Western Journal of Emergency Medicine最新文献

{"title":"National Study of Firearm Presence and Storage Practices in Homes of Rural Adolescents.","authors":"Benjamin Linden, Megan Sinik, Kristel Wetjen, Pam Hoogerwerf, Junlin Liao, Charles Jennissen","doi":"10.5811/westjem.35252","DOIUrl":"10.5811/westjem.35252","url":null,"abstract":"<p><strong>Introduction: </strong>Firearm-related unintentional and suicide death rates in adolescents are higher in rural areas. In 2020, the overall rural firearm death rate was 28% higher than the urban rate. Firearm access significantly increases the risk. The study objective was to evaluate firearm exposure and storage practices in the homes of rural adolescents.</p><p><strong>Methods: </strong>We conducted a cross-sectional, anonymous survey of attendees at the 2021 National FFA (formerly Future Farmers of America) Convention & Exposition. Descriptive, bivariate, and multivariable logistic regression analyses were performed.</p><p><strong>Results: </strong>A total of 3,296 adolescents 13-18 years of age participated in our survey. Overall, 87% of respondents reported having rifles/shotguns, 71% had handguns, and 69% had both rifles/shotguns and handguns in their homes. The odds of those living on farms having rifles/shotguns and handguns were 7.5 and 2 times higher, respectively, as compared to those from towns. Rifles/shotguns and handguns were stored unlocked and/or loaded at least some of the time in 63% and 64% of homes, respectively. Respondents from farms had 1.5 and 1.7 times greater odds of having rifles/shotguns and handguns stored unlocked and loaded, respectively, as compared to those from town. The South, West and Midwest had odds that were 5.9, 3.2, and 2.8 times higher for rifles/shotguns and 8.1, 5.2, and 4.3 times greater for handguns to be stored loaded and unlocked, respectively, as compared to the Northeast. Only 43% of respondents reported ammunition being locked and stored separately from firearms.</p><p><strong>Conclusion: </strong>Most rural adolescents surveyed lived in homes with firearms, and a large proportion of those firearms were not stored safely. Firearm presence and storage differed by region and home setting. Unsafe storage practices could be contributing to the higher unintentional and suicide death rates seen in rural areas.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"632-642"},"PeriodicalIF":1.8,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498140","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":"Variations in Out-of-Hospital Cardiac Arrest Resuscitation Performance and Outcomes in Ohio.","authors":"Michelle M J Nassal, Henry E Wang, Jonathan R Powell, Justin L Benoit, Ashish R Panchal","doi":"10.5811/westjem.19422","DOIUrl":"10.5811/westjem.19422","url":null,"abstract":"<p><strong>Introduction: </strong>Understanding characteristics of top-performing emergency medical service (EMS) agencies and hospitals can be an important tool for improving community out-of-hospital cardiac arrest (OHCA) care. We compared deidentified EMS and hospital-level variations in OHCA performance and outcomes in Ohio.</p><p><strong>Methods: </strong>We analyzed adult OHCA data from the 2019 Ohio Cardiac Arrest Registry to Enhance Survival (Ohio CARES). We limited the analysis to EMS agencies and receiving hospitals with ≥10 OHCA episodes. The primary outcomes were return of spontaneous circulation (ROSC) and survival to hospital discharge. We compared OHCA outcomes between EMS agencies using linear mixed models, with EMS agency as a random effect and adjusting for Utstein variables. We repeated the analysis by receiving hospital. We compared EMS agency population demographics, response times, and resuscitation characteristics of the top 10% of agencies against remaining agencies using chi-squared tests.</p><p><strong>Results: </strong>We included 2,841 OHCA among 44 EMS agencies in our analysis. The ROSC varied three-fold; mean 27.9%, range 15.8%‒51.0%. Among 40 hospitals, survival varied two-fold; mean 12.9%, range 8.1%‒19.0%. Top-performing EMS agencies included both medium- and large-sized agencies that tended to treat younger patients (59 vs 62 years, P<0.01) in public areas (15.7% vs 12.3%, P<0.01). There were no differences in bystander-witnessed arrest, bystander cardio-pulmonary resuscitation (CPR), or EMS response time. However, top-performing EMS agencies used less mechanical CPR (61.7% vs 76.0%, P<0.01) and were more successful in advanced airway placement (89.6% vs 74.8% P<0.01).