The western journal of emergency medicine
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Falls are a frequent reason geriatric patients visit the emergency department (ED). To help providers, the Geriatric Emergency Department Guidelines were created to establish a standard of care for geriatric patients in the ED. We conducted a survey of emergency providers to assess 1) their knowledge of fall epidemiology and the geriatric ED guidelines; 2) their current ED practice for geriatric fall patients; and 3) their willingness to conduct fall-prevention interventions. ⋯ Emergency providers understand the importance of geriatric fall prevention but lack knowledge of which patients to screen and are not willing to spend more than a few minutes on screening for fall interventions. Future studies must take into account provider knowledge and willingness to intervene.
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Rapid spread of coronavirus disease 2019 (COVID-19) in the United States, especially in New York City (NYC), led to a tremendous increase in hospitalizations and mortality. There is very limited data available that associates outcomes during hospitalization in patients with COVID-19. ⋯ In this retrospective cohort study originating in NYC, older age, admission levels of D-dimer of more than 1000 ng/mL, CRP of more than 200 mg/L and lymphopenia were associated with mortality in individuals hospitalized for COVID-19. We recommend using these risk factors on admission to triage patients to critical care units or surge units to maximize the use of surge capacity beds.
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Multicenter Study
Identifying Patients at Greatest Risk of Mortality due to COVID-19: A New England Perspective.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly since December 2019, resulting in a pandemic that has, as of May 24, 2020, yielded over 5.3 million confirmed cases and over 340,000 deaths. As businesses move to safely reopen and frontline healthcare workers (HCW) continue to face this crisis, it is essential that health officials know who in the population is at the greatest risk of mortality if hospitalized and, therefore, has the greatest need to protect themselves from being infected. We examined the factors that increase the risk of mortality among hospitalized COVID-19 patients. ⋯ Being age 60 or older or having a history of diabetes or COPD are the most useful risk factors associated with mortality in hospitalized COVID-19 patients. As states ease stay-at-home orders, risk factors of severe disease can be used to identify those more likely to have worse outcomes if infected and hospitalized and, therefore, who in particular should continue to follow public health guidelines for avoiding infection: stay home if possible; practice physical distancing; and wear a facemask.
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As scholarship moves into the digital sphere, applicant and promotion and tenure (P&T) committee members lack formal guidance on evaluating the impact of digital scholarly work. The P&T process requires the appraisal of individual scholarly impact in comparison to scholars across institutions and disciplines. As dissemination methods evolve in the digital era, we must adapt traditional P&T processes to include emerging forms of digital scholarship. ⋯ P&T committees can critically appraise the quality and impact of digital scholarship using specific, validated tools. Applicants for appointment and promotion should highlight and prepare their digital scholarship to specifically address quality, impact, breadth, and relevance. It is our goal to provide specific, timely guidance for both stakeholders to recognize the value of digital scholarship in advancing our field.
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Emergency medicine residency programs around the country develop didactic conferences to prepare residents for board exams and independent practice. To our knowledge, there is not currently an evidence-based set of guidelines for programs to follow to ensure maximal benefit of didactics for learners. ⋯ Recommendations in this manuscript include best practices in formatting didactics, selection of facilitators and instructors, and duration of individual sessions. Authors also recommend following the Model of Clinical Practice of Emergency Medicine when developing content, while incorporating sessions dedicated to morbidity and mortality, research methodology, journal article review, administration, wellness, and professionalism.