Western Journal of Emergency Medicine最新文献

{"title":"Increase in Ultrasound-guided Nerve Blocks Observed After Implementation of a Nerve Block Supply Cart in the Emergency Department.","authors":"Aurora Jin, Allison Cohen, Aileen Virella, Nicholas Bielawa, Martin Miller, Mathew Nelson","doi":"10.5811/westjem.53900","DOIUrl":"10.5811/westjem.53900","url":null,"abstract":"<p><strong>Introduction: </strong>Ultrasound-guided nerve blocks (UGNB) are an effective and safe method of pain control that are increasingly used for pain management in the emergency department (ED). However, performing these procedures is often time-intensive due to the need to locate and gather necessary supplies. Our ED recently implemented use of a nerve block cart, which contains all the supplies needed for performing a nerve block. Our objective in this quality improvement study was to assess whether the presence of an ED nerve block supply cart was associated with an increase in the number of UGNBs performed.</p><p><strong>Methods: </strong>We conducted a retrospective review of point-of-care ultrasound examinations performed in a single academic quaternary-care community ED over 22 months, looking at 11-month time periods before and after implementation of an ED nerve block supply cart in March 2023. Our primary outcome measure was documentation of a UGNB, and our secondary outcome measure was the type of UGNB performed.</p><p><strong>Results: </strong>We reviewed 14,321 ultrasound exams over 22 months-11 months pre-cart (6,853) and 11 months post-cart (7,468) implementation. We noted a statistically significant increase in the number of UGNBs, from 21 performed in the pre-cart period (0.31% of all ultrasound exams [95% CI, 0.17-0.43%], to 50 UGNBs in the post-cart period (0.67% of all ultrasound exams [95% CI, 0.46-0.86%], P < .01). The fascia iliaca block was the most common UGNB performed in both the pre- (52.4%) and post-cart (62.0%) periods.</p><p><strong>Conclusion: </strong>We found that the deployment of an ED nerve block supply cart was associated with an increased number of ultrasound-guided nerve blocks performed by emergency clinicians in our hospital.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 4","pages":"1034-1038"},"PeriodicalIF":2.3,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674266","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":"Using \"Own-Point-of-View\" Video and Stimulated Recall to Reveal Physician Thought Processes: A Methodology Paper.","authors":"Milisa Manojlovich, Caitlin Cassady, Sarah J Parker, Ellie Davis, Charlotte Ahr, David Ryamukuru, Anna Wang, Kalyan Pasupathy, Hardeep Singh, Prashant Mahajan","doi":"10.5811/westjem.54032","DOIUrl":"10.5811/westjem.54032","url":null,"abstract":"<p><strong>Introduction: </strong>Video methods used in medicine have been described as the \"gold standard\" because they show events as they occurred and with a level of detail unattainable when events are reconstructed using other methods. In stimulated recall, video or pictures during interviews prompt discussion about participants' thoughts or feelings when images were captured. Coupled with video, stimulated recall can deepen researchers' understanding of a participant's thinking at the time. However, conducting video-based stimulated recall interviews with participants is poorly described in the literature because of word count limits in today's journals. In this paper we describe how we used video with stimulated recall interviews to learn how the diagnostic process evolves for emergency physicians.</p><p><strong>Methods: </strong>We used the theory of distributed cognition to describe how information processing develops over time and occurs across physicians, the technologies used, and social organization. We conducted a qualitative study, collecting data in pediatric and adult emergency departments (ED) of an academic Level I trauma center. Participants wore head-mounted video cameras for two hours while providing care to ED patients and revealed their thinking throughout the diagnostic process in subsequent stimulated recall interviews. We reviewed video recordings to identify situations related to the diagnostic process or to one of the concepts in distributed cognition. We identified short video clips from each session to display during interviews and prepared accompanying questions. Stimulated-recall interviews were conducted using video conferencing technology, audio recorded, transcribed, and verified for accuracy. We used content analysis to analyze results.