Western Journal of Emergency Medicine最新文献

{"title":"Time Motion Analysis of Emergency Physician Workload in Urgent Care Settings.","authors":"Scott Odorizzi, Jessica Hogan, Sabrain Idris, Loraina Marzano, Veronique Rowley, Max Yan, Yuxin Zhang, Jeffrey J Perry","doi":"10.5811/westjem.41536","DOIUrl":"10.5811/westjem.41536","url":null,"abstract":"<p><strong>Introduction: </strong>The Predictors of Workload in the Emergency Room (POWER) study, published in 2009 using data from 2003, examined the workload of emergency physicians using the Canadian Triage and Acuity Scale (CTAS) as a surrogate marker. Many hospitals use a case-mix formula incorporating annual census and POWER's study data to determine staffing levels. However, significant changes in emergency medicine have occurred since its publication, including the implementation of electronic health record systems, increased patient complexity, real-time dictation software, and human health resource challenges due to the COVID-19 pandemic. In this study we aimed to quantify the time required to perform tasks during the care of ambulatory emergency department (ED) patients. Our secondary objective was to stratify these times based on CTAS and clinician factors.</p><p><strong>Methods: </strong>We conducted a prospective observational time-motion study in the urgent care section of a tertiary-care, academic ED with 90,000 visits annually, 70% of which are ambulatory. Research assistants shadowed physicians on two 8-hour shifts daily (8 am-12 am) from July 12-August 14, 2022, tracking the time taken by physicians to perform tasks. We calculated aggregate task times per patient.</p><p><strong>Results: </strong>We observed 1,204 patient encounters over 65 shifts by 37 unique physicians. The mean treatment time was 21.6 minutes (95% confidence interval [CI] 19.9 - 23.3) for ambulatory CTAS 2 patients; 22.5 minutes (95% CI 21.2 - 23.6) for CTAS 3 patients; 19.7 minutes (95% CI 17.9 - 21.6) for CTAS 4 patients; and 17.4 minutes (95% CI 14.9 - 19.9) for CTAS 5 patients. Compared to the previous 2003 POWER study data, CTAS 4 and 5 patient assessment times took 31% and 58% longer, respectively. Total assessment time by CTAS was statistically significant only comparing CTAS 5 patients to all others (P = .02). Physicians who dictated their charts spent 34% less time (2.1 minutes per patient) charting than those who typed them.</p><p><strong>Conclusion: </strong>The average time to see an ambulatory ED patient was 21.7 minutes. Low-acuity urgent care patients take longer to assess now than 20 years ago. The CTAS alone is a poor marker of workload for ambulatory patients, necessitating a reassessment of staffing and compensation formulas.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"804-809"},"PeriodicalIF":2.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837996","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":"Outcomes of Copperhead Snake Envenomation Managed in a Clinical Decision Unit.","authors":"Mary A Wittler, Brian Hiestand, Amlak Bantikassegn, David M Cline, Jennifer L Hannum","doi":"10.5811/westjem.20369","DOIUrl":"10.5811/westjem.20369","url":null,"abstract":"<p><strong>Objectives: </strong>Copperhead envenomations are the most common snakebite in the United States, and the majority are categorized as mild-moderate severity. The need for prolonged observation to monitor for signs of envenomation supports observation in a clinical decision unit (CDU). To our knowledge, no articles to date have reported on the clinical outcomes of patients managed in a snakebite CDU protocol.</p><p><strong>Methods: </strong>We performed a five-year structured, retrospective cohort study of adult patients managed in a single-center CDU, compared to a 10-year period of historical cohort managed inpatient at the same institution. Several clinical parameters were abstracted for comparison. The primary outcome was effective management in CDU observation as measured by length of stay (LOS), disposition, and documented return for care within the hospital system. Secondary outcomes were management comparisons between groups, as measured by LOS, frequency of antivenom use and vials administered, and surgical interventions.