Does the number of pages received per hour affect resident productivity?

Background: Workflow interruptions are common for emergency physicians and are shown to have downstream consequences such as patient dissatisfaction, delay in clinical response, and increase in medical error. However, the impact of passive interruptions on physician productivity is unclear and has not been well studied. We sought to evaluate if the number of pages received per hour significantly affects the number of patients seen per hour.

Machine Learning Methods for Predicting Patient-Level Emergency Department Workload.

Background: Work Relative Value Units (wRVUs) are a component of many compensation models, and a proxy for the effort required to care for a patient. Accurate prediction of wRVUs generated per patient at triage could facilitate real-time load balancing between physicians and provide many practical operational and clinical benefits.

Objective: We examined whether deep-learning approaches could predict the wRVUs generated by a patient's visit using data commonly available at triage.

Impact of a Mandatory Prescription Drug Monitoring Program Check on Emergency Department Opioid Prescribing Rates.

Background: Prescription drug monitoring programs (PDMPs) exist in 49 states to guide opioid prescribing. In 40 states, clinicians must check the PDMP prior to prescribing an opioid. Data on mandated PDMP checks show mixed results on opioid prescribing.

Association of resident characteristics with patterns of patient self-assignment.

Objective: We hypothesized that resident characteristics impact patterns of patient self-assignment in the emergency department (ED). Our goal was to determine if male residents would be less likely than their female colleagues to see patients with sensitive (e.g.

Early, awake proning in emergency department patients with COVID-19.

Objective: Proning has been shown to improve oxygenation and mortality in certain populations of intubated patients with acute respiratory distress syndrome. Small observational analyses of COVID-19 patients suggest awake proning may lead to clinical improvement. Data on safety and efficacy is lacking.

Deep-learning approaches to identify critically Ill patients at emergency department triage using limited information.

Study Objective: Triage quickly identifies critically ill patients, facilitating timely interventions. Many emergency departments (EDs) use emergency severity index (ESI) or abnormal vital sign triggers to guide triage. However, both use fixed thresholds, and false activations are costly.

Information Management in the Emergency Department.

Information management in the emergency department (ED) is a challenge for all providers. The volume of information required to care for each patient and to keep the ED functioning is immense. It must be managed through varying means of communication and in connection with ED information systems.

Assessment of Unintentional Duplicate Orders by Emergency Department Clinicians Before and After Implementation of a Visual Aid in the Electronic Health Record Ordering System.

Importance: Electronic health records allow teams of clinicians to simultaneously care for patients, but an unintended consequence is the potential for duplicate orders of tests and medications.

Objective: To determine whether a simple visual aid is associated with a reduction in duplicate ordering of tests and medications.

Design, Setting, And Participants: This cohort study used an interrupted time series model to analyze 184 694 consecutive patients who visited the emergency department (ED) of an academic hospital with 55 000 ED visits annually.

Variations in Opioid Prescribing Behavior by Physician Training.

Introduction: Opioid abuse has reached epidemic proportions in the United States. Patients often present to the emergency department (ED) with painful conditions seeking analgesic relief. While there is known variability in the prescribing behaviors of emergency physicians, it is unknown if there are differences in these behaviors based on training level or by resident specialty.

In vivo kinematics of the scaphoid, lunate, capitate, and third metacarpal in extreme wrist flexion and extension.

Purpose: Insights into the complexity of active in vivo carpal motion have recently been gained using 3-dimensional imaging; however, kinematics during extremes of motion has not been elucidated. The purpose of this study was to determine motion of the carpus during extremes of wrist flexion and extension.

Methods: We obtained computed tomography scans of 12 healthy wrists in neutral grip, extreme loaded flexion, and extreme loaded extension.

Carpal and forearm kinematics during a simulated hammering task.

Purpose: Hammering is a functional task in which the wrist generally follows a path of motion from a position of combined radial deviation and extension to combined ulnar deviation and flexion, colloquially referred to as a dart thrower's motion. The purpose of this study was to measure wrist and forearm motion and scaphoid and lunate kinematics during a simulated hammering task. We hypothesized that the wrist follows an oblique path from radial extension to ulnar flexion and that there would be minimal radiocarpal motion during the hammering task.

Studying primate carpal kinematics in three dimensions using a computed-tomography-based markerless registration method.

The functional morphology of the wrist pertains to a number of important questions in primate evolutionary biology, including that of hominins. Reconstructing locomotor and manipulative capabilities of the wrist in extinct species requires a detailed understanding of wrist biomechanics in extant primates and the relationship between carpal form and function. The kinematics of carpal movement, and the role individual joints play in providing mobility and stability of the wrist, is central to such efforts.

Automatic determination of anatomical coordinate systems for three-dimensional bone models of the isolated human knee.

The combination of three-dimensional (3-D) models with dual fluoroscopy is increasingly popular for evaluating joint function in vivo. Applying these modalities to study knee motion with high accuracy requires reliable anatomical coordinate systems (ACSs) for the femur and tibia. Therefore, a robust method for creating ACSs from 3-D models of the femur and tibia is required.

Conformational changes in the carpus during finger trap distraction.

Purpose: Wrist distraction is a common treatment maneuver used clinically for the reduction of distal radial fractures and midcarpal dislocations. Wrist distraction is also required during wrist arthroscopy to access the radiocarpal joint and has been used as a test for scapholunate ligament injury. However, the effect of a distraction load on the normal wrist has not been well studied.

A computational approach to the "optimal" screw axis location and orientation in the scaphoid bone.

Purpose: The development of small cannulated screws permitted minimally invasive percutaneous fixation of acute scaphoid fractures. There are known mechanical advantages to increased screw length and central screw placement, as well as documented deleterious effects of screw malposition, including articular protrusion, proximal pole fracture, and nonunion. The purpose of this study was to compare 2 methods of calculating a screw axis accessible via a volar surgical approach.

Interfragmentary motion in patients with scaphoid nonunion.

Purpose: Scaphoid nonunions are a common complication of scaphoid fractures and frequently progress to degenerative arthritis. This study evaluated the effect of scaphoid nonunion on the in vivo kinematics of the radioscaphocapitate articulation.

Methods: Computed tomography with a markerless registration technique was used to quantify motion of the scaphoid, lunate, and capitate in vivo, in 6 patients with unilateral scaphoid nonunion.

Biomechanical comparison of single-row arthroscopic rotator cuff repair technique versus transosseous repair technique.

This study determined the effect of tear size on gap formation of single-row simple-suture arthroscopic rotator cuff repair (ARCR) vs transosseous Mason-Allen suture open RCR (ORCR) in 13 pairs of human cadaveric shoulders. A massive tear was created in 6 pairs and a large tear in 7. Repairs were cyclically tested in low-load and high-load conditions, with no significant difference in gap formation.

Simulated radioscapholunate fusion alters carpal kinematics while preserving dart-thrower's motion.

Purpose: Midcarpal degeneration is well documented after radioscapholunate fusion. This study tested the hypothesis that radioscapholunate fusion alters the kinematic behavior of the remaining lunotriquetral and midcarpal joints, with specific focus on the dart-thrower's motion.

Methods: Simulated radioscapholunate fusions were performed on 6 cadaveric wrists in an anatomically neutral posture.

A digital database of wrist bone anatomy and carpal kinematics.

The skeletal wrist consists of eight small, intricately shaped carpal bones. The motion of these bones is complex, occurs in three dimensions, and remains incompletely defined. Our previous efforts have been focused on determining the in vivo three-dimensional (3-D) kinematics of the normal and abnormal carpus.