Western Journal of Emergency Medicine最新文献

{"title":"Emergency Department Utilization by Race, Ethnicity, Language, and Medicaid Status.","authors":"Daniel J Berger, Colin Jenkins, John Wong-Castillo, Sarahrose Jonik, Nancy P Gordon","doi":"10.5811/westjem.41511","DOIUrl":"10.5811/westjem.41511","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency department (ED) use varies by age, sex, race, ethnicity, language preference, and payor type. Most studies comparing ED use by patients with English vs non-English preference (ELP/NELP) have used racially aggregated data, potentially masking differences across population subgroups. In this study we aimed to disaggregate the associations of race, ethnicity, language preference, and Medicaid coverage with ED utilization.</p><p><strong>Methods: </strong>We used cross-sectional study electronic health record data for 2,047,105 Kaiser Permanente Northern California members who were 25 - 85 years of age in January 2019 and had been continuous health plan members during 2018 - 2019. We tabulated the percentages of adults in seven racial and ethnic groups (White, Black, Hispanic, Chinese, Filipino, Vietnamese, South Asian) within three age groups (25 - 44, 45 - 64, 65 - 85) who had ≥1 ED visit in 2019. Modified log-Poisson regression was used to examine racial, ethnic, and language preference differences after adjusting for demographic and Medicaid status covariates.</p><p><strong>Results: </strong>The study population was 51.8% White, 53.2% female, 9.6% NELP, and 6.2% Medicaid-insured. Overall, 18% had ≥ 1 ED visit. Compared with White adults, Black and Hispanic adults were more likely and Chinese, Vietnamese, and South Asian adults were less likely to have ≥ 1 ED visit. After adjusting for all covariates, NELP adults 25 - 64 years of age were 10% less likely to have had an ED visit. However, while NELP was associated with a 10-20% lower ED visit prevalence among Hispanic, Filipino, Chinese, and Vietnamese adults 25 - 64, the prevalence was 10% higher among White and South Asian adults 45 - 64 and Filipino and South Asian adults aged 65 - 85. Adults with Medicaid coverage aged 25 - 64 were twice as likely and adults aged 65 - 85 were 50% more likely to have had ≥ 1 ED visit.</p><p><strong>Conclusion: </strong>This study of a US adult health-plan membership found several significant differences in ED use across racial, ethnic, and language subgroups and a higher prevalence of ED use by Medicaid-covered adults ≤ 65 years of age in most racial and ethnic groups. Our findings highlight the importance of using disaggregated data, particularly for Asian ethnic groups, when comparing ED use in different populations. Further research is needed to identify similarities and differences in social, personal, and policy factors driving ED use in diverse adult populations to better inform population-specific health interventions.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"951-959"},"PeriodicalIF":2.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837922","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":"Improved Outcomes and Cost with Palliative Care in the Emergency Department: Case-Control Study.","authors":"Brandon Chalfin, Spencer M Salazar, Regina Laico, Susan Hughes, Patrick J Macmillan","doi":"10.5811/westjem.35388","DOIUrl":"10.5811/westjem.35388","url":null,"abstract":"<p><strong>Introduction: </strong>Palliative care consultation teams provide significant advantages for patients, healthcare professionals, and hospitals, particularly in pain management, family support, and clinician satisfaction. Numerous studies show that inpatient palliative care services yield benefits regardless of the timing of initiation, contributing to shortened hospital stays and cost savings. Recent studies have focused on the timing and setting of palliative care, especially in emergency departments (ED), highlighting improved patient outcomes when initiated early. This study explores the potential of embedding hybrid physicians (double-boarded physicians in palliative and emergency medicine) in the ED to further enhance patient care and reduce hospital resources.</p><p><strong>Methods: </strong>This small pilot case-control study included a subset of all patients referred by emergency physicians and hospitalists for palliative care within 24 hours of registration, physically present in the ED. Cases consisted of all the patients seen by hybrid physicians embedded in the ED. Matched controls were seen by palliative care-boarded clinicians (various other primary specialties) during palliative care rounds in the hospital. Matches were based on diagnosis, comorbidities, and referral date. Outcomes measured included hospital length of stay, total charges, discharge disposition, code status changes, and ED visits not resulting in admission. Statistical analyses used chi-square tests for categorical data and Wilcoxon rank-sum test for continuous data.