Western Journal of Emergency Medicine最新文献

{"title":"Pilot Study: Impact of Primary Spoken Language as a Social Determinant of Health on CPR Education and Utilization.","authors":"Charles W LeNeave, Brian Meier, Heather Liffert, John C Perkins","doi":"10.5811/westjem.48504","DOIUrl":"10.5811/westjem.48504","url":null,"abstract":"","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"1129"},"PeriodicalIF":2.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regional STEMI Program Historical Mortality Rates in Maine, USA.","authors":"Olivia Pearson, Sara Kovacs, Rachel Crowe, Thomas Ryan, Colin Phillips","doi":"10.5811/westjem.48505","DOIUrl":"10.5811/westjem.48505","url":null,"abstract":"","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"1133-1134"},"PeriodicalIF":2.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experience Sampling to Assess Burnout in Emergency Medicine: An Acceptability and Feasibility Pilot.","authors":"Joshua J Baugh, Justin Margolin, Ali S Raja, Benjamin A White","doi":"10.5811/westjem.39651","DOIUrl":"10.5811/westjem.39651","url":null,"abstract":"<p><strong>Introduction: </strong>Despite prior efforts to improve well-being in emergency medicine, clinician burnout in the specialty is rising. In this study we examined the acceptability and feasibility of using a method called \"experience sampling\" to explore factors important to clinician experience in emergency departments (ED). Experience sampling enables the measuring of work experience in real time, with more granular detail than in usual burnout surveys. The approach may reveal new opportunities for improving work experience in emergency medicine at a critical time.</p><p><strong>Methods: </strong>We conducted this pilot study in a large, urban, academic, quaternary care ED. Iterative multidisciplinary focus groups were used to generate a brief, experience-sampling tool that was comprised of three different surveys to assess emergency clinician experience before, during, and after shifts. These were deployed using a smartphone application to a convenience sample of 11 clinicians (three attending physicians, two residents, five physician assistants, and one registered nurse) during four shifts each. A post-pilot survey was also sent to all participants to evaluate their experience of using the tool. Our primary outcome measures were feasibility, assessed by the survey response rates during the pilot, and acceptability, assessed by participant sentiment as expressed in the post-pilot surveys. Secondary outcomes were quantitative- and qualitative-experience data collected using the tool.</p><p><strong>Results: </strong>The overall response rates for pre-shift, on-shift, and post-shift surveys were 79%, 73%, and 91%, respectively. All participants responded to the post-pilot survey and indicated they would be willing to use the experience-sampling tool again in the future. Many participants noted that the simple and open-ended on-shift questions were relatively easy to complete; some also said on-shift survey questions could present added difficulty during busy shifts. Four participants said the exercise of completing surveys itself improved on-shift experience by prompting reflection. Common themes associated with positive experiences included manageable patient volumes, excellent teamwork, interesting cases, adequate staffing, and feeling able to provide adequate care. Common themes associated with negative experiences included crowding, inadequate staffing, feeling overwhelmed, complex patient cases, difficult disposition plans, and feeling unable to provide adequate care.</p><p><strong>Conclusion: </strong>Experience sampling is an acceptable and feasible method for measuring clinician experience in a busy academic ED. Further studies could potentially use this approach to identify targets for reducing burnout in emergency medicine.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"1105-1111"},"PeriodicalIF":2.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Substance Use is Associated With Frequent Emergency Department Visits in Cardiac Patients.","authors":"Tai Metzger, David A Berger, Ramin Homayouni","doi":"10.5811/westjem.48499","DOIUrl":"10.5811/westjem.48499","url":null,"abstract":"","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"1122-1123"},"PeriodicalIF":2.