Western Journal of Emergency Medicine最新文献

{"title":"Weighing In.","authors":"Iyesatta M Emeli, Patrick G Meloy","doi":"10.5811/westjem.18690","DOIUrl":"10.5811/westjem.18690","url":null,"abstract":"","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 6","pages":"946-948"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772759","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 Emergency Department-Initiated HIV Pre-Exposure Prophylaxis.","authors":"Ezra Bisom-Rapp, Kishan Patel, Katrin Jaradeh, Tuna C Hayirli, Christopher R Peabody","doi":"10.5811/westjem.33611","DOIUrl":"10.5811/westjem.33611","url":null,"abstract":"<p><strong>Introduction: </strong>Pre-exposure prophylaxis (PrEP) for HIV-using antiretroviral medication in non-infected individuals to prevent HIV-has immense potential to slow the spread of the virus. However, uptake has been insufficient, and stark racial disparities exist in both HIV acquisition and PrEP usage, making PrEP access a health equity issue. A promising venue to engage high-risk populations in PrEP care is the emergency department (ED); however, existing ED PrEP initiatives have been costly or have had limited success. We hypothesize that two strategies could overcome these barriers: prescribing PrEP during an ED visit and providing patients with an initial supply of PrEP medication in the ED. Here, we describe the results of a qualitative study exploring multidisciplinary emergency clinicians and HIV clinicians' needs and views about the feasibility of such an initiative.</p><p><strong>Methods: </strong>We conducted 22 semi-structured interviews with multidisciplinary clinicians from an urban, safety-net medical center in the ED and the on-site HIV clinic that provides PrEP services. We performed thematic analysis to summarize challenges and potential solutions described by participants.</p><p><strong>Results: </strong>Participants' responses fell into three thematic categories: operational challenges; patient-level considerations; and potential impacts. Operational challenges highlighted the difficulty of PrEP initiation in a busy ED and clinician support needs. Patient-level considerations included the complex psychosocial needs of ED patients who could benefit from PrEP. Finally, participants anticipated that an ED-based PrEP initiation program could positively impact both individual patients and public health.</p><p><strong>Conclusion: </strong>Interviews with emergency department and HIV clinic staff revealed important considerations and potential solutions for ED-initiated PrEP workflows. Clinicians in both specialties were enthusiastic about such an initiative, which could facilitate its success. This study lays the groundwork for the future design of an efficient and innovative workflow to leverage the ED as an essential entry point into HIV prevention services.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 6","pages":"985-992"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency Department Food Insecurity Screening, Food Voucher Distribution and Utilization: A Prospective Cohort Study.","authors":"Alexander J Ulintz, Seema S Patel, Katherine Anderson, Kevin Walters, Tyler J Stepsis, Michael S Lyons, Peter S Pang","doi":"10.5811/westjem.18513","DOIUrl":"10.5811/westjem.18513","url":null,"abstract":"<p><strong>Objective: </strong>Food insecurity is a prevalent social risk among emergency department (ED) patients. Patients who may benefit from food insecurity resources may be identified via ED-based screening; however, many patients experience difficulty accessing resources after discharge. Co-locating resources in or near the ED may improve utilization by patients, but this approach remains largely unstudied. This study characterized the acceptance and use of a food voucher redeemable at a hospital food market for patients who screened positive for food insecurity during their ED visit.</p><p><strong>Methods: </strong>This prospective cohort study, conducted at a single county-funded ED, included consecutive adult patients who presented on weekdays between 8 AM-8 PM from July-October 2022 and consented to research participation. We excluded patients who required resuscitation on arrival or could not provide written informed consent in English. Study participants completed a paper version of the two-question Hunger Vital Sign screening tool, administered by research staff. Participants who screened positive received a uniquely numbered $30 food voucher redeemable at the hospital's co-located food market. Voucher redemption was quantified through regular evaluation of market receipt records at 30-day intervals. The primary outcome was the proportion of redeemed vouchers. Secondary outcomes included the proportion of participants screening positive for food insecurity, proportion of participants accepting vouchers, and associated descriptive statistics.