Real-Time Electronic Patient Portal Use Among Emergency Department Patients.

Importance: Patients with inequitable access to patient portals frequently present to emergency departments (EDs) for care. Little is known about portal use patterns among ED patients.

Objectives: To describe real-time patient portal usage trends among ED patients and compare demographic and clinical characteristics between portal users and nonusers.

Clinical and financial outcome impacts of comprehensive geriatric assessment in a level 1 geriatric emergency department.

Background: The aging population has led to an increase in emergency department (ED) visits by older adults who have complex medical conditions and high social needs. The purpose of this study was to assess if comprehensive geriatric evaluation and management impacted service utilization and cost by older adults admitted to the ED.

Methods: This is a retrospective matched case-control study at a level 1 geriatric ED (GED) from January 1, 2018-March 31, 2020.

Clinical Cybersecurity Training Through Novel High-Fidelity Simulations.

Background: Cybersecurity risks in health care systems have traditionally been measured in data breaches of protected health information, but compromised medical devices and critical medical infrastructure present risks of disruptions to patient care. The ubiquitous prevalence of connected medical devices and systems may be associated with an increase in these risks.

Objective: This article details the development and execution of three novel high-fidelity clinical simulations designed to teach clinicians to recognize, treat, and prevent patient harm from vulnerable medical devices.

Survey and Chart Review to Estimate Medicare Cost Savings for Home Health as an Alternative to Hospital Admission Following Emergency Department Treatment.

Background: Almost 70% of hospital admissions for Medicare beneficiaries originate in the emergency department (ED). Research suggests that some of these patients' needs may be better met through home-based care options after evaluation and treatment in the ED.

Objective: We sought to estimate Medicare cost savings resulting from using the Home Health benefit to provide treatment, when appropriate, as an alternative to inpatient admission from the ED.

Inpatient Readmissions and Emergency Department Visits within 30 Days of a Hospital Admission.

Introduction: Inpatient hospital readmissions have become a focus for healthcare reform and cost-containment efforts. Initiatives targeting unanticipated readmissions have included care coordination for specific high readmission diseases and patients and health coaching during the post-discharge transition period. However, little research has focused on emergency department (ED) visits following an inpatient admission.

Identifying frequent users of emergency department resources.

Background: There is growing focus on frequent users of acute care resources. If these patients can be identified, interventions can be established to offer more consistent management plans to decrease inappropriate utilization.

Objective: To compare a hospital-specific approach with a region-wide approach to identify frequent Emergency Department (ED) users.

Impact of wireless electronic medical record system on the quality of patient documentation by emergency field responders during a disaster mass-casualty exercise.

Introduction: The use of wireless, electronic, medical records and communications in the prehospital and disaster field is increasing.

Objective: This study examines the role of wireless, electronic, medical records and communications technologies on the quality of patient documentation by emergency field responders during a mass-casualty exercise.

Methods: A controlled, side-to-side comparison of the quality of the field responder patient documentation between responders utilizing National Institutes of Health-funded, wireless, electronic, field, medical record system prototype ("Wireless Internet Information System for medicAl Response to Disasters" or WIISARD) versus those utilizing conventional, paper-based methods during a mass-casualty field exercise.

Effect of mandated nurse-patient ratios on patient wait time and care time in the emergency department.

Objectives: The objective was to evaluate the effect of mandated nurse-patient ratios (NPRs) on emergency department (ED) patient flow.

Methods: Two institutions implemented an electronic tracking system embedded within the electronic medical record (EMR) of two EDs (an academic urban, teaching medical center-Hospital A; and a suburban community hospital-Hospital B), with a combined census of 60,000/year, to monitor real-time NPRs and patient acuity, such that compliance with state-mandated ratios could be prospectively monitored. Data were queried for a 1-year period after implementation and included patient wait times (WTs), ED care time (EDCT), patient acuity, ED census, and NPR status for each nurse, patient, and the ED overall.

Impact of an express admit unit on emergency department length of stay.

Background: Express admit units (EAUs) have been proposed as a way to expedite patient flow through the Emergency Department (ED).

Objectives: We sought to determine the effect of opening a five-bed EAU unit for temporary placement of admitted patients on our ED length of stay (LOS) and waiting room times (WT).

Method: This was a before-and-after interventional study of the 3-month period immediately before (pre-EAU) and after opening (post-EAU) of the EAU.

Impact of an internet-based emergency department appointment system to access primary care at safety net community clinics.

Study Objective: We evaluate the effect of an Internet-based, electronic referral system (termed IMPACT-ED for Improving Medical home and Primary care Access to the Community clinics Through the ED) on access and follow-up at primary care community clinics for safety net emergency department (ED) patients.

Methods: We conducted a nonblinded interventional trial at an urban, safety net, hospital ED with a census of 39,000 annually. IMPACT-ED identified patients who had no source of regular care and lived in a 15-ZIP-code low-income area served by 3 community clinics.

Improving service quality by understanding emergency department flow: a White Paper and position statement prepared for the American Academy of Emergency Medicine.

Emergency Department (ED) crowding is a common problem in the United States and around the world. Process reengineering methods can be used to understand factors that contribute to crowding and provide tools to help alleviate crowding by improving service quality and patient flow. In this article, we describe the ED as a service business and then discuss specific methods to improve the ED quality and flow.

Can urine dipstick be used as a surrogate for serum creatinine in emergency department patients who undergo contrast studies?

Contrast-induced nephropathy (CIN) is a complication associated with contrasted computed tomography (CT). Elevated creatinine (Cr) is often used to screen for CIN. This study evaluates dipstick urinalysis (Udip) detection of Cr > 1.

The impact of a pneumatic tube and computerized physician order management on laboratory turnaround time.

Study Objective: We assess the effect of sequential modifications in laboratory processing, including pneumatic tube transport and fully computerized order management, on laboratory turnaround time in the emergency department (ED).

Methods: This was an observational analysis of a comprehensive computerized database derived from ED, laboratory, and hospital information systems. The setting was an academic urban ED with annual census of 38,000.

Tablet computing for disaster scene managers.

WIISARD utilizes wireless technology to improve the care of victims following a mass casualty disaster. The WIISARD Scene Manager device (WSM) is designed to enhance the collection and accessibility of real-time data on victims, ambulances and hospitals for disaster supervisors and managers. We recently deployed WSM during a large-scale disaster exercise.

A wireless first responder handheld device for rapid triage, patient assessment and documentation during mass casualty incidents.

Medical care at mass casualty incidents and disasters requires rapid patient triage and assessment, acute care and disposition often in the setting of overwhelming numbers of victims, limited time, and little resources. Current systems rely on a paper triage tag on which rescuers and medical providers mark the patient's triage status and record limited information on injuries and treatments administered in the field. In this manuscript, we describe the design, development and deployment of a wireless handheld device with an electronic medical record (EMR) for use by rescuers responding to mass casualty incidents (MCIs) and disasters.

Impact of rapid entry and accelerated care at triage on reducing emergency department patient wait times, lengths of stay, and rate of left without being seen.

Study Objective: Patients who leave before being seen by a physician represent a significant problem for many emergency departments (EDs). We sought to determine the effect of a new ED rapid entry and accelerated care at triage (REACT) process on the frequency of patients who leave before being seen.

Methods: We conducted a before-after intervention design to study the effect of REACT for ambulatory patients presenting to our urban academic center ED with a census of approximately 37,000.