</p><p><strong>Results: </strong>The two cohorts included 59 patients on CDU observation protocol compared to 36 patients as historical inpatient management. Fifty-four patients (92%) were discharged from observation. Five patients converted to inpatient admission, mostly secondary to uncontrolled pain. After discharge, six patients in the CDU cohort (10.2%) returned for care within the network for wound checks and/or concern for extremity swelling; all were discharged. Compared to the inpatient cohort, patients managed in CDU observation had shorter LOS, less antivenom administered, and fewer surgical interventions.</p><p><strong>Conclusion: </strong>Copperhead snakebites can be managed effectively in clinical decision unit observation. The majority of patients were discharged from observation with few return visits. Few patients required admission; those who did were secondary to pain control issues. Anticipated gains of CDU observation are shortened length of stay and lower resource utilization.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"1062-1069"},"PeriodicalIF":2.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837984","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 Twice-weekly Scheduled Dialysis Through the Emergency Department for Patients with End-stage Renal Disease.","authors":"Shilpa Raju, Micah Ownbey, Jennifer Cotton, Jamal Jones, Jo Abraham, Christy Hopkins, Emad Awad","doi":"10.5811/westjem.31053","DOIUrl":"10.5811/westjem.31053","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with end-stage renal disease (ESRD) who do not have access to standard dialysis often rely on emergency-only dialysis (EOD) through the emergency department (ED). Compared to standard dialysis, EOD leads to higher hospitalization rates, hospital days, and higher mortality. Our objective in this this study was to examine hospitalization rates and total hospital days after transitioning patients with ESRD from ED EOD to scheduled ED dialysis, and subsequently to standard outpatient dialysis.</p><p><strong>Methods: </strong>We performed this retrospective study at a single, academic teaching hospital over the course of 10 years (2014-2023). Patients >18 years of age who received dialysis primarily through the ED for more than one year were included in the study. We studied two cohorts. Cohort 1 consisted of patients with ESRD who transitioned from ED EOD to twice-weekly ED dialysis. Cohort 2 was composed of patients who were transitioned from twice-weekly ED dialysis to standard outpatient dialysis. We performed paired patient analysis using the Wilcoxon signed-rank test. Primary outcomes included hospitalizations per month and total hospital days.</p><p><strong>Results: </strong>Overall, there were seven patients in cohort 1 (mean age 39 years, 86% female) and 20 patients in cohort 2 (mean age 44, 50% female). Patients who transitioned to twice-weekly ED dialysis from ED EOD had lower hospitalizations per month (1.44 vs 0.26, P <.05) and fewer total hospital days per month (2.18 vs 1.20, P < .05). Patients who transitioned from twice-weekly scheduled ED dialysis to standard outpatient dialysis had even lower hospitalizations per month (0.10 vs 0.02, P < .01) and total hospital days (0.31 vs 0.08, P < .01).</p><p><strong>Conclusion: </strong>Introducing scheduled twice-weekly ED dialysis sessions for unfunded patients with end-stage renal disease was associated with lower overall hospitalization rates and hospital days than emergency-only dialysis. These measures were decreased further after transitioning patients from ED scheduled dialysis to standard dialysis.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"1047-1054"},"PeriodicalIF":2.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837975","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 Medical Student Involvement on Emergency Department Outcomes: A Tertiary Center Analysis.","authors":"Ryan Ballard, Asfia Qureshi, Chengu Niu, Keith Grams, Mathew Devine, Nagesh Jadhav, Richard Alweis","doi":"10.5811/westjem.42229","DOIUrl":"10.5811/westjem.42229","url":null,"abstract":"<p><strong>Introduction: </strong>Increasing patient use of emergency departments (ED) and overcapacity threaten both efficiency of the care provided and the teaching mission. We investigated the influence of medical student (MS) involvement on ED throughput, resource use, and clinical outcomes, and we addressed gaps in existing literature that primarily focus on resident physicians and singular throughput metrics.