</p><p><strong>Results: </strong>Eleven attending physicians from February 2022-May 2023 (five from the pediatric ED and six from the adult ED) interacted with 52 patients over a total of 24.4 hours on video. We obtained patients' permission to film encounters before a participating physician provided care, wearing the head-mounted camera. We conducted individual stimulated recall interviews (mean 53 minutes, range 33-63 minutes) with all 11 physicians, which uncovered perspectives beyond what was revealed on film. For example, the complexity of cognition resides in patients as well as physicians. Thus, physicians must exert great effort to elicit the patient story and make a likely diagnosis in the chaotic, noisy environment of the ED.</p><p><strong>Conclusion: </strong>Using innovative methods to uncover emergency physicians' cognitive processes has the potential to advance our understanding in other settings. This methodology brings awareness to how one's thoughts can become visible and, thus, amenable to reflection and change.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 4","pages":"1073-1081"},"PeriodicalIF":2.3,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673842","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":"Association of Pregnancy Documentation with Radiological Imaging in the Emergency Department.","authors":"Angela G Campbell, Austin Knies, Paul Musey, Kelli K Ryckman, Sami Gharbi, Sarah Wiehe","doi":"10.5811/westjem.50731","DOIUrl":"10.5811/westjem.50731","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency department (ED) encounters are common for pregnant individuals in the United States. Radiological imaging is frequently ordered for diagnostics in the ED but generally avoided during pregnancy. This study examines missed pregnancy documentation and the association of pregnancy documentation with radiological imaging among individuals who have an ED encounter while pregnant.</p><p><strong>Methods: </strong>We used a retrospective cohort of pregnant individuals who had a live birth in an urban county in Indiana 2022-2023. We pulled all ED encounters occurring between 42-279 days of gestation (N = 4,597) that did not occur within five days of delivery. Our primary outcome measure was pregnancy documentation in the patient's electronic health record and receipt of radiological imaging (radiograph and computed tomography) of the chest, abdomen or spine. We used descriptive statistics and logistic regressions for the analysis.</p><p><strong>Results: </strong>Pregnancy was not documented in 273 of the 4,597 encounters (5.9%). A larger percentage of encounters with missed pregnancy documentation occurred with non-Hispanic Black patients (162/273, 59.3%) compared to non-Hispanic White patients (75/273, 27.5%); (odds ratio 1.70, 95% CI, 1.21-2.41) for non-Hispanic Blacks relative to non-Hispanic Whites. Radiological imaging occurred in 147 of the 4,324 encounters with a documented pregnancy (3.4%), compared with 30 of the 273 encounters where the pregnancy was not documented (11.0%). Missed pregnancy documentation was associated with 2.11 times (95%CI, 1.30-3.42) the odds of receiving radiological imaging when adjusted for confounders.</p><p><strong>Conclusion: </strong>Missed pregnancy documentation occurred in 5.9% of emergency encounters with pregnant patients. While this is uncommon, it is still significantly associated with receipt of radiological imaging. Disparities in odds of pregnancy documentation in the ED may contribute to differences in maternal outcomes and highlights the necessity of ensuring equitable care for all pregnant individuals.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 4","pages":"985-993"},"PeriodicalIF":2.3,"publicationDate":"2026-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673832","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":"Clinical Characteristics of an Emergency Department-led Asynchronous Care Platform.","authors":"Shivam Shah, Ikaasa Suri, Helen Gordan, Nicole Schwartz, Rubayet Hossain, Donald Apakama, Rishi Khakhkhar, Taylor Marren, Benjamin S Abella, Nicholas Gavin, Ethan E Abbott","doi":"10.5811/westjem.53265","DOIUrl":"10.5811/westjem.53265","url":null,"abstract":"<p><strong>Background: </strong>Asynchronous care has emerged as a promising approach to improving healthcare accessibility while potentially reducing costs, particularly for low-acuity conditions. Our objective was to describe the use patterns, patient characteristics, and short-term clinical outcomes of an emergency department (ED)-led asynchronous care platform managing low-acuity conditions in a large, academic health system.