Western Journal of Emergency Medicine最新文献

{"title":"Emergency Medicine Milestones Final Ratings Are Often Subpar.","authors":"Diane L Gorgas, Kevin B Joldersma, Felix K Ankel, Wallace A Carter, Melissa A Barton, Earl J Reisdorff","doi":"10.5811/westjem.18703","DOIUrl":"https://doi.org/10.5811/westjem.18703","url":null,"abstract":"<p><strong>Background: </strong>The emergency medicine (EM) milestones are objective behaviors that are categorized into thematic domains called \"subcompetencies\" (eg, emergency stabilization). The scale for rating milestones is predicated on the assumption that a rating (level) of 1.0 corresponds to an incoming EM-1 resident and a rating of 4.0 is the \"target rating\" (albeit not an expectation) for a graduating resident. Our aim in this study was to determine the frequency with which graduating residents received the target milestone ratings.</p><p><strong>Methods: </strong>This retrospective, cross-sectional study was a secondary analysis of a dataset used in a prior study but was not reported previously. We analyzed milestone subcompetency ratings from April 25-June 24, 2022 for categorical EM residents in their final year of training. Ratings were dichotomized as meeting the expected level at the time of program completion (ratings of ≥3.5) and not meeting the expected level at the time of program completion (ratings of ≤3.0). We calculated the number of residents who did not achieve target ratings for each of the subcompetencies.</p><p><strong>Results: </strong>In Spring 2022, of the 2,637 residents in the spring of their last year of training, 1,613 (61.2%) achieved a rating of ≥3.5 on every subcompetency and 1,024 (38.8%) failed to achieve that rating on at least one subcompetency. There were 250 residents (9.5%) who failed to achieve half of their expected subcompetency ratings and 105 (4.0%) who failed to achieve the expected rating (ie, rating was ≤3.0) on every subcompetency.</p><p><strong>Conclusion: </strong>When using an EM milestone rating threshold of 3.5, only 61.2% of physicians achieved the target ratings for program graduation; 4.0% of physicians failed to achieve target ratings for any milestone subcompetency; and 9.5% of physicians failed to achieve the target ratings for graduating residents in half of the subcompetencies.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 5","pages":"735-738"},"PeriodicalIF":1.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355052","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 Slit Lamp Interdisciplinary Training Via Longitudinal Assessment in Medical Practice.","authors":"Samara Hamou, Shayan Ghiaee, Christine Chung, Maureen Lloyd, Kelly Khem, Xiao Chi Zhang","doi":"10.5811/westjem.18514","DOIUrl":"https://doi.org/10.5811/westjem.18514","url":null,"abstract":"<p><strong>Introduction: </strong>Eye emergencies make up nearly 3% of US emergency department (ED) visits. While emergency physicians (EP) should diagnose and treat these ophthalmologic emergencies, many trainees report limited ocular exposure and insufficient training throughout their residency to confidently conduct a thorough slit-lamp exam.</p><p><strong>Methods: </strong>We created an interdisciplinary, simulation-based mastery learning (SBML) curriculum to teach emergency attending physicians how to operate the slit lamp with multimodal learning methodology at a tertiary academic center. The EPs first demonstrate their initial slit-lamp competency with a 20-item checklist, and they then review the necessary curricular content to pass their independent readiness test before completing their in-person teaching and demonstration session with an ophthalmology attending to demonstrate procedural mastery (minimal passing score >90%).</p><p><strong>Results: </strong>Fifteen EPs were enrolled; all completed the final exam of the curriculum. The pre- and post-curriculum checklist scores increased by an average of seven points (<i>P</i> = .002); 86.7% of EPs felt confident in completing a slit-lamp exam after the curriculum, compared to 20% at the beginning. Five of 15 reported teaching learners within the two-month post-curricular period, ranging from 5-30 students. The hands-on teaching was the most positively reviewed element of the curriculum.</p><p><strong>Conclusion: </strong>The SBML program successfully trained EPs on performing a comprehensive slit-lamp exam with promising results of downstream education to junior learners. We encourage other institutions to leverage SBML as a teaching modality for procedural-based training and advocate cross-discipline education initiatives.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 5","pages":"725-734"},"PeriodicalIF":1.