Improving physician well-being and reducing burnout using a peer-to-peer recognition program.

Background: Drivers of physician burnout include an intricate interplay between health care organizational structures, societal influences, and individual-level factors. In the traditional workforce, peer-to-peer recognition programs (PRPs) have reduced burnout by building a sense of community and effectively creating a "wellness culture." We implemented a PRP in an emergency medicine (EM) residency and determined its impact on subjective symptoms of burnout and wellness.

Traumatic Injuries in Sexual Assault Patients in the Emergency Department.

Introduction: The emergency department (ED) is at the forefront for treatment of sexual assault patients. Many require treatment for injuries sustained during the assault, ranging from mild to severe. Our objective in this study was to characterize types of injuries associated with sexual assault and identify associated factors.

"Diffusion of innovations": a feasibility study on the pericapsular nerve group block in the emergency department for hip fractures.

Objective: Hip fractures are associated with significant morbidity and mortality. Ultrasound-guided peripheral nerve blocks are a safe method to manage pain and decrease opioid usage. The pericapsular nerve group (PENG) block is a novel, potentially superior block because of its motor-sparing effects.

Mitigating the gender gap: How "DOCTOR" badges affect physician identity.

Objectives: Patients and their families frequently misclassify female physicians in the Emergency Department (ED) as non-physicians. Physician misidentification impacts the environment of care on multiple levels; including patient satisfaction and physician well-being. Implementing "DOCTOR" badges may be a low-cost tool to rectify these problems.

Kidney and Ureteral Stones.

Renal colic is a common complaint that presents to the emergency department. It is estimated that 13% of men and 7% of women will develop a renal stone. There is a high probability of recurrence, with 50% within 5 years.

External Validation of the STONE Score, a Clinical Prediction Rule for Ureteral Stone: An Observational Multi-institutional Study.

Study Objective: The STONE score is a clinical decision rule that classifies patients with suspected nephrolithiasis into low-, moderate-, and high-score groups, with corresponding probabilities of ureteral stone. We evaluate the STONE score in a multi-institutional cohort compared with physician gestalt and hypothesize that it has a sufficiently high specificity to allow clinicians to defer computed tomography (CT) scan in patients with suspected nephrolithiasis.

Methods: We assessed the STONE score with data from a randomized trial for participants with suspected nephrolithiasis who enrolled at 9 emergency departments between October 2011 and February 2013.

Ultrasonography versus computed tomography for suspected nephrolithiasis.

Background: There is a lack of consensus about whether the initial imaging method for patients with suspected nephrolithiasis should be computed tomography (CT) or ultrasonography.

Methods: In this multicenter, pragmatic, comparative effectiveness trial, we randomly assigned patients 18 to 76 years of age who presented to the emergency department with suspected nephrolithiasis to undergo initial diagnostic ultrasonography performed by an emergency physician (point-of-care ultrasonography), ultrasonography performed by a radiologist (radiology ultrasonography), or abdominal CT. Subsequent management, including additional imaging, was at the discretion of the physician.

Applying the International Classification of Headache Disorders to the emergency department: an assessment of reproducibility and the frequency with which a unique diagnosis can be assigned to every acute headache presentation.

Study Objective: Although almost 2 decades have passed since the International Headache Society first introduced its International Classification of Headache Disorders (ICHD), the applicability of this classification scheme in the emergency department (ED) has not been assessed. As a first step toward identifying the role the ICHD should play in the ED, we address 2 questions: Can a structured interview and adherence to the ICHD allow ED headache patients to be classified in a reproducible manner? With the ICHD, how often can one specific diagnosis be assigned to each ED headache presentation?

Methods: This was a structured interview and medical record review of patients with nontraumatic headache, performed in an urban ED from March 2004 through August 2005. Using the data from the interview and the subject's ED record, 2 emergency medicine investigators independently classified each of the headaches twice: first, to determine presence or absence of a primary headache disorder, and then to determine presence or absence of a secondary headache disorder.

Comparison of laboratory values obtained by phlebotomy versus saline lock devices.

Objectives: To assess the utility of a peripheral saline lock device (SLD) as an alternative to a second venipuncture for obtaining selected blood samples.

Methods: This prospective study used a comparative design and was conducted in an urban emergency department (ED). Adult patients with an existing SLD in place who required serial phlebotomy were eligible for inclusion in the study.

A clinical trial of trimethobenzamide/diphenhydramine versus sumatriptan for acute migraines.

Background: Although various classes of medication are used to treat acute migraine in the emergency department (ED), no treatment offers complete pain relief without side effects or recurrence of headache. Consequently, even though several antiemetic medications as well as SQ sumatriptan have demonstrated efficacy and tolerability for the ED treatment of migraine, there remains a need for more effective parenteral therapies. Open-label studies suggest that the combination of trimethobenzamide and diphenhydramine (TMB/DPH) may provide effective relief in a high proportion of migraineurs.

Concordance between capnography and arterial blood gas measurements of carbon dioxide in acute asthma.

Study Objective: We examine the concordance between end-tidal partial pressure of CO2 (PetCO2) measured by capnography and arterial partial pressure of carbon dioxide (PaCO2) obtained by arterial blood gas in acute asthmatic patients presenting to the emergency department.

Methods: This was a prospective observational cohort study of acutely ill adult asthmatic patients undergoing an arterial blood gas measurement as part of their evaluation. PetCO2 was recorded during exhalation into a capnograph while arterial blood was pulsing in the arterial blood gas tubing.

Who should be estimating a patient's weight in the emergency department?

Objectives: Medical personnel often need to estimate a patient's weight rapidly and accurately to administer pharmacologic agents whose dosages are based on weight. Inaccurate estimates of weight may result in administration of either subtherapeutic or, in other cases, toxic doses of medications. The hypothesis of this study was that the patient is a more accurate estimator of his or her own weight than the physician or nurse caring for him or her.

Delayed presentation of diffuse axonal injury: a case report.

This report highlights a case of delayed onset of diffuse axonal injury in the apparent absence of direct head trauma. This case questions the appropriate observation period for patients with signs of diffuse axonal injury presenting after a high-velocity crash.

The role of anticonvulsants in preventive migraine therapy.

The mainstay of migraine treatment is pharmacotherapy. There have been numerous medications used to prevent migraine headaches, including b-blockers, calcium-channel blockers, anticonvulsants, and nonsteroidal anti-inflammatory drugs. Sodium valproate is the only antiepileptic drug approved by the Food and Drug Administration for migraine prevention.