</p><p><strong>Conclusions: </strong>The ROSC and survival after out-of-hospital cardiac arrest varied across EMS agencies and hospitals in Ohio. Top-performing EMS agencies exhibited unique demographic characteristics, used less mechanical CPR, and were more successful in airway placement. These variations in OHCA care and outcomes can indicate opportunities for system improvement in Ohio.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"541-548"},"PeriodicalIF":1.8,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498183","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":"Simulation-based Training Changes Attitudes of Emergency Physicians Toward Transesophageal Echocardiography.","authors":"Michael Danta, Alyssa Y Nguyen-Phuoc, Suman Gupta, Aneri Sakhpara, Jeanette Kurbedin, Errel Khordipour, Antonios Likourezos, Lawrence Haines, Amish Aghera, Jefferson Drapkin, Judy Lin","doi":"10.5811/westjem.20788","DOIUrl":"10.5811/westjem.20788","url":null,"abstract":"<p><strong>Objective: </strong>The American College of Emergency Physicians recommends that transesophageal echocardiography (TEE) be used to \"maintain the standard of ultrasound-informed resuscitation\" in cardiac arrest. To date, no standards exist on how to train emergency physicians (EP) on TEE use in the emergency department (ED). We propose a novel educational paradigm using simulation to train EPs on the use of TEE in cardiac arrest.</p><p><strong>Methods: </strong>A total of 63 EPs at a single-center academic teaching hospital participated in a 90-minute simulation-based education session to summarize the use of TEE in cardiac resuscitation and practice related procedural skills. The session consisted of a simulated cardiac arrest scenario using both transthoracic echocardiography (TTE) and TEE and hands-on practice on a high-fidelity TEE task trainer. Participants filled out anonymous surveys before and after the training session, which evaluated their subjective attitudes toward TEE, knowledge of its role in cardiac arrest, and perceived efficacy of the curriculum in introducing the modality.</p><p><strong>Results: </strong>Survey results indicated fewer perceived barriers to performing TEE in resuscitation after completion of the course, with statistically significant decreases in the following: not understanding image acquisition (85.5% pre vs 27.4% post; P<0.001), interpretation (66.1% pre vs 25.8% post; P<0.001), indications (29.0% pre vs 0.0% post; P<0.001), contraindications (35.5% pre vs. 3.2% post; P<0.001), and the potential benefit for the patient (24.2% pre vs 3.2% post; P <0.001). Finally, 68% of EPs stated they were \"extremely likely\" to use TEE in cardiac arrest with the availability of assistance from a credentialed attending.</p><p><strong>Conclusion: </strong>The survey responses suggest that a short, simulation-based course can generate interest in the incorporation of TEE in cardiac resuscitation as well as overcome many of the perceived barriers regarding TEE. Moreover, they suggest that the participating academic EPs would be interested in using TEE in critical patients in the future when available.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"465-468"},"PeriodicalIF":1.8,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498169","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":"Feasibility of an Emergency Department-based Food Insecurity Screening and Referral Program.","authors":"Victor Cisneros, Ian Dennis Capo Olliffe, Marco Santos Esteban, Joseph Bui, Armin Takallou, Shahram Lotfipour, Bharath Chakravarthy","doi":"10.5811/westjem.40006","DOIUrl":"10.5811/westjem.40006","url":null,"abstract":"<p><strong>Introduction: </strong>Food insecurity (FI) remains a pervasive issue in the United States, affecting over 12.8% of households. Marginalized populations, particularly those in urban areas, are disproportionately impacted. The emergency department (ED) holds potential as a vital outreach hub, given its diverse patient population and extensive service coverage. In this study we explore the feasibility of implementing an ED-based FI screening and referral program at an urban, academic teaching hospital. We aimed to assess the prevalence of FI among ED patients and evaluate the feasibility of a three- and six-week follow-up to assess patients' FI and related barriers to resource referral utilization.