Coding Disparity and Specificity during Emergency Department Visits after Transitioning to the Tenth Version of the International Classification of Diseases.

The purpose of this study was to examine coding changes using the International Classification of Diseases (ICD) after the transition from ICD-9 to ICD-10. We studied a national cohort of emergency department visits from the Veterans Health Administration (VHA) before and after the transition, focusing on coding disparity and coding specificity. The cohort accounted for 2 million emergency department visits by 1.

Prescriptions Written for Opioid Pain Medication in the Veterans Health Administration Between 2000 and 2016.

Objectives: The purpose of this study was to identify national opioid pain medication (OPM) prescribing trends within the Veterans Health Administration (VA), and assess the impact of educational campaigns introduced in 2010 and 2013.

Methods: We created a national cohort that documents more than 21 million patient records and 97 million outpatient OPM prescriptions covering a 17-year period. We examined OPM prescriptions in emergency departments, outpatient clinics, and inpatient settings.

Opioid pain medication prescriptions obtained through emergency medical visits in the Veterans Health Administration.

Objective: This study sought to characterize national patterns for opioid pain medication (OPM) prescriptions received during emergency medical encounters in the Veterans Health Administration (VA).

Design: The authors conducted a retrospective study of all emergency department (ED) visits by adults in the VA between January 2009 and June 2015. We examined demographics, comorbidities, utilization measures, diagnoses, and prescriptions.

The Decline in Hydrocodone/Acetaminophen Prescriptions in Emergency Departments in the Veterans Health Administration Between 2009 to 2015.

Introduction: The purpose of the study was to measure national prescribing patterns for hydrocodone/acetaminophen among veterans seeking emergency medical care, and to see if patterns have changed since this medication became a Schedule II controlled substance.

Methods: We conducted a retrospective cohort study of emergency department (ED) visits within the Veterans Health Administration (VA) between January 2009 and June 2015. We looked at demographics, comorbidities, utilization measures, diagnoses, and prescriptions.

Ebola: a review for emergency providers.

Filoviruses, including Ebola virus, are associated with outbreaks of severe febrile illness with high fatality rates in humans. The 2014 outbreak of Ebola virus in West Africa is by far the largest outbreak in history and the first to spread to highly populated urban areas. The potential for such an epidemic to spread beyond Africa through international travel has raised concern in the world community as well as in American and international health agencies.

How long are patients willing to wait in the emergency department before leaving without being seen?

Introduction: Our goal was to evaluate patients' threshold for waiting in an emergency department (ED) waiting room before leaving without being seen (LWBS). We analyzed whether willingness to wait was influenced by perceived illness severity, age, race, triage acuity level, or insurance status.

Methods: We conducted this survey-based study from March to July 2010 at an urban academic medical center.

Support for a waiting room time tracker: a survey of patients waiting in an urban ED.

Background: Emergency Department (ED) crowding and inpatient boarding lead to lengthy wait times for patients, which may cause them to choose to leave without being seen. A new initiative to improve communication with patients is to provide an estimated wait time with a "time tracker" display, but it is unclear whether ED patients would welcome this.

Objective: To estimate the proportion of ED patients who would favor a time tracker display.

Patients leaving against medical advice (AMA) from the emergency department--disease prevalence and willingness to return.

Background: How patients fare once they leave the emergency department (ED) against medical advice (AMA), and the extent of illness burden that accompanies them, remains unstudied.

Objective: To determine the fate of patients leaving the ED AMA for a defined period of time post-discharge.

Methods: This was a prospective follow-up study of a convenience sample of patients leaving the ED AMA during two 6-month periods in consecutive calendar years at an urban academic ED with 32,000 annual patient visits.

Male patient visits to the emergency department decline during the play of major sporting events.

Objectives: To study whether emergency department (ED) visits by male patients wane simultaneously with the play of scheduled professional and college sports events.

Methods: Retrospective cohort analysis looked at ED male patient registration rates during a time block lasting from two hours before, during, and two hours after the play of professional football games (Monday night, Sundays, post-season play), major league baseball, and a Division I college football and basketball team, respectively. These registration rates were compared to rates at similar times on similar days of the week during the year devoid of a major sporting contest.

Synovial fluid analysis.

AsA prompt and accurate diagnosis of a painful, swollen joint is imperative, primarily in the case of a septic joint, as delayed therapy may result in progression of disease or permanent loss of function. Procurement and analysis of synovial fluid (SF) are paramount in helping the clinician to determine a patient's clinical condition and further course of treatment. Measurement of white blood cell (WBC) counts, crystal analysis by polarized microscopy, and microbiologic studies including Gram stain and culture are the SF parameters that are collectively most important in the ultimate determination by a clinician of the presence or absence of an infectious or inflammatory joint.

The use of rabies immune globulin by emergency physicians.

We sought to determine the incidence of practice patterns by emergency physicians that are non-compliant with present day World Health Organization recommendations regarding the administration of rabies immune globulin (RIG) in the prophylaxis of rabies. Of the 110 patients receiving RIG for rabies-prone wounds, 46 patients (41.8%; 95% CI 32-51.

Low risk of infection in selected human bites treated without antibiotics.

To assess the need for antibiotics in low-risk human bite wounds, a prospective, double-blind, placebo-controlled study involving 127 patients presenting with low-risk human bite wounds over 2 years to a 40,000 visit per year major academic ED was performed. Low-risk bites penetrated only the epidermis and did not involve hands, feet, skin, overlying joints, or cartilaginous structures. Exclusion criteria included age less than 18 years, puncture wounds, immunocompromise, allergy to penicillin or related compound, or bites greater than 24 hours old.

Environmental insults: smoke inhalation, submersion, diving, and high altitude.

In the expanding search for recreation, we spend more and more of our time in various environments. Whether the air is thin or compressed or smoke-filled or there is no air at all, emergency physicians continue to meet and treat the various pulmonary emergencies that the environment may create. The authors present the background, diagnosis, and management of a few of the more common pulmonary emergencies that the environment may produce.

Malaria: a rising incidence in the United States.

Malaria is frequently a deadly disease, particularly in tropical countries of the world where this protozoan infection is endemic. While physicians in tropical countries are familiar with the presentation, those who do not practice in endemic regions of the world may neglect to add tropical diseases to their differential diagnosis of fever. Epidemiologic data from the CDC show the number of cases of malaria being diagnosed in the United States in the last decade has risen sharply.