Western Journal of Emergency Medicine最新文献

{"title":"Hepatitis C Care Cascade in Opioid-Dependent Emergency Department Patients.","authors":"Jordi Garcia-Diaz, Whitney Covington Taylor, Lauren A Walter","doi":"10.5811/westjem.47232","DOIUrl":"https://doi.org/10.5811/westjem.47232","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency departments (ED) have become important venues for hepatitis C (HCV) screening. Similarly, EDs have had increasing engagement in the management and treatment of opioid use disorder (OUD). Persons with OUD are at disproportionate risk for acquiring HCV. We sought to assess the intersection between OUD and HCV care through observing the uptake of HCV screening and subsequent steps in the HCV care cascade in an ED-OUD cohort.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed patients enrolled in an ED-OUD treatment program as a convenience sample subgroup of a larger institutional ED opt-out HCV screening program conducted at a single urban site in Alabama between July 2019-June 2022. Opt-out, nonfocused HCV screening provision was standardized at triage, excluding pregnant and incarcerated individuals. Descriptive analyses were conducted to ascertain screening uptake, positive screening, confirmatory testing, linkage to HCV treatment centers, and initiation of antiviral therapy. Additional patient level demographics considered included sex, race, age, insurance status, and domicile status.</p><p><strong>Results: </strong>Of the approximately 75,000 patients screened annually across the study timeframe, July 2019-June 2022, 359 patients with OUD were enrolled; enrolled participants were more likely to be male (64.9%), white (77.4%), aged 25 to 44 (73.3%), uninsured (80.5%) and housed (80.5%). Only 99 (27.6%) received an HCV antibody (Ab) screening test, 52 (52.5%) of which were positive. Thirty-three patients (63.5%) of the Ab-positive cohort were confirmed HCV viremic or 9.2% of the entire OUD cohort. Three (9.1%) of those with active viremia had documented post-ED HCV-specific care and only one was initiated on direct-acting antiviral therapy. White patients were more likely to be Ab-positive as compared to Black patients (88.5% vs 9.6%); however, Black patients were more likely to have active viremia (15.2%). Antibody-positive females had higher rates of viremia (80.0%) compared to Ab-positive males (53.1%).</p><p><strong>Conclusion: </strong>Screening capture, subsequent RNA-positive linkage to care, and medication initiation rates were suboptimal, revealing opportunities for improvement across the care continuum. Incidence of active HCV viremia in the ED-OUD patient cohort is nine times higher than that in the general population and three times higher than that of the local general ED cohort.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 5","pages":"1393-1401"},"PeriodicalIF":2.3,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Real-time Feedback on the Quality of Cardiopulmonary Resuscitation for Medical Students in Colombia.","authors":"Jose Luis Piñeros-Alvarez, Nelson Esteban Portuguez-Jaramillo, Astrid Lorena Urbano-Cano","doi":"10.5811/westjem.50647","DOIUrl":"https://doi.org/10.5811/westjem.50647","url":null,"abstract":"<p><strong>Introduction: </strong>High-quality cardiopulmonary resuscitation (CPR) is essential to improve survival in cases of cardiac arrest. However, skill acquisition based solely on instructor observation has proven to be limited. In this context, real-time feedback devices emerge as promising tools to optimize CPR training.</p><p><strong>Objective: </strong>In this study our goal was to evaluate the effect of using a real-time feedback device on the quality of CPR performed by medical students at a public university in Colombia.</p><p><strong>Methods: </strong>This was an experimental study with fourth-year medical students, randomly assigned to two groups. Both groups received the same initial theoretical and practical training in basic CPR. Subsequently, the intervention group practiced with a real-time feedback device, while the control group trained without technological feedback. The primary outcome measure was the target of chest compressions, simultaneously meeting both a rate of 100-120 compressions/minute and a depth of 5-6 cm (maximum value: 100%), as well as ventilations delivered within the 500-600 mL volume range. Secondary outcomes included isolated data on compression depth and rate during two simulated scenarios: hands-only CPR for two minutes and five cycles of 30 chest compressions and two ventilations.