Emergency Medicine Commons^™

Increasing Operating Room Efficiency Through Decreased Turnover Times, R. Keith Wolfskill

Student Scholarly Projects

The Operating Room (OR) is the financial engine of the modern hospital or surgical center. Over 40% of the hospital's cost is invested in the OR, but the facility recoups a monetary return of around 60-70%. Turnover time is a crucial factor in reducing costs. Uncontrolled, it can inflate operating costs, but when managed effectively, it can boost surgeon, patient, and staff satisfaction, enhance patient safety, and significantly reduce operational costs. The literature underscores the importance of reducing the time between operating room turnovers to improve OR efficiency. A key strategy that research consistently shows to be effective is the …

Safety And Feasibility Of Third-Party Cytotoxic T Lymphocytes For High-Risk Patients With Covid-19, Dolores Grosso, John L. Wagner, Allyson O'Connor, Kaitlyn Keck, Yanping Huang, Zi-Xuan Wang, Hilary Mehler, Benjamin Leiby, Phyllis Flomenberg, Usama Gergis, Neda Nikbakht, Michael Morris, Julie Karp, Alexis R. Peedin, Neal Flomenberg

COVID-19 Papers, Posters, and Presentations

Cytotoxic T lymphocytes (CTLs) destroy virally infected cells and are critical for the elimination of viral infections such as those caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Delayed and dysfunctional adaptive immune responses to SARS-CoV-2 are associated with poor outcomes. Treatment with allogeneic SARS-CoV-2-specific CTLs may enhance cellular immunity in high-risk patients providing a safe, direct mechanism of treatment. Thirty high-risk ambulatory patients with COVID-19 were enrolled in a phase 1 trial assessing the safety of third party, SARS-CoV-2-specific CTLs. Twelve interventional patients, 6 of whom were immunocompromised, matched the HLA-A∗02:01 restriction of the CTLs and received …

Emergency Care For Patients On Amyloid-Targeting Therapies In Alzheimer's Disease, Thomas K. Hagerman, Michelle Suh, Gayatri Devi, Jennifer Sutherland, Gloria Chiang, Don Melady, Kevin Biese, Maura Kennedy

Journal of Geriatric Emergency Medicine

The introduction of novel amyloid-targeting therapies for Alzheimer’s disease presents challenges for emergency clinicians. Patients on these therapies may present with amyloid related imaging abnormalities (ARIA) that are only detectable on magnetic resonance imaging and have significant implications for emergency department (ED) pathways, particularly for patients with stroke-like symptoms and those requiring anticoagulants. In this article, we highlight key considerations for the practicing clinician and ED administrators, including the identification of ARIA, protocols for imaging and treatment considerations, and strategies for interdisciplinary collaboration to ensure optimal care for this unique patient population.

Contributors To Faculty Wellness In An Academic Emergency Department Before And During The Pandemic: A Qualitative Study, Nicholas D. Hartman, Casey Glass, Manoj Pariyadath, Kathleen Hosmer, Meagan Hunt, Nicklaus Ashburn, Cedric Lefebvre

Journal of Wellness

Introduction: Burnout is well known as a prevalent hazard in emergency medicine (EM) careers, but the literature is less clear about what specific work-related factors actually contribute to wellness and burnout among academic EM faculty.

Objectives: 1) To explore themes and specific concerns that contribute to faculty wellness in an academic emergency department, in a qualitative fashion. 2) To determine whether these themes and concerns changed appreciably in the time of the COVID-19 pandemic.

Methods: EM faculty members at an academic institution were invited to participate in the study, including an on-line survey and a structured interview. Survey results were …

Pragmatism And Feasibility: A Qualitative Study Of Experiences Implementing And Upgrading Care In Geriatric Emergency Departments, Anita Chary, Annika Bhananker, Vivian Ramont, Lauren Southerland, Aanand Naik, Kyler Godwin, Maura Kennedy

Faculty, Staff and Students Publications

OBJECTIVES: Implementation and sustainability of new care processes in emergency departments (EDs) is difficult. We describe experiences of implementing geriatric care processes in EDs that upgraded their accreditation level for the Geriatric Emergency Department Accreditation (GEDA) program. These EDs can provide a model for adopting and sustaining guidelines for evidence-based geriatric care.