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355051","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":"Cross-Sectional Study of Thiamine Deficiency and Its Associated Risks in Emergency Care.","authors":"Joseph Miller, Daniel Grahf, Hashem Nassereddine, Jimmy Nehme, Jo-Ann Rammal, Jacob Ross, Kaitlin Rose, Daniel Hrabec, Sam Tirgari, Christopher Lewandowski","doi":"10.5811/westjem.18472","DOIUrl":"https://doi.org/10.5811/westjem.18472","url":null,"abstract":"<p><strong>Background: </strong>Growing data indicates that thiamine deficiency occurs during acute illness in the absence of alcohol use disorder. Our primary objective was to measure clinical factors associated with thiamine deficiency in patients with sepsis, diabetic ketoacidosis, and oncologic emergencies.</p><p><strong>Methods: </strong>This was an analysis of pooled data from cross-sectional studies that enrolled adult emergency department (ED) patients at a single academic center with suspected sepsis, diabetic ketoacidosis, and oncologic emergencies. We excluded patients who had known alcohol use disorder or who had received ED thiamine treatment prior to enrollment. Investigators collected whole blood thiamine levels in addition to demographics, clinical characteristics, and available biomarkers. We defined thiamine deficiency as a whole blood thiamine level below the normal reference range and modeled the adjusted association between this outcome and age.</p><p><strong>Results: </strong>There were 269 patients, of whom the average age was 57 years; 46% were female, and 80% were Black. Fifty-five (20.5%) patients had thiamine deficiency. In univariate analysis, age >60 years (odds ratio [OR] 2.5, 95% confidence interval [CI], 1.3-4.5), female gender (OR 1.9, 95% CI 1.0-3.4), leukopenia (OR 4.9, 95% CI 2.3-10.3), moderate anemia (OR 2.8, 95% CI 1.5-5.3), and hypoalbuminemia (OR 2.2, 95% CI 1.2-4.1) were associated with thiamine deficiency. In adjusted analysis, thiamine deficiency was significantly higher in females (OR 2.1, 95% CI 1.1-4.1), patients >60 years (OR 2.0, 95% CI 1.0-3.8), and patients with leukopenia (OR 5.1, 95% CI 2.3-11.3).</p><p><strong>Conclusion: </strong>In this analysis, thiamine deficiency was common and was associated with advanced age, female gender, and leukopenia.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 5","pages":"675-679"},"PeriodicalIF":1.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355049","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":"Equity in the Early Pain Management of Long Bone Fractures in Black vs White Patients: We Have Closed the Gap.","authors":"Dietrich Jehle, Krishna K Paul, Stanley Troung, Jackson M Rogers, Blake Mireles, John J Straub, Georgiy Golovko, Matthew M Talbott, Ronald W Lindsey, Charles P Mouton","doi":"10.5811/westjem.18531","DOIUrl":"10.5811/westjem.18531","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with long bone fractures often present to the emergency department (ED) with severe pain and are typically treated with opioid and non-opioid analgesics. Historical data reveals racial disparities in analgesic administration, with White patients more likely to receive analgesics. With the diversifying US population, health equity is increasingly crucial. In this study we aimed to evaluate the early administration of opioid and non-opioid analgesia among Black and White patients with long bone and femur fractures in EDs over different time frames using a substantial database.</p><p><strong>Methods: </strong>We retrospectively extracted Information from 57 US healthcare organizations within the TriNetX database, encompassing 95 million patients. The ED records from 2003-2023 were subjected to propensity score matching for age and gender. We focused on four cohorts: two comprising Black and White patients diagnosed with long bone fractures, and another two with Black and White patients diagnosed solely with femur fractures. We examined analgesic administration rates over 20 years (2003-2023) at five-year intervals (2003-2008; 2008-2013; 2013-2018; 2018-2023), and further analyzed the rates for the most recent two-year period (2021-2023).</p><p><strong>Results: </strong>Disparities in analgesic administration significantly diminished over the study period. For patients with long bone fractures (1,095,052), the opioid administration gap narrowed from 6.3% to 1.1%, while non-opioid administration disparities reduced from 4.4% to 0.3%. Similar trends were noted for femur fractures (265,181). By 2021-2023, no significant differences in analgesic administration were observed between racial groups.</p><p><strong>Conclusion: </strong>Over the past 20 years, the gap in early administration of opioid and non-opioid analgesics for Black and White patients presenting with long bone fractures or femur fractures has been disappearing.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 5","pages":"809-816"},"PeriodicalIF":1.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355053","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":"Exploring Medical Student Experiences of Trauma in the Emergency Department: Opportunities for Trauma-informed Medical Education.","authors":"Giselle Appel, Ahmed T Shahzad, Kestrel Reopelle, Stephen DiDonato, Frances Rusnack, Dimitrios Papanagnou","doi":"10.5811/westjem.18498","DOIUrl":"https://doi.org/10.5811/westjem.18498","url":null,"abstract":"<p><strong>Purpose: </strong>During the third-year emergency medicine (EM) clerkship, medical students are immersed in traumatic incidents with their patients and clinical teams. Trauma-informed medical education (TIME) applies trauma-informed care (TIC) principles to help students manage trauma. We aimed to qualitatively describe the extent to which students perceived the six TIME domains as they navigated critical incidents during their EM clerkship.