</p><p><strong>Methods: </strong>This single-center, observational study was conducted at an urban, academic ED from 2018-2024. Initial FI screening was performed using a validated two-question survey adapted from the Hunger Vital Sign screening tool. Participants who screened positive were enrolled and completed the 10-item US Department of Agriculture Adult Food Security survey, received a food assistance guide, and were followed up at three- and six-week intervals to assess changes in FI status.</p><p><strong>Results: </strong>Among 6,339 participants, 1,069 (16.9%) experienced FI, with the highest rates among Black non-Hispanic (24.7%) and Spanish-speaking participants (28.7%). Of the 1,069 participants who screened positive for FI, 630 (59.0%) were enrolled in the study. Of the enrolled participants, 161 (25.6%) completed the three-week follow-up phone calls, and 48 (7.6%) completed the six-week follow-up. The mean FI score for these 48 participants decreased from 6.67 (SD 2.68) at enrollment to 4.75 (SD 2.85) at the three-week follow-up (P < 0.001), and to 4.25 (SD 3.48) by the six-week follow-up (P < 0.001). Barriers to using the food resource guide, such as time constraints, transportation, and misplacement of resources, limited many participants' engagement.</p><p><strong>Conclusion: </strong>This study demonstrated the feasibility and effectiveness of an ED-based food insecurity screening and resource referral program, associated with a significant reduction in food insecurity scores among participants. However, barriers such as time constraints, transportation issues, and misplacement of referral materials limited engagement. Addressing these barriers through tailored follow-up and systematic support systems, including universal screening during ED intake and personalized assistance, can enhance the program's accessibility and impact.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"396-405"},"PeriodicalIF":1.8,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498133","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 Systematic Review of Guidelines for Emergency Department Care of Sexual Minorities: Implementable Actions to Improve Care.","authors":"Michael I Kruse, Sawyer Karabelas-Pittman, Grace Northrop, Joanna Stuart, Suneel Upadhye, Blair L Bigham","doi":"10.5811/westjem.20355","DOIUrl":"10.5811/westjem.20355","url":null,"abstract":"<p><strong>Introduction: </strong>Sexual minorities, including lesbian, gay, bisexual, asexual, pansexual, and others make up 4.0-5.4% of the North American population. Stigmatization and minority stress can lead to poorer health status in sexual minorities, and a previous scoping review showed gaps in the emergency medicine (EM) literature for care of sexual minorities. In this review we sought to examine existing guidelines for the care of sexual minorities that made recommendations relevant to care in the emergency department (ED).</p><p><strong>Methods: </strong>Using the PRISMA criteria, we performed a systematic search of OVID Medline, EMBASE, CINAHL, and the grey literature for clinical practice guidelines (CPG) and best practice statements (BPS) published until July 31, 2022. Articles were included if they were in English, included medical care of sexual minority populations of any age, in any setting, region, or nation, and were of national or international scope. Exclusion criteria included primary research studies, systematic or narrative reviews or otherwise non-CPG or BPS statements, editorials or letters to the editor, articles of regional or individual hospital scope, non-medical articles, or if a more recent version of the CPG or BPS existed. We identified, recorded, and assessed for quality all recommendations relevant to using the AGREE-II and AGREE-REX tools. Inter-rater reliability was assessed using the interclass correlation coefficient. We coded recommendations for the relevant point of care while in the ED (triage, registration, rooming, investigations, etc).</p><p><strong>Results: </strong>We excluded 2,413 of 2,534 unique articles. Only nine articles contributed 11 ED-relevant recommendations. Seven of the nine articles were found to be of moderate to high quality; 6 of 11 recommendations were identified as high quality and adaptable. They included recommendations for screening, testing, and care of HIV+ sexual minority populations, and general or trauma care for men who have sex with men and sexual minority populations in general.