</p><p><strong>Results: </strong>In a four-year period, 68 cases were attended by hybrid physicians over 57 disparate days. These cases had significantly shorter hospital stays (median 2.1 days) compared to controls (6.5 days, P<.001). Total charges were also lower for cases ($37,800) than for controls ($78,000, P<.001). A notable secondary outcome was that 26.5% of ED visits in the case group did not result in hospital admission, compared to all controls being admitted (P<.001). In addition, more cases than controls had a code status of comfort care at discharge (P=.07) CONCLUSION: Embedding hybrid physicians in the ED significantly shortened hospital stays and reduced charges for seriously ill patients. These findings support the further exploration of integrating such physicians into ED settings to enhance patient care and optimize hospital resources.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"1040-1046"},"PeriodicalIF":2.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837977","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":"Cognitive Frame and Time Pressure as Moderators Of Clinical Reasoning: A Case Control Study.","authors":"Andrew J Monick, Xiao Chi Zhang","doi":"10.5811/westjem.24851","DOIUrl":"10.5811/westjem.24851","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency physicians (EP) are uniquely positioned to benefit from a deeper understanding of cognitive bias, particularly in the context of limited processing time. The framing effect-the tendency to evaluate identical information inconsistently given varying methods of presentation- presents a particular challenge within emergency medicine (EM). Understanding how the presentation of clinical information affects medical decision-making is paramount, given variability in how information is received. In this study we aimed to assess whether the imposition of a cognitive frame and time pressure affected participants' differential diagnoses.</p><p><strong>Methods: </strong>We recruited attending physicians in emergency medicine (EM) and third-year EM residents via email from our university hospital. They were asked to review two case vignettes: one consistent with pulmonary embolism (PE), the other with interstitial lung disease. Each vignette had two versions, one emphasizing features consistent with the respective diagnoses. Each pair of vignettes contained objectively identical clinical information. Subjects were randomly assigned to one of four conditions based on 1) the specific or non-specific-frame version of each case and 2) the inclusion or exclusion of time pressure. Subjects provided their top three differential diagnoses for each case. Our primary outcome measure was identification of intended diagnosis.</p><p><strong>Results: </strong>A total of 39 subjects completed the study. Two-sided Fisher exact tests showed that varying cognitive frames affected the likelihood of EPs identifying PE as a diagnosis of interest (P = .01). Among EPs who identified PE, the likelihood of this diagnosis leading their differential diagnosis was also related to frame (P = .01).</p><p><strong>Conclusion: </strong>The results of this work reveal that cognitive frame and time pressure may independently influence diagnostic reasoning among emergency physicians, bearing implications for medical education.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"1055-1061"},"PeriodicalIF":2.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837916","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 Daily Meteorological Changes on Stroke Incidence Across the United States.","authors":"Randall L Ung, Jeffrey S Lubin","doi":"10.5811/westjem.39685","DOIUrl":"10.5811/westjem.39685","url":null,"abstract":"<p><strong>Introduction: </strong>Various variables of weather are hypothesized to exert a small but measurable, significant influence on the development of cerebral infarctions (strokes). Improved characterization of this relationship would enhance understanding of the impact of climate change on healthcare demand. However, current data are conflicting regarding the exact nature of the direction and magnitude of the relationship between weather variables and stroke incidence.</p><p><strong>Methods: </strong>We conducted a retrospective analysis using patient data from 2019 across the contiguous United States obtained from the TriNetX global research data network and weather data from the National Oceanic and Atmospheric Administration database. Data from hospitalized patients who had a diagnosis of cerebral infarction, as defined from International Classification of Diseases, 10^th Rev, diagnosis codes, were used for analysis. Negative binomial regression calculated the incidence rate ratio (IRR) between stroke and various weather variables: temperature (°C), change in temperature, pressure, change in pressure, and precipitation.