Design and Implementation of an Opioid Scorecard for Hospital System-Wide Peer Comparison of Opioid Prescribing Habits: Observational Study.

Background: Reductions in opioid prescribing by health care providers can lead to a decreased risk of opioid dependence in patients. Peer comparison has been demonstrated to impact providers' prescribing habits, though its effect on opioid prescribing has predominantly been studied in the emergency department setting.

Objective: The purpose of this study is to describe the development of an enterprise-wide opioid scorecard, the architecture of its implementation, and plans for future research on its effects.

Relationship between on-demand telehealth visits and emergency department and hospital surge during the COVID-19 pandemic.

Objectives: The relationship between COVID-19-related telehealth calls could be used to predict emergency department visits and hospital surges 3 days later potentially facilitating staffing adjustments in advance of patient arrivals. The purpose of this research was to study the temporal association between frequencies of on demand telehealth calls and emergency department surges during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic.

Methods: This cohort study examined patients who self-initiated synchronous audio-video on-demand telehealth calls between January 1, 2020 and June 30, 2022, and compared these to emergency department arrivals.

A Model Curriculum for an Emergency Medicine Residency Rotation in Clinical Informatics.

Audience: This curriculum is designed for emergency medicine residents at all levels of training. The curriculum covers basic foundations in clinical informatics for improving patient care and outcomes, utilizing data, and leading improvements in emergency medicine.

Length Of Curriculum: The curriculum is designed for a four-week rotation.

SISTER (system implementation of select transfers in emergency room) model to reduce ED boarding.

Objective: This study describes a novel transfer model implemented between an academic, level 1 trauma center (Hospital A) and a nearby affiliate community hospital (Hospital B). Primary outcome is change in boarding hours and percentage of boarders in the Hospital A emergency department. Secondary objectives of this study include how improved flow in the emergency department to reduce boarding improves length of stay, prevents patients from escalating to more acute acuity levels of care, reduces patient morbidity and mortality and therefore improves health care costs as well.

Association of Initial SARS-CoV-2 Test Positivity With Patient-Reported Well-being 3 Months After a Symptomatic Illness.

Importance: Long-term sequelae after symptomatic SARS-CoV-2 infection may impact well-being, yet existing data primarily focus on discrete symptoms and/or health care use.

Objective: To compare patient-reported outcomes of physical, mental, and social well-being among adults with symptomatic illness who received a positive vs negative test result for SARS-CoV-2 infection.

Design, Setting, And Participants: This cohort study was a planned interim analysis of an ongoing multicenter prospective longitudinal registry study (the Innovative Support for Patients With SARS-CoV-2 Infections Registry [INSPIRE]).

Providers Electing to Receive Electronic Result Notifications: Demographics and Motivation.

Background: Automated electronic result notifications can alert health care providers of important clinical results. In contrast to historical notification systems, which were predominantly focused on critical laboratory abnormalities and often not very customizable, modern electronic health records provide capabilities for subscription-based electronic notification. This capability has not been well studied.

Reduction in Hospital System Opioid Prescribing for Acute Pain Through Default Prescription Preference Settings: Pre-Post Study.

Background: The United States is in an opioid epidemic. Passive decision support in the electronic health record (EHR) through opioid prescription presets may aid in curbing opioid dependence.

Objective: The objective of this study is to determine whether modification of opioid prescribing presets in the EHR could change prescribing patterns for an entire hospital system.

Characterizing non-heroin opioid overdoses using electronic health records.

Introduction: The opioid epidemic is a modern public health emergency. Common interventions to alleviate the opioid epidemic aim to discourage excessive prescription of opioids. However, these methods often take place over large municipal areas ( and may fail to address the diversity that exists within each opioid case ().

Discrepancies in Written Versus Calculated Durations in Opioid Prescriptions: Pre-Post Study.

Background: The United States is in the midst of an opioid epidemic. Long-term use of opioid medications is associated with an increased risk of dependence. The US Centers for Disease Control and Prevention makes specific recommendations regarding opioid prescribing, including that prescription quantities should not exceed the intended duration of treatment.