</p><p><strong>Conclusion: </strong>This is the most comprehensive review of guidance documents for care of sexual minority populations to date. It identifies 11 actionable recommendations for the ED and identifies opportunities for community-led development of comprehensive clinical practice guidelines for care of sexual minority populations in the ED.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"431-440"},"PeriodicalIF":1.8,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498151","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":"Monitoring the Evolving Match Environment in Emergency Medicine 2023.","authors":"Anthony Sielicki, Brian Milman, Andrew Little, Miriam Kulkarni, James Morris, Laura Hopson, Michael Kiemeney","doi":"10.5811/westjem.18562","DOIUrl":"10.5811/westjem.18562","url":null,"abstract":"<p><strong>Introduction: </strong>The 2023 National Residency Matching Program (NRMP) Match in emergency medicine (EM) left 554 spots and 132 EM programs unfilled. The Council of Residency Directors Match Task Force sought to characterize the programs that did and did not fill, learn more about their Supplemental Offer and Acceptance Program (SOAP) applicants, determine residency programs' needs for future NRMP Matches, and inquire what actions program leaders would like to see to promote a healthy future for training in EM.</p><p><strong>Methods: </strong>We conducted a web-based survey of EM residency program leadership during March and April 2023. We generated descriptive statistics from these survey results. Thematic analysis was used for free-text responses.</p><p><strong>Results: </strong>Of 287 programs, 160 (55.7%) responded to the survey, including 59 of 132 programs (44.7%) that did not fill in the Match. Unfilled programs were overall content with the quality of applicants in the SOAP. Programs expressed varying opinions on why fewer students are choosing EM. While most agreed there are concerns about the workforce (78.1%), even more spread exists on what actions should be taken to help support the future of residency training in EM.</p><p><strong>Conclusion: </strong>Here we present data regarding the 2023 Match environment for EM and describe a residency program-level needs assessment and desire for action. Annual review of the Match data and residency program needs should be continued until we see improvement in the Match environment for EM.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"233-240"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721485","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":"Blood Pressure Variability and Outcome Predictors for Traumatic Brain Injury Patients with Diffuse Axonal Injury: A Retrospective Cohort Study.","authors":"Christine E Ren, Anastasia Ternovskaia, Fatima Mikdashi, Hassan Syed, Isha Vashee, Vainavi Gambhir, Natalie Chao, Jessica V Downing, David Dreizin, Quincy K Tran","doi":"10.5811/westjem.20346","DOIUrl":"10.5811/westjem.20346","url":null,"abstract":"<p><strong>Background: </strong>Diffuse axonal injury (DAI), a feature seen in severe traumatic brain injury (TBI), is associated with substantial morbidity and mortality. Although blood pressure variability (BPV) has been shown to impact TBI outcomes overall, its relevance in DAI cases remains uncertain. We investigated whether 24-hour post-injury BPV and other clinical factors were linked to patient outcomes.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of Level I trauma center-admitted TBI patients with radiographic DAI diagnosis (computed tomography/magnetic resonance imaging). Hospital disposition (home, nursing facility, hospice/death) and Glasgow Coma Scale (GCS) on hospital day 5 (HD5GCS) were outcomes of interest. We assessed associations with clinical factors using ordinal logistic regression.</p><p><strong>Results: </strong>Among 153 patients (mean age 49 ±20 years, 74% male), median admission GCS was 5.0 (3.0-12.5), HD5GCS was 8.0 (6.0-11), and median hospital stay was 25 (15.5-34.5) days. The BPV, measured as successive variation in systolic blood pressure (SBP_SV) and standard deviation in systolic blood pressure (SBP_SD), was not significantly associated with hospital disposition. SBP_SV and SBP_SD were also not associated with our secondary outcome of HD5GCS. Initial international normalized ratio (INR) (Coefficient -3.67, odds ratio [OR] 0.03, 95% confidence interval [CI] 0.00-0.70), cerebral contusion (Coeff -2.39, OR 0.09, 95% CI 0.01-0.75), and HD5GCS (Coeff 0.59, OR 1.80, 95% CI 1.30-2.49) were associated with increased odds of discharge to hospice or death. Administration of blood products (Coeff 1.06, OR 2.89, 95% CI 1.10-7.60), vasopressors (Coeff 1.40, OR 4.05, 95% CI 1.37-11.96), and hyperosmolar therapy (Coeff 1.23, OR 3.41, 95% CI 1.36-8.54), and concurrent intraventricular hemorrhage (Coeff 0.99, OR 2.70, 95% CI 0.86-6.49) were linked to poorer HD5GCS.