Paths of Emergency Department Care: Development of a Decision Aid to Facilitate Shared Decision Making in Goals of Care Discussions in the Acute Setting.

Background: Goals of care (GOC) conversations in the emergency department (ED) are often a brief discussion of code status rather than a patient-oriented dialogue. We aimed to develop a guide to facilitate conversations between ED clinicians and patients to elicit patient values and establish goals for end-of-life care, while maintaining ED efficiency. , a conversation guide, is the product of this work.

Pediatric Ice Pop Administration to Improve Patient Experience Scores.

Objective: To assess the impact on patient experience scores of giving an ice pop (Popsicle, Good Humor-Breyers, Oakland, CA) to patients in a pediatric emergency department (ED).

Patients And Methods: A prospective two-center trial was conducted at a tertiary academic pediatric ED and a community ED from January 1, 2018, through March 31, 2018. The intervention arm gave an ice pop to all eligible patients 0 to 14 years of age on even-numbered days versus conventional practice on odd-numbered days.

Factors Associated With Potentially Missed Diagnosis of Appendicitis in the Emergency Department.

Importance: Appendicitis may be missed during initial emergency department (ED) presentation.

Objective: To compare patients with a potentially missed diagnosis of appendicitis (ie, patients with symptoms associated with appendicitis, including abdominal pain, constipation, nausea and/or vomiting, fever, and diarrhea diagnosed within 1-30 days after initial ED presentation) with patients diagnosed with appendicitis on the same day of ED presentation to identify factors associated with potentially missed appendicitis.

Design, Setting, And Participants: In this cohort study, a retrospective analysis of commercially insured claims data was conducted from January 1 to December 15, 2019.

Use of natural language processing to improve predictive models for imaging utilization in children presenting to the emergency department.

Objective: To examine the association between the medical imaging utilization and information related to patients' socioeconomic, demographic and clinical factors during the patients' ED visits; and to develop predictive models using these associated factors including natural language elements to predict the medical imaging utilization at pediatric ED.

Methods: Pediatric patients' data from the 2012-2016 United States National Hospital Ambulatory Medical Care Survey was included to build the models to predict the use of imaging in children presenting to the ED. Multivariable logistic regression models were built with structured variables such as temperature, heart rate, age, and unstructured variables such as reason for visit, free text nursing notes and combined data available at triage.

Evaluation of emergency department derived delirium prediction models using a hospital-wide cohort.

Objective: Delirium is acute disorder of attention and cognition. We conducted an observational study using a hospital-wide database to validate three delirium prediction models that were developed to predict prevalent delirium within the first day of hospitalization after ED visit.

Methods: This was a retrospective cohort study at the academic medical center to evaluate the predictive ability of three previously developed prediction models for delirium from 2014 to 2017.

Shift-Based Emotional Stress Reactions in Emergency Nurses After Traumatizing Events.

Introduction: Emergency nurses experience multiple traumatizing events during clinical work. Early identification of work-related tension could lead to a timely intervention supporting well-being. We sought to discover whether there is an immediately measurable effect on emotional stress, as determined by changes between pre- and postshift survey scores, associated with exposure to traumatizing events during a single emergency nursing shift.

Progression of Emergency Medicine Resident Patient Experience Scores by Level of Training.

Background: Patient satisfaction surveys are vital to measuring a patient's experience of care. How scores of patients managed by emergency medicine (EM) residents change as residents progress through training is not known.

Objectives: To evaluate whether EM residents' patient satisfaction scores improve as residency training progresses, similar to clinical skill improvement.

Prediction of Risk of Death for Patients Starting Dialysis: A Systematic Review and Meta-Analysis.

Background And Objectives: Dialysis is a preference-sensitive decision where prognosis may play an important role. Although patients desire risk prediction, nephrologists are wary of sharing this information. We reviewed the performance of prognostic indices for patients starting dialysis to facilitate bedside translation.

Safety of parenteral ketorolac use for analgesia in geriatric emergency department patients.

Objective: To assess the safety of a single dose of parenteral ketorolac for analgesia management in geriatric emergency department (ED) patients.

Methods: This was a retrospective study of all administrations of parenteral ketorolac to adults ≥65 years of age and matched controls. The primary outcome was the occurrence of any of the following adverse events within 30 days of the ED visit: gastrointestinal bleeding, intracranial bleeding, acute decompensated heart failure, acute coronary syndrome, dialysis, transfusion, and death.

Caring for Children With Autism in an Emergency Department Setting.

Objective: Patients with autism spectrum disorder (ASD) and other developmental delays represent a unique patient population. We described a cohort of children with ASD cared for in an emergency department (ED) setting and the specific health care resources used for their care.

Methods: This is an observational study of consecutive children (<18 years) with ASD presenting for ED care.

Pediatric emergency medical services in privately insured patients: A 10-year national claims analysis.

Objective: To characterize pediatric Emergency Medicine Service (EMS) transports to the Emergency Department (ED) using a national claims database.

Methods: We included children, 18 years and younger, transported by EMS to an ED, from 2007 to 2016 in the OptumLabs Data Warehouse. ICD-9 and ICD-10 diagnosis codes were used to categorize disease system involvement.

