Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
-
Sex disparities in the diagnosis and treatment of chest pain or suspected angina have been demonstrated in multiple clinical settings. Out-of-hospital (OOH) care for chest pain is protocol-driven and may be less likely to demonstrate differences between men and women. ⋯ For OOH patients with chest pain, sex disparities in treatment are significant and do not appear to be explained by differences in patient age, race, or underlying cardiac risk.
-
Determine if 1) proximity of referral to a federally qualified health center (FQHC) improves initial follow-up rates for discharged emergency patients, 2) improved initial follow-up rates are associated with improved rates for an "ongoing relationship" with the FQHC, and 3) an ongoing relationship with an FQHC is associated with decreased subsequent emergency department (ED) utilization over a 2-year follow-up period. ⋯ Overall patient follow-up to an FQHC was low, but increased with next-day or same-week referral. The ongoing relationship rate was low, but increased with temporal proximity of ED referral. Increased comorbidities and medication usage were significantly associated with increased initial follow-up rates, development of an ongoing relationship, and subsequent ED utilization. Patients with an ongoing relationship with the FQHC had higher ED utilization over the 2-year follow-up period, likely due to a higher rate of comorbidities.
-
Randomized Controlled Trial
Mobile crisis team intervention to enhance linkage of discharged suicidal emergency department patients to outpatient psychiatric services: a randomized controlled trial.
Many suicidal patients treated and released from emergency departments (ED) fail to follow through with subsequent outpatient psychiatric appointments, often presenting back for repeat ED services. Thus, the authors sought to determine whether a mobile crisis team (MCT) intervention would be more effective than standard referral to a hospital-based clinic as a means of establishing near-term clinical contact after ED discharge. This objective was based on the premise that increased attendance at the first outpatient mental health appointment would initiate an ongoing treatment course, with subsequent differential improvements in psychiatric symptoms and functioning for patients successfully linked to care. ⋯ Community-based mobile outreach was a highly effective method of contacting suicidal patients who were discharged from the ED. However, establishing initial postdischarge contact in the community versus the clinic did not prove more effective at enhancing symptomatic or functional outcomes, nor did successful linkage with outpatient psychiatric care. Overall, participants showed some improvement shortly after ED discharge regardless of outpatient clinical contact, but nonetheless remained significantly symptomatic and at risk for repeated ED presentations.
-
Although many high-quality migraine clinical trials have been performed in the emergency department (ED) setting, almost as many different primary outcome measures have been used, making data aggregation and meta-analysis difficult. The authors assessed commonly used migraine trial outcomes in two ways. First, the authors examined the association of each commonly used outcome versus the following patient-centered variable: the research subject's wish, when asked 24 hours after investigational medication administration, to receive the same medication the next time they presented to an ED with migraine ("would take again"). This variable was chosen as the criterion standard because it provides a simple, dichotomous, clinically sensible outcome, which allows migraineurs to factor important intangibles of efficacy and adverse effects of treatment into an overall assessment of care. The second part of the analysis assessed how sensitive to true efficacy each outcome measure was by calculating sample size requirements based on results observed in previously conducted clinical trials. ⋯ "Would take again" was associated with all migraine outcome measures we examined. No individual outcome was more closely associated with "would take again" than any other. Even the best-performing alternate outcome misclassified more than 20% of subjects. However, sample sizes based on "would take again" tended to be larger than other outcome measures. On the basis of these findings and this outcome measure's inherent patient-centered focus, "would take again," included as a secondary outcome in all ED migraine trials, is proposed.
-
This study sought to investigate the minimal laryngoscope illumination required for proper laryngoscopy and intubation in different ambient light settings as determined by paramedics. ⋯ Minimal illumination requirements in the out-of-hospital setting may be lower than previously recommended. Ambient light intensity affects this minimal illumination requirement, with brighter ambient light conditions necessitating more laryngoscope light output. Further studies assessing out-of-hospital laryngoscope illumination should consider ambient light conditions.