</p><p><strong>Results: </strong>Of the 396 eligible individuals approached, 377 (95.2%) consented and completed food insecurity screening. Most were middle-aged (median 53 years, interquartile range 30-58 years), 191 were female (50.4%), 242 were Black (63.9%), and 343 were non-Hispanic (91.0%). Of the participants, 228 (60.2%) screened positive for food insecurity and 224 received vouchers (98.2%), of which 86 were redeemed (38.4%) a median of nine days after the ED visit.</p><p><strong>Conclusion: </strong>A high proportion of participants screened positive for food insecurity and accepted food vouchers; however, less than half of all vouchers were redeemed at the co-located food market. These results imply ED food voucher distribution for food insecurity is feasible, but co-location of resources alone may be insufficient in addressing the social risk and alludes to a limited understanding of facilitators and barriers to resource utilization following ED-based social needs screening.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 6","pages":"993-999"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772884","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":"Why Do Patients Opt for the Emergency Department over Other Care Choices? A Multi-Hospital Analysis.","authors":"Charles W Stube, Alexander S Ljungberg, Jason A Borton, Kunal Chadha, Kyle J Kelleran, E Brooke Lerner","doi":"10.5811/westjem.18647","DOIUrl":"10.5811/westjem.18647","url":null,"abstract":"<p><strong>Introduction: </strong>There are several options for receiving acute care besides emergency departments (ED), such as primary care physician (PCP) offices, urgent care centers (UCC), and telehealth services. It is unknown whether these alternative modes of care have decreased the number of ED visits for patients or whether they are considered before visiting the ED. A comprehensive study considering all potential methods of care is needed to address the evolving landscape of healthcare. Our goal was to identify any factors or barriers that may have influenced a patient's choice to visit the ED as opposed to a UCC, PCP, another local ED, or use telehealth services.</p><p><strong>Methods: </strong>We surveyed ED patients between three hospital sites in the greater Buffalo, NY, area. The survey consisted of questions regarding the patients' reasons and rationale for choosing the ED over the alternative care options. The study also involved a health record review of the patients' diagnoses, tests/procedures, consults, and final disposition after completion of the survey.</p><p><strong>Results: </strong>Of the 590 patients consented and surveyed, 152 (25.7%) considered seeking care at a UCC, 18 (3.1%) considered telehealth services, and 146 (24.7%) attempted to contact their PCP. On the recommendation of their PCP, patients presented to the ED 110 (20.7%) times and on the recommendation of the clinician at the UCC 54 (9.2%) times. Patients' perceived seriousness of their condition was the most common reason for their selected mode of transport to the ED and reason for choosing the ED as opposed to alternative care sites (PCP, UCC, telehealth). Based on criteria for an avoidable ED visit, 83 (14.1%) ED patients met these criteria.</p><p><strong>Conclusion: </strong>Individuals prioritize the perceived severity of their condition when deciding where to seek emergency care. While some considered alternatives (PCP, UCC, telehealth services), uncertainties about their condition and recommendations from other clinicians led many to opt for ED care. Our findings suggest a potential gap in understanding the severity of symptoms and determining the most suitable place to seek medical care for these particular conditions.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 6","pages":"921-928"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772762","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":"An Assessment of the Presence of <i>Clostridium tetani</i> in the Soil and on Other Surfaces.","authors":"Michael Shalaby, Alessandro Catenazzi, Melissa F Smith, Robert A Farrow Ii, David Farcy, Oren Mechanic, Tony Zitek","doi":"10.5811/westjem.18702","DOIUrl":"10.5811/westjem.18702","url":null,"abstract":"<p><strong>Introduction: </strong>Standard emergency medicine practice includes tetanus vaccine administration as part of wound care management for patients who are not fully immunized. Since there have been no available studies in the United States reaffirming the prevalence of <i>Clostridium tetani (C tetani)</i> since 1926, we sought to identify its prevalence in a major urban county in the US.