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship of Tijuana River Flow and Ocean Bacteria Counts and Emergency Department Diarrhea Cases.","authors":"Jaya Jost, Conor Youngblood, Peter Jost, Roberto Medero","doi":"10.5811/westjem.41492","DOIUrl":"10.5811/westjem.41492","url":null,"abstract":"<p><strong>Introduction: </strong>The Tijuana River, which affects southern San Diego Beaches, is severely contaminated with untreated sewage. Exposure to pathogens can lead to various health problems, commonly gastrointestinal (GI) illnesses. We aimed to look for any relationship between Tijuana River flow rates and ocean pollution levels and levels of diarrhea at a nearby Emergency Department (ED).</p><p><strong>Methods: </strong>In this retrospective study that spanned the 2023 dry season and included Hurricane Hillary, we compared Tijuana River flow rates and fecal bacterial counts on the southern San Diego County coastline to the number of visits to a nearby ED, specifically a 225-patient sample size, with the chief complaint of diarrhea, a potential waterborne illness.</p><p><strong>Results: </strong>In late August of 2023, after Hurricane Hillary made landfall as a tropical storm in Baja California, Mexico, there was a large increase in the Tijuana River flow rate and a correspondingly significant increase in diarrhea cases at 3.25 times the mean, from a mean of 4.25 cases per week to 14 cases the week of Hurricane Hillary.</p><p><strong>Conclusion: </strong>We found a significant correlation between Tijuana River transboundary flow rates and Emergency Department case levels of diarrhea, a known waterborne illness, in the summer of 2023.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"876-879"},"PeriodicalIF":2.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of Previous Emergency Department Visit Information on Care of Current Patients.","authors":"Ricardo X Noriega, Juan Nañez, Emily Hartmann, Scott B Crawford, Chantel D Sloan-Aagard","doi":"10.5811/westjem.40047","DOIUrl":"10.5811/westjem.40047","url":null,"abstract":"<p><strong>Introduction: </strong>Past patient data from health information exchanges (HIE) can enhance physician-patient interactions, although how and how often is unclear. We sought to determine how and how often past medical records provided by an HIE impacts current decision-making by emergency physicians.</p><p><strong>Methods: </strong>We identified qualifying emergency department (ED) visits between September 24-26, 2022. The primary feature of a qualifying visit was a separate ED visit within three days prior at a separate hospital system. Fifty-five charts with essential details of each patient's most recent visit were reviewed in duplicate by 22 emergency medicine residents. Reviewers accessed prior medical records for each patient via an HIE clinical viewer. The primary outcome was the influence of knowledge from prior records on interactions during the most recent visit, measured with 11 Likert-scale ratings. Reviewer agreement was used as an indicator of confidence.</p><p><strong>Results: </strong>Reviewers most frequently agreed that the information from the prior visit was valuable \"a moderate amount\" (25% of all reviewer pairs) and agreed that the information would cause them to change their approach (69%). They would adjust treatment protocols because of understanding what had been tried previously (67%) and ask the patient different questions (78%). There was also agreement that they would further compare laboratory tests or imaging between visits (67%) and better understand patient behavioral patterns (73%).</p><p><strong>Conclusion: </strong>Access to patients' previous medical records (diagnoses, imaging reports, discharge reports, etc) via HIEs impacts how emergency physicians communicate with patients, evaluate cases, and make medical decisions.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"815-822"},"PeriodicalIF":2.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of Microsoft Copilot in the Diagnostic Process of Pulmonary Embolism.","authors":"Banu Arslan, Mehmet Necmeddin Sutasir, Ertugrul Altinbilek","doi":"10.5811/westjem.24995","DOIUrl":"10.5811/westjem.24995","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with pulmonary embolism (PE) often present with non-specific signs and symptoms mimicking other conditions and complicating diagnosis. In this study we aimed to evaluate the performance of an artificial-intelligence tool, Microsoft Copilot, in the diagnostic process of PE, using clinical data including demographics, complaints, and vital signs.</p><p><strong>Methods: </strong>We conducted this study using 140 clinical vignettes, including 70 patients with and 70 patients without PE. The vignettes were derived from published case reports within the last 10 years. We used Copilot for its free GPT-4 integration to analyze clinical data and answer two questions after each vignette. We compared Copilot's ability to identify PE within the top 10 differential diagnoses, and its ability to predict the risk of PE when compared to the use of the Wells score by two independent investigators.