The Effects of Implementing a "Waterfall" Emergency Physician Attending Schedule.

Introduction: Increases in emergency department (ED) crowding and boarding are a nationwide issue resulting in worsening patient care and throughput. To compensate, ED administrators often look to modifying staffing models to improve efficiencies.

Methods: This study evaluates the impact of implementing the waterfall model of physician staffing on door-to-doctor time (DDOC), door-to-disposition time (DDIS), left without being seen (LWBS) rate, elopement rate, and the number of patient sign-outs.

Triage physicians in an academic emergency department: Impact on resident education.

Background: Overcrowding in emergency departments (EDs) in the United States has been linked to worse patient outcomes. Implementation of countermeasures such as a physician-in-triage (PIT) system have improved patient care and decreased wait times. The purpose of this study was to evaluate how a PIT system affects medical resident education in an academic ED.

Pragmatic Randomized Controlled Pilot Trial on Trigger Point Injections With 1% Lidocaine Versus Conventional Approaches for Myofascial Pain in the Emergency Department.

Background: Myofascial neck and back pain is an increasingly common chief symptom in the emergency department. Currently, there are no widely accepted conventional therapies, and there is little evidence on the efficacy of interventions such as trigger point injections (TPIs).

Objective: This study evaluates whether TPIs with 1% lidocaine can improve myofascial back and neck pain compared with conventional therapies.

Public Performance Metrics: Driving Physician Motivation and Performance.

Introduction: As providers transition from "fee-for-service" to "pay-for-performance" models, focus has shifted to improving performance. This trend extends to the emergency department (ED) where visits continue to increase across the United States. Our objective was to determine whether displaying public performance metrics of physician triage data could drive intangible motivators and improve triage performance in the ED.

Characterizing Frequent Flyers of an Emergency Department Using Cluster Analysis.

Emergency department (ED) overcrowding has been a pain point in hospitals across the globe. "Frequent flyers," who visited the ED at a much higher rate than average, account for almost one third of ED visits even though they represent only a small proportion of all ED patients. In this study, we used data-mining methods to cluster ED frequent flyers at a large academic medical center in the US.

Emergency department patient experience: Same location, same provider, different scores by different survey methods.

Background: Recent findings on emergency department (ED) patient experience surveys and concerns for the low response rates challenge the quality and reliability of the survey reports. We assessed the consistency of an ED patient experience survey report and identified the effects of patient demographics on ED patient experiences.

Methods: We conducted a prospective, cross-sectional study at a university-based ED from July to December 2017.

Occipital Nerve Blocks in the Emergency Department for Initial Medication-Refractory Acute Occipital Migraines.

Migraines are consistently among the top 20 primary coded diagnoses in emergency departments, constituting 4.5% of all chief complaints. In a significant subset of these, pain arises from the occipital region innervated by the greater (GON) and lesser occipital nerve.

Use of occipital nerve block in emergency department treatment of status migrainosus.

Migraine headaches make up a significant proportion of emergency department visits. There are multiple pharmacologic treatment modalities for migraine abortive therapy; however, these treatments are rarely targeted to the precise area of pain and thus elicit multiple systemic effects. It has been well established in the anesthesia pain literature that occipital nerve blocks can provide not only immediate pain relief from occipital migraines, but can also result in a long-term resolution of occipital migraines.

Deep arteriovenous malformations in the basal ganglia, thalamus, and insula: multimodality management, patient selection, and results.

Objective: This study sought to describe a single institution's experience treating arteriovenous malformations (AVMs) of the basal ganglia, thalamus, and insula in a multimodal fashion.

Methods: We conducted a retrospective review of all deep AVMs treated at our institution between 1997 and 2011 with attention to patient selection, treatment strategies, and radiographic and functional outcomes.

Results: A total of 97 patients underwent initial treatment at our institution.