Call me Dr Ishmael: trends in electronic health record notes available at emergency department visits and admissions.

Objectives: Numerous studies have identified information overload as a key issue for electronic health records (EHRs). This study describes the amount of text data across all notes available to emergency physicians in the EHR, trended over the time since EHR establishment.

Materials And Methods: We conducted a retrospective analysis of EHR data from a large healthcare system, examining the number of notes and a corresponding number of total words and total tokens across all notes available to physicians during patient encounters in the emergency department (ED).

Patient Preferences for Diagnostic Imaging: CTA vs MRA When Diagnosing Pulmonary Embolism.

Objective: To identify preferences regarding choice of diagnostic imaging (computed tomographic angiography [CTA] vs magnetic resonance angiography [MRA]) for the evaluation of pulmonary embolism.

Methods: We conducted 4 focus group discussions with residents of 2 Wisconsin cities. Community members ≥18 years old were recruited via telephone using a commercially available telephone database.

Natural language processing and entrustable professional activity text feedback in surgery: A machine learning model of resident autonomy.

Background: Entrustable Professional Activities (EPAs) contain narrative 'entrustment roadmaps' designed to describe specific behaviors associated with different entrustment levels. However, these roadmaps were created using expert committee consensus, with little data available for guidance. Analysis of actual EPA assessment narrative comments using natural language processing may enhance our understanding of resident entrustment in actual practice.

Effect of a split-flow physician in triage model on abdominal CT ordering rate and yield.

Objective: The objective of this study was to compare the rate and clinical yield of computed tomography (CT) imaging between patients presenting with abdominal pain initially seen by a physician in triage (PIT) versus those seen only by physicians working in the main emergency department (ED).

Methods: A retrospective study was conducted of all self-arrivals >18 years old presenting to a single ED with abdominal pain. Nine-hundred patients were randomly selected from both the PIT and traditional patient flow groups and rates and yields of CT imaging were compared, both alone and in a model controlling for potential confounders.

Entrustable Professional Activities in General Surgery: Trends in Resident Self-Assessment.

Objective: Effective self-assessment is a cornerstone of lifelong professional development; however, evidence suggests physicians have a limited ability to self-assess. Novel strategies to improve the accuracy of learner self-assessment are needed. Our institution's surgical entrustable professional activity (EPA) implementation strategy incorporates resident self-assessment to address this issue.

Implementation of Entrustable Professional Activities into a General Surgery Residency.

Objective: Concerns over resident ability to practice effectively after graduation have led to the competency-based medical education movement. Entrustable professional activities (EPAs) may facilitate competency-based medical education in surgery, but implementation is challenging. This manuscript describes 1 strategy used to implement EPAs into an academic general surgery residency.

Development and validation of a pragmatic natural language processing approach to identifying falls in older adults in the emergency department.

Background: Falls among older adults are both a common reason for presentation to the emergency department, and a major source of morbidity and mortality. It is critical to identify fall patients quickly and reliably during, and immediately after, emergency department encounters in order to deliver appropriate care and referrals. Unfortunately, falls are difficult to identify without manual chart review, a time intensive process infeasible for many applications including surveillance and quality reporting.

Training and Interpreting Machine Learning Algorithms to Evaluate Fall Risk After Emergency Department Visits.

Background: Machine learning is increasingly used for risk stratification in health care. Achieving accurate predictive models do not improve outcomes if they cannot be translated into efficacious intervention. Here we examine the potential utility of automated risk stratification and referral intervention to screen older adults for fall risk after emergency department (ED) visits.

What Are We Measuring? Evaluating Physician-Specific Satisfaction Scores Between Emergency Departments.

Introduction: Most emergency departments (ED) use patient experience surveys (i.e., Press Ganey) that include specific physician assessment fields.

By Default: The Effect of Prepopulated Prescription Quantities on Opioid Prescribing in the Emergency Department.

Introduction: Opioid prescribing patterns have come under increasing scrutiny with the recent rise in opioid prescriptions, opioid misuse and abuse, and opioid-related adverse events. To date, there have been limited studies on the effect of default tablet quantities as part of emergency department (ED) electronic order entry. Our goal was to evaluate opioid prescribing patterns before and after the removal of a default quantity of 20 tablets from ED electronic order entry.

Using the Hendrich II Inpatient Fall Risk Screen to Predict Outpatient Falls After Emergency Department Visits.

Objectives: To evaluate the utility of routinely collected Hendrich II fall scores in predicting returns to the emergency department (ED) for falls within 6 months.

Design: Retrospective electronic record review.

Setting: Academic medical center ED.

The Impact of an Emergency Department Front-End Redesign on Patient-Reported Satisfaction Survey Results.

Introduction: For emergency department (ED) patients, delays in care are associated with decreased satisfaction. Our department focused on implementing a front-end vertical patient flow model aimed to decrease delays in care, especially care initiation. The physical space for this new model was termed the Flexible Care Area (FCA).

The Impact of Emergency Department Census on the Decision to Admit.

Objective: We evaluated the effect of emergency department (ED) census on disposition decisions made by ED physicians.

Methods: We performed a retrospective analysis using 18 months of all adult patient encounters seen in the main ED at an academic tertiary care center. Patient census information was calculated at the time of physician assignment for each individual patient and included the number of patients in the waiting room (waiting room census) and number of patients being managed by the patient's attending (physician load census).