</p><p><strong>Conclusion: </strong>Blood pressure variability was not correlated with outcomes in patients with diffuse axonal injury. Low Glasgow Coma Score on hospital day 5, high initial INR, and concomitant cerebral contusion were associated with poorer outcomes.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"367-377"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721655","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":"Two-year Results of an Emergency Department Night Shift Buy-out Program.","authors":"Charlotte W Croteau, Joshua N Goldstein, Lauren Nentwich, Ali S Raja, Michael VanRooyen, Joshua J Baugh","doi":"10.5811/westjem.20303","DOIUrl":"10.5811/westjem.20303","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency physicians have the highest rates of burnout among our physician peers, with prior literature suggesting clinician schedules can play a significant role in burnout. We assessed our transition from a tenure- and age-based paradigm to an egalitarian, night shift buy-out program that allows schedule flexibility for physicians at all stages of their careers.</p><p><strong>Methods: </strong>The night shift buy-out program was implemented in the emergency department (ED) of an academic, quaternary-care center that treats approximately 100,000 adult patients annually with 56 faculty emergency physicians. We sought to create a cost-neutral program, carefully balancing incentives between nocturnists and those wanting to reduce allotted night shifts. Ultimately, the program was designed to allow all faculty to buy out of any number of nights for $500 per night shift, with the funds generated used to increase nocturnist salaries. We analyzed two years of the program (July 2022-June 2024) to assess trends in night shift buy-outs, the primary outcome. We also conducted an all-faculty survey after the program's first year to gauge sentiments about the program.</p><p><strong>Results: </strong>Over two years, 22 faculty (42%) fully bought out of nights; an additional 10 (15%) bought out of some nights. By year two, the program could grant all faculty their preferred night-shift allotment. Faculty who bought out fully had worked longer in EM on average, worked fewer clinical hours per year, were more likely to be associate/full professors, and were less likely to be women. Nocturnists had the highest mean clinical hours of the four groups, had the lowest average tenure, and were least likely to be associate/full professors. A total of 86% of faculty responded to the survey, to which more than 80% of those buying out reported that reducing the night-shift burden was either \"very important\" or \"critical for continuing in this job.\"</p><p><strong>Conclusion: </strong>Our academic ED transitioned from a tenure- and age-based, overnight shift paradigm to an egalitarian buy-out program that allows physicians flexibility at all career stages. This approach could improve career satisfaction and reduce burnout among emergency physicians.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"290-294"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721608","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":"Push and Pull: What Factors Attracted Applicants to Emergency Medicine and What Factors Pushed Them Away Following the 2023 Match.","authors":"Michael Kiemeney, James Morris, Lauren Lamparter, Moshe Weizberg, Andy Little, Brian Milman","doi":"10.5811/westjem.21249","DOIUrl":"10.5811/westjem.21249","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency medicine (EM) historically enjoyed a nearly 100% match rate. A rapid change saw 46% of EM programs with one or more unfilled positions after the 2023 Match. Much has been discussed about potential causes, and characteristics of unfilled programs have been investigated. We surveyed recent applicants to EM to further understand what continues to draw them to EM and what concerns deter them from choosing a career in EM.