</p><p><strong>Results: </strong>Copilot correctly included PE in the differential diagnosis in 94.3% of cases by listing it within the top 10 conditions. Risk assessment by Copilot yielded significantly higher levels in patients with PE (P<.05). No statistically significant difference was found in the Wells scores between patients with PE and without PE (P>.05). Copilot demonstrated better discriminatory power than the Wells score in risk assessment of PE (area under the curve 0.713 vs 0.583), with statistical significance (P<0.001 vs P=.091). Sensitivity, specificity, positive predictive value, and negative predictive value for discriminating between the combination of low- and intermediate- vs high-risk categories were 34%, 97.1%, 92.3%, and 59.6%, respectively.</p><p><strong>Conclusion: </strong>This study explores the potential of Copilot as a tool in clinical decision-making, demonstrating a high rate of correctly identifying PE and improved performance over the Wells score. However, further validation in larger populations and real-world settings is crucial to fully realize its potential.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"1030-1039"},"PeriodicalIF":2.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342421/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Dobbs on Evaluation and Treatment of Ectopic Pregnancy: National Survey of Emergency Physicians.","authors":"Monica Saxena, Dara Kass, Esther Choo","doi":"10.5811/westjem.41205","DOIUrl":"10.5811/westjem.41205","url":null,"abstract":"<p><strong>Introduction: </strong>Inconsistent and ever-changing state abortion laws across the United States raise the possibility of deviation from established standards of emergency care. Yet the experiences of emergency physicians in this era have not been captured. We sought to examine the experiences of US emergency physicians in the management of presumed ectopic pregnancy since the Dobbs Supreme Court ruling and passage of new abortion restrictions affecting clinical decision-making around pregnancy termination.</p><p><strong>Methods: </strong>This was a cross-sectional survey of US emergency physicians administered online between April 1-15, 2024. The survey was completed by 150 board-certified US emergency physicians-50 physicians each from states categorized as abortion restrictive, semi-restrictive, or permissive-who were queried about any reported delays in or adaptations to the assessment and/or management of patients with known or suspected ectopic pregnancy.</p><p><strong>Results: </strong>We found that 24% of physicians in restrictive or semi-restrictive states reported delays in the management of patients with suspected or confirmed ectopic pregnancy, and 54% of physicians reported adaptations to care of these patients including repeat testing and arranging alternative care in cases where they might previously have delivered definitive care in the emergency department.</p><p><strong>Conclusion: </strong>In a post-Dobbs practice environment, emergency physicians across the United States, practicing in states with various abortion restrictions, reported delays and adaptations of care for patients with presumed or suspected ectopic pregnancy including deviations from standard of care in emergency medicine.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"1021-1024"},"PeriodicalIF":2.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a 3-Tier Priority System for Emergency Department Patients' Follow-up in Orthopaedic Surgery.","authors":"Samantha M R Kling, Christian Rose, Darlene Veruttipong, Sonia Rose Harris, Nadia Safaeinili, Cati G Brown-Johnson, Sheneé Laurence, Shashank Ravi, Michael J Gardner, Jonathan G Shaw","doi":"10.5811/westjem.35484","DOIUrl":"10.5811/westjem.35484","url":null,"abstract":"<p><strong>Introduction: </strong>Increasing demand for emergency department (ED) services and strained specialty-care access requires referral precision and was the impetus for a collaborative redesign of referrals between the Department of Emergency Medicine and Department of Orthopaedic Surgery.</p><p><strong>Methods: </strong>Guided by root cause analysis of delays in post-emergency department (ED) specialty follow-up in our academic health system, the intervention targeted the finding that all ED referrals were marked \"urgent\" without differentiation by acuity of orthopedic issues. After implementation, referrals were triaged into three tiers-immediate, urgent, and routine-with stipulated follow-up timeframes. We evaluated differences in completion of scheduling and realized visits, across five calendar months (July-November) pre- and post-implementation (2021 vs 2022). Logistic regression assessed the relationship between patient demographics and outcomes. We report medians and interquartile ranges.