</p><p><strong>Results: </strong>Our study included 92,422 patients across 92 healthcare systems. Regression analysis revealed a small but statistically significant association between stroke and change in temperature (IRR 1.0047, confidence interval 1.0012 - 1.0083, P = .010). The remaining variables in our model did not have a statistically significant effect on incidence of stroke.</p><p><strong>Conclusion: </strong>The data suggest that one aspect of weather, specifically day-to-day increases of ambient temperature, has a measurable small magnitude but statistically significant impact on local stroke patterns.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"984-989"},"PeriodicalIF":2.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837978","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":"Sepsis Presentation, Interventions, and Outcome Differences Among Men and Women in the Emergency Department.","authors":"Joseph O'Brien, Jon W Schrock","doi":"10.5811/westjem.40005","DOIUrl":"10.5811/westjem.40005","url":null,"abstract":"<p><strong>Objectives: </strong>Sepsis is a common presentation to the emergency department (ED) and represents a life-threatening syndrome with high mortality rates. The existing literature has conflicting findings regarding outcomes between sexes. Our goal in this study was to investigate the clinical presentation, interventions, and outcomes based on sex for sepsis in the ED.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study to identify patients presenting with sepsis to the ED. We employed the Global Collaborative Network from 119 international healthcare organizations in the TriNetX Research Network. Sepsis was defined according to International Classification of Diseases, 10^th Rev, codes. To evaluate sex differences in sepsis presentation, we collected data on age, comorbidities, sex, vital signs, laboratory values, medications, intensive care unit (ICU) admission, mechanical ventilation, and mortality at 30 days, 90 days, and one year. We used a 1:1 propensity score matching by age, race, comorbidities, and infection source to identify and balance potential risk factors across the study groups to investigate mortality, interventions, and intensive care unit admission trends. Data abstraction and analysis were conducted in the TriNetX platform.</p><p><strong>Results: </strong>In total, 920,160 patients were included in this study. The most common infection source for both females and males was respiratory, accounting for 40% and 46.2% of sepsis cases, respectively. After adjusting for urinary tract infection as an infection source, females were less likely to receive piperacillin-tazobactam (21% vs 23.6%; odds ratio [OR] 0.76; 95% confidence interval [CI] 0.75 - 0.77), vancomycin (32.9% vs 36%; OR, 0.87; 95% CI 0.86 - 0.88), and vasopressors (16.5% vs 17.6%; OR, 0.92; 95% CI 0.91 - 0.93). Females had a lower all-cause mortality at 30 days (12.1% vs 13%; OR 0.91; 95% CI 0.90 - 0.92), 90 days (17.1% vs 18.7%; OR 0.91; 95% CI 0.90 - 0.92), and one year (21.5% vs 23.3%; OR 0.90; 95% CI 0.89 - 0.91).</p><p><strong>Conclusion: </strong>Females demonstrated 10% lower odds of mortality from sepsis at 30 days, 90 days, and one year (absolute difference: 0.9%, 1.6%, 1.8%, respectively). Females were less likely to receive vasopressors, vancomycin, or piperacillin-tazobactam, even after accounting for urinary tract infection as the sepsis source.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"880-887"},"PeriodicalIF":2.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838008","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":"Emergency Medicine Scholarly Tracks: A Mixed- methods Study of Faculty and Resident Experiences.","authors":"Jason Rotoli, Ryan Bodkin, Grace VanGorder, Valerie Lou, Lindsey Picard, Beau Abar","doi":"10.5811/westjem.19453","DOIUrl":"10.5811/westjem.19453","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency medicine (EM) scholarly tracks have been adopted for increased subspecialty exposure and training. However, current literature fails to elucidate the impact on faculty and resident careers and resident and faculty engagement opportunities or demonstrate barriers to continuation. The purpose of this study was to evaluate the perceived impact of EM scholarly tracks on participating faculty (eg, resident interaction/mentorship, career satisfaction, perceived barriers to implementation) and recent graduates (eg, faculty mentorship, reasons for track selection, perceived barriers to continuation).</p><p><strong>Methods: </strong>This mixed-methods study includes a cross-sectional quantitative survey with 30 EM residents (who graduated between 2021-2023) and semi-structured, one-hour qualitative interviews with six faculty in a large, tertiary-care academic medical center with a university-based hospital and medical school. We conducted frequency analyses on demographics, timing of tracks, mentorship impact, and implementation barriers. Chi-square analyses were used to compare the most and least common reasons for track selection. We evaluated faculty data in a program evaluation framework, seeking commonalities and idiosyncratic experiences.