COVID-19 Pandemic Surge: After-Action Report of a Coalition of Emergency Departments in New York City.

The coronavirus disease (COVID-19) pandemic has stressed the US health care system in unprecedented ways. In March and April 2020, emergency departments (EDs) throughout New York City experienced high volumes and acuity related to the pandemic. Here, we present a structured after-action report of a coalition of 9 EDs within a hospital system in the New York City metropolitan area, with an emphasis on best practices developed during the prolonged surge as well as specific opportunities for growth.

An Exemplar Interprofessional Academic Emergency Nurse Practitioner Program: A Blueprint for Success.

Emergency department census rates and manpower gaps have continued to rise over the past decade, creating a demand for well-prepared emergency nurse practitioners (ENPs). The implementation of the consensus model for advanced practice nurses has brought acknowledgment by leading health care, physician, and nursing organizations of the ENP specialty as critical to building a high-quality emergency care workforce. Recognition of the ENP's unique skill set, and therefore need of specialty certification, has led to a growing interest in the expansion of nurse practitioner curricula in emergency care.

Written Informed Consent for Computed Tomography of the Abdomen/Pelvis is Associated with Decreased CT Utilization in Low-Risk Emergency Department Patients.

Introduction: The increasing rate of patient exposure to radiation from computerized tomography (CT) raises questions about appropriateness of utilization. There is no current standard to employ informed consent for CT (ICCT). Our study assessed the relationship between informed consent and CT utilization in emergency department (ED) patients.

Costs of Rapid HIV Screening in an Urban Emergency Department and a Nearby County Jail in the Southeastern United States.

Emergency departments and jails provide medical services to persons at risk for HIV infection and are recommended venues for HIV screening. Our main objective in this study was to analyze the cost per new HIV diagnosis associated with the HIV screening program in these two venues. The emergency department's parallel testing program was conducted at Grady Memorial Hospital in Atlanta, Georgia starting in 2008; the jail's integrated testing program began at the Fulton County (GA) Jail in 2011.

Diagnostic accuracy and use of nonmydriatic ocular fundus photography by emergency physicians: phase II of the FOTO-ED study.

Study Objective: During the first phase of the Fundus Photography vs Ophthalmoscopy Trial Outcomes in the Emergency Department study, 13% (44/350; 95% confidence interval [CI] 9% to 17%) of patients had an ocular fundus finding, such as papilledema, relevant to their emergency department (ED) management found by nonmydriatic ocular fundus photography reviewed by neuro-ophthalmologists. All of these findings were missed by emergency physicians, who examined only 14% of enrolled patients by direct ophthalmoscopy. In the present study, we evaluate the sensitivity of nonmydriatic ocular fundus photography, an alternative to direct ophthalmoscopy, for relevant findings when photographs are made available for use by emergency physicians during routine clinical care.

Diagnosing HIV in men who have sex with men: an emergency department's experience.

In the United States, men who have sex with men (MSM) constitute the risk group in which the prevalence of new HIV infection is increasing. The percentage of undiagnosed HIV infection and HIV risk behaviors in MSM and non-MSM participating in an emergency department-based rapid HIV screening program were compared. Medical records of all male patients participating in the program from May 2008 to October 2010 were reviewed.

Feasibility of nonmydriatic ocular fundus photography in the emergency department: Phase I of the FOTO-ED study.

Objectives: Examination of the ocular fundus is imperative in many acute medical and neurologic conditions, but direct ophthalmoscopy by nonophthalmologists is underutilized, poorly performed, and difficult without pharmacologic pupillary dilation. The objective was to examine the feasibility of nonmydriatic fundus photography as a clinical alternative to direct ophthalmoscopy by emergency physicians (EPs).

Methods: Adult patients presenting to the emergency department (ED) with headache, acute focal neurologic deficit, diastolic blood pressure ≥ 120 mm Hg, or acute visual change had ocular fundus photographs taken by nurse practitioners using a nonmydriatic fundus camera.

Efficacy of an emergency department-based HIV screening program in the Deep South.

Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) continue to be a significant public health concern in the United States. It disproportionately affects persons in the Deep South of the United States, specifically African Americans. This is a descriptive report of an Emergency Department (ED)-based HIV screening program in the Deep South using the 2006 Centers for Disease Control and Prevention (CDC) recommendations for rapid testing and opt-out consent.