</p><p><strong>Methods: </strong>A cross-sectional, mixed methods survey was distributed in the summer of 2023 to a convenience sample of respondents via the listservs of national EM resident and student organizations as well as clerkship directors in EM. We did not calculate response rate due to listserv convenience sampling. A total of 213 responses were received, representing 7.7% of the total number of EM applicants (2,765) in 2023. Applicants were asked to rank from 1 to 5 their experiences with EM and the characteristics of the specialty that were important in their career decision. We calculated means and 95% confidence intervals for quantitative results. We performed qualitative analysis of free-text responses to identify themes.</p><p><strong>Results: </strong>Positive factors for applicants were interactions with EM faculty (4.29 on 1-5 scale) and residents (4.42) as well as clinical experiences in third-year (4.53) and fourth-year clerkships (4.62). Applicants continue to be drawn to EM by the variety of pathology encountered (4.66), flexible lifestyle (4.63), and high-acuity patient care (4.43). Most applicants (68.5%) experienced advisement away from EM. Of those who received negative advisement, non-emergency physicians were the most common source (73.3%). Factors negatively influencing a career choice in EM were corporate influence (2.51), ED crowding (2.52), burnout (2.59), presence of advanced practice practitioners (APP) in EM (2.63), and workforce concerns (2.85). Job concerns stemming from the 2021 EM workforce report were identified by respondents as the primary reason for recent Match results.</p><p><strong>Conclusion: </strong>Applicants noted clinical experiences in the emergency department and interactions with EM attendings and residents as positive experiences. High-acuity patient care, variety of pathology, and flexible lifestyle continue to attract applicants. Applicants identified EM workforce concerns as the primary contributor to recent EM Match results. Corporate influence, ED crowding, burnout, and presence of APPs in the ED were also significant issues.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"261-270"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721601","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 Between Social Risk Factors and Emergency Department Use: National Health Interview Survey 2016-2018.","authors":"Iraa Guleria, Jennifer A Campbell, Abigail Thorgerson, Sanjay Bhandari, Leonard E Egede","doi":"10.5811/westjem.18616","DOIUrl":"10.5811/westjem.18616","url":null,"abstract":"<p><strong>Background: </strong>Evidence shows that social risks are highly prevalent in the patient population that presents to the emergency department (ED) for care; however, understanding the relationship between social risk factors and ED utilization at the population level remains unknown.</p><p><strong>Methods: </strong>We used the National Health Interview Survey from the 2016-2018 sample adult files. The sample included 82,364 individuals, representing a population size of 238,888,238. The primary independent variables included six social risk factors: economic instability; lack of community; educational deficit; food insecurity; social isolation; and inadequate access to care. The outcome included ED use in the prior year. Covariates included age, race/ethnicity, insurance status, obesity, mental health (depression/anxiety), and comorbidities. We ran logistic regression models to test the relationship between the independent and dependent variables adjusting for covariates.</p><p><strong>Results: </strong>In the study sample, 20% had at least one ED visit in the prior year. In the fully adjusted model, individuals reporting economic instability (odds ratio [OR] 1.33, 95% confidence interval [CI] 1.25-1.42), lack of community (OR 1.10, 95% CI 1.05-1.15), educational deficit (OR 1.12, 95% CI 1.06-1.18), food insecurity (OR 1.77, 95% CI 1.66-1.89), and social isolation (OR 1.32, 95% CI 1.26-1.39) had significantly higher odds of ED use. Inadequate access to care was significantly related to lower odds of ED use (OR 0.75, 95% CI 0.69-0.81).</p><p><strong>Conclusions: </strong>Social risk factors are significantly associated with higher odds of ED use in the United States adult population. Interventions that integrate social and medical needs are greatly needed, as is understanding the role that preventive medicine may play in reducing avoidable ED visits.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"307-314"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721605","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}