</p><p><strong>Methods: </strong>We conducted a retrospective observational analysis of 123,503 encounters with patients >21 years of age at an urban, tertiary-care hospital, comparing cases with and without MS participation. We excluded patients seen by advanced practice practitioners. We compared continuous variables using t-tests with bootstrap, and categorical variables by chi-square tests. Continuous variables were reported with mean and standard deviation.</p><p><strong>Results: </strong>We analyzed patient encounters both with and without MS coverage across various complexity levels from January 1, 2022-December 31, 2023. Of the 123,503 patient encounters, 9,635 (7.8%) involved MS participation, and 113,868 (92.2%) did not. Across all encounters, door-to-physician time showed no significant difference between encounters with (28.1 minutes ± 38.6) and without medical students (28.4 minutes ± 38.0; P = .435), while door-to-triage and arrival-to-disposition time (292.6 minutes ± 193.7 vs 270.4 minutes ± 532.8; P < .001) and doctor-to-disposition time (266.8 minutes ± 186.1 vs. 242.9 minutes ± 376.4; P < .001) were significantly longer. In high-complexity encounters, patients seen with medical students experienced shorter door-to-physician (26.6 vs 28.2 minutes, P < .001), door-to-triage (13.6 vs 14.5 minutes, P = .03), arrival-to-disposition (301.1 vs 307.7 minutes, P = .02), and doctor-to-disposition times (275.2 vs 281.3 minutes, P =.02).</p><p><strong>Conclusion: </strong>We found that medical student involvement is associated with longer patient stays in low- to medium-complexity cases but improved efficiency in the management of high-complexity cases. Increased rates of some diagnostic imaging and higher admission rates occurred with medical students. Our single-center design highlights the need for multicenter validation of these findings to inform future resource allocation and educational strategies in the ED.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"773-780"},"PeriodicalIF":2.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837974","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":"Fears Related to Blood-Injection-Injury Inhibit Bystanders from Giving First Aid.","authors":"András N Zsido, Botond Laszlo Kiss, Julia Basler, Bela Birkas","doi":"10.5811/westjem.35869","DOIUrl":"10.5811/westjem.35869","url":null,"abstract":"<p><strong>Introduction: </strong>Prehospital emergency care is vital for saving lives, and increasing bystander involvement can improve survival and recovery. One potential barrier to providing first aid is blood-injury injection (BII) phobia, which affects up to 20% of people, with 3-5% experiencing severe fear. Identifying such barriers may help tailor interventions to encourage willingness to provide first aid.</p><p><strong>Methods: </strong>We developed and validated the Probability of Giving First-aid Scale (PGFAS), a six-item questionnaire, using the polytomous Rasch Model to assess reliability and validity. The PGFAS was then used to examine how anxiety and disgust-sensitivity related to BII phobia impact the likelihood of providing medical assistance.</p><p><strong>Results: </strong>Fear of injections and blood draws (β = -0.0987), blood (β = -0.0897) and mutilation (β = -0.1205) significantly reduced the likelihood of giving first aid. However, fear of sharp objects, medical examinations, symptoms of illness, disgust sensitivity, and contamination fear did not have a significant effect.</p><p><strong>Conclusion: </strong>The Probability of Giving First-aid Scale may serve as a screening tool to identify individuals less likely to provide first aid and could be useful in assessing first-aid training effectiveness. Our findings highlight the importance of preparing first-aid responders and incorporating activities that reinforce helper identity into training programs.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"970-977"},"PeriodicalIF":2.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837971","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":"Pupillometry in the Emergency Department: A Tool for Predicting Patient Disposition.","authors":"Hector Gonzalez, Yanying Chen, Newton Addo, Debbie Y Madhok","doi":"10.5811/westjem.39912","DOIUrl":"10.5811/westjem.39912","url":null,"abstract":"<p><strong>Introduction: </strong>The ability to accurately assess and predict the disposition of comatose patients from within the emergency department (ED) remains a critical challenge. Traditional methods lack precision and consistency. Our goal was to evaluate the prognostic capability of the neurological pupil index (NPI) in predicting patient disposition from within the ED.