</p><p><strong>Methods: </strong>We employed a constructivist, modified grounded theory approach to explore medical students' experiences. We used the critical incident technique to elicit narratives to better understand the six TIME domains as they naturally appear in the clerkship. Participants were asked to describe a traumatic incident they experienced during the clerkship, followed by the clerkship's role in helping them manage the incident. Using the framework method, transcripts were analyzed 1) deductively by matching transcript excerpts to relevant TIME domains and 2) inductively by generating de novo themes to capture factors that affected students' handling of trauma during critical incidents.</p><p><strong>Results: </strong>Twelve participants were enrolled and interviewed in July 2022. \"Safety\" was the most frequently described TIME domain, whereas \"Gender, Cultural, and Historical issues\" and \"Peer Support\" were discussed least. Inductive analysis revealed themes that hindered or supported their ability to manage traumatic experiences, which were grouped into three categories: 1) student interactions with the learning environment: complex social determinants of health, inequalities in care, and overt discrimination; 2) student interactions with patients: ethically ambiguous care, witnessing acute patient presentations, and reactivation of past trauma; and 3) student interactions with supervisors: power dynamics, invalidation of contributions, role-modeling, and student empowerment.</p><p><strong>Conclusion: </strong>The six TIME domains are represented in students' perceptions of immediate, stressful critical incidents during their EM clerkship, with \"Safety\" being the most commonly described; however, the degree to which these domains are supported in students' experiences of the EM clerkship differ, and instances of inadequately experienced domains may contribute to student distress. Understanding the EM clerkship through the specific lens of students' experiences of trauma may be an effective strategy to guide curricular changes that promote a supportive learning environment for students in the emergency department.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 5","pages":"828-837"},"PeriodicalIF":1.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355054","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 Prehospital Ultrasound Training on Simulated Paramedic Clinical Decision-Making.","authors":"Andrea Roche, Evan Watkins, Andrew Pettit, Jacob Slagle, Isain Zapata, Andrew Seefeld, Nena Lundgreen Mason","doi":"10.5811/westjem.18439","DOIUrl":"https://doi.org/10.5811/westjem.18439","url":null,"abstract":"<p><strong>Introduction: </strong>When used appropriately, focused limited-scope ultrasound exams could potentially provide paramedics with accurate and actionable diagnostic information to guide prehospital decision-making. In this study we aimed to investigate the impact of a 13-hour prehospital ultrasound training course on the simulated clinical decision-making of paramedics as well as their ultrasound skills, knowledge, and self-confidence.</p><p><strong>Methods: </strong>We evaluated the ultrasound competence of 31 participants using post-course written and practical assessments. Written clinical decision scenarios were administered pre- and post-training. Post-training scenarios included an uninterpreted ultrasound clip to aid decision-making. Scenarios included extended focused assessment with sonography in trauma, pulmonary exam, and focused echocardiography combined with carotid pulse check exams. Correct answers to scenarios were defined as those selected by a veteran emergency physician. Participants also indicated their confidence in each of their decisions using a Likert scale.</p><p><strong>Results: </strong>Training yielded a statistically significant increase in both mean scenario score (35.5% absolute increase) and mean participant self-confidence (15.8% relative increase), across all exam/decision types assessed (<i>P</i> ≤ 0.001). The focused pulmonary exam yielded the largest increase in both mean score improvement (59.7% absolute increase) and paramedic confidence in their decisions (28.6% increase).</p><p><strong>Conclusion: </strong>Trained paramedics can perform focused ultrasound exams and accurately interpret and apply actionable exam findings in the context of written scenarios. Analysis through our model characterized the theoretical clinical yield of each prehospital ultrasound exam and demonstrated how each exam may provide improved decision accuracy in several specific simulated clinical contexts. These results provide support for growing evidence that focused limited-scope ultrasound may be an effective prehospital diagnostic tool in the hands of trained paramedics.