</p><p><strong>Results: </strong>Of 106 eligible participants, 98 (92.5%) completed the test (46 intervention / 52 control). Regarding the primary outcome, the intervention group showed significantly higher compliance with the compression target compared to the control group (median values: intervention group 31% vs control group 0%, P < .001). In the hands-only CPR test, the intervention group achieved a higher compression target (72% [40.7-81] vs 3.4% [0-40]; P < .05) and better depth control (5.5 cm [5-5.6] vs 6 cm [5.6-6.1]); P < .05], with no differences in rate (P = .71). In the test with cycles of 30 chest compressions and two ventilations, the intervention group performed better, with a higher compression target (73% [5-83] vs 0.5% [0-19]), P< .05) and better depth control (5.5 cm [5-5.8] vs 6 cm [5.9-6.1], P < .05). No significant differences were observed in ventilation. Both groups had a median target completion of 0% with tidal volumes (intervention group, 265 mL; control group, 291 mL), accounting for failure at well below the recommended 500-600 mL.</p><p><strong>Conclusion: </strong>Real-time feedback significantly improved chest compression quality in medical students, although ventilation difficulties persisted. Future research is needed to assess long-term skill retention and clinical application.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 5","pages":"1331-1339"},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Procedural Faculty Development Course for Emergency Physicians Practicing in Community and Academic Settings.","authors":"Ryan Walsh, Charles Lei, Saralyn R Williams, Kurt Smith, Jason Lesnick, Sean Boaglio, Amanda Smith, Michael Olushoga, Jonathan Andereck, Jeremy S Boyd","doi":"10.5811/westjem.61860","DOIUrl":"https://doi.org/10.5811/westjem.61860","url":null,"abstract":"<p><strong>Introduction: </strong>Maintaining competence in high-acuity, low-occurrence (HALO) procedures poses a challenge for emergency physicians as they progress past residency training or practice in lower-acuity settings. Simulation-based deliberate practice offers a feasible method to sustain procedural competence. We developed and evaluated a blended, faculty development procedural curriculum designed to improve confidence and clinical application of HALO skills across a five-hospital emergency medicine (EM) network.</p><p><strong>Methods: </strong>A faculty needs assessment and departmental quality data informed the creation of a 4-hour procedural curriculum course. The blended curriculum included asynchronous precourse procedural guides and videos followed by a 4-hour, in-person deliberate practice session led by peer EM faculty instructors. Year one procedures included cricothyroidotomy, transvenous pacing, catheter thoracostomy, neonatal resuscitation, and peritonsillar abscess drainage. Year two curriculum included fiberoptic nasotracheal intubation, pediatric airway management, ultrasound-guided pericardiocentesis, intraosseous access, lateral canthotomy, balloon tamponade of gastrointestinal hemorrhage, fascia iliaca nerve block, and orthopedic reduction/splinting. All stations used clinical equipment stocked across the enterprise. Anonymous pre- and post-course surveys measured self-reported procedural confidence and global course satisfaction. Procedure billing data and faculty self-report were used to evaluate clinical application.</p><p><strong>Results: </strong>In year one, 62 of 90 (69%) participants completed surveys which demonstrated significant increases in confidence across all procedures (P < .01) with high satisfaction (median 5, IQR 5-5). Year two results were similar: 67 of 87 (77%) completed surveys, again showing significant confidence gains (P < .01) and high satisfaction (median 5, IQR 5-5). Seventy percent (47 of 67) of year two respondents were returning participants; among them, 68% reported performing at least one procedure reviewed in year one. All reported increased confidence during clinical performance. Peritonsillar abscess drainage increased from 14 procedures precourse to 133 in year one and 83 in year two, with 35% performed in regional hospitals. We observed no change in procedure-related quality incidents.</p><p><strong>Conclusion: </strong>Our faculty procedural curriculum offers a framework that emergency departments can use to support faculty in increasing confidence in performing HALO and other low-frequency procedures. Future research should evaluate the durability of this educational approach, including how long the intervention preserves procedural confidence without decay.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 5","pages":"1452-1456"},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prehospital Flumazenil: Five-Year Review of Use, Indications, Outcomes, and Adverse Events in Suspected Benzodiazepine Overdose.","authors":"Cameron G Hanson, Bryan P Beaver, Eric Frantz, Thomas Dunn, Stephen Thornton, Isabel Cava, Ryan C Jacobsen","doi":"10.5811/westjem.62063","DOIUrl":"https://doi.org/10.5811/westjem.62063","url":null,"abstract":"<p><strong>Introduction: </strong>Historically, flumazenil was employed as both a diagnostic aid in unresponsive patients and as an antidote for suspected benzodiazepine overdose in both emergency departments and out-of-hospital settings. However, its prehospital application has been historically constrained by long-standing concerns regarding adverse events, leading many emergency medical service (EMS) systems to restrict or avoid its use. The use of flumazenil in the prehospital setting remains underreported in the literature, despite its inclusion in the treatment protocols of various EMS agencies. We conducted a descriptive analysis of the use of flumazenil by EMS in the out-of-hospital setting across the state of Kansas over a five-year period. We characterize the frequency, indications, patient outcomes, and associated adverse events of flumazenil administration, thereby contributing to a better understanding of its role, safety, and clinical relevance in prehospital care.