Background: Reducing unnecessary routine laboratory testing is a Choosing Wisely® recommendation, and new areas of overuse were noted during the COVID-19 pandemic.
Objective: To reduce unnecessary repetitive routine laboratory testing for patients with COVID-19 during the pandemic across a large safety net health system.
Designs, Settings And Participants: This quality improvement initiative was initiated by the System High-Value Care Council at New York City Health + Hospitals (H + H), the largest public healthcare system in the United States consisting of 11 acute care hospitals.
Background: Clinician champions are front-line clinicians who advocate for and influence practice change in their local context. The strategies they use when leading efforts to reduce the use of low-value care have not been well described. The purpose of this study is to identify and describe strategies used by six clinician champions who led a low-value care initiative in their clinical setting.
View Article and Find Full Text PDFBackground: Low back pain is a common emergency department (ED) complaint that does not always necessitate imaging. Unnecessary imaging drives medical overuse with potential to harm patients. Quality improvement (QI) interventions have shown to be an effective solution.
View Article and Find Full Text PDFIntroduction: Coronavirus disease 2019 (COVID-19) caused a disproportionate number of patients to seek emergency care at hospitals in New York City (NYC) during the initial crisis. Our urban emergency department (ED), a member of the NYC public hospital system had to process the increased volume while also differentiating our patients' critical needs. We established a forward treatment area (FTA) directly in front of the ED to accomplish these goals from March 23-April 16, 2020.
View Article and Find Full Text PDFObjectives: The goal of this study was to describe outcomes and associated characteristics of patients who were intubated during the initial (3/2020-4/2020) New York City surge of the severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic, during which time we were confronted by an unknown and unprecedented respiratory distress syndrome with extremely high degrees of morbidity and mortality. Our secondary aim was to analyze our physician's rapidly evolving approaches to COVID-19 airway management.
Methods: A retrospective cohort analysis of all patients intubated at two emergency departments (EDs) for COVID-19 suspected respiratory failure.
Background: New York City (NYC) emergency departments (EDs) experienced a surge of patients because of coronavirus disease 2019 (COVID-19) in March 2020. NYC Health and Hospitals established rapid medical screening exams (MSE) and each hospital designated areas to perform their MSE. Five of the 11 hospitals created a forward treatment area (FTA) external to the ED to disposition patients before entering who presented with COVID-like symptoms.
View Article and Find Full Text PDFJ Am Coll Emerg Physicians Open
June 2020
The transportation of mental health patients between facilities by emergency medical services personnel poses a unique risk to both patients and their providers. Increasingly, common injuries are occurring and difficulties are arising during this transition in care. Proximal causes exist that could be addressed to help mitigate many of the complexities that occur during this shift in care.
View Article and Find Full Text PDFDisaster Med Public Health Prep
June 2021
Over the past century, society has achieved great gains in medicine, public health, and health-care infrastructure, particularly in the areas of vaccines, antibiotics, sanitation, intensive care and medical technology. Still, despite these developments, infectious diseases are emerging at unprecedented rates around the globe. Large urban centers are particularly vulnerable to communicable disease events, and must have well-prepared response systems, including on the front-line level.
View Article and Find Full Text PDFEmergency physicians rely on a multitude of different imaging modalities in the diagnosis of genitourinary emergencies. There are many considerations to be taken into account when deciding which imaging modality should be used first, as oftentimes several diagnostic tools can be used for the same pathologic condition. These factors include radiation exposure, sensitivity, specificity, age of patient, availability of resources, cost, and timeliness of completion.
View Article and Find Full Text PDFGenitourinary trauma often occurs concomitantly with other abdominopelvic trauma, but nevertheless is important to master in diagnosis, management, and treatment. There are subtleties to diagnosis and important steps that should not be missed to properly manage patients.
