Impact of Geriatric Consult Evaluations on Hospital Admission Rates for Older Adults.

Introduction: We examined the impact of a geriatric consult program in the emergency department (ED) and an ED observation geriatric care unit (GCU) setting on hospital admission rates for older ED patients.

Methods: We performed a retrospective case control study from June 1-August 31, 2019 (pre-program) to September 24, 2019-January 31, 2020 (post-program). Post-program geriatric consults were readily available in the ED and required in the GCU setting.

Use of the electronic medical record to screen for high-risk geriatric patients in the emergency department.

Older adults with multimorbidities have the highest rate of emergency department (ED) usage. These patients are typically on numerous medications, may have underlying dementia, and often present with falls and delirium. Identifying these high-risk older adults for possible intervention is challenging in the ED setting since available screening methods are manual and resource-intensive.

Emergency Department Patients Who Leave Before Treatment Is Complete.

Introduction: Emergency department (ED) patients who leave before treatment is complete (LBTC) represent medicolegal risk and lost revenue. We sought to examine LBTC return visits characteristics and potential revenue effects for a large healthcare system.

Methods: This retrospective, multicenter study examined all encounters from January 1-December 31, 2019 at 18 EDs.

Procedural frequency: Results from 18 academic, community and freestanding emergency departments.

Background: Emergency physicians must maintain procedural skills, but clinical opportunities may be insufficient. We sought to determine how often practicing emergency physicians in academic, community and freestanding emergency departments (EDs) perform 4 procedures: central venous catheterization (CVC), tube thoracostomy, tracheal intubation, and lumbar puncture (LP).

Methods: This was a retrospective study evaluating emergency physician procedural performance over a 12-month period.

The impact of hospital boarding on the emergency department waiting room.

Background: Patient boarding in the emergency department (ED) is a significant issue leading to increased morbidity/mortality, longer lengths of stay, and higher hospital costs. We examined the impact of boarding patients on the ED waiting room. Additionally, we determined whether facility type, patient acuity, time of day, or hospital occupancy impacted waiting rooms in 18 EDs across a large healthcare system.

Discharge prescription optimization by emergency medicine pharmacists in an academic emergency department in the United States.

Background Emergency medicine (EM) pharmacists may be uniquely positioned to optimize discharge prescriptions for emergency department (ED) patients but the clinical significance of interventions and association with patient outcomes are not well-described. Objective To evaluate the clinical significance of EM pharmacist interventions completed during review of ED discharge prescriptions. Setting This study was conducted in an academic medical center ED.

Operationalizing COVID-19 testing: Who, what, when, where, why, and how.

The authors review the rationale behind and approaches to testing for COVID-19, the quality of currently available tests, the role of data analytics in strategizing testing, and using the electronic medical record and other programs designed to steward COVID-19 testing and follow-up of patients.

An intervention based on the Electronic Medical Record to improve smoking cessation guidance in an urban tertiary care center emergency department.

Introduction: Smoking remains a major public health issue and a leading cause of death and disability in the United States. The objective of this study was to determine the effect of a simple intervention on smoking guidance, based on the electronic medical record (EMR), including providing discharge instructions and/or cessation counseling to emergency department (ED) patients who smoke.

Methods: This was an interventional before-and-after study in an ED with 70000 visits per year.

Ketamine Safety and Use in the Emergency Department for Pain and Agitation/Delirium: A Health System Experience.

Introduction: Two protocols were developed to guide the use of subdissociative dose ketamine (SDDK) for analgesia and dissociative sedation ketamine for severe agitation/excited delirium in the emergency department (ED). We sought to evaluate the safety of these protocols implemented in 18 EDs within a large health system.

Methods: We conducted a retrospective chart review to evaluate all adult patients who received intravenous (IV) SDDK for analgesia and intramuscular (IM) dissociative sedation ketamine for severe agitation/excited delirium in 12 hospital-based and six freestanding EDs over a one-year period from the protocol implementation.