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study evaluating the Mount Sinai Health System asynchronous care platform for managing urinary tract infections, conjunctivitis, cold sores, vaginal candidiasis, emergency contraception, and oral contraceptive prescriptions between December 2023-October 2024 during an initial rollout period. Individual charts were reviewed by two trained abstractors and two emergency physicians. The primary outcome was any subsequent ED or clinic visit within seven days. Secondary outcomes included change in diagnosis and medication at relevant follow-up visits. We used descriptive statistics to characterize the cohort and outcomes.</p><p><strong>Results: </strong>During the study period, there were 19,204 ED encounters for conditions matching asynchronous care chief complaint categories, of which 343 encounters (1.8%) from 277 unique patients were managed via the asynchronous care platform. The median patient age was 32.6 years (interquartile range IQR 28.3-41.2), and 258 (93.1%) were female. Overall chief complaints included cystitis/urinary complaints in 157 (45.8%) encounters, conjunctivitis/eye complaints in 57 (16.6%), and vaginal/vulvar candidiasis in 96 (28.0%). At the encounter level, 18 (5.2%) were up-triaged from the asynchronous care platform to synchronous virtual urgent care or in-person evaluation after initial screening. We observed the primary outcome of a subsequent ED or clinic visit within seven days in 68 patients (24.5%). Five patients (1.5%; 95% CI, 0.5-3.5%) were identified with a change in diagnosis within the seven-day outcome window, with all diagnostic changes occurring within 1-3 days of the index asynchronous care encounter (median one day).</p><p><strong>Conclusion: </strong>In this single-center study, an asynchronous care platform demonstrated a viable pathway for managing select low-acuity conditions in an urban academic health system. This structured platform, with appropriate triage pathways and low rates of diagnostic discordance, shows promise as a model to expand access to care for select low-acuity complaints.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 4","pages":"920-929"},"PeriodicalIF":2.3,"publicationDate":"2026-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436643/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673964","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":"Regarding Racial Disparities in Door-to-Clinician Time for Cardiac Chest Pain in the Emergency Department.","authors":"Christian Angelo I Ventura, Ava D Cabanilla, Edward E Denton","doi":"10.5811/westjem.63931","DOIUrl":"10.5811/westjem.63931","url":null,"abstract":"","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 4","pages":"1113-1114"},"PeriodicalIF":2.3,"publicationDate":"2026-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674310","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":"Does Skin Color Influence Differential Diagnosis Generation in a Simulated Cardiac Arrest?","authors":"Hannah E Miller, Claudia Tarrant, Miles Lamberson, Cate Nicholas, Katherine Dolbec","doi":"10.5811/westjem.53204","DOIUrl":"10.5811/westjem.53204","url":null,"abstract":"<p><strong>Introduction: </strong>It is not known whether skin color influences inclusion of substance use on medical students' differential diagnoses for a simulated cardiac arrest. Our objective in this study was to investigate whether the presence of a dark-skinned or light-skinned manikin in the lab correlated with their decision to include substance use on the differential as a possible cause of cardiac arrest.</p><p><strong>Methods: </strong>In this study at a single institution, all fourth-year medical students in an emergency medicine course participated in a manikin-based cardiac arrest simulation case. The simulation sessions alternated between the use of a light-skinned and a dark-skinned manikin. Both were adult sized. After the first shock was delivered, students individually documented their differential diagnosis for the cause of the cardiac arrest on deidentified, free-text research forms. We excluded forms if they were blank, had been completed by a non-medical student, or could not be associated with the skin color of the manikin used. The primary outcome measure was how often students included substance use as a cause of cardiac arrest anywhere in their differential diagnoses. We compared the relationship between manikin skin color and the students' consideration of substance use as a cause of cardiac arrest, using the Fisher exact test.</p><p><strong>Results: </strong>Of 270 eligible participants, 271 surveys were returned; 75 (27.7%) were excluded. Of the remaining 196 surveys, 96 were associated with the light-skinned and 100 with the dark-skinned manikin. Among the 100 respondents using the dark-skinned manikin, one student (1%) listed substance use as the leading diagnosis, while none (0%) of the students using the light-skinned manikin listed substance use as the leading diagnosis. In each group, only 20% of students (n = 39 total) listed substance use anywhere on the differential diagnosis (P = 1.00).