</p><p><strong>Methods: </strong>We performed a retrospective observational cohort design to evaluate the use of flumazenil by EMS clinicians in the state of Kansas from January 2015-August 2020. Patient care reports documenting prehospital administration of flumazenil were obtained from the Kansas Board of EMS. Data extracted included demographics, indications, initial and subsequent Glasgow Coma Scale (GCS) scores when available, clinical response, and the occurrence of adverse events. Our primary outcome measure was GCS improvement following administration, with secondary outcome measures including patterns and outcomes with flumazenil use in the prehospital setting, clinical response, and occurrence of adverse side effects.</p><p><strong>Results: </strong>A total of 80 cases involving EMS administration of flumazenil were identified with 69 cases meeting inclusion criteria. No seizures or adverse events were associated with flumazenil use (0/69; 95% CI, 0-4.3%), even in administrations with possible contraindications. Of the 69 cases analyzed, 24 cases documented suspected benzodiazepine overdose, all of which documented neurologic improvement (24/24; 95% CI, 87.5-100%), with 17 receiving flumazenil alone and 7 with naloxone coadministration.</p><p><strong>Conclusion: </strong>In this small sample, no adverse events were noted with flumazenil administration in the prehospital setting. Flumazenil administration was commonly associated with documented improvement in GCS in suspected benzodiazepine overdose. These findings suggest that exclusion in EMS protocols based solely on concern for adverse events in the prehospital setting can be reconsidered. Further research is needed to better define its safety, efficacy, and clinical utility in this setting.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 5","pages":"1321-1326"},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravenous Ketamine for Depressed and Suicidal Adolescents in the Emergency Department: A Randomized Double-Blind Trial.","authors":"Tatyana Vayngortin, Ekta Patel, Shamilka Seneviratne, Daniel Lowet, Christian D Saavedra Chavez, Christine Chau, Kathryn Hollenbach, Fareed Saleh, John Kanegaye","doi":"10.5811/westjem.53968","DOIUrl":"https://doi.org/10.5811/westjem.53968","url":null,"abstract":"<p><strong>Introduction: </strong>Adolescents frequently seek care in the emergency department (ED) for behavioral health emergencies. Due to national shortages in staffing, limited opportunities to begin treatment on site in most centers and, thus, the frequent default to elusive inpatient psychiatric beds as a means of stabilization, adolescents may spend prolonged amounts of time boarding in the ED, often without treatment. Ketamine is a rapid-acting antidepressant with emerging evidence in adults, but data are limited on its effectiveness in suicidal youth. We aimed to evaluate the effectiveness of a single dose of intravenous (IV) ketamine on depression and suicidality scores compared to placebo in adolescents with treatment-resistant depression presenting to the ED with suicidal ideation.</p><p><strong>Methods: </strong>We conducted a two-arm randomized double-blind placebo controlled trial on a convenience sample of adolescents 12-17 years of age with treatment-resistant depression (trialed at least two antidepressants for at least four weeks each) who presented to the ED with suicidal ideation requiring psychiatric admission. Exclusion criteria included psychosis, substance abuse disorder, intoxication, developmental delay, aggressive behavior, and medical contraindications to ketamine. Subjects were randomized to receive a single dose of ketamine (0.2 mg/kg IV, maximum 35 mg) or saline placebo over two minutes. They completed the Beck Youth Inventory (BYI) and Suicidal Ideation Questionnaire (SIQ) at baseline and at 1 hour, 3 hours, 1 day, 3 days, and 7 days post-treatment. We compared groups with the Fisher exact and two-sided rank-sum tests. Our primary outcome measure was the proportion of subjects with a reduction of ≥ 50% on the BYI and SIQ within 3 hours after treatment.</p><p><strong>Results: </strong>The 29 subjects (14 placebo, 15 ketamine) did not differ significantly in demographic and clinical characteristics. Despite reductions in BYI and SIQ in both groups, the proportions achieving ≥ 50% reductions did not differ significantly at 1 hour (SIQ: placebo, 0% vs ketamine 14.3 % [P = .48]; BYI Anxiety Inventory: placebo, 0% vs ketamine 21.4% [P = .22]; BYI Depression Inventory: placebo, 0% vs ketamine 15.4% [P = .22]). Differences at 3 hours were less pronounced. Adverse effects were more frequent in the ketamine group, most notably signs of dissociation (7% vs 60%, P = .004), with none after the 1-hour observation period.