</p><p><strong>Results: </strong>RESIDENT DATA: Most participants pursued either academic or hybrid academic/community careers (18/30). Additionally, most participants reported a positive impact on mentorship (25/30). The most common reason for choosing a track was \"area of clinical interest\" (mean 2.93, P <.001). The least common reason was \"lowest effort/amount of work\" (mean 1.47, P<.05) when compared to half of the other choices. Most residents did not report barriers to track continuation.</p><p><strong>Faculty data: </strong>Faculty frequently discussed how resident scholarly tracks led to increased one-on-one faculty: resident time. Additionally, they reported the opportunity for specialization of residents not seeking fellowships. A reported barrier to continuation of and resident engagement in tracks was the balance needed between teaching enough and over-teaching, which can discourage learner interest.</p><p><strong>Conclusion: </strong>Recent EM graduates and current faculty members participating in scholarly tracks reported a positive impact on engagement and mentorship with minimal reported barriers to implementation and continuation. Scholarly tracks may offer more than educational benefits to participants, including individualized mentorship and career guidance.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"786-794"},"PeriodicalIF":2.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837967","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":"Comparative Efficacy of Face-to-Face and Right-Rear Upright Intubation in a Randomized Crossover Manikin Study.","authors":"Cheng-Wei Tseng, Chung-Shiung Wen, Sheng-Han Yu, Yung-Cheng Su, Shu-Sheng Li, Hsin-Ling Chen, Tzu-Yao Hung","doi":"10.5811/westjem.39983","DOIUrl":"10.5811/westjem.39983","url":null,"abstract":"<p><strong>Introduction: </strong>Upright intubation is essential for managing difficult airways but can be challenging, especially for less experienced clinicians. Face-to-face intubation may lower first-pass success rates due to unfamiliar orientation. New videolaryngoscope devices have the potential to improve intubation success. We aimed to compare first-pass success rates, intubation duration, and glottic view between the right-rear and face-to-face approaches, using channeled videolaryngoscope, hyperangulated videolaryngoscope, and video stylet for upright intubation.</p><p><strong>Methods: </strong>We conducted a cross-over manikin simulation study involving 30 participants-19 attending physicians, six residents, and five nurse practitioners-to compare the efficacy of these devices to a standard Macintosh videolaryngoscope, using both right-rear and face-to-face approaches.</p><p><strong>Results: </strong>We used Cox regression analysis to calculate hazard ratios for the following variables: first-pass success rate; intubation time; glottic view quality (Cormack-Lehane grade [C-L]); and percentage of glottis opening score (POGO]. The right-rear approach demonstrated a substantial improvement in first-pass success rates compared to face-to-face, with rates of 93% vs 78% and a hazard ratio of 2.10 (95% confidence interval 1.58-2.80). Additionally, both the video stylet and channeled videolaryngoscope techniques further optimized first-pass success rates and enhanced glottic visualization, achieving a CL grade I view and POGO scores of 100%, even in the inverted face-to-face orientation. These devices outperformed the standard Macintosh and hyperangulated videolaryngoscopes.</p><p><strong>Conclusion: </strong>The right-rear approach was associated with higher first-pass success rates and provided a more familiar orientation for operators during upright intubation. Video stylets and channeled videolaryngoscopes also contributed to improved success rates, shorter intubation times, and better glottic visualization.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"1086-1094"},"PeriodicalIF":2.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837917","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":"A Missed Meal, A Missed Diagnosis: Why Emergency Departments Must Lead on Food Insecurity Screening.","authors":"Victor Cisneros, Ian Olliffe, Raymen R Assaf","doi":"10.5811/westjem.47454","DOIUrl":"10.5811/westjem.47454","url":null,"abstract":"","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"1120-1121"},"PeriodicalIF":2.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837954","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":"Physicians in Greece's Emergency Departments: Attitudes, Readiness, and Need for Formal Training.","authors":"Sarah Aly, Dimitrious Babales, Olympia Kouliou, Andrew Ulrich, Eleanor Reid, Dimitrios Tsiftsis","doi":"10.5811/westjem.39964","DOIUrl":"10.5811/westjem.39964","url":null,"abstract":"<p><strong>Introduction: </strong>Despite the recent recognition of emergency medicine (EM) as a distinct specialty in Greece, emergency departments(ED) there continue to be staffed by physicians with training in other medical specialties, although some hold EM certifications. In this study we aimed to evaluate the perceived level of competency and preparedness of physicians who work in EDs in Greece. We also sought to identify gaps in clinical EM expertise, solicit opinions on the need for EM residency training in Greece, and determine the well-being and job satisfaction of physicians practicing in Greek EDs.