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 5","pages":"784-792"},"PeriodicalIF":1.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355016","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":"Methadone Initiation in the Emergency Department for Opioid Use Disorder.","authors":"Daniel Wolfson, Roz King, Miles Lamberson, Jackson Lyttleton, Colin T Waters, Samantha H Schneider, Blake A Porter, Kyle M DeWitt, Peter Jackson, Martha W Stevens, John Brooklyn, Richard Rawson, Elly Riser","doi":"10.5811/westjem.18530","DOIUrl":"https://doi.org/10.5811/westjem.18530","url":null,"abstract":"<p><strong>Introduction: </strong>Overdose deaths from high-potency synthetic opioids, including fentanyl and its analogs, continue to rise along with emergency department (ED) visits for complications of opioid use disorder (OUD). Fentanyl accumulates in adipose tissue; although rare, this increases the risk of precipitated withdrawal in patients upon buprenorphine initiation. Many EDs have implemented medication for opioid use disorder (MOUD) programs using buprenorphine. However, few offer methadone, a proven therapy without the risk of precipitated withdrawal associated with buprenorphine initiation. We describe the addition of an ED-initiated methadone treatment pathway and compared its 72-hour follow-up outpatient treatment engagement rates to our existing ED-initiated buprenorphine MOUD program.</p><p><strong>Methods: </strong>We expanded our ED MOUD program with a methadone treatment pathway. From February 20-September 19, 2023, we screened 20,504 ED arrivals; 5.1% had signs of OUD. We enrolled 61 patients: 28 in the methadone; and 33 in the buprenorphine pathways. For patients who screened positive for opioid use, shared decision-making was employed to determine whether buprenorphine or methadone therapy was more appropriate. Patients in the methadone pathway received their first dose of up to 30 milligrams (mg) of methadone in the ED. Two additional methadone doses of up to 40 mg were dispensed at the time of the ED visit and held in the department, allowing patients to return each day for observed dosing until intake at an opioid treatment program (OTP). We compared 72-hour rates of outpatient follow-up treatment engagement at the OTP (for those on methadone) or at the addiction treatment center (ATC) (for those on buprenorphine) for the two treatment pathways.</p><p><strong>Results: </strong>Of the 28 patients enrolled in the methadone pathway, 12 (43%) successfully engaged in follow-up treatment at the OTP. Of the 33 patients enrolled in the buprenorphine pathway, 15 (45%) successfully engaged in follow-up treatment at the ATC (relative risk 1.06; 95% confidence interval 0.60-1.87).</p><p><strong>Conclusion: </strong>Methadone initiation in the ED to treat patients with OUD resulted in similar 72-hour follow-up outpatient treatment engagement rates compared to ED-buprenorphine initiation, providing another viable option for MOUD.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 5","pages":"668-674"},"PeriodicalIF":1.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355019","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 \"A Shorter Door-in-Door-out Time Is Associated with Improved Outcome in Large Vessel Occlusion Stroke\".","authors":"Gillian Cooper, Vainavi Gambhir, Zoe Gasparotti, Samantha Camp, William Gum, Robinson Okolo, Riya Raikar, Chad Schrier, Jessica Downing, Quincy K Tran","doi":"10.5811/westjem.18668","DOIUrl":"10.5811/westjem.18668","url":null,"abstract":"","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 5","pages":"856-857"},"PeriodicalIF":1.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355048","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":"Reduced Time to Admit Emergency Department Patients to Inpatient Beds Using Outflow Barrier Analysis and Process Improvement.","authors":"Marjorie A Erdmann, Ipe S Paramel, Cari Marshall, Karissa LeHew, Abigail Kee, Sarah Soliman, Monica Monica Vuong, Sydney Sydney Spillane, Joshua Joshua Baer, Shania Shania Do, Tiffany Tiffany Jones, Derek Derek McGuire","doi":"10.5811/westjem.18626","DOIUrl":"https://doi.org/10.5811/westjem.18626","url":null,"abstract":"<p><strong>Objective: </strong>Because admitted emergency department (ED) patients waiting for an inpatient bed contribute to dangerous ED crowding, we conducted a patient flow investigation to discover and solve outflow delays. After solution implementation, we measured whether the time admitted ED patients waited to leave the ED was reduced.