</p><p><strong>Conclusion: </strong>The ED offers an opportunity to deliver rapid-acting antidepressant treatment for suicidal adolescents. Although low-dose ketamine was not associated with greater reductions in depression or suicidality than placebo, this study demonstrated feasibility and highlights the need for larger studies to determine optimal ketamine dosing, route of administration, and implementation strategies in the ED setting.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 5","pages":"1374-1383"},"PeriodicalIF":2.3,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence-Driven Cost Savings from Emergency Department Chest Pain Patient Evaluation: A Monte Carlo Simulation.","authors":"Christopher W Baugh, Andrew Luo, Christopher Zeuthen, Kian D Samadian, Ricardo E De Armas, Michael Senter-Zapata, Michael J Zellweger, Hans-Peter Brunner-LaRocca","doi":"10.5811/westjem.56973","DOIUrl":"https://doi.org/10.5811/westjem.56973","url":null,"abstract":"<p><strong>Introduction: </strong>Chest pain patients presenting to the emergency department (ED) often require risk stratification through stress testing, which may necessitate hospitalization. This practice contributes to ED crowding by occupying beds with low-risk patients who may derive limited benefit from testing, thereby increasing bed occupancy, prolonging ED boarding times, amplifying crowding, and resource strain. Use of an artificial intelligence (AI)-driven clinical decision support tool improves the detection of obstructive coronary artery disease and focuses diagnostic testing on those most likely to benefit.</p><p><strong>Methods: </strong>We created a Monte Carlo simulation informed by available published inputs and ran 1,000 trials to estimate the national impact of using an AI-driven decision-support tool to reduce avoidable downstream cardiac testing among eligible U.S. ED patients with chest pain. Model inputs included patient demographics, chest pain history, electrocardiogram (ECG) findings, medication use, and lab values (including some nonroutine tests). Our primary outcome was U.S. annual cost savings from reclassifying eligible ED patients using an AI-driven decision-support tool. Secondary outcomes included reductions in short-stay hospitalizations, cancer cases, and cancer deaths due to averted radiation exposure.</p><p><strong>Results: </strong>Universal adoption of an AI-driven decision-support tool was estimated to save a mean (standard deviation) of $675 million ($340 million) by avoiding 688,000 (147,000) downstream cardiac diagnostic tests. This resulted in annual decreases of 537,000 (115,000) hospitalizations, 8.30 million (1.96 million) bed hours, 490 (150) new cancer diagnoses, and 250 (80) cancer deaths.</p><p><strong>Conclusion: </strong>Assuming similar recategorization of patients seen in a European outpatient cohort, widespread adoption of an AI-driven clinical decision-support tool to evaluate U.S. ED patients with suspected obstructive coronary disease could yield substantial benefits by reducing avoidable downstream cardiac testing. By accurately identifying patients who do not require urgent diagnostics, this approach could help mitigate crowding, relieve resource strain, and improve patient flow-supporting a more efficient emergency care system.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 5","pages":"1340-1352"},"PeriodicalIF":2.3,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sustainability in Quality Improvement: Outcomes of a Novel Pediatric Virtual Urgent Care in Ontario, Canada.","authors":"Emma Lim, Julie Strychowsky, Anna C Gunz, Sheena Belisle","doi":"10.5811/westjem.54076","DOIUrl":"https://doi.org/10.5811/westjem.54076","url":null,"abstract":"<p><strong>Introduction: </strong>Virtual care is expected to play an increasingly important role in the Canadian healthcare system, with the 2023-2024 Health Canada Departmental Plan outlining the advancement of digital health solutions as a focal point. However, key outcomes of transitioning from traditional in-person healthcare appointments to a virtual model of care are not yet well-described. Here, we apply the Sustainability in Quality Improvement (SusQI) framework to patients seen in a novel pediatric virtual urgent care (VUC) program to quantify the environmental, economic, and social impacts of virtual care.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of provincial pediatric VUC visits staffed by pediatric emergency physicians and nurse practitioners during the 2020-2025 fiscal years. We focused on three key metrics: (1) economic value, measured as travel costs avoided; (2) environmental value, measured in fuel saved (L) and carbon emissions reduced (kg CO₂ eq); and (3) social value, assessed using Ontario Marginalization (ON-Marg) Index quintiles.