Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Oregon introduced a state policy, HB 3090, on October 6, 2017, which increased requirements on emergency departments (EDs) to improve transitions to outpatient mental health care. The objective of this study was to examine the policy's impact among low-income adolescent patients who face severe barriers to follow-up. ⋯ There was a small increase in short-term outpatient mental health visits after the policy, but the association weakened over time, and other key outcomes did not change. Putting pressure on EDs to perform better in this area is likely to be a minimally effective strategy without accompanying strengthening of mental health resources.
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Alcohol withdrawal syndrome (AWS) is a common condition prompting emergency department (ED) presentation. However, there are limited recent, large-scale, robust data available on the incidence, admission, and medical treatment of AWS in the ED. ⋯ AWS represents a common reason for ED presentation, with most patients being admitted. We identified a rising incidence with a shift in management to include agents such as phenobarbital and gabapentin. These findings provide important evidence on current trends in AWS to inform health policy and knowledge translation efforts as well as emphasizing the need for ongoing research and evaluation of clinical practices to optimize outcomes for patients with AWS.
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The emergency physician (EP) workforce has been a recent focus after a workforce projection predicted a surplus of EPs by 2030. A previous study of Iowa emergency departments (EDs) demonstrated wide variability in ED staffing patterns and attributed it to the lack of EP job candidates. With the recent increase in emergency medicine (EM) residency positions, the objectives of this study were to understand how Iowa ED physician staffing has changed in regard to presence of board-certified EPs and what operational differences in Iowa EDs may be associated with staffing to provide insight into what may be occurring in other predominantly rural states. ⋯ Iowa EDs are predominantly staffed by non-EPs, and this remains unchanged despite a decade of increasing EM residency positions nationally. There remains a significant disparity between CAHs and non-CAHs. This study demonstrates that EM residency position increases have not penetrated rural Iowa EDs, where there remains both a substantial shortage and desire for EP staffing.
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Identifying patients in the emergency department (ED) at higher risk for in-hospital mortality can inform shared decision making and goals-of-care discussions. Electronic health record systems allow for integrated multivariable logistic regression (LR) modeling, which can provide early predictions of mortality risk in time for crucial decision making during a patient's initial care. Many commonly used LR models require blood gas analysis values, which are not frequently obtained in the ED. The goal of this study was to develop an all-cause mortality prediction model, derived from commonly collected ED data, which can assess mortality risk early in ED care. ⋯ The EDEM model was predictive of in-hospital mortality and was superior to REMS.