Evaluating the impact of emergency department crowding on disposition patterns and outcomes of discharged patients.

Background: Crowding is a major challenge faced by EDs and is associated with poor outcomes.

Objectives: Determine the effect of high ED occupancy on disposition decisions, return ED visits, and hospitalizations.

Methods: We conducted a retrospective analysis of electronic health records of patients evaluated at an adult, urban, and academic ED over 20 months between the years 2012 and 2014.

False activation of the cardiac catheterization laboratory for primary PCI.

Objectives: We sought to evaluate trends in door-to-balloon (D2B) times and false activation rates for the cardiac catheterization laboratory (CCL) in patients presenting to the emergency department (ED) with acute ST-elevation myocardial infarction (STEMI). In patients with STEMI, national efforts have focused on reducing D2B times for primary percutaneous coronary intervention (P-PCI). This emphasis on time-to-treatment may increase the rate of false CCL activations and unnecessary healthcare utilization.

Hypothenar hammer syndrome: case report and review.

Background: Hypothenar hammer syndrome is a rare vascular overuse syndrome characterized by post-traumatic vascular insufficiency of the hand from repetitive compression over the hypothenar eminence. Patients with occupations predisposing to repetitive use of the hypothenar eminence as a tool are at high risk. Repetitive trauma compresses a superficial segment of the ulnar artery against the hook of hamate as it exits Guyon's canal, damaging the intimal layer of the artery and causing vasospasm, platelet aggregation, and thrombus formation, leading to pain and paresthesias that eventually progress to claudication and ischemia.

Effect of testing and treatment on emergency department length of stay using a national database.

Objectives: Testing and treatment are essential aspects of the delivery of emergency care. Recognition of the effects of these activities on emergency department (ED) length of stay (LOS) has implications for administrators planning efficient operations, providers, and patients regarding expectations for length of visit; researchers in creating better models to predict LOS; and policy-makers concerned about ED crowding.

Methods: A secondary analysis was performed using years 2006 through 2008 of the National Hospital Ambulatory Medical Care Survey (NHAMCS), a nationwide study of ED services.

Little's law flow analysis of observation unit impact and sizing.

Expanding hospital capacity by developing an observation unit may be an important strategy in congested hospitals. Understanding the principles for evaluating the potential impact and appropriate sizing of an observation unit is important. The objective of this paper is to contrast two approaches to determining observation unit sizing and profitability, real options, and a flow analysis based on Little's Law.

Use of an administrative data set to determine optimal scheduling of an alcohol intervention worker.

Background: Brief alcohol interventions are efficacious in reducing alcohol-related consequences among emergency department (ED) patients. Use of non-clinical staff may increase alcohol screening and intervention; however, optimal scheduling of an alcohol intervention worker (AIW) is unknown.

Objectives: Determine optimal scheduling of an AIW based on peak discharge time of alcohol-related ED visits.

Characterizing waiting room time, treatment time, and boarding time in the emergency department using quantile regression.

Objectives: The objective was to characterize service completion times by patient, clinical, temporal, and crowding factors for different phases of emergency care using quantile regression (QR).

Methods: A retrospective cohort study was conducted on 1-year visit data from four academic emergency departments (EDs; N = 48,896-58,316). From each ED's clinical information system, the authors extracted electronic service information (date and time of registration; bed placement, initial contact with physician, disposition decision, ED discharge, and disposition status; inpatient medicine bed occupancy rate); patient demographics (age, sex, insurance status, and mode of arrival); and clinical characteristics (acuity level and chief complaint) and then used the service information to calculate patients' waiting room time, treatment time, and boarding time, as well as the ED occupancy rate.

Parotid swelling and facial nerve palsy: an uncommon presentation of sarcoidosis.

Sarcoidosis is a granulomatous disease of unknown etiology that can affect virtually any organ system. Diagnosing sarcoidosis can be challenging, since manifestations of the disease will vary depending on the organ systems involved. The present case describes a 24-year-old woman with bilateral jaw pain and swelling, who developed bilateral facial nerve palsies secondary to sarcoidosis.

