Annals of emergency medicine
-
Although the focus of emergency care is on the diagnosis and treatment of acute illnesses and injuries or the stabilization of patients for ongoing treatment, some patients may benefit from a palliative approach. Little is known about delivering palliative care in the emergency department (ED). We explore the attitudes, experiences, and beliefs of emergency providers about palliative care in the ED, using structured qualitative methods. ⋯ Providers ranked improved communication and documentation from outpatient providers as their highest priority for improvement. Attitudinal and structural barriers may need to be overcome to improve palliative care in the ED. Despite targeted recruitment, attending physician participation was low.
-
Clinical research requires high-quality data collection. Data collected at the emergency department evaluation is generally considered more precise than data collected through chart abstraction but is cumbersome and time consuming. We test whether trained research assistants without a medical background can obtain clinical research data as accurately as physicians. We hypothesize that they would be at least as accurate because they would not be distracted by clinical requirements. ⋯ The relatively fair interrater reliability observed in our study is consistent with previous studies evaluating interrater reliability for cardiovascular disease in the inpatient setting. With respect to research data, we found that prospective ascertainment of clinical data is more often correct when done by research assistants compared with clinicians simultaneously evaluating patients.
-
We determine the sensitivity, specificity, and clinical utility of the Gram's stain of peritoneal fluid in patients undergoing paracentesis. ⋯ The Gram's stain result was rarely positive in patients undergoing paracentesis, and when positive, it rarely provided clinically useful information.
-
Editor's capsule summary for Cruz et al: (1) WHAT IS ALREADY KNOWN ON THIS TOPIC: Valid clinical research requires high-quality data collection. Physicians are commonly considered the standard by which valid prospective data are obtained. WHAT QUESTION THIS STUDY ADDRESSED: This study determined whether non-medically trained research assistants could reliably collect subjective historical data from emergency department patients with chest pain. ⋯ Research assistants demonstrated fair to excellent reliability (as defined by crude agreement and kappa) when obtaining cardiac histories and cardiac risk factors. HOW THIS MIGHT CHANGE CLINICAL PRACTICE: The results of this study will not change clinical practice. They do, however, provide evidence to support the use of trained research assistants for the collection of certain types of clinical data.
-
Since 2003, the Society of Chest Pain Centers (SCPC) has provided hospital accreditation for acute coronary syndrome care processes. Our objective is to evaluate the association between SCPC accreditation and adherence to the American College of Cardiology/American Heart Association (ACC/AHA) evidence-based guidelines for non-ST-segment elevation myocardial infarction (NSTEMI). The secondary objective is to describe the clinical outcomes and the association with accreditation. ⋯ SCPC-accredited hospitals had higher NSTEMI ACC/AHA evidence-based guideline adherence in the first 24 hours of care on 2 of the 5 measures. No difference in outcomes was observed. Further studies are needed to better understand the association between SCPC accreditation and improved care for patients with acute coronary syndrome.