Risk factors for recurrent anaphylaxis-related emergency department visits in the United States.

Background: Anaphylaxis is a potentially life-threatening allergic reaction with a strong risk of recurrence.

Objective: To assess risk factors associated with recurrent anaphylaxis-related emergency department (ED) visits within 1 year of an ED visit for anaphylaxis in a large observational cohort study.

Methods: We used an administrative claims database to identify patients seen from 2008 through 2012 in the ED for anaphylaxis based on an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code algorithm.

Trends in opioid use in commercially insured and Medicare Advantage populations in 2007-16: retrospective cohort study.

Objective: To describe trends in the rate and daily dose of opioids used among commercial and Medicare Advantage beneficiaries from 2007 to 2016.

Design: Retrospective cohort study of administrative claims data.

Setting: National database of medical and pharmacy claims for commercially insured and Medicare Advantage beneficiaries in the United States.

The research to practice continuum: Development of an evidence-based visual aid to improve informed consent for procedural sedation.

In order to fully participate in informed consent, patients must understand what it is that they agreeing, or not agreeing, to. In most cases, patients look to their clinicians to help develop the appropriate understanding required to give informed consent. Using a visual aid as an adjunct to risk communication in a stressful setting as the Emergency Department has a clear potential in facilitating the communication process.

National trends in emergency department visits and hospitalizations for food-induced anaphylaxis in US children.

Background: Food is the leading cause of anaphylaxis in children seen in emergency departments in the United States, yet data on emergency department visits and hospitalizations related to food-induced anaphylaxis are limited. The objective of our study was to examine national time trends of pediatric food-induced anaphylaxis-related emergency department visits and hospitalizations.

Methods: We conducted an observational study using a national administrative claims database from 2005 through 2014.

Access to primary care and computed tomography use in the emergency department.

Background: The decision to obtain a computed tomography CT scan in the emergency department (ED) is complex, including a consideration of the risk posed by the test itself weighed against the importance of obtaining the result. In patients with limited access to primary care follow up the consequences of not making a diagnosis may be greater than for patients with ready access to primary care, impacting diagnostic reasoning. We set out to determine if there is an association between CT utilization in the ED and patient access to primary care.

Clinical care review systems in healthcare: a systematic review.

Background: Clinical care review is the process of retrospectively examining potential errors or gaps in medical care, aiming for future practice improvement. The objective of our systematic review is to identify the current state of care review reported in peer-reviewed publications and to identify domains that contribute to successful systems of care review.

Methods: A librarian designed and conducted a comprehensive literature search of eight electronic databases.

Safety and Efficacy of Intravenous Lidocaine for Pain Management in the Emergency Department: A Systematic Review.

Study Objective: We evaluate the safety and efficacy of intravenous lidocaine in adult patients with acute and chronic pain who are undergoing pain management in the emergency department (ED).

Methods: We searched Ovid CENTRAL, Ovid EMBASE, and Ovid MEDLINE databases for randomized controlled trials and observational studies from inception to January 2017. Efficacy outcomes included reduction in pain scores from baseline to postintervention and need for rescue analgesia.

Physician, Interrupted: Workflow Interruptions and Patient Care in the Emergency Department.

Background: It is unclear how workflow interruptions impact emergency physicians at the point of care.

Objectives: Our study aimed to evaluate interruption characteristics experienced by academic emergency physicians.

Methods: This prospective, observational study collected interruptions during attending physician shifts.

Opioid Prescribing for Opioid-Naive Patients in Emergency Departments and Other Settings: Characteristics of Prescriptions and Association With Long-Term Use.

Study Objective: We explore the emergency department (ED) contribution to prescription opioid use for opioid-naive patients by comparing the guideline concordance of ED prescriptions with those attributed to other settings and the risk of patients' continuing long-term opioid use.

Methods: We used analysis of administrative claims data (OptumLabs Data Warehouse 2009 to 2015) of opioid-naive privately insured and Medicare Advantage (aged and disabled) beneficiaries to compare characteristics of opioid prescriptions attributed to the ED with those attributed to other settings. Concordance with Centers for Disease Control and Prevention (CDC) guidelines and rate of progression to long-term opioid use are reported.

Risk factors for severe anaphylaxis in the United States.

Background: Anaphylaxis is an acute systemic allergic reaction and may be life-threatening.

Objective: To assess risk factors associated with severe and near-fatal anaphylaxis in a large observational cohort study.

Methods: We analyzed administrative claims data from Medicare Advantage and privately insured enrollees in the United States from 2005 to 2014.

Outcomes of Emergency Department Anaphylaxis Visits from 2005 to 2014.

Background: Although the incidence of anaphylaxis appears to be increasing, trends in anaphylaxis-related health care utilization are not well understood.

Objective: To better understand the potential increasing health care burden, we analyzed the changes in anaphylaxis-related health care utilization, including emergency department (ED) discharges, observation stays, inpatient admissions, intensive care unit admissions, and endotracheal intubations.

Methods: We conducted an observational study examining outcomes of anaphylaxis-related ED visits between January 1, 2005, and December 31, 2014.