The Association Between Use of Brain CT for Atraumatic Headache and 30-Day Emergency Department Revisitation.

Objective: The purpose of this article is to describe the association between initial CT for atraumatic headache and repeat emergency department (ED) visitation within 30 days of ED discharge.

Materials And Methods: A retrospective observational study was performed at an academic urban ED with more than 85,000 annual visits. All adult patients with a chief complaint of headache from January through December 2010 who were discharged after ED evaluation were included in the analysis.

Incidence of actionable findings on contrast enhanced magnetic resonance angiography ordered for pulmonary embolism evaluation.

Purpose: To determine the incidence of actionable findings on contrast-enhanced magnetic resonance angiography (MRA) scans performed for the primary diagnosis of pulmonary embolism (PE).

Materials And Methods: This was a HIPAA-compliant and IRB-approved single center, retrospective study of consecutive series of patients evaluated with contrast-enhanced MRA for PE. The final radiology report of each MRA was reviewed.

Observation and inpatient status: clinical impact of the 2-midnight rule.

Background: In response to growing concern over frequency and duration of observation encounters, the Centers for Medicare and Medicaid Services enacted a rules change on October 1, 2013, classifying most hospital encounters of <2 midnights as observation, and those ≥2 midnights as inpatient. However, limited data exist to predict the impact of the new rule.

Objective: To answer the following: (1) Will the rule reduce observation encounter frequency? (2) Are short-stay (<2 midnights) inpatient encounters often misclassified observation encounters? (3) Do 2 midnights separate distinct clinical populations, making this rule logical? (4) Do nonclinical factors such as time of day of admission impact classification under the rule?

Design, Setting And Patients: Retrospective descriptive study of all observation and inpatient encounters initiated between January 1, 2012 and February 28, 2013 at a Midwestern academic medical center.

Quality and safety implications of emergency department information systems.

The Health Information Technology for Economic and Clinical Health Act of 2009 and the Centers for Medicare & Medicaid Services "meaningful use" incentive programs, in tandem with the boundless additional requirements for detailed reporting of quality metrics, have galvanized hospital efforts to implement hospital-based electronic health records. As such, emergency department information systems (EDISs) are an important and unique component of most hospitals' electronic health records. System functionality varies greatly and affects physician decisionmaking, clinician workflow, communication, and, ultimately, the overall quality of care and patient safety.

Established and novel initiatives to reduce crowding in emergency departments.

Introduction: The American College of Emergency Physicians (ACEP) Task Force on Boarding described high-impact initiatives to decrease crowding. Furthermore, some emergency departments (EDs) have implemented a novel initiative we term "vertical patient flow," i.e.

Effectiveness of MR angiography for the primary diagnosis of acute pulmonary embolism: clinical outcomes at 3 months and 1 year.

Purpose: To determine the effectiveness of MR angiography for pulmonary embolism (MRA-PE) in symptomatic patients.

Materials And Methods: We retrospectively reviewed all patients whom were evaluated for possible pulmonary embolism (PE) using MRA-PE. A 3-month and 1-year from MRA-PE electronic medical record (EMR) review was performed.

Emergency department contrast practices for abdominal/pelvic computed tomography-a national survey and comparison with the american college of radiology appropriateness criteria(®).

Background: Controversy exists regarding the need for contrast agents for emergency abdominal computed tomography (CT).

Objectives: We surveyed United States (US) academic Emergency Departments (EDs) to document national practice. We hypothesized variable contrast use for abdominal/pelvic CT, including variance from the American College of Radiology's (ACR) Appropriateness Criteria(®), an evidence-based guideline.

Emergency department discharge prescription interventions by emergency medicine pharmacists.

Study Objective: We determine the rate and details of interventions associated with emergency medicine pharmacist review of discharge prescriptions for patients discharged from the emergency department (ED). Additionally, we evaluate care providers' satisfaction with such services provided by emergency medicine pharmacists.

Methods: This was a prospective observational study in the ED of an academic medical center that serves both adult and pediatric patients.

A 9-year-old boy with exertional syncope.

Background: Syncope in the pediatric population is a common and mostly benign event. There is a subset of patients, however, in whom exertional syncope is the manifestation of a life-threatening cardiac abnormality.

Objective: We present a rare but serious cause of syncope in children that often presents as sudden cardiac death.

Assessment of Medicare's imaging efficiency measure for emergency department patients with atraumatic headache.

Study Objective: Computed tomography (CT) use has increased rapidly, raising concerns about radiation exposure and cost. The Centers for Medicare & Medicaid Services (CMS) developed an imaging efficiency measure (Outpatient Measure 15 [OP-15]) to evaluate the use of brain CT in the emergency department (ED) for atraumatic headache. We aim to determine the reliability, validity, and accuracy of OP-15.

An empirical assessment of boarding and quality of care: delays in care among chest pain, pneumonia, and cellulitis patients.

Background: As hospital crowding has increased, more patients have ended up boarding in the emergency department (ED) awaiting their inpatient beds. To the best of our knowledge, no study has compared the quality of care of boarded and nonboarded patients.

Objectives: This study sought to examine whether being a boarded patient and boarding longer were associated with more delays, medication errors, and adverse events among ED patients admitted with chest pain, pneumonia, or cellulitis.