medical students in sepsis identification, and thus, the purpose of this study was to determine the extent of training and education of medical students in the identification and treatment of sepsis.

Methods: This study is aimed at …

A Module-Based Novel Approach To Electrocardiogram Interpretation For Emergency Medicine Residents, Alexandra Koutsoubis, Emily Fishbein, Jennifer White, Md

Phase 1

Purpose: In the Emergency Department, accurate ECG interpretation is essential as many conduction abnormalities are treatable and can lead to death if inaccurately diagnosed. Learning how to read a 12-lead ECG is part of medical education, taught through the following approach: rate, rhythm, axis. In the ED, this tedious approach doesn’t relay important information that should be garnered from the ECG with accuracy. Currently, resources for residents to improve ECG interpretation skills are limited. The purpose of the study was to design a module that teaches an accurate way of interpreting an ECG, that allows for pragmatic, pattern recognition of …

The Effect Of The Surgery Rotation Sequence On Surgery And Emergency Medicine Nbme Scores, Anna Lin, Gerald Isenberg, Md, Chaiya Laoteppitaks, Md

Phase 1

Purpose: Within a school, the formerly fourth year emergency medicine clerkship was added to the third year curriculum in a sequence with general surgery and surgical subspecialty clerkships. Together, a student can be placed in any permutation of the three clerkships, but a student will take the Surgery and EM NBME exam after the completion of the respective clerkship regardless of the order of clerkships. The purpose of this project was to look to see if there was a significance difference in NBME scores between four different sequences of clerkships and to see if sequence of a third year student’s …

Validation Of A 5-Item Tool To Measure Patient Assessment Of Clinician Compassion In The Emergency Department., Praveen Sabapathi, Michael B. Roberts, Brian M Fuller, Michael A Puskarich, Christopher W Jones, J Hope Kilgannon, Valerie Braz, Christina Creel-Bulos, Nathaniel Scott, Kristina L Tester, Anthony Mazzarelli, Stephen Trzeciak, Brian W Roberts

PCOM Scholarly Works

BACKGROUND: To test if the 5-item compassion measure (a tool previously validated in the outpatient setting to measure patient assessment of clinician compassion) is a valid and reliable tool to quantify a distinct construct (i.e. clinical compassion) among patients evaluated in the emergency department (ED).

METHODS: Cross-sectional study conducted in three academic emergency departments in the U.S. between November 2018 and April 2019. We enrolled adult patients who were evaluated in the EDs of the participating institutions and administered the 5-item compassion measure after completion of care in the ED. Validity testing was performed using confirmatory factor analysis. Cronbach's alpha …

Bringing Upstairs Care Downstairs; Integration Of Rehabilitation Medicine, Care Management, And The Hospital Elder Life Program (Help) Into An Emergency Department., Robert Anderson, Molly Anderson, Rhonda Babine, Farid Feghali, Elizabeth Dunstan, Matthew Glazer, Susan Horton, Stephanie O'Brien, Elizabeth Pontius, David Smith, Megan Viens, Heather Williams

Journal of Maine Medical Center

Introduction: Services such as physical therapy (PT), occupational therapy (OT), speech-language pathology (SLP), social work (SW), care management, and elder life specialists have long been an established part of care for patients admitted to Maine Medical Center (MMC) but not for patients in the Emergency Department (ED). Methods and Results: Driven in part by changes in Medicare reimbursement models, care management established a presence in the Emergency Department (ED) in 2003 with a focus on care planning and cost avoidance. In recent years PT, OT, SLP, SW, and the Hospital Elder Life Program (HELP) have increased their ED involvement substantially. …

Improving Ed Door To Puncture Times For Endovascular Thrombectomy In Acute Ischemic Stroke, Richard F. Schmidt, Md, Nabeel Herial, Md, Robin D'Ambrosio, Bsn, Erin Simko, Bsn, Fred Rincon, Md, Maria Aini, Md, Pascal Jabbour, Md, Stavropoula Tjoumakaris, Md, M. Reid Gooch, Md, Robert H. Rosenwasswer, Md, Robin Dharia, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Objectives

• Optimize the management of patients presenting to TJUH with AIS who are candidates for ET.
• Enable continued process improvement through improved data collection methods and identification of new process metrics.