METHODS: We performed qualitative interviews with geriatric ED nurse and physician leaders overseeing their ED's geriatric accreditation processes. The interview guide was based on the Consolidated Framework for Implementation Research (CFIR), a framework consisting of a comprehensive set of factors that impact implementation of evidence-based interventions. We used …

Frailty Explains Variation In Emergency Department Use For Older Veterans During The Covid-19 Pandemic, Justine Seidenfeld, Karen M. Stechuchak, Valerie A. Smith, Catherine Stanwyck, Chelsea Perfect, Courtney Van Houtven, Susan Nicole Hastings

Journal of Geriatric Emergency Medicine

Background: Older adults were critically vulnerable to disruptions in health care during the COVID-19 pandemic, but it is not known if changes in ED utilization varied based on patient characteristics. Using a cohort of older Veterans, we examined changes in ED visit rates based on four characteristics of interest: age, race, area deprivation index, and frailty

Methods: Participants were aged ≥65, with ≥2 visits in primary or geriatric clinics between 02/02/2018-05/07/2019. An adjusted negative binomial regression model was constructed for each characteristic. We report mean counts of all ED visits by quarter for subgroups separately, and report rate …

The Association Between Prolonged Sars-Cov-2 Symptoms And Work Outcomes, Arjun K Venkatesh, Huihui Yu, Caitlin Malicki, Michael Gottlieb, Joann G Elmore, Mandy J Hill, Ahamed H Idris, Juan Carlos C Montoy, Kelli N O'Laughlin, Kristin L. Rising, Kari A Stephens, Erica S Spatz, Robert A Weinstein

Department of Emergency Medicine Faculty Papers

While the early effects of the COVID-19 pandemic on the United States labor market are well-established, less is known about the long-term impact of SARS-CoV-2 infection and Long COVID on employment. To address this gap, we analyzed self-reported data from a prospective, national cohort study to estimate the effects of SARS-CoV-2 symptoms at three months post-infection on missed workdays and return to work. The analysis included 2,939 adults in the Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE) study who tested positive for their initial SARS-CoV-2 infection at the time of enrollment, were employed before the pandemic, and completed …

Metal Pneumonitis From “Non-Toxic” Decorative Cake Dust Aspiration: A Case Report, Taylor Sanders, Mitchell Hymowitz, Christine Murphy

School of Medicine Faculty Publications

Introduction: Metallic luster dusts are decorative agents for cakes and other confections. While some powders are labeled “non-edible,” they are also marketed as “non-toxic.” We present a case of a child who developed acute metal pneumonitis after accidental aspiration of metallic luster dust. Case Report: A four-year-old presented to the emergency department (ED) in respiratory distress after attempting to ingest gold decorative metallic luster dust. In the ED she was placed on supplemental oxygen. Her initial chest radiograph (CXR) was unremarkable. Her condition worsened despite high-flow nasal cannula oxygen, and she was intubated. A repeat CXR revealed patchy perihilar and …

Geriatric Emergency Medicine Fellowship Journal Club: Strategies For Success In Geriatric Emergency Medicine Research, Priyank Bhatnagar, Lauren Southerland, Ula Hwang, Jacques Lee

Journal of Geriatric Emergency Medicine

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Geriatric Emergency Medicine Fellowship Journal Club – Community Paramedicine, Priyank Bhatnagar Dr., Don Melady

Journal of Geriatric Emergency Medicine

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Development And Implementation Of A Digital Quality Measure Of Emergency Cancer Diagnosis, Paarth Kapadia, Andrew J Zimolzak, Divvy K Upadhyay, Saritha Korukonda, Riyaa Murugaesh Rekha, Umair Mushtaq, Usman Mir, Daniel R Murphy, Alexis Offner, Gary A Abel, Georgios Lyratzopoulos, Luke T A Mounce, Hardeep Singh

Faculty, Staff and Students Publications

PURPOSE: Missed and delayed cancer diagnoses are common, harmful, and often preventable. Automated measures of quality of cancer diagnosis are lacking but could identify gaps and guide interventions. We developed and implemented a digital quality measure (dQM) of cancer emergency presentation (EP) using electronic health record databases of two health systems and characterized the measure's association with missed opportunities for diagnosis (MODs) and mortality.