Crowding delays treatment and lengthens emergency department length of stay, even among high-acuity patients.

Study Objective: We determine the effect of crowding on emergency department (ED) waiting room, treatment, and boarding times across multiple sites and acuity groups.

Methods: This was a retrospective cohort study that included ED visit and inpatient medicine occupancy data for a 1-year period at 4 EDs. We measured crowding at 30-minute intervals throughout each patient's ED stay.

Forecasting models of emergency department crowding.

Objectives: The authors investigated whether models using time series methods can generate accurate short-term forecasts of emergency department (ED) bed occupancy, using traditional historical averages models as comparison.

Methods: From July 2005 through June 2006, retrospective hourly ED bed occupancy values were collected from three tertiary care hospitals. Three models of ED bed occupancy were developed for each site: 1) hourly historical average, 2) seasonal autoregressive integrated moving average (ARIMA), and 3) sinusoidal with an autoregression (AR)-structured error term.

The emergency department occupancy rate: a simple measure of emergency department crowding?

Study Objective: We examine the validity of the emergency department (ED) occupancy rate as a measure of crowding by comparing it to the Emergency Department Work Index Score (EDWIN), a previously validated scale.

Methods: A multicenter validation study was conducted according to ED visit data from 6 academic EDs for a 3-month period in 2005. Hourly ED occupancy rate (ie, total number of patients in ED divided by total number of licensed beds) and EDWIN scores were calculated.

Academic radiology and the emergency department: does it need changing?

Rational And Objectives: The increasing importance of imaging for both diagnosis and management in patient care has resulted in a demand for radiology services 7 days a week, 24 hours a day, especially in the emergency department (ED). We hypothesized the resident preliminary reports were better than generalist radiology interpretations, although inferior to subspecialty interpretations.

Materials And Methods: Total radiology volume through our Level I pediatric and adult academic trauma ED was obtained from the radiology information system.

Risk adjustment and outcome measures for out-of-hospital respiratory distress.

The purpose of the Emergency Medical Services Outcomes Project (EMSOP) is to develop a foundation and framework for out-of-hospital outcomes research. In prior work, this group delineated the priority conditions, described conceptual models, suggested core and risk adjustment measures potentially useful to emergency medical services research, and summarized out-of-hospital pain measurement. In this fifth article in the EMSOP series, the authors recommend specific risk-adjustment measures and outcome measures for use in out-of-hospital research on patients presenting with respiratory distress.

Establishing the scope and methodological approach to out-of-hospital outcomes and effectiveness research.

Outcomes research offers out-of-hospital medicine a valuable methodology for studying the effectiveness of services provided in the out-of hospital setting. A clear understanding of the history and constructs of outcomes research is necessary for its integration into emergency medical services research. This report describes the conceptual framework of outcomes research and key methodological considerations for the successful implementation of out-of-hospital outcomes research.

Emergency Medical Services Outcomes Project (EMSOP) IV: pain measurement in out-of-hospital outcomes research.

The purpose of the Emergency Medical Services Outcomes Project (EMSOP) is to develop a foundation and framework for out-of-hospital outcomes research. In prior work (EMSOP I), discomfort had the highest weighted score among outcome categories for the top 3 adult conditions (ie, minor trauma, respiratory distress, chest pain) and the first and third highest rankings for children's conditions (ie, minor trauma, respiratory distress). In this fourth article in the EMSOP series, we discuss issues relevant to the measurement of pain in the out-of-hospital setting, recommended pain measures that require evaluation, and implications for outcomes research focusing on pain.

Emergency Medical Services Outcomes Project III (EMSOP III): the role of risk adjustment in out-of-hospital outcomes research.

The purpose of the Emergency Medical Services Outcomes Project (EMSOP) is to develop a foundation and framework for out-of-hospital outcomes research. Fundamental to that purpose is the identification of priority conditions, risk-adjustment measures (RAMs), and outcome measures. In this third EMSOP article, we examine the topic of risk adjustment, discuss the relevance of risk adjustment for out-of-hospital outcomes research, and recommend RAMs that should be evaluated for potential use in emergency medical services (EMS) research.