</p><p><strong>Conclusion: </strong>Among fourth-year medical students participating in a simulated cardiac arrest, we found no correlation between manikin skin color and the inclusion of substance use on their differential for cardiac arrest. Overall, their decision to include substance use in their differentials was low regardless of skin color, suggesting the need to improve their awareness of substance use as a potential cause of cardiac arrest.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 4","pages":"1018-1022"},"PeriodicalIF":2.3,"publicationDate":"2026-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674061","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 Evaluation of a Clinical Point-of-care Ultrasound Intervention in an Academic Emergency Department.","authors":"Alyssa Platt, Timothy Peterson, Erica Peethumnongsin, Maragatha Kuchibhatla, Rebecca G Theophanous","doi":"10.5811/westjem.53918","DOIUrl":"10.5811/westjem.53918","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Point-of-care ultrasound (POCUS) can expedite patient diagnoses and improve procedural safety in emergency department (ED) patients. Nevertheless, clinical POCUS use lags in many ED sites nationwide, with only 40% of community physicians using POCUS according to a study from 2019-2021. We studied the impact of a multifaceted clinical POCUS intervention to address barriers and increase clinical POCUS use.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a prospective cohort study at a single academic hospital that included ED attendings, residents, and advance practice clinicians (APC). A multifaceted four-week intervention for emergency clinicians from December 2023-January 2024 addressed barriers to POCUS use identified on a pre- and post-intervention survey. The intervention included POCUS education during clinical shifts by ultrasound faculty, clinical POCUS workflow demonstration during resident conference/faculty meetings, and QR code reference files on machines for a total of two hours of additional training per clinician. The primary outcome was the number of clinical ED POCUS performed during the 18 months pre-intervention and 12 months post-intervention. Secondary outcomes were POCUS workflow knowledge exam scores and POCUS revenue. We analyzed clinical POCUS numbers from July 2022-December 2024 using an interrupted time series model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Forty-two of 99 emergency clinicians (42.4%) responded to surveys pre-intervention and 28 post-intervention (28.3%). Fifty-six physicians/APCs (56.6%) participated in the in-person POCUS intervention (17 attendings, 34 residents, 5 APCs). The unadjusted number of POCUS exams performed increased from 6,708 pre-intervention (18 months) to 11,600 post-intervention (12 months). After controlling for the underlying secular trend, we saw no effect of the intervention with no significant increase in overall number of POCUS exams performed per 100 ED patients after the intervention (mean level change = -0.81, 95% CI, -2.43 to 0.82; P = .33). Neither was there an increase in the slope of the secular trend post-intervention (difference in slope, β = 0.00, 95% CI, -0.10 to 0.10; P = .98 for post-intervention, β = 0.02, 95% CI, -0.08 to 0.12 for sustainability period). Monthly POCUS revenue increased ~$55,000 in total billed and $10,000 reimbursed (~16% reimbursement). This was the professional component only that was billed by the physician and not the technical component covering equipment and maintenance. Post-intervention mean knowledge scores were 88% correct (standard deviation 12.0) with 16/22 participants (72.7%) passing the assessment (score &gt; 90%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;A multifaceted intervention was not shown to improve clinical point-of-care ultrasound use and revenue when accounting for an underlying sustained secular upward trend in number of POCUS exams performed per 100 emergency department patients throughout the study period. ","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 4","pages":"1023-1033"},"PeriodicalIF":2.3,"publicationDate":"2026-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674217","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":"Unveiling Unwritten Curricula: Enhancing Junior Faculty Development in Academic Emergency Medicine.","authors":"Abagayle Bierowski, Casey Morrone, Erin Hoag, Ridhima Ghei, Michael Pasirstein, Julie Blaszczak, Dimitrios Papanagnou","doi":"10.5811/westjem.50856","DOIUrl":"10.5811/westjem.50856","url":null,"abstract":"<p><strong>Introduction: </strong>The transition