METHODS: On the basis of literature and expert input, we defined EP as a new cancer diagnosis within 30 days after emergency department or inpatient visit. We identified EPs for lung cancer and colorectal cancer (CRC) …

Free Flap Reconstruction Following Head And Neck Trauma, Larissa Sweeny, Anne C. Kane, Carissa M. Thomas, Neal Futran, Joseph M. Curry, Andrés M. Bur, G. Nina Lu, Aishwarya Shukla, Hunter Skoog, Jaime A. Pena Garcia, Angela E. Alnemri, Rahul Alapati, Michael Dileo, Andrew Fuson, Kenneth Tan, Farshid Taghizadeh, Gina D. Jefferson, Daniel Petrisor, Mark K. Wax

School of Medicine Faculty Publications

Background: Free flap (FF) reconstruction of traumatic injuries to the head and neck is uncommon. Methods: Multi-institutional retrospective case series of patients undergoing FF reconstruction for a traumatic injury (n = 103). Results: Majority were gunshot wounds (GSW; 85%, n = 88) and motor vehicle accidents (11%, n = 11). Majority underwent osseous reconstruction (82%, n = 84). FF failures (9%, n = 9/103) occurred in GSW patients (100%, n = 9/9) and when multiple subsites were injured (89%, n = 8/9). Preoperative antibiotics correlated with lower rates of a neck washouts (4% vs. 19%) (p = 0.01) and 30-day …

Future Directions For Emergency Medical Services Development In Low- And Middle-Income Countries, Peter Delaney, Jon Moussally, Benjamin Wachira

Emergency Medicine, East Africa

The lack of prehospital care access in low- and middle-income countries is one of the greatest unmet needs and, therefore, one of the most urgent priorities in global health. Establishing emergency medical services in low- and middle-income countries poses significant challenges and complexities, requiring solutions tailored to prevailing conditions, informed by needs assessments, and adapted to meet local demands in a culturally appropriate and sustainable manner. In areas without existing emergency medical services, patients must rely on informal networks of untrained bystanders and community members to provide first aid and transport to definitive care. Since 2005, training lay first responders …

Call Me Dr Ishmael: Trends In Electronic Health Record Notes Available At Emergency Department Visits And Admissions, Brian W Patterson, Daniel J Hekman, Frank J Liao, Azita G Hamedani, Manish N Shah, Majid Afshar

Faculty, Staff and Student Publications

OBJECTIVES: Numerous studies have identified information overload as a key issue for electronic health records (EHRs). This study describes the amount of text data across all notes available to emergency physicians in the EHR, trended over the time since EHR establishment.

MATERIALS AND METHODS: We conducted a retrospective analysis of EHR data from a large healthcare system, examining the number of notes and a corresponding number of total words and total tokens across all notes available to physicians during patient encounters in the emergency department (ED). We assessed the change in these metrics over a 17-year period between 2006 and …

Examining Enrollment & Engagement In A Hospital-Based Violence Prevention Intervention Study At A Level 1 Trauma Center, Leigh Frederick

Electronic Theses and Dissertations

BACKGROUND: Violence is a significant healthcare issue that affects the health and well-being of individuals, families, and communities. Violence prevention and intervention programs are a powerful way to stop the revolving door of violent injury in our hospitals and communities. The Health Alliance for Violence Intervention (HAVI), develops and connects violence intervention programs, promotes equity for victims of violence globally, and is dedicated to engaging patients during the window of opportunity when they are recovering in the hospital after a violent injury to reduce the chance of retaliation (related to the injury) and recurrence. A small body of research shows …

Ekg Is Key: A Quality Improvement Project To Decrease Door-To-Ekg Time In A Rural Emergency Department, Amanda Southwell

Doctor of Nursing Practice Projects

Background: Electrocardiograms (EKGs) are the priority when evaluating patients with chest pain who present to the Emergency Department (ED). The American Heart Association and other governing bodies suggest a 10-minute door-to-EKG (DTE) time. The target facility displayed a delay in DTE times.