</p><p><strong>Method: </strong>This prospective observational study followed 50 comatose patients (Glasgow Coma Scale [GSC] score < 9) who were enrolled via convenience sampling and subsequently treated in the ED at a Level 1 trauma center and public safety-net hospital in San Francisco, CA. We calculated NPI scores and collected data on patient demographics, clinical characteristics, and outcomes. The NPI scores were categorized into three groups: 0 (very poor); 0.1-3.0 (poor to moderate); and 3.1-5.0 (good). We used ANOVA, the Pearson chi-squared test, Wilcoxon rank-sum test, and Fisher exact test to assess the association between NPI scores and discharge status. Results were reported as odds ratios with 95% confidence intervals, with a P-value < .05 considered statistically significant.</p><p><strong>Results: </strong>The median age of patients in this study was 58 years (IQR 42-74), and 66% were male. Higher NPI scores (five-point scale with 3.1-5.0 considered normal) were significantly associated with an increased likelihood of ED discharge (82%), , while lower NPI scores (0, nonreactive pupil) were predominantly associated with hospital admission (92%) (P < .001). Significant predictors of discharge status included patient age, GCS scores, and coma etiology.</p><p><strong>Conclusion: </strong>This study highlights the utility of the NPI in predicting patient disposition from within the ED. Higher NPI scores were strongly associated with an increased likelihood of ED discharge. These findings support the idea that NPI has the potential to enhance the accuracy of prognostic assessments, in comparison to subjective characterizations of pupil activity. Additional research with larger, multicenter cohorts are needed to confirm these results and establish standardized protocols for integration of NPI in ED workflow.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"1078-1085"},"PeriodicalIF":2.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837990","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":"Letter of Concern from the Association of Academic Chairs of Emergency Medicine Regarding ACGME Proposed Changes.","authors":"Richard J Hamilton, Lance B Becker, Richard E Wolfe, D Adam Algren, Thomas Arnold, Michael Baumann, Ross P Berkeley, Terrell S Caffery, Chad M Cannon, Theodore J Corbin, Michael E Chansky, Harinder S Dhindsa, Charles L Emerman, David A Farcy, Chris Fox, Michael A Gibbs, Christopher S Goode, Steven Andy Godwin, Dietrich Jehle, David Johnson, Samuel M Keim, Babak Khazaeni, Barry J Knapp, Clint Hawthorne, John D Hoyle, Michael Christopher Kurz, Evan Leibner, Robert McNamara, Robert F McCormack, Edward A Michelson, Chadwick Miller, Ashley Norse, Andrew Nugent, Brian J O'Neil, David T Overton, Edward A Panacek, William F Paolo, Denis R Pauzé, Amanda L Perez, Ralph J Riviello, Scott W Rodi, Peter S Pang, Juan A Gonzalez Sanchez, David Seaberg, Adam Schwartz, Stephen A Shiver, David P Sklar, Ben C Smith, Jeffrey R Stowell, Marc D Squillante, J Jeremy Thomas, Terry Vanden Hoek, Gregory A Volturo, E Lea Walters, Thomas E Wyatt, Donald M Yealy","doi":"10.5811/westjem.48840","DOIUrl":"10.5811/westjem.48840","url":null,"abstract":"<p><p>This letter, signed by over 50 academic chairs of emergency medicine, urges the ACGME to reconsider a proposed mandate requiring all emergency medicine residency programs to adopt a four-year training model. The authors argue that current three-year programs are supported by data demonstrating equivalent educational and clinical outcomes compared to four-year formats. They criticize the flawed survey methodology underpinning the proposal, note the loss of milestone-based training flexibility, and highlight the lack of added scholarly or clinical value in the fourth year. The letter also outlines negative consequences for fellowship participation, workforce development, trainee debt, and diversity. The signatories advocate for maintaining the current flexible training model to preserve excellence, equity, and innovation in emergency medicine education.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"769-772"},"PeriodicalIF":2.