from resident to junior faculty in academic emergency medicine (EM) may be shaped not only by formal training and institutional policies but also by the \"unwritten curriculum,\" a set of norms and expectations embedded in institutional culture. However, the unwritten curriculum and its potential to impact junior faculty development remains largely unexplored. Little is known about how junior faculty perceive, experience, and navigate these informal expectations, or the formal and informal structures that influence this process. In this study we aimed to explore junior faculty members' experiences with the unwritten curriculum in academic EM, with a focus on how they interpret and navigate institutional norms and identify supports and barriers encountered during their early faculty development.</p><p><strong>Methods: </strong>Within their first five years, EM faculty at academic institutions distinct from their residency training sites completed an anonymous, iteratively developed survey designed to explore experiences with the unwritten curriculum, informed by Schlossberg's transition theory framework. The primary analytic focus was identification of themes describing how junior faculty perceive and navigate implicit institutional norms. Open-ended responses underwent thematic analysis using a structured codebook, applied by two independent reviewers with consensus-based coding and adjudication by a third when disagreements arose.</p><p><strong>Results: </strong>A total of 35 junior faculty members completed the survey. All participants indicated influence of the unwritten curriculum on their professional development. Major themes identified include the unspoken importance of mentorship and peer guidance; implicit expectations and norms surrounding engagement, productivity, and visibility; work-life integration; cultural adjustment; scholarly output; and gaps in onboarding, feedback, and role clarity. Participants emphasized challenges in navigating departmental politics, understanding hierarchical nuances, and balancing unspoken expectations for committee involvement and informal social participation. Additionally, unclear feedback processes, inconsistent evaluation expectations, and cultural norms for active engagement were noted as barriers to integration and professional growth.</p><p><strong>Conclusion: </strong>Junior faculty in academic EM described the unwritten curriculum as a meaningful influence on their early faculty experience. Within this sample, participants highlighted mentorship, feedback transparency, and structured faculty development as potential mechanisms to support navigation of implicit expectations during the transition to junior faculty. These findings reflect individual perceptions rather than program characteristics and should be interpreted within the context of the study's scope.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 4","pages":"1048-1061"},"PeriodicalIF":2.3,"publicationDate":"2026-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674305","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":"De-Labeling of Penicillin Allergy in the Emergency Department at a Veterans Affairs Hospital.","authors":"Brian Chen, Phuong Khanh T Nguyen, My-Phuong Pham, Cynthia Koh, Christopher J Graber","doi":"10.5811/westjem.48957","DOIUrl":"10.5811/westjem.48957","url":null,"abstract":"<p><strong>Introduction: </strong>Penicillin allergy is one of the most reported drug allergies, but studies have shown that patients who report an allergy frequently do not have a significant reaction when challenged. Avoidance of penicillin or beta-lactam antibiotics in these patients results in increased hospitalization costs, suboptimal antibiotic therapy, and risk for subsequent infection with multidrug resistant organisms.</p><p><strong>Methods: </strong>This was a single-center, retrospective chart review that included patients ≥ 18 years of age with documented penicillin allergy who presented to the emergency department (ED) over a one-year period. Clinical pharmacy specialists in the ED reviewed and stratified patient allergy risk. Patients with low-risk allergy histories who were to be admitted and gave formal consent were given an oral amoxicillin challenge and then observed in the ED for at least one hour. Patients who were eligible for challenge but were to be discharged from the ED were given the option to be seen in the allergy clinic. The primary outcome was the incidence of adverse reactions related to the oral amoxicillin challenge for patients. An exploratory secondary outcome was the average length of stay (LOS) in the ED for oral amoxicillin-challenged patients compared to the average LOS for non-oral amoxicillin-challenged patients. We performed descriptive statistics on all variables.