</p><p><strong>Results: </strong>A total of 12,900 virtual visits were completed during the study period, 99.9% via the Webex platform. Net savings totaled $998,100. Environmental benefits included 128,700 L of fuel saved and 384,200 kg CO₂ eq emissions avoided. Summary ON-Marg Index scores were similar between groups (2.87 for in-person emergency department (ED) visits; 2.91 for virtual visits). Data collected between July 2023-April 2025 show that 10.6% (353) of visits resulted in subsequent in-person ED presentation.</p><p><strong>Conclusion: </strong>Virtual urgent care resulted in significant financial and environmental savings per visit. These benefits included reduced financial and time burdens for families, lower hospital-related expenditures, improved environmental performance, and diversion of low-acuity cases from the ED. Comparable ON-Marg scores between patients seen virtually and in-person suggest accessibility across socioeconomic groups. These findings indicate that pediatric VUC is a viable complement to traditional care, providing meaningful cost and environmental savings while ensuring equitable access.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 5","pages":"1141-1148"},"PeriodicalIF":2.3,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intubation Practices and Outcomes in Diverse Emergency Departments Within a Single Health System.","authors":"Sarah Gonzalez-Bankich, Emily C Sterrett, Tim Crittenden, Brian Burrows, Joseph Borawski, Neel Kapadia, Beiyu Liu, Emily Greenwald","doi":"10.5811/westjem.61961","DOIUrl":"https://doi.org/10.5811/westjem.61961","url":null,"abstract":"<p><strong>Introduction: </strong>Endotracheal intubation (ETI) is a life-saving procedure commonly performed in emergency departments (ED). Prior research has demonstrated significant variability in ETI experience, practices, and outcomes across EDs. Health systems often include a mix of ED environments, from large academic hospitals to community-based and freestanding EDs. However, little is known about how ETI experiences and outcomes vary within a single health system. Our objective in this study was to compare first-attempt success across three EDs representing different practice environments but within one health system.</p><p><strong>Methods: </strong>This retrospective observational study used institutional data from 1,659 ETI events between November 2021-January 2025 to compare ETI-related outcomes across three EDs representing a spectrum of settings: an academic Level I trauma center (A); a community teaching hospital (B); and a nonteaching community site (C). Our primary outcome measure was first-attempt success. We also assessed adverse airway outcomes and ETI-related patient and procedural characteristics. Chi-square tests evaluated the association of ETI-related outcomes and hospital sites.</p><p><strong>Results: </strong>Annual ED volumes were approximately 82,000 (A), 64,000 (B), and 49,000 (C), with respective ETI encounters per 1,000 patients of 5, 2, and 0.4. The community teaching hospital had the highest first-attempt success rate of 90.2% (B: 331/367; 95% CI, 87.2-93.2), followed by the academic center with 84.6% (A: 1038/1227, 95% CI, 82.6-86.6), and then by the nonteaching community site with 78.5% (C: 51/65; 95% CI, 68.5-88.5) (P = .01). Adverse airway outcomes occurred in 10.5% of ETIs and did not vary significantly between sites (A: 139/1,227 [11.3%]; B: 29/367 [7.9%]; C: 6/65 [9.2%], P = .16). The most common indication was airway protection, followed by altered mental status and cardiopulmonary arrest for all three sites. Trainees performed the majority of ETIs at hospital A (1,096/1,227; 89.3%), while attending physicians predominated at B (295/367; 80.4%) and C (64/65; 98.5%).</p><p><strong>Conclusion: </strong>We found significant variation in first-attempt success between the three ED sites, although overall success and adverse airway outcomes were comparable. These findings suggest that first-attempt success may be impacted by factors such as patient differences, role and training level of laryngoscopists, and inherent site-level differences such as patient volume and acuity.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 5","pages":"1353-1363"},"PeriodicalIF":2.3,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying Social Need Trends Among Emergency Department Super-Users: A Latent Class Analysis.","authors":"Shwath Kumaravel, Emily Parker, Eleanor Friedman, Kimberly A Stanford","doi":"10.5811/westjem.58307","DOIUrl":"https://doi.org/10.5811/westjem.58307","url":null,"abstract":"<p><strong>Introduction: </strong>Frequent emergency department (ED) users, particularly those with high rates of use, often experience complex social determinants of health (SDOH) that contribute to their repeated visits and may lead to adverse health outcomes. Our objective in this study was to characterize the needs most commonly affecting this population, which may support the creation of tailored interventions with a higher chance of success.