Identifying Emergency Department Symptom-Based Diagnoses with the Unified Medical Language System.

Introduction: Many patients who are discharged from the emergency department (ED) with a symptom-based discharge diagnosis (SBD) have post-discharge challenges related to lack of a definitive discharge diagnosis and follow-up plan. There is no well-defined method for identifying patients with a SBD without individual chart review. We describe a method for automated identification of SBDs from ICD-10 codes using the Unified Medical Language System (UMLS) Metathesaurus.

Impact of Emergency Department Tele-intake on Left Without Being Seen and Throughput Metrics.

Objectives: More than 2 million patients present to a U.S. emergency department (ED) annually and leave without being seen (LWBS) due to delays in initiating care.

Standard Anatomic Terminologies: Comparison for Use in a Health Information Exchange-Based Prior Computed Tomography (CT) Alerting System.

Background: A health information exchange (HIE)-based prior computed tomography (CT) alerting system may reduce avoidable CT imaging by notifying ordering clinicians of prior relevant studies when a study is ordered. For maximal effectiveness, a system would alert not only for prior same CTs (exams mapped to the same code from an exam name terminology) but also for similar CTs (exams mapped to different exam name terminology codes but in the same anatomic region) and anatomically proximate CTs (exams in adjacent anatomic regions). Notification of previous same studies across an HIE requires mapping of local site CT codes to a standard terminology for exam names (such as Logical Observation Identifiers Names and Codes [LOINC]) to show that two studies with different local codes and descriptions are equivalent.

Asynchronous automated electronic laboratory result notifications: a systematic review.

Objective: To systematically review the literature pertaining to asynchronous automated electronic notifications of laboratory results to clinicians.

Methods: PubMed, Web of Science, and the Cochrane Collaboration were queried for studies pertaining to automated electronic notifications of laboratory results. A title review was performed on the primary results, with a further abstract review and full review to produce the final set of included articles.

Workplace Violence and Harassment Against Emergency Medicine Residents.

Introduction: Several studies have shown that workplace violence in the emergency department (ED) is common. Residents may be among the most vulnerable staff, as they have the least experience with these volatile encounters. The goal for this study was to quantify and describe acts of violence against emergency medicine (EM) residents by patients and visitors and to identify perceived barriers to safety.

Patient crossover and potentially avoidable repeat computed tomography exams across a health information exchange.

Objective: The purpose of this study was to measure the number of repeat computed tomography (CT) scans performed across an established health information exchange (HIE) in New York City. The long-term objective is to build an HIE-based duplicate CT alerting system to reduce potentially avoidable duplicate CTs.

Methods: This retrospective cohort analysis was based on HIE CT study records performed between March 2009 and July 2012.

Significant but reasonable radiation exposure from computed tomography-related medical imaging in the ICU.

Admission to an intensive care unit (ICU) is associated with increased medical imaging and radiation exposure, yet few studies have estimated the risk of cancer associated with these examinations. The purpose of this study was to review computed tomography (CT) scans performed on patients admitted to two urban academic ICUs, predict their radiation exposure, and calculate their estimated lifetime attributable risk of cancer (LAR). An electronic chart review was performed on all CT scans performed between January 2007 and December 2011.

Knowledge Translation and Barriers to Imaging Optimization in the Emergency Department: A Research Agenda.

Researchers have attempted to optimize imaging utilization by describing which clinical variables are more predictive of acute disease and, conversely, what combination of variables can obviate the need for imaging. These results are then used to develop evidence-based clinical pathways, clinical decision instruments, and clinical practice guidelines. Despite the validation of these results in subsequent studies, with some demonstrating improved outcomes, their actual use is often limited.

Radiation exposure among patients with the highest CT scan utilization in the emergency department.

The risk of cancer from computed tomography (CT) scan radiation is a rising concern in the medical field. Our objectives were to determine how many patients received more than ten CT scans in an academic emergency department (ED) over the course of 7 years and to quantify their radiation exposure and lifetime attributable risk of cancer. An electronic chart review was performed at our urban academic institution with an annual census of 110,000 patients.