Speed And Safety: Emergency Department Ultrasound Lockboxes For Peripheral Iv’S, M. Trifan, S. Schiff, D. Devlin, B. Warden, M. Magee

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Objectives

• To decrease the average amount of time needed to place an USGIV by installing lock-boxes with all necessary materials on the ultrasound carts.
• To eliminate a time-consuming step in gathering materials for USGIV, while satisfying safety standards for securing sharps in the department

Small Bowel Obstruction: Facilitating Diagnosis And Optimizing Resuscitation And Management, Robin Naples, Md, Kendrick Law, Md, Quinton Campbell, Md, Ryan Bateman, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Introduction

As a common surgical emergency that presents in our Emergency Department, Small Bowel Obstruction (SBO) is a disease process where appropriate treatment relies on early detection, fluid resuscitation, and gastric decompression. Despite SBO representing a common emergency, many patients experience inadequate or delayed management as compared to established guidelines, potentially leading to suboptimal treatment and resolution of SBO. As order sets and alerts within Epic are in place for other disease processes whose management relies on timely diagnosis and fluid resuscitation (e.g. sepsis), objectives for our quality improvement plan involve incorporating elements of alerts and order sets within our …

Escalation Of Care After Admission Within 24 Hours, Joseph Jean, Md, Mitchell Berman, Md, Christopher Ponce, Md, Kory London, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Objectives

1. Identify high risk patients in the ED who require hospital admission and may need higher levels of care.
2. Identify patterns or diagnoses in the ED that predispose patient care to escalations after admission.

Improving Emergency Department Efficiency Through Easier Access To Policies, Meryl Abrams, Md, Uma Damle, Md, Adam Brown, Do, Carlos Rodriguez, Md, Frederick Randolph, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Objectives

1. We aim to help residents, faculty and auxiliary staff to more easily locate and use institutional clinical policies.
2. To improve patient safety by having the institutionally developed policies be more readily available.

Implementation Of A ‘Flow’ Attending Reduces Overall Ed Length Of Stay In Telehealth Intake Model, R. Fuega, K. Maloney, R. A. Band, B. H. Slovis, K. S. London, J. L. White

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Background

In an effort to improve our efficiency, the Department of Emergency Medicine recently transitioned from an in person physician triage model to a telehealth intake model. With this change, many new gaps have been identified. By uncoupling triage from the in person intake provider, we lost the ability to manage “quick” discharges, to provide secondary oversight of the patients in the internal waiting room, and to directly supervise patients seen in the fast track area. In order to address these new concerns, and to mitigate the loss felt by removing the in person provider from intake, a ‘flow’ attending …

Initial Response To The Opioid Crisis: Availability Of Buprenorphine And Warm Handoff In The Ed, Lauren Selame, Md, Benjamin H. Slovis, Md, Ma, Theodore Christopher, Md, Facep, Kory S. London, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Background:

• The United States is in the midst of an opioid crisis.
• The Centers for Disease Control and Prevention has cited Emergency Departments (ED) as important centers for treatment and referral, including medication assisted treatment (MAT), which has been shown to be superior to motivational interviewing and referral alone.1,2
• While direct linkage to outpatient programs via the ED may be an opportunity to better serve this population, data on such “warm handoff” interventions are sparse.

Objective: We initiated an ED opioid use disorder (OUD) pathway, which aimed to initiate buprenorphine therapy and perform warm handoff directly into the community for …

It Takes A Village: Developing An Airway Management Bundle To Standardize Emergent Intubation Processes In The Emergency Department, James Sacca, Md, Daniel Casey Kim, Md, Dimitri Papanagnou, Md, Mph, Edd(C)

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Problem Definition

Airway management is at the core of emergent patient care. Emergent intubations in the Emergency Department (ED) at Thomas Jefferson University Hospital (TJUH) have been noted by staff to be variable and not standardized. Staff have also described that equipment tends to be difficult to locate during intubations.

There is no objective data to confirm these claims. Furthermore, there is no bundle in place to guide emergent intubations in the ED.

Our team sought immediate actions to improve ED airway processes.