Purpose: The Doctor of Nursing Practice (DNP) quality improvement (QI) project aimed to decrease the average DTE time for patients over 18 years old with chest pain who presented to the ED registration area.

Methods: The DNP project consisted of an EKG suite to perform EKGs near the ED registration/triage area. Registration and ED staff were educated on …

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome After Sars-Cov-2 Infection, Elizabeth R. Unger, Jin-Mann S. Lin, Lauren E. Wisk, Huihui Yu, Michelle L'Hommedieu, Helen Lavretsky, Juan Carlos C. Montoy, Michael A. Gottlieb, Kristin L. Rising, Nicole L. Gentile, Michelle Santangelo, Arjun K. Venkatesh, Robert M. Rodriguez, Mandy J. Hill, Rachel E. Geyer, Efrat R. Kean, Sharon Saydah, Samuel A. Mcdonald, Ryan Huebinger, Ahamed H. Idris, Jocelyn Dorney, Bala Hota, Erica S. Spatz, Kari A. Stephens, Robert A. Weinstein, Joann G. Elmore

Department of Emergency Medicine Faculty Papers

IMPORTANCE: Chronic symptoms reported following an infection with SARS-CoV-2, such as cognitive problems, overlap with symptoms included in the definition of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

OBJECTIVE: To evaluate the prevalence of ME/CFS-like illness subsequent to acute SARS-CoV-2 infection, changes in ME/CFS symptoms through 12 months of follow-up, and the association of ME/CFS symptoms with SARS-CoV-2 test results at the acute infection-like index illness.

DESIGN, SETTING, AND PARTICIPANTS: This prospective, multisite, longitudinal cohort study (Innovative Support for Patients with SARS-CoV-2 Infections Registry [INSPIRE]) enrolled participants from December 11, 2020, to August 29, 2022. Participants were adults aged 18 to 64 …

Gender And Emergency Physicians’ Experiences Of Leading Decision Making About Restraint Use: A Qualitative Study, Anita Chary, Beatrice Torres, Elise Brickhouse, Datonye Charles, Ynhi Thomas, Michelle Suh

Faculty, Staff and Students Publications

No abstract provided.

Well-Being And Leadership Within The Emergency Department, Jacob T. Berg, Thomas Matese, Dennis Anthony Cardriche, David Hotwagner

HCA Healthcare Journal of Medicine

This article looks at well-being and the role of leadership from the perspective of emergency medicine. The importance of leadership within the emergency department (ED), emergency medicine writing at large, and the prevention of burnout and compassion fatigue cannot be overstated. This article looks at the need for more research and measured interventions within the ED. It also highlights some measures that could be taken to help improve well-being from a leadership perspective to improve patient safety and outcomes within the ED.

Deciphering Dyspnea: Exercise-Related Flail Mitral Valve Masquerading As Pneumonia, Mehtab Galeh, Amjad Nader, Rania Esteitie

Journal of Shock and Hemodynamics

A 62-year-old male presented with a sudden onset of dyspnea following a racquetball session. Vital signs revealed a blood pressure of 136/63 mm Hg, heart rate of 116 beats/min, respiratory rate of 26 breaths/min, temperature of 98.7º F, and oxygen saturation of 85% on room air. The physical examination was notable for tachycardia, no audible murmur, and bilateral coarse breath sounds on lung auscultation. Pertinent laboratory data showed leukocytosis, elevated lactic acidosis, and elevated brain natriuretic peptide. Arterial blood gas analysis on room air revealed a pH of 7.39, partial pressure of carbon dioxide of 32 mm Hg, and arterial …