View Article and Find Full Text PDFCardiogenic shock is the leading cause of morbidity and mortality in patients presenting with acute coronary syndrome. Although early reperfusion strategies are essential to the management of these critically ill patients, additional treatment plans are often needed to stabilize and treat the patient before reperfusion may be possible. This article discusses pharmacologic and surgical interventions, their indications and contraindications, management strategies, and treatment algorithms.
View Article and Find Full Text PDFBackground: National emergency department (ED) bounceback rates within 30 days of previous ED discharge have been found to be as high as 26%. We hypothesize that having a primary care physician (PCP) would prevent bouncebacks to the ED because a patient would have a medical resource for follow-up and continued care.
Methods: We performed a prospective, consecutive, anonymous survey study of adult ED patients at a suburban teaching hospital with 88,000 visits annually, from July 5, 2011 through August 8, 2011.
The QT interval measures the time from the start of the QRS complex to the end of the T wave. Prolongation of the QT interval may lead to malignant ventricular tachydysrhythmias, including torsades de pointes. Causes of QT prolongation include congenital abnormalities of the sodium or potassium channel, electrolyte abnormalities, and medications; idiopathic causes have also been identified.
View Article and Find Full Text PDFThis article presents an overview of facial wound management, beginning with a brief review of basic anatomy of the head and face as it relates to wound care. Basic wound management is discussed, and techniques for repairing specific cosmetically high-risk areas of the face, particularly the eyes, lips, and ears, are reviewed. Also described are the proper techniques for the management of an auricular hematoma.
View Article and Find Full Text PDFRegional nerve blocks of the face are important skills every emergency physician ought to know. Facial anesthesia improves cosmetic outcomes, reduces pain, and improves patient satisfaction. Understanding the anatomy of the head and face is essential to the application of regional anesthesia, and this anatomy will be reviewed in depth.
View Article and Find Full Text PDFHypertension in pregnancy is increasing in prevalence and incidence and its treatment becoming more commonplace. Associated complications of pregnancy, including end-organ damage, preeclampsia, eclampsia, and postpartum eclampsia, are leading sources of maternal and fetal morbidity and mortality, requiring an emergency physician to become proficient with their identification and treatment. This article reviews hypertension in pregnancy as it relates to outcomes, with special emphasis on preeclampsia, eclampsia, and postpartum eclampsia.
View Article and Find Full Text PDFBackground: The specialty of emergency medicine (EM) continues to experience a significant workforce shortage in the face of increasing demand for emergency care.
Summary: In July 2009, representatives of the leading EM organizations met in Dallas for the Future of Emergency Medicine Summit. Attendees at the Future of Emergency Medicine Summit agreed on the following: 1) Emergency medical care is an essential community service that should be available to all; 2) An insufficient emergency physician workforce also represents a potential threat to patient safety; 3) Accreditation Council for Graduate Medical Education/American Osteopathic Association (AOA)-accredited EM residency training and American Board of Medical Specialties/AOA EM board certification is the recognized standard for physician providers currently entering a career in emergency care; 4) Physician supply shortages in all fields contribute to-and will continue to contribute to-a situation in which providers with other levels of training may be a necessary part of the workforce for the foreseeable future; 5) A maldistribution of EM residency-trained physicians persists, with few pursuing practice in small hospital or rural settings; 6) Assuring that the public receives high quality emergency care while continuing to produce highly skilled EM specialists through EM training programs is the challenge for EM's future; 7) It is important that all providers of emergency care receive continuing postgraduate education.
Physician shortages are being projected for most medical specialties. The specialty of emergency medicine continues to experience a significant workforce shortage in the face of increasing demand for emergency care. The limited supply of emergency physicians, emergency nurses, and other resources is creating an urgent, untenable patient care problem.
View Article and Find Full Text PDFBackground: Molar pregnancy is a rare form of pregnancy, affecting approximately 1 in 1000 pregnancies in the United States. Hyperthyroidism is a rare complication of molar pregnancy; thyroid storm occurs even less frequently.
Objectives: To discuss a rare cause of thyroid storm in a woman of reproductive age.