</p><p><strong>Methods: </strong>We sampled soil, rusted metal, concrete, and dog feces to determine the prevalence of <i>C tetani</i> in a single metropolitan county in the United States. Soil samples and swabs were collected from four locations: the soil of a public park and an elementary school; dog feces from a single public dog park; and rusted surfaces (metal and concrete) in common student areas of a university campus. The presence of <i>C tetani</i> in each sample was determined using a quantitative polymerase chain reaction.</p><p><strong>Results: </strong>In total, 200 samples were collected, of which 37 (18.5%) tested positive for <i>C tetani</i> DNA. Among the 140 samples taken from the soil, just one (0.7%) tested positive for <i>C tetani</i> DNA. Of the 40 samples of rusted metal and concrete surfaces, 30 (75%) tested positive for <i>C tetani</i>, and six (30%) of the 20 samples from dog feces tested positive for <i>C tetani</i>.</p><p><strong>Conclusion: </strong>We found that <i>C tetani</i> is frequently present on rusted metal and concrete surfaces but rarely in soil samples. Minor wounds contaminated with soil may be considered low risk for tetanus. However, future studies should assess the burden of <i>C tetani</i> in other similar urban, suburban, and rural environments to help determine the threat of <i>C tetani</i> more exactly.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 6","pages":"890-893"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772812","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":"Comments on \"Bicarbonate and Serum Lab Markers as Predictors of Mortality in the Trauma Patient\".","authors":"Patrick McGinnis, Samantha Camp, Minahil Cheema, Shriya Jaddu, Quincy Tran, Jessica Downing","doi":"10.5811/westjem.31021","DOIUrl":"10.5811/westjem.31021","url":null,"abstract":"","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 6","pages":"1025-1026"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency Department Patient Satisfaction Scores Are Lower for Patients Who Arrive During the Night Shift.","authors":"Tony Zitek, Luke Weber, Tatiana Nuñez, Luis Puron, Adam Roitman, Claudia Corbea, Dana Sherman, Michael Shalaby, Frayda Kresch, David A Farcy","doi":"10.5811/westjem.20326","DOIUrl":"10.5811/westjem.20326","url":null,"abstract":"<p><strong>Background: </strong>Increasingly, patient satisfaction scores are being used to assess emergency physicians. We sought to determine whether the patient satisfaction scores collected by our hospital system are lower for patients who are treated in the emergency department (ED) on night shifts as compared to those treated on day shifts.</p><p><strong>Methods: </strong>We performed a cross-sectional analysis of patient satisfaction scores from three EDs in Florida. We obtained satisfaction data from NRC Health (the company that provides our surveys) using a random sample of 1,000 completed surveys from patients treated in 2022; we also performed manual chart review to obtain clinical data. The satisfaction surveys asked patients how likely they would be to recommend the facility (from 0-10). Patients who provided a score of 9 or 10 were considered \"promoters.\" For our primary analysis, we compared the percentage of promoters for the day shift encounters (7 AM to 7 PM) to the night shift encounters (7 PM to 7 AM). We also performed a multivariable logistic regression analysis using several demographic and clinical variables to further assess the association between night shift arrival and satisfaction scores.</p><p><strong>Results: </strong>Of the 1,000 surveys analyzed, 66.3% of patients arrived during the day shift, and 33.7% arrived during the night shift. Of those who arrived during the day shift, 525 (79.2%) were promoters compared to 228 (67.7%) of those who arrived during the night shift, a difference of 11.5% (95% confidence interval [CI] 5.7-17.4%), <i>P</i> < 0.001. On multivariable analysis, night shift arrival was associated with a lower chance of a patient being a promoter, with adjusted odds ratio 0.60 (95% CI 0.43-0.84), <i>P</i> = 0.003.</p><p><strong>Conclusion: </strong>Patients who presented to the ED during the night shift were less likely to be promoters than patients who arrived during the day shift. Assessments of patient satisfaction data should account for time of visit and other facility-related and operational characteristics.