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342429/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837981","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":"Disaster Medicine Core Competencies: Comparative Analysis of Emergency Medicine Residency Training in Taiwan and the United States.","authors":"Joyce Tay, Wei-Kuo Chou, Ming-Tai Cheng, Chih-Wei Yang, Shuo-Kuen Huang, Chien-Hao Lin","doi":"10.5811/westjem.24961","DOIUrl":"10.5811/westjem.24961","url":null,"abstract":"<p><strong>Background: </strong>Situated in the western Pacific Ocean, Taiwan has faced a diverse array of natural and man-made disasters. Since 2000, disaster medicine education has been progressively integrated into various medical professions, with a focus on training disaster medical assistance teams, managing chemical and radiological emergencies, and enhancing prehospital and hospital emergency management capabilities. Despite the key roles of emergency physicians (EP) as primary responders and crucial managerial personnel during disasters, a comprehensive assessment of the disaster medicine core competencies (DMCC) required for emergency medicine (EM) residency training might serve as a blueprint for Taiwan's EM residency core curriculum. We sought to survey the most critical DMCCs, prioritize them, and determine their appropriateness for the EM residency training program. We also compare dthe prioritization of DMCCs between Taiwan and the United States.</p><p><strong>Methods: </strong>To accomplish these objectives, we employed a modified Delphi method over three rounds. Initially, three EPs developed a draft of DMCCs for Taiwan. This draft, including 42 DMCCs, was subsequently reviewed by a task force comprising 22 leaders in disaster medicine from EM residency training hospitals across Taiwan. The Delphi method facilitated consensus on the DMCCs through three iterative rounds of polling, with each round evaluating the appropriateness of the proposed competencies. The study also compared the prioritized DMCCs proposed in both Taiwan and the US.</p><p><strong>Results: </strong>The following 15 DMCCs were rated as highly appropriate with high consensus agreement: personal protective equipment (PPE); decontamination; incident command systems; mass casualty incidents; basic concepts and nomenclature of disaster medicine; medical response to chemical emergencies; triage; identification, notification, activation, and information collection; medical response to radiation emergencies; medical response to bioterrorism and biological emergencies; mental health; disaster exercises; prehospital disaster management; communication and information management; and health consequences of different disasters. A comparison with DMCCs in the US revealed shared prioritization for PPE and decontamination competencies. However, Taiwan placed greater emphasis on prehospital disaster operation management, mental health implications, and health consequences across different disasters, while the US focused more extensively on emergency management within hospitals.</p><p><strong>Conclusion: </strong>The expert-consensus-driven ranking of DMCCs in the study showed noteworthy agreement with the US. However, the roles of EPs, experience of previous disasters, and government policies may influence specific competencies. This underscores the importance of incorporating local context into disaster medicine training.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"1095-1104"},"PeriodicalIF":2.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837920","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":"Real-time Patient Experience Surveys Lead to Better Scores.","authors":"Keith Willner","doi":"10.5811/westjem.18713","DOIUrl":"10.5811/westjem.18713","url":null,"abstract":"<p><strong>Introduction: </strong>The patient satisfaction survey is a controversial fixture of modern emergency care. Patients who are satisfied are more likely to adhere to the treatment plan and less likely to pursue legal action. However, the current surveys are susceptible to recall bias. This study uses an analysis of data collected in a separate study to assess how patients rated their physicians' care when asked key questions in person by a trained volunteer versus in the Doctors section of the Press Ganey (PG) survey.</p><p><strong>Methods: </strong>This was an analysis of prospectively collected data obtained in a separate study evaluating how patients experience their emergency care when learners are present. Trained medical student volunteers administered the survey to a convenience sample of patients slated for discharge at a single, community, tertiary-care hospital emergency department (ED) for a total of 12 weeks between June-October 2022. We compared this with the hospital's PG data for the questions on which the survey was based.