Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Comparative Study
Scope of Practice and Autonomy of Physician Assistants in Rural Versus Urban Emergency Departments.
This was a study of the scope of practice and autonomy of emergency medicine (EM) physician assistants (PAs) practicing in rural versus urban emergency departments (EDs). ⋯ Rural PAs reported a broader scope of practice, more autonomy, and less access to physician supervision than urban PAs.
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The median emergency department (ED) boarding time for admitted patients has been a nationally reportable core measure that now also affects ED accreditation and reimbursement. However, no direct national probability samples of ED boarding data have been available to guide this policy until now. The authors studied new National Hospital Ambulatory Medical Care Survey (NHAMCS) survey items to establish baseline values, to generate hypotheses for future research, and to help improve survey quality in the future. ⋯ In this national survey, ED boarding of admitted patients disproportionately affects hospitals with higher ED volumes, which also see sicker patients who wait longer to be seen, but not hospitals with higher proportions of Medicaid or uninsured visits. This finding implies that, unlike other quality measures, there is a negative volume-outcome relationship for timely hospitalization from the ED.
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Systems theory suggests that there should be relatively high correlations among quality measures within an organization. This was an examination of hospital performance across three types of quality measures included in Medicare's Hospital Inpatient Value-Based Purchasing (HVBP) program: emergency department (ED)-related clinical process measures, inpatient clinical process measures, and patient experience measures. The purpose of this analysis was to determine whether hospital achievement and improvement on the ED quality measures represent a distinct domain of quality. ⋯ Little consistency was found in achievement or improvement across the three quality domains, suggesting that the ED performance represents a distinct domain of quality. Implications include the following: 1) there are broad opportunities for hospitals to improve, 2) patients may not experience consistent quality levels throughout their hospital visit, 3) quality improvement interventions may need to be tailored specifically to the department, and 4) consumers and policy-makers may not be able to draw conclusions on overall facility quality based on information about one domain.
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Despite several expert panel recommendations and cellulitis treatment guidelines, there are currently no clinical decision rules to assist clinicians in deciding which emergency department (ED) patients should be treated with oral antibiotics and which patients require intravenous (IV) therapy at first presentation of cellulitis amenable to outpatient treatment. ⋯ These risk factors should be considered when initiating empiric antibiotic therapy for ED patients with cellulitis amenable to outpatient treatment.
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Psychological distress not only has substantial health and social consequences, but is also associated with emergency department (ED) use. Previous studies have typically used cross-sectional data to focus on the relation between serious psychological distress and dichotomized ED utilization measures, without assessing the volume of ED use or examining nonserious levels of psychological distress. The objective of this study was to explore the association between ED utilization volume and the full spectrum of psychological distress. ⋯ Even a low level of psychological distress, and not just serious psychological distress, may be an early indicator of future ED use. These results highlight the need to develop novel responses to better manage or avert ED use not only for adults with serious psychological distress but also for those who are experiencing even mild symptoms of psychological distress.