</p><p><strong>Results: </strong>A total of 144 patients received an allergy assessment in the ED, 20 who received an oral amoxicillin challenge and 124 who did not. Baseline characteristics were similar in both groups. The average total LOS in the oral amoxicillin-challenged patients was a non-significant 36 minutes longer compared to the non-challenged patients (P = 0.4). Of 144 patients, 71 (49%) had their penicillin allergy removed as a result of the challenge.. One patient experienced a mild and self-limited reaction to the oral amoxicillin challenge (0.7%; 95% CI, 0.02-3.8%).</p><p><strong>Conclusion: </strong>An ED pharmacist-led, penicillin de-labeling protocol was safe and feasible. A secondary exploratory analysis showed no significant difference in length of stay between patients who received the oral amoxicillin challenge in the ED vs those who did not. Performing a proper penicillin allergy evaluation in the ED can have lasting benefits for patients and antimicrobial stewardship.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 4","pages":"848-854"},"PeriodicalIF":2.3,"publicationDate":"2026-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436650/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673976","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 Boarders Managed by a Critical Care Consult Service versus Standard Care.","authors":"Matthew Johnson, Alexander Bracey, Ashar Ata, William DaSilva, Sean Patrick Geary, Iman Aly, Warren Hayashi, Rachel Leavitt, James Mantas, Christopher Hanowitz, Luke Duncan, Denis Pauze, Gregory P Wu","doi":"10.5811/westjem.53002","DOIUrl":"10.5811/westjem.53002","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency department (ED) boarding of critically ill patients awaiting intensive care unit (ICU) admission has been associated with delays in time-sensitive interventions, prolonged lengths of stay (LOS), increased crowding, and higher incidence of morbidity and mortality. To address this, our institution implemented an ED critical care consult team in 2020 and established a resuscitation and emergency critical care fellowship in 2022. The critical care consult team, staffed by emergency physicians with additional resuscitation or critical care training, provides consultative support for resuscitations and the management of boarding critically ill patients 10 hours per day, with the dual goals of improving clinical care and optimizing patient flow. The primary outcome of this study was to evaluate the rate of patients downgraded from their initial admission level of care (ICU, Intermediate care) to a lesser intensity of care (intermediate, ward, home). Secondary outcomes included ED, ICU, and hospital LOS.</p><p><strong>Methods: </strong>We conducted a retrospective chart review of all patients ≥ 18 years old with ICU or intermediate care admission orders placed between November 1-30, 2024. Patients were sequentially identified via the electronic health record, and clinical and quality assurance data were collected in a REDCap database.</p><p><strong>Results: </strong>During the study period, the ED critical care consult team was active on 73% of days, staffed primarily by resuscitation and emergency critical care fellows. Of 372 eligible patients, 18% (68/372) were managed by the critical care consult team after initial assessment by primary emergency physician staff, while 82% (304/372) served as controls and did not have involvement with the critical care consult team. Patients evaluated by the team had higher acuity, with 30.9% presenting with an Emergency Severity Index (ESI) score 1 compared to 4.6% in the control group. Despite this, the downgrade rate was significantly higher in the ED3CT cohort (29.4% vs 11.8%, p=0.001). No differences were observed in ED (0.62 days vs 0.60 days, P = .80), ICU (5.1 days vs. 5.2 days, P = .93), or hospital LOS (9.7 days vs 10.8 days, P = .68).</p><p><strong>Conclusion: </strong>These findings suggest that ED-based critical care physicians, including fellows in training, may facilitate earlier identification of patients suitable for lower levels of care despite initially higher acuity. While there was no change in ED, ICU, and hospital length of stay, it is possible that this is related to systemic problems with hospital bed availability. The high rate of downgrades highlights the benefits of ED-based critical care physicians advancing care of critically ill patients boarding in the ED.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 4","pages":"971-976"},"PeriodicalIF":2.3,"publicationDate":"2026-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673980","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}