</p><p><strong>Methods: </strong>This was a mixed-methods, cross-sectional, electronic, nationally representative survey of physicians working in EDs across all health districts in Greece. The survey was administered in Greek and anonymously conducted online. We used the Pearson chi-squared test to determine whether there was an association between EM certification and comfort with seeing subsets of patients. The study received institutional review board approval, and all participants signed an online consent form.</p><p><strong>Results: </strong>The study surveyed 105 of 263 physicians working in 52 Greek EDs (39.9% response rate). We found that of the 105 physicians surveyed, 63 (60.0%) were not certified in EM. A Pearson chi-squared test revealed a significant association between comfort level in seeing pediatric, trauma, and critically ill patients, and EM certification (X² = 13.37, P = .001). Qualitative analysis found that physicians had a desire to engage in training opportunities, with many citing cost, time, and age as barriers. Despite these challenges, 64.1% of physicians reported satisfaction with their decision to work in the ED.</p><p><strong>Conclusion: </strong>Most frontline emergency physicians working in Greece are uncomfortable caring for the full breadth of ED patients. This survey represents the first assessment of the attitudes, clinical preparedness, and perceived need for EM residency training among emergency physicians in Greece. Critical next steps should include enhanced training on targeted aspects of emergency care for practicing emergency physicians in the nation and continued efforts to establish formal EM residency training in Greece.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"1002-1007"},"PeriodicalIF":2.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837988","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 COVID-19 on Patients with a Preferred Language Other than English in the Emergency Department.","authors":"Molly Thiessen, Emily Hopkins, Jennifer Whitfield, Kristine Rodrigues, David Richards, Leah Warner, Jason Haukoos","doi":"10.5811/westjem.18610","DOIUrl":"10.5811/westjem.18610","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic had a disproportionate impact on minority communities, including patients who identify as having a preferred language other than English (PLOE). Our primary goal in this study was to evaluate the effect of the COVID-19 pandemic on patients with a PLOE in the emergency department (ED), and the use of interpreter services. Secondary outcomes evaluated were measures of patient care, including length of stay, number of studies performed, and unplanned return visits to the ED.</p><p><strong>Methods: </strong>We performed an interrupted time series study of prospectively collected electronic health record (EHR) adult ED and language services data from an urban, safety-net hospital.</p><p><strong>Results: </strong>The total number of patients presenting to the ED went down in the early peak of the pandemic; however, the percentage of patients with a PLOE went up compared with previous years (19% vs 16%) and, despite making up only 19% of total patients, comprised 44% of total COVID-19 positive patients. In-person interpreter use decreased (prevalence ratio 0.49, 95% confidence Interval [CI] 0.43-0.56) while telephonic and video interpretation increased (prevalence ratio 3.97, 95% CI 3.56-4.43). Baseline testing was unchanged. All groups experienced a decrease in median LOS in 2020, but this was only found to be significant for patients who speak a language other than English or Spanish (P<0.001). None of the patient groups experienced a significant increase in unscheduled returns in 2020.</p><p><strong>Conclusion: </strong>Our data confirms that COVID-19 disproportionately affected patients with a PLOE, with patients with a PLOE 2.9 times more likely to test positive for COVID-19 than their English-speaking counterparts. Efforts should be made to mitigate this effect via language-concordant care, professional interpreters, and culturally appropriate interaction and information dissemination, not only as it relates to planning for public health crises, but in the day-to-day function of the healthcare system at large. Continued research into the factors driving these inequities and ways to mitigate them is warranted.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"960-969"},"PeriodicalIF":2.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837972","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}