</p><p><strong>Methods: </strong>In June 2022, a team using Lean Healthcare methodologies identified flow delays and underlying barriers in a Midwest, mid-sized hospital. We calculated barriers' magnitudes of burden by the frequency of involvement in delays. During October-December 2022, solutions targeting barriers were implemented. In October 2023, we tested whether waiting time, defined as daily median time in minutes from admission disposition to departure (ADtoD), declined by conducting independent sample, single-tailed <i>t</i>-test comparing pre- to post-intervention time periods, January 1-September 30, 2022 (273 days) to January 1-September 30, 2023 (273 days). Additionally, we regressed ADtoD onto pre-/post period while controlling for ED volume (total daily admissions and ED daily encounters) and hospital occupancy. A run chart analysis of monthly median ADtoD assessed improvement sustainability.</p><p><strong>Results: </strong>Process mapping revealed that three departments (ED, environmental services [EVS], and transport services) co-produced the outflow of admitted ED patients wherein 18 delays were identified. The EVS-clinical care collaboration failures explained 61% (11/18) of delays. Technology contributed to 78% (14/18) of delays primarily because staff's technology did not display needed information, a condition we coined \"digital blindness.\" Comparing pre- and post-intervention days (3,144 patients admitted pre-intervention and 3,256 patients post), the median minutes a patient waited (ADtoD) significantly decreased (96.4 to 87.1 minutes, <i>P</i> = 0.04), even while daily ED encounter volume significantly increased (110.7 to 117.3 encounters per day, <i>P</i> < 0.001). After controlling in regression for other factors associated with waiting, the intervention reduced ADtoD by 12.7 minutes per patient (standard error 5.10, <i>P</i> = 0.01; 95% confidence interval -22.7, -2.7). We estimate that the intervention translated to ED staff avoiding 689 hours of admitted patient boarding over nine months (ADtoD coefficient [-12.7 minutes] multiplied by post-intervention ED admissions [3,256] and divided by 60). Run chart analysis substantiated the intervention's sustainability over nine months.</p><p><strong>Conclusion: </strong>After systemwide patient flow investigation, solutions resolving digital blindness and environmental services-clinical care collaboration failures significantly reduced ED admitted patient boarding.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 5","pages":"748-757"},"PeriodicalIF":1.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355022","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":"Making A Difference: Launching a Multimodal, Resident-Run Social Emergency Medicine Program.","authors":"Naomi P Newton, Christopher Freeman, Patricia Panakos","doi":"10.5811/westjem.18509","DOIUrl":"https://doi.org/10.5811/westjem.18509","url":null,"abstract":"<p><strong>Introduction: </strong>Social medicine seeks to incorporate patients' social contexts into their medical care. Emergency physicians are uniquely positioned to address social determinants of health (SDoH) on the frontlines of the healthcare system. Miami-Dade County (MDC) is a diverse and socially vulnerable area. In 2020, the University of Miami-Jackson Health System (UM-JHS) emergency medicine (EM) residency program launched a multimodal, resident-led Social EM program to identify and address SDoH in the emergency department (ED).</p><p><strong>Methods: </strong>We use a four-pillar approach to SDoH in the ED: Curriculum Integration; Community Outreach; Access to Care; and Social Justice. Residents graduate with a knowledge of Social EM principles through an 18-month curriculum, an elective, and a longitudinal track. We developed sustainable initiatives through interdepartmental and community-based partnerships, including a Narcan distribution initiative, an ED-based program linking uninsured patients to follow-up care, a human trafficking education initiative, and a quality improvement initiative for incarcerated patients.</p><p><strong>Results: </strong>Given that the 18-month curriculum was launched in 2022, a full rotation of the curriculum had not been completed as of this writing, and data collection and analysis is an ongoing process. The initial pretest and post-test survey data show improvement in knowledge and confidence in managing Social EM topics. The Narcan initiative has screened 1,188 patients, of whom 144 have received Narcan. The ED-based patient navigation program has enrolled 31 patients to date, 18 of whom obtained outpatient care. Analysis of the impact/effectiveness of the program's other initiatives is ongoing.</p><p><strong>Conclusion: </strong>To our knowledge, this is one of the most robust social EM programs to date, as many other programs primarily focus on service opportunities. Rooted in the revised principles of Bloom's taxonomy of cognitive learning, this program moves beyond understanding Social EM tenets to generating solutions to address SDoH in and outside the ED.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 5","pages":"739-747"},"PeriodicalIF":1.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418877/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355018","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}