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 6","pages":"929-937"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772888","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":"Perceptions and Use of Automated Hospital Outcome Data by EMS Providers: A Pilot Study.","authors":"Michael Kaduce, Antonio Fernandez, Scott Bourn, Dustin Calhoun, Jefferson Williams, Mallory DeLuca, Heidi Abraham, Kevin Uhl, Brian Bregenzer, Baxter Larmon, Remle P Crowe, Alison Treichel, J Brent Myers","doi":"10.5811/westjem.21175","DOIUrl":"10.5811/westjem.21175","url":null,"abstract":"<p><strong>Background: </strong>Our primary objective evaluated the perception of emergency medical service (EMS) providers' review of automated hospital outcome data. Secondarily, we assessed participation in outcome review as a means of microlearning to obtain continuing education (CE).</p><p><strong>Methods: </strong>From October-December 2023, three high-volume EMS systems participated in a three-part intervention with results evaluated using a mixed-methods approach. First, EMS providers (emergency medical technicians and paramedics) were invited, via their electronic health record (EHR), to complete a presurvey evaluating their perceptions of reviewing outcomes. Then, EMS providers were notified about the opportunity to earn CE via a microlearning intervention, offering Commission on Accreditation for Pre-Hospital Continuing Education (CAPCE)-approved CE hours for completion of outcome reviews and associated learning modules. Finally, EMS providers were invited to complete a post-survey mirroring the pre-survey. Qualitative analyses identified themes among open-ended responses. Quantitative analyses examined perceptions between pre- and post- surveys.</p><p><strong>Results: </strong>Of 843 providers contacted, 217 responded to the pre-survey (25.7%). The most endorsed rationale for reviewing outcomes included improving clinical knowledge (95%), improving patient care (94%), and knowing whether care made a difference (93%). Nearly all (91%) reported being more likely to review outcomes if CE were awarded. Among the 67 who completed the open-ended items, the three dominant themes included enhance personal confidence and competence (43%); acquire personal knowledge (39%); and operations (21%). Of 211 providers who participated in the intervention, 56 (27%) were awarded CE. A total of 152 providers responded to the post-survey, and the percentage who agreed that reviewing outcomes improves job satisfaction rose from 89% to 95% between pre- and post-surveys (<i>P</i> = 0.05).</p><p><strong>Conclusion: </strong>EMS providers supported the personal and professional development and patient care improvement of reviewing patients' outcomes with associated CE. Further study is warranted to evaluate the generalizability of these findings and the best user experience.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 6","pages":"949-957"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772657","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":"Comparison of Emergency Department Disposition Times in Adult Level I and Level II Trauma Centers.","authors":"Sierra Lane, Jeffry Nahmias, Michael Lekawa, John Christian Fox, Carrie Chandwani, Shahram Lotfipour, Areg Grigorian","doi":"10.5811/westjem.20523","DOIUrl":"10.5811/westjem.20523","url":null,"abstract":"<p><strong>Introduction: </strong>The efficient utilization of resources is a crucial aspect of healthcare, particularly in both Level I and Level II American College of Surgeons (ACS)-verified trauma centers. The effect of resource allocation on emergency department length of stay (ED-LOS) of trauma patients has remained under-investigated. As ED crowding has become more prevalent, especially at quaternary care centers, an evaluation of the potential disparities in ED-LOS between Level I and Level II trauma centers is warranted. We hypothesized a longer ED-LOS at Level I centers compared to Level II centers.</p><p><strong>Methods: </strong>We queried the 2017-2021 Trauma Quality Improvement Process (TQIP) database for trauma patients ≥18 years of age presenting to either a Level-I or -II center. The TQIP defines ED-LOS as the time from arrival until the time an ED disposition (admission or discharge) order is written. We excluded transferred patients and those with missing data regarding ACS trauma center verification level. We performed bivariate analyses, as well as subgroup analyses based on location of disposition.