Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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The Tuscan Emergency Medicine Initiative (TEMI) is a comprehensive emergency medicine (EM) training program designed to build an EM training infrastructure in Tuscany, Italy. The program has successfully trained a team of instructors using a train-the-trainers model, certified 350 physicians who are already practicing in emergency departments (EDs), and established a master's program as a bridge to specialty training at the region's three universities. Using lessons learned from this program, the authors identify eight factors (The Eight Cs) that can serve as a guide to implementing a collaborative EM program in other environments: collaboration, context, culture, credibility, consulting, consistency, critique, and conclusion. Each of these topics is described in detail and may be useful to other international interventions.
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Multicenter Study Comparative Study
Comparison of adverse events during procedural sedation between specially trained pediatric residents and pediatric emergency physicians in Israel.
The aim was to compare the rate of procedural sedation-related adverse events of pediatric residents with specific training in "patient safety during sedation" and pediatric emergency physicians (PEPs) who completed the same course or were teaching faculty for it. ⋯ Unsupervised pediatric residents with training in patient safety during sedation performed procedural sedations with a rate of adverse events similar to that of PEPs.
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The role of paramedics with extended skills is evolving, enabling them to assess and treat patients in the community. A United Kingdom service led by extended-role paramedic practitioners (PPs) is aimed at managing minor acute illness and injury among older people in the home when appropriate, avoiding unnecessary transfer to the emergency department (ED). ⋯ This study suggests that appropriately trained paramedics with extended skills treating older people with minor acute conditions in the community are as safe as standard EMS transfer and treatment within the ED.
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Improving patient identification (ID), by using two identifiers, is a Joint Commission safety goal. Appropriate identifiers include name, date of birth (DOB), or medical record number (MRN). ⋯ Medical providers often miss ID errors and infrequently verify patient ID with two identifiers during CPOE.
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Comparative Study
Actual financial comparison of four strategies to evaluate patients with potential acute coronary syndromes.
Small studies have shown that a negative computed tomography coronary angiogram (CTA) in low-risk chest pain patients predicts a low rate of 30-day adverse events. The authors hypothesized that an immediate CTA strategy would be as effective but less costly than alternative strategies for evaluation of patients with potential acute coronary syndrome (ACS). ⋯ Compared to the other strategies, immediate CTA was as safe, identified as many patients with CAD, had the lowest cost, had the shortest LOS, and allowed discharge for the majority of patients. Larger prospective studies should confirm safety before immediate CTA replaces other strategies to rule out possible ACS.