Western Journal of Emergency Medicine最新文献

{"title":"Development and Evaluation of a Novel Curriculum for Whole Blood Transfusion by Paramedics in the Prehospital Environment.","authors":"Eric Garfinkel, Robby May, Asa Margolis, Eric Cohn, Steven Colburn, Tom Grawey, Matthew Levy","doi":"10.5811/westjem.19438","DOIUrl":"10.5811/westjem.19438","url":null,"abstract":"<p><strong>Introduction: </strong>Resuscitation with low-titer O+ whole blood improves the outcomes of patients with hemorrhagic shock. Recently, some emergency medical services (EMS) agencies have started to carry blood in the field. However, there exists no standardized training program to teach paramedics the fundamentals of blood administration. This study describes one EMS system's experience with implementing