</p><p><strong>Results: </strong>Of 2,225,067 trauma patients, 59.3% (1,318,497) received treatment at Level I centers. No significant differences were found in Injury Severity Scores between patients admitted to the operating room or non-intensive care unit (ICU) locations, or discharged home from Level-I and -II centers (all <i>P</i> < 0.05). The ED-LOS for trauma patients was longer at Level-I centers for all patient categories: overall (198 vs 145 minutes [min], <i>P</i> < 0.001), discharged home (286 vs 160 min, <i>P</i> < 0.001), non-ICU admissions (234 vs 164 min, <i>P</i> < 0.001), and those requiring surgery (126 vs 101 min, <i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>Even when treating patients with similar injury severity, trauma patients at Level I trauma centers had longer ED-LOS compared to Level II centers, irrespective of the patients' final disposition (surgery, non-ICU admission, or discharge). To optimize resource utilization and alleviate ED saturation, further research must delve into the underlying causes of these discrepancies to identify best practices and solutions.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 6","pages":"938-945"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of COVID-19 Pandemic on Emergency Department Visits for Opioid Use Disorder Across University of California Health Centers.","authors":"Matthew Heshmatipour, Ding Quan Ng, Emily Yi-Wen Truong, Jianwei Zheng, Alexandre Chan, Yun Wang","doi":"10.5811/westjem.18468","DOIUrl":"10.5811/westjem.18468","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Coronavirus 2019 (COVID-19) has had a devastating impact on mental health and access to addiction treatment in the United States, including in California, which resulted in the highest rates of emergency department visits (ED) for opioid poisoning in 2020. As California slowly returns to pre-pandemic normalcy, it remains uncertain whether the rates of opioid-related events have slowed down over time. We hypothesized that the number of opioid-related ED visits were exacerbated after the period of the COVID-19 pandemic and continue at a high rate in the present.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this analysis we searched the University of California (UC) Health Data Warehouse-a database of electronic health records from six academic medical centers-for opioid related ED visits, identifiying using the following International Classification of Diseases, 10&lt;sup&gt;th&lt;/sup&gt; Ed, Clinical Modification codes: F11 codes, and T40.0*, T40.1*, T40.2*, T40.3*, T40.4*, T40.6*. Opioid overdose-associated visits were classified by types of opioids involved: heroin (T40.1*); prescription opioids (T40.2* or T40.3*); and synthetic opioids (T40.4*). We performed interrupted time analysis to estimate the immediate (level) change and change-in-time trend (trend change), from before (January 2018-October 2019) and during the pandemic (April 2020-December 2022). Monthly visit rates were evaluated with negative binomial regression adjusted for first-order autoregression and using all-cause ED counts as the offset. We present effect sizes as rate ratios (RR) and 95% confidence intervals (CI), tested at α = .05.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We observed a decrease in overall ED visits from 28,426 to 25,121 visits in December 2019 and June 2021, respectively across all six UC Health Centers. Before COVID-19, we found that ED visit rates steadily increased for all outcomes (&lt;i&gt;P&lt;/i&gt; &lt; 0.05) except synthetic opioids. Total opioid-related ED visit rates increased by 15% (RR 1.15, 95% CI 1.02-1.29, &lt;i&gt;P&lt;/i&gt; = 0.20) immediately after March 2020 before decreasing by 0.5% every month, albeit without statistical significance (RR .995, 95% CI .991-1.00, &lt;i&gt;P&lt;/i&gt; = 0.06). Opioid-related events across the six academic medical centers increase from 232 in December 2019, representing a single month's total, and peaked at 315 in June 2021. Similar trends were observed with prescription opioid overdoses, with a step increase of 44% (RR 1.44, 95% CI 1.10-1.89, &lt;i&gt;P&lt;/i&gt; = .008) before plateauing after March 2020 (RR 1.01, 95% CI .998-1.02, &lt;i&gt;P&lt;/i&gt; = 0.12). Specifically, the total number of prescription opioid-related ED visits more than doubled between December 2019 (22 visits) and June 2021 (49 visits). After March 2020, ED visit rates for synthetic opioid overdoses were increasing steadily by 4% every month (RR 1.04, 95% CI 1.02-1.06, &lt;i&gt;P&lt;/i&gt; = .001), unlike with heroin, which was observed with an 8% monthly reduction (RR .92, 95% CI .90-.93, &lt;i&gt;P&lt;/i&gt; &lt; ","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 6","pages":"883-889"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772898","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}