Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Policymakers have increasingly focused on emergency department (ED) utilization for primary care-treatable conditions as a potentially avoidable source of rising health care costs. The objective was to determine the association of health insurance type and arrival time, as indicators of limited availability of primary care, with primary care-treatable classification of ED visits. ⋯ These findings add to prior work that implicates insurance type and arrival time in the variation of primary care-treatable ED visits. Although primary care-treatable classification of ED visits was most associated with uninsured or Medicaid visits, this classification increased most rapidly among Medicare visits during the study period.
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Multicenter Study
Increases in Emergency Department Occupancy Are Associated With Adverse 30-day Outcomes.
The associations between emergency department (ED) crowding and patient outcomes have not been investigated comprehensively in different types of ED. The study objective was to examine the associations of changes over time in ED occupancy with patient outcomes in a sample of EDs that vary by size and location. A secondary objective was to explore whether the relationship between ED occupancy and patient outcomes differed by ED characteristics (size/type and medical and nursing staffing ratios). ⋯ In Quebec EDs, increases in bed occupancy are associated with an increase in the rates of 30-day adverse outcomes, even after adjustment for patient and ED characteristics. The results raise important concerns about the quality of care during periods of ED crowding.
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Advanced Trauma Life Support (ATLS) has been shown to improve outcomes related to trauma resuscitation; however, omissions from this protocol persist. The objective of this study was to evaluate the effect of a trauma resuscitation checklist on performance of ATLS tasks. ⋯ Implementation of a trauma checklist was associated with greater ATLS task performance and with increased frequency and speed of primary and secondary survey task completion.
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Few parameters are available to predict neurologic outcome of post-cardiac arrest patients in the early stage of treatment. Optic nerve sheath diameter (ONSD) has been used to indirectly assess intracranial pressure. This study evaluated whether ONSD, an additional parameter in initial brain computed tomography (CT) scans, can be an early predictor of neurologic outcome in post-cardiac arrest patients. ⋯ Optic nerve sheath diameter on initial brain CT correlated closely with the neurologic outcome of hypoxic ischemic encephalopathy and had good reliability. Additional prospective work may be justified evaluating the standardization and diagnostic performance in real time use as a predictive tool for neurologic outcome following cardiac arrest.
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Social media are becoming increasingly integrated into both the clinical and the research dimensions of emergency medicine. They can provide methods for sharing crucial information to targeted individuals or groups in a rapid fashion. As a result, investigators conducting emergency research under the exception from prospective informed consent requirements are beginning to turn to social media platforms as they engage in required community consultation and public disclosure activities before their research begins. ⋯ Second, recognize how those outreach methods relate to the specific goals of community consultation and public disclosure. Third, consider whether or not the intended audiences of community consultation and public disclosure will be available via social media. Finally, think about how social media outreach efforts will be measured and assessed before consultation and disclosure activities are under way.