</p><p><strong>Results: </strong>Compared to the 393 urgent referrals to the Department of Orthopaedic Surgery pre-implementation, there were 463 total referrals post-implementation as follows: 11/463 (2.4%) marked as immediate; 123/463 (26.6%) urgent; and 329/463 (71.1%) routine. Similar proportions successfully scheduled pre- and post-implementation (41.5% vs 45.1%; P = .28). On average, immediate referrals completed scheduling within 1.0 (0.0 - 1.0) day and were seen in 4.0 (2.0 - 8.0) days, urgent referrals completed scheduling within 2.0 (1.0 - 4.0) and 7.0 (5.0 - 15.0) days, and routine within 3.0 (1.0 - 6.0) and 12.0 (6.0 - 19.5) days. Race/ethnicity and insurance were related to odds of successful scheduling; Black patients had lower odds than all other groups (odds ratio [OR] 0.3 - 0.4). All insurance categories had higher odds of successful scheduling relative to Medicaid out-of-network (OR 3.5 - 7.2).</p><p><strong>Conclusion: </strong>A three-tier ED-to-orthopedics referral triage system was quickly adopted and differentiated referrals by urgency but did not impact time to follow-up or loss to follow-up. Structural inequities in access to follow-up care remain.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"843-852"},"PeriodicalIF":2.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scoping Review of Adult Emergency Department Discharge Interventions.","authors":"Mary-Kate Gorlick, Shriman Balasubramanian, Gregory Han, Andy Hickner, Pranita Talukder, Peter Ad Steel, Lynn Jiang","doi":"10.5811/westjem.35264","DOIUrl":"10.5811/westjem.35264","url":null,"abstract":"<p><strong>Introduction: </strong>The discharge process is a crucial component of the emergency department (ED) encounter, with poor discharge quality often leading to negative patient outcomes. While numerous interventions have been implemented to improve this process, a comprehensive review of these interventions has not been conducted. This study provides a scoping, summative review of adult ED discharge interventions to date, evaluating the literature for potential best practices and future directions.</p><p><strong>Methods: </strong>We conducted a scoping review of published literature on MEDLINE ALL (Ovid), Embase (Ovid), the Cochrane Central Register of Controlled Trials (Wiley), and CINAHL (EBSCOhost) on February 7, 2023, for articles reporting on ED-based discharge interventions. We excluded the following: studies involving pediatric patient populations; discharge from non-ED settings; in-ED risk screening and/or case management as the primary intervention; interventions occurring mostly after the ED encounter (even if initiated at time of discharge); and studies not written in English.</p><p><strong>Results: </strong>The initial electronic database search yielded 3,842 unique titles and abstracts. After applying inclusion/exclusion criteria at various screening stages, we included 100 papers and abstracts in the final review. These studies, published between 2003 - 2023, predominantly originated from the US (66%). Using narrative synthesis, we summarized ED discharge intervention themes to form seven concept subgroups by consensus: mode of discharge; additional resource provision; addition of a discharge coordinator; follow-up assistance; pharmaceutical intervention; patient-centered education; and clinician/discharger-centered education. Effective strategies included enhanced discharge discussions and education by dedicated personnel, structured discharge checklists, and delivery of instructions at an appropriate reading level. However, because few studies have examined long-term patient-centered outcomes, such as ED return visits, hospitalizations, and mortality, cost-benefit analysis for interventions is lacking. Furthermore, the experiences of vulnerable populations who have limited-English proficiency are under-represented in current attempts to innovate ED discharge.</p><p><strong>Conclusion: </strong>We found that interventions aimed at improving patient comprehension of discharge instructions were the most frequently studied and had the greatest impact on patient outcomes. This review highlights promising directions for patient-centered innovation; it also underscores the need for more research to optimize the adult ED discharge process and warrants a call to action.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"823-834"},"PeriodicalIF":2.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}