Improving patient flow in acute coronary syndromes in the face of hospital crowding.

Background: The current paradigm for the evaluation of patients with suspected acute coronary syndromes (ACS) in the emergency department (ED) is focused on the identification of patients with active underlying coronary disease. The majority of patients evaluated in the ED setting do not have active underlying cardiac disease.

Objective: To measure the effect of bedside point-of-care (POC) cardiac biomarker testing on telemetry unit admissions from the ED.

Estimating the clinical impact of bringing a multimarker cardiac panel to the bedside in the ED.

Objectives: We examined the use of point-of-care (POC) testing of cardiac biomarkers against standard core laboratory testing to determine the time-savings and estimate a cost-benefit ratio at our institution.

Methods: We prospectively enrolled 151 patients presenting to the emergency department undergoing evaluation for acute coronary syndrome and conducted both central laboratory troponin T (TnT) testing at baseline and 6 hours as well as POC assays of creatine kinase MB, troponin I (TnI), and myoglobin at baseline and 2 hours. Sensitivity/specificity was calculated to measure the ability of the POC-accelerated pathway to identify enzyme elevations at rates parallel to our core laboratory.

Emergency department crowding: factors influencing flow.

Background: THE OBJECTIVE OF THIS STUDY WAS TO EVALUATE THOSE FACTORS, BOTH INTRINSIC AND EXTRINSIC TO THE EMERGENCY DEPARTMENT (ED) THAT INFLUENCE TWO SPECIFIC COMPONENTS OF THROUGHPUT: "door-to-doctor" time and dwell time.

Methods: We used a prospective observational study design to determine the variables that played a significant role in determining ED flow. All adult patients seen or waiting to be seen in the ED were observed at 8pm (Monday-Friday) during a three-month period.

Authorship, collaboration, and predictors of extramural funding in the emergency medicine literature.

Objectives: The objectives of the study were to examine the last decade of general emergency medicine (EM) literature published in the United States for trends with regard to authorship and multidisciplinary collaboration and to estimate the effect on extramural funding.

Methods: Print articles published in the Academic Emergency Medicine, Annals of Emergency Medicine, Journal of Emergency Medicine, and American Journal of Emergency Medicine between 1994 and 2003 were reviewed. Original research, case reports/series, and others (consensus/educational) were considered; abstracts, book reviews, and editorials were not.

Classifying patients suspected of appendicitis with regard to likelihood.

Background: We sought to develop a clinical predictive model for acute appendicitis and contrast it with current clinical practice.

Methods: A prospective observational study of patients presenting with signs or symptoms consistent with acute appendicitis. Random-partition modeling was used to develop an appendicitis likelihood model (ALM).

Funding and publishing trends of original research by emergency medicine investigators over the past decade.

Objectives: To update the profile of author-reported funding of reports of original research published since 1994 in the four U.S. peer-reviewed general emergency medicine (EM) journals.