</p><p><strong>Results: </strong>A total of 625 patients were approached over the study period with 313 agreeing to participate (response rate 50.1%). There were 8,460 patients discharged from the ED during those times (overall rate 3.70%). During the contemporaneous PG study quarter, the ED received 266 responses during the shifts for which the study enrolled patients, of a total 8,460 discharged from the ED during those times (response rate 3.14%). All key questions favored the in-person survey vs mailed PG survey: \"I felt informed\" score 79.2 (262) vs 75.6 (265), P = .02; \"I felt like my [doctor] took time to listen\" 85.0 (261) vs 79.6 (266), P = .05; and \"satisfaction with care team\" 83.0 (263) vs 74.7 (265), P = .0013.</p><p><strong>Conclusion: </strong>This study shows higher satisfaction scores with an in-person survey. There was also a dramatically improved response rate compared with mail in PG forms, suggesting less recall bias. An absolute 5-point difference in PG score could lead to a relative 30-point change in percentile rank. This was a limited, single-site study whose results are hypothesis-generating but suggest a new pursuit for administrations seeking to improve their scores and possibly better understand patients' experience of their care.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"810-814"},"PeriodicalIF":2.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837992","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":"Randomized Trial of Self-Selected Music Intervention on Pain and Anxiety in Emergency Department Patients with Musculoskeletal Back Pain.","authors":"Charlotte E Goldfine, Jenna M Wilson, Jenson Kaithamattam, Mohammad Adrian Hasdianda, Kate Mancey, Alexander Rehding, Kristin L Schreiber, Peter R Chai, Scott G Weiner","doi":"10.5811/westjem.34871","DOIUrl":"10.5811/westjem.34871","url":null,"abstract":"<p><strong>Introduction: </strong>Acute musculoskeletal back pain is a frequent cause of emergency department (ED) visits, often with suboptimal relief from standard treatments. Recent evidence suggests listening to music may modulate pain and anxiety. In this pilot randomized controlled trial, we evaluated the impact of a brief session of patient-selected music vs noise cancellation on pain severity and anxiety in patients presenting to the ED with back pain.</p><p><strong>Methods: </strong>Patients with acute back pain completed a baseline survey to assess demographics, medication information, and psychosocial factors. The ED patients were randomized to listen to self-selected music or to noise cancellation (control). Patients rated their pain and anxiety (0-10) before and immediately after the intervention. We used analyses of covariance to examine whether post-intervention pain and anxiety differed between the groups, while controlling for baseline trait pain catastrophizing. A mediation analysis was conducted to explore the role of post-intervention anxiety as a mediator of the group difference in post-intervention pain.</p><p><strong>Results: </strong>Forty patients were enrolled with an average age of 47.2 years (range 21 - 81). and 27 patients (68%) were female. At baseline, patients in the music group reported higher pain catastrophizing compared to patients in the noise cancellation group. There were no other group differences in baseline characteristics. Post-intervention, patients in the music group reported significantly lower anxiety (3.0 ± 0.7 vs 5.5 ± 0.7, P = 0.016) and pain severity (6.1 ± 0.4 vs.7.5 ± 0.4, P = 0.037) compared to the noise cancellation group. A mediation analysis showed that post-intervention anxiety partially mediated the association between intervention group (music vs noise cancellation) and post-intervention pain.</p><p><strong>Conclusion: </strong>A brief session of self-selected music resulted in lower pain and anxiety scores than noise cancellation among patients with musculoskeletal back pain in the ED. Patients who listened to music reported lower post-intervention anxiety, which partially contributed to lower post-intervention pain severity.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"1112-1119"},"PeriodicalIF":2.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837991","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}