</p><p><strong>Methods: </strong>This was a retrospective analysis of patients evaluated by an ED social medicine team in a large urban academic ED from May 2021-December 2023. Patients were identified either via frequent ED use (patients with the 10 highest number of visits each month) or referred by ED staff. We assigned 11 categories of medical, mental health, and social needs through chart review and team documentation. The primary outcome was the identification of distinct need-based subgroups among patients with high ED use, using latent class analysis of documented social, mental health, and medical needs.</p><p><strong>Results: </strong>Of the 181 patients, representing approximately 0.4% of the ED patient population, 149 (82.3%) were frequent ED users, with a median of 14 ED visits annually (IQR 8-21), while the rest were referred by ED staff (median 2 visits (1-4.25). The majority were non-Hispanic Black (159, 87.8%) and publicly insured (163, 90.0%). The most common needs were related to housing instability (116, 64.1%) and limited access to outpatient care (112, 61.9%). Latent class analysis revealed four distinct subgroups, all of which included limited access to outpatient care: 1) primarily limited access to outpatient care (40, 22.1%); 2) housing instability and other basic needs (27, 14.9%); 3) housing instability, psychotic disorders, other basic needs, and inability to live independently (23, 12.7%); and 4) housing instability, substance use, and psychotic disorders (91, 50.3%).</p><p><strong>Conclusion: </strong>This analysis identified four distinct need-based subgroups of frequent ED users, suggesting the need for tailored, multifaceted interventions. Housing instability, psychiatric illness, substance use, and outpatient care access were prevalent across groups, underscoring the importance of including resources for these basic needs in any programs developed for this population. Findings support prioritizing coordinated care models, particularly those that incorporate housing, behavioral health, substance use resources, and navigation support, for this vulnerable population.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 5","pages":"1180-1188"},"PeriodicalIF":2.3,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Quality Improvement Campaign Reduces Head and Cervical Spine Imaging in Low-risk Trauma Patients.","authors":"Jude C Luke, Rebecca N Kubick, Heidi J Sucharew, Kayla Winkler, Mary L Giles, Natalie E Kreitzer, Anita L Goel, David O Thompson","doi":"10.5811/westjem.50707","DOIUrl":"10.5811/westjem.50707","url":null,"abstract":"<p><strong>Introduction: </strong>While computed tomography (CT) is invaluable for detecting life-threatening injuries in the emergency department (ED), the literature shows increasing use of head CT and cervical spine CT in low-risk trauma patients without a corresponding rise in injuries identified. These low-yield exams expose patients to avoidable radiation, increase costs, and contribute to inefficiencies in already overburdened EDs. In this study we evaluated the impact of a multimodal quality improvement (QI) campaign to reduce the use of head and cervical spine CT in low-risk trauma patients.</p><p><strong>Methods: </strong>This prospective QI intervention involved two EDs within one healthcare network: an academic trauma center and a community hospital. We collected data on baseline CT use for six months, followed by a 23-month intervention period. Primary outcomes were monthly rates of low-risk trauma head and cervical spine CT per 100 ED patients; secondary outcome was the rate of all-cause CT use per 100 ED patients. We plotted rates over time using u-charts with mean-shift lines. Pre- and post-shift differences were summarized as rate ratios (RR) with 95% confidence intervals, compared using the Poisson test.</p><p><strong>Results: </strong>Use of head CT for low-risk trauma decreased from 5.00 to 4.01 per 100 patients at the academic site (RR = 0.80, 95% CI, 0.75-0.86, P < .001) and from 6.64 to 5.12 per 100 patients at the community site (RR 0.77, 95% CI, 0.73-0.82, P < .001). Use of cervical spine CT for low-risk trauma decreased from 3.36 to 2.83 per 100 patients at the academic site (RR = 0.84, 95% CI, 0.78-0.91, P < .001) and from 4.31 to 3.49 at the community site (RR = 0.81, 95% CI, 0.75-0.87, P < .001). All-cause CT use decreased at the academic site from 53.06 to 47.91 CT exams per 100 patients [RR = 0.90, 95% CI, 0.89-0.92, P < .001] but remained unchanged at the community site.</p><p><strong>Conclusion: </strong>A structured quality improvement campaign led to a significant reduction in the use of head and cervical spine CT in low-risk trauma patients. These findings provide a framework for promoting evidence-based imaging practice.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 4","pages":"947-955"},"PeriodicalIF":2.3,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673851","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}