Effect of prehospital cardiac catheterization lab activation on door-to-balloon time, mortality, and false-positive activation.

Background: Reperfusion of ST elevation myocardial infarction (STEMI) is most effective when performed early. Notification of the cardiac catheterization laboratory (cath lab) prior to hospital arrival based on paramedic-performed ECGs has been proposed as a strategy to decrease time to reperfusion and mortality. The purpose of this study was to compare the effects of cath lab activation prior to patient arrival versus activation after arrival at the emergency department (ED).

At-risk populations and the critically ill rely disproportionately on ambulance transport to emergency departments.

Study Objective: Emergency department (ED) crowding increases ambulance diversion. Ambulance diversion disproportionately affects individuals who rely on ambulance transport. The purpose of this study is to determine which populations rely most on ambulance transport.

Griev_Ing: death notification skills and applications for fourth-year medical students.

Background And Purpose: Our study examined whether GRIEV_ING improved death notification skills of medical students, whether pretesting with simulated survivors primed learners and improved results of the intervention, and whether feedback on the simulated encounter improved student performance.

Methods: GRIEV_ING training was given to 138 fourth-year medical students divided into three groups: exposure to simulated survivor (SS) with written feedback, exposure to SS but no feedback, and no exposure to SS before the training. Students were tested on self-confidence before and after the intervention and were rated by SSs on interpersonal communication and death notification skills.

Medical error identification, disclosure, and reporting: do emergency medicine provider groups differ?

Objectives: To determine if the three types of emergency medicine providers--physicians, nurses, and out-of-hospital providers (emergency medical technicians [EMTs])--differ in their identification, disclosure, and reporting of medical error.

Methods: A convenience sample of providers in an academic emergency department evaluated ten case vignettes that represented two error types (medication and cognitive) and three severity levels. For each vignette, providers were asked the following: 1) Is this an error? 2) Would you tell the patient? 3) Would you report this to a hospital committee? To assess differences in identification, disclosure, and reporting by provider type, error type, and error severity, the authors constructed three-way tables with the nonparametric Somers' D clustered on participant.

Do EMS personnel identify, report, and disclose medical errors?

Objective: To evaluate self-reports of prehospital providers' error frequency, disclosure, and reporting in their actual practice and in hypothetical scenarios.

Methods: The authors surveyed a convenience sample of prehospital providers attending a statewide emergency medical services conference using a two-part instrument. Part 1 evaluated respondent demographics and actual practice patterns.

Parental preferences for error disclosure, reporting, and legal action after medical error in the care of their children.

Objective: No data exist on parental preferences for disclosure, reporting, and seeking legal action after errors in the care of their children are disclosed. This study examined parental preferences for error disclosure and reporting; responses to error disclosure; and preferences and responses by race/ethnicity, gender, age, and insurance.

Methods: A 4-scenario survey instrument portraying a range of medical error was provided to a convenience sample of parents who presented with children to an emergency department.

Inadequate follow-up controller medications among patients with asthma who visit the emergency department.

Study Objective: The purpose of this study is to determine the frequency with which primary care physicians add inhaled corticosteroids to the regimen of asthmatic patients after a visit to the emergency department (ED) among patients not previously prescribed inhaled corticosteroids and to determine the rate at which inhaled corticosteroids prescribed in the ED were continued by primary care physicians.

Methods: We conducted a structured retrospective cohort study using electronic medical record review of consecutive patients aged 6 to 45 years, treated for acute asthma exacerbation (International Classification of Diseases, Ninth Revision code 493.00 through 493.

The influence of the causes and contexts of medical errors on emergency medicine residents' responses to their errors: an exploration.

Purpose: To determine emergency medicine residents' emotional and behavioral responses to their medical errors and examine associations between residents' responses to medical error and perceptions of their training.

Method: In 2003, 55 residents at two U.S.

Advanced statistics: how to determine whether your intervention is different, at least as effective as, or equivalent: a basic introduction.

The majority of studies published in the emergency medicine literature attempt to show a difference between two interventions, but often fail to do so. Failing to detect a difference, however, is not the same as demonstrating that one intervention is at least as effective as or better than the other intervention, or that the two interventions are equivalent--a fine point that is often overlooked. The purpose of this paper is to review classical hypothesis testing and then introduce the methodology to determine whether one intervention is at least as effective as another intervention, or whether two interventions are equivalent.

Comparison of responses to a US 2 dollar bill versus a chance to win 250 US dollars in a mail survey of emergency physicians.

Objectives: To evaluate whether small monetary incentives improve physicians' responses to surveys. To the best of the authors' knowledge, no one has evaluated emergency physicians' response rate and cost per participant of a small monetary incentive relative to a chance to win a more substantial sum. The authors compared emergency physicians' responses and per-participant costs between a US 2 dollar bill and a 250 US dollars lottery.

Variability in emergency physician decision making about prescribing opioid analgesics.

Study Objective: The purpose of this study is to determine what factors influence emergency physicians' decisions to prescribe an opioid analgesic for 3 common, painful conditions.

Methods: We developed items thought to influence the decision to prescribe an opioid analgesic through a review of the literature, expert consultation, and interviews with practicing emergency physicians. We developed a baseline vignette and items expected to influence the decision for each of the 3 conditions: migraine, back pain, and ankle fracture.

Racial and ethnic disparities in emergency department analgesic prescription.

Objectives: We examined racial and ethnic disparities in analgesic prescription among a national sample of emergency department patients.

Methods: We analyzed Black, Latino, and White patients in the 1997-1999 National Hospital Ambulatory Medical Care Surveys to compare prescription of any analgesics and opioid analgesics by race/ethnicity.

Results: For any analgesic, no association was found between race and prescription; opioids, however, were less likely to be prescribed to Blacks than to Whites with migraines and back pain, though race was not significant for patients with long bone fracture.

The effect of race/ethnicity and desirable social characteristics on physicians' decisions to prescribe opioid analgesics.

Objective: Racial/ethnic disparities in physician treatment have been documented in multiple areas, including emergency department (ED) analgesia. The purpose of this study was to determine if physicians were predisposed to different treatment decisions based on patient race/ethnicity and if physicians' treatment predispositions changed when socially desirable information about the patient (occupation, socioeconomic status, and relationship with a primary care physician) was made explicit.

Methods: The authors developed three clinical vignettes designed to engage physicians' decision-making processes.

Racial and ethnic disparities in the clinical practice of emergency medicine.

There is convincing evidence that racial and ethnic disparities exist in the provision of health care, including the provision of emergency care; and that stereotyping, biases, and uncertainty on the part of health care providers all contribute to unequal treatment. Situations, such as the emergency department (ED), that are characterized by time pressure, incomplete information, and high demands on attention and cognitive resources increase the likelihood that stereotypes and bias will affect diagnostic and treatment decisions. It is likely that there are many as-yet-undocumented disparities in clinical emergency practice.

Declining payments for emergency department care, 1996-1998.

Study Objective: We describe recent trends in payments from different payer classes and assess their relative importance to the financial solvency of emergency departments.

Methods: We used Medical Expenditure Panel Survey data from 1996 and 1998. The unit of analysis was the ED visit.