Journal of the American College of Emergency Physicians open
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J Am Coll Emerg Physicians Open · Dec 2020
Prediction of emergency department resource requirements during triage: An application of current natural language processing techniques.
Accurate triage in the emergency department (ED) is critical for medical safety and operational efficiency. We aimed to predict the number of future required ED resources, as defined by the Emergency Severity Index (ESI) triage protocol, using natural language processing of nursing triage notes. ⋯ Machine learning of nursing triage notes, combined with clinical data available at ED presentation, can be used to predict the number of required future ED resources. These findings suggest that machine learning may be a valuable adjunct tool in the initial triage of ED patients.
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J Am Coll Emerg Physicians Open · Dec 2020
Multicenter registry of United States emergency department patients tested for SARS-CoV-2.
This paper summarizes the methodology for the registry of suspected COVID-19 in emergency care (RECOVER), a large clinical registry of patients from 155 United States (US) emergency departments (EDs) in 27 states tested for SARS-CoV-2 from March-September 2020. The initial goals are to derive and test: (1) a pretest probability instrument for prediction of SARS-CoV-2 test results, and from this instrument, a set of simple criteria to exclude COVID-19 (the COVID-19 Rule-Out Criteria-the CORC rule), and (2) a prognostic instrument for those with COVID-19. ⋯ Abstracted clinical data included 204 variables representing the earliest manifestation of infection, including week of testing, demographics, symptoms, exposure risk, past medical history, test results, admission status, and outcomes 30 days later. In addition to the primary goals, the registry will provide a vital platform for characterizing the course, epidemiology, clinical features, and prognosis of patients tested for COVID-19 in the ED setting.
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J Am Coll Emerg Physicians Open · Dec 2020
Microdosing and standard-dosing take-home buprenorphine from the emergency department: A feasibility study.
Emergency department (ED)-initiated buprenorphine may prevent overdose. Microdosing is a novel approach that does not require withdrawal, which can be a barrier to standard inductions. We aimed to evaluate the feasibility of an ED-initiated buprenorphine/naloxone program providing standard-dosing and microdosing take-home packages and of randomizing patients to either intervention. ⋯ ED-initiated take-home standard-dosing and microdosing buprenorphine/naloxone programs are feasible, and a randomized controlled trial would be acceptable to our target population.
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J Am Coll Emerg Physicians Open · Nov 2020
Incidence, delays, and outcomes of STEMI during COVID-19 outbreak: Analysis from the France PCI registry.
The aim of this study was to assess the impact of the coronavirus disease 2019 (COVID-19) outbreak on incidence, delays, and outcomes of ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI) in France. ⋯ According to the multicenter France PCI registry, the COVID-19 outbreak in France was associated with a significant decline in STEMI undergoing PPCI and longer transfer time for patients who presented directly to the ED. Mortality rates doubled, but the difference was not statistically significant.
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J Am Coll Emerg Physicians Open · Nov 2020
Design and implementation of a temporary emergency department-intensive care unit patient care model during the COVID-19 pandemic surge.
The ongoing pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in rapid surges of critically ill patients infected with coronavirus disease 2019 (COVID-19) pneumonia presenting to the emergency department (ED) and requiring ICU admission nationwide. Despite adaptations in critical care personnel staffing, bed availability and supply provision, many inpatient ICUs have become acutely crowded, leading to boarding of critically ill patients with COVID-19 and other diseases in the ED. ⋯ Critical care-trained emergency physicians took call and came into the hospital overnight/on weekends to provide bedside treatment to admitted ICU patients boarding for prolonged periods in our ED. In this manuscript, we describe the creation and execution of the ED-ICU service and the characteristics and management of the patients who received care under this model.