Summary of NIH Medical-Surgical Emergency Research Roundtable held on April 30 to May 1, 2009.

Study Objective: In 2003, the Institute of Medicine Committee on the Future of Emergency Care in the United States Health System convened and identified a crisis in emergency care in the United States, including a need to enhance the research base for emergency care. As a result, the National Institutes of Health (NIH) formed an NIH Task Force on Research in Emergency Medicine to enhance NIH support for emergency care research. Members of the NIH Task Force and academic leaders in emergency care participated in 3 roundtable discussions to prioritize current opportunities for enhancing and conducting emergency care research.

Climate change and emergency medicine: impacts and opportunities.

There is scientific consensus that the climate is changing, that human activity plays a major role, and that the changes will continue through this century. Expert consensus holds that significant health effects are very likely. Public health and health care systems must understand these impacts to properly pursue preparedness and prevention activities.

Effectiveness of a simulation-based medical student course on managing life-threatening medical conditions.

Objectives: To assess the competency and the comfort level of medical students in lifesaving skills after a simulation-based training session and then determine skill retention after 1 year.

Methods: Prospective observational before-after case series of medical students entering the third year. Each student participated in a half-day "How to Save a Life" course.

Performance of an algorithm for assessing smallpox risk among patients with rashes that may be confused with smallpox.

After the 2001 anthrax bioterror attacks, the Centers for Disease Control and Prevention developed an algorithm to evaluate patients rapidly for suspected smallpox. A prospective, multicenter study examined the performance of this algorithm in assessing patients with an acute, generalized vesicular or pustular rash (AGVPR) admitted to emergency departments and inpatient units of 12 acute-care hospitals in 6 states. Of 26,747 patients (3.

Utility of routine testing for patients with asymptomatic severe blood pressure elevation in the emergency department.

Study Objective: Recommendations for the treatment of emergency department (ED) patients with asymptomatic severely elevated blood pressure advise assessment for occult, acute hypertensive target-organ damage. This study determines the prevalence of unanticipated, clinically meaningful test abnormalities in ED patients with asymptomatic severely elevated blood pressure.

Methods: This was a prospective observational study at 3 urban academic EDs.

West Nile virus among hospitalized, febrile patients: a case for expanding diagnostic testing.

In Georgia, most individuals reported with West Nile virus (WNV) disease have been diagnosed with West Nile neuroinvasive disease (WNND). Relatively few cases of West Nile Fever (WNF) are reported, and the burden of illness due to WNV is likely underestimated. From July through October 2003, WNV serologic testing was performed on enrolled patients>or=18 years of age with fever admitted to a large, urban hospital in Atlanta, Georgia through the emergency department (ED).

Evaluation and treatment of patients with severely elevated blood pressure in academic emergency departments: a multicenter study.

Study Objective: Current guidelines advise that emergency department (ED) patients with severely elevated blood pressure be evaluated for acute target organ damage, have their medical regimen adjusted, and be instructed to follow up promptly for reassessment. We examine factors associated with performance of recommended treatment of patients with severely elevated blood pressure.

Methods: Observational study performed during 1 week at 4 urban, academic EDs.

Protected clinical teaching time and a bedside clinical evaluation instrument in an emergency medicine training program.

In a process that has evolved over the last four years, the Emory University Emergency Medicine Education Committee has developed an "academic attending" teaching shift incorporating a formatted lecture series with a clinical evaluation exercise (CEE). The program structures the approach to clinical teaching at the bedside, provides an objective clinical evaluation tool specific to emergency medicine residents, and provides targeted learning for medical students and residents rotating in the emergency department (ED). The CEE instrument was designed to be quick and efficient, satisfy requirements of assessment of the Accreditation Council for Graduate Medical Education (ACGME) general competencies, and incorporate the language of the "Model of the Clinical Practice of Emergency Medicine.

Urine dipstick as a screening test for serum creatinine elevation in emergency department patients with severe hypertension.

Objective: Patients presenting to the emergency department (ED) with severe hypertension require assessment for acute end-organ damage. Serum creatinine (SCr) measurement is routinely recommended to detect renal dysfunction. The authors assessed the utility of the urine dipstick test in screening for acute SCr elevation in this population.