Electronic medical record-based interventions to encourage opioid prescribing best practices in the emergency department.

Objective: Overdose from opioids has reached epidemic proportions. Large healthcare systems can utilize existing technology to encourage responsible opioid prescribing practices. Our study measured the effects of using the electronic medical record (EMR) with direct clinician feedback to standardize opioid prescribing practices within a large healthcare system.

Incremental Prognostic Value of Guideline-Directed Medical Therapy, Transradial Access, and Door-to-Balloon Time on Outcomes in ST-Segment-Elevation Myocardial Infarction.

Background: Systems to improve ST-segment-elevation myocardial infarction (STEMI) care have traditionally focused on improving door-to-balloon time. However, prompt guideline-directed medical therapy and transradial primary percutaneous coronary intervention (PCI) are also associated with reduced STEMI mortality. The incremental prognostic value of each facet of STEMI care on clinical outcomes within a STEMI system of care is unknown.

4-Step Protocol for Disparities in STEMI Care and Outcomes in Women.

Background: Women with ST-segment elevation myocardial infarction (STEMI) receive suboptimal care and have worse outcomes than men. Whether strategies to reduce STEMI care variability impact disparities in the care and outcomes of women with STEMI is unknown.

Objectives: The study assessed the care and outcomes of men versus women with STEMI before and after implementation of a comprehensive STEMI protocol.

Older adults in the Emergency Department: predicting physicians' burden levels.

The aging of the U.S population will have impact on hospital Emergency Departments (ED) nationwide. To date, ED research has focused on utilization rates and acuity without considering issues of burden and stress that emergency physicians may experience caring for the increasing numbers of older adult patients.

Etiology and clinical course of abdominal pain in senior patients: a prospective, multicenter study.

Background: The authors describe the epidemiology and clinical course of older persons examined in emergency departments (EDs) for abdominal pain.

Methods: This was a prospective, multicenter, observational study of older persons (>or=60 years) examined in participating EDs for nontraumatic abdominal pain. Medical records were reviewed for demographics, ED diagnoses, findings of radiographic imaging, disposition, operative procedures, length of hospitalization, and final diagnoses.

The use of abdominal computed tomography in older ED patients with acute abdominal pain.

The objectives of this study were to determine the prevalence of use of abdominal computed tomography (CT) in older ED patients with acute nontraumatic abdominal pain, describe the most common diagnostic CT findings, and determine the proportion of diagnostic CT results. This was a prospective, observational, multicenter study of 337 patients 60 years or older. History was obtained prospectively; charts were reviewed for radiographic findings, dispositions, diagnoses, and clinical course, and patients were followed up at 2 weeks for additional information.

Troponin T in elders with suspected acute coronary syndromes.

Troponin T (TnT) elevations (> or =0.1 ng/mL) indicate an increased risk of adverse outcomes in patients with acute coronary syndromes (ACS). There is little data on the prognostic significance of TnT in elders with ACS.

The effect of mental status screening on the care of elderly emergency department patients.

Study Objectives: We determine the effect of screening examinations for mental status impairment on the care of elderly patients in the emergency department and prospectively assess recognition of mental status impairment by emergency physicians.

Methods: We performed a prospective cross-sectional study. Patients were 70 years of age or older and presented to an urban teaching hospital ED over a 17-month period.

A brief risk-stratification tool to predict repeat emergency department visits and hospitalizations in older patients discharged from the emergency department.

Objectives: To evaluate the predictive ability of a simple six-item triage risk screening tool (TRST) to identify elder emergency department (ED) patients at risk for ED revisits, hospitalization, or nursing home (NH) placement within 30 and 120 days following ED discharge.

Methods: Prospective cohort study of 650 community-dwelling elders (age 65 years or older) presenting to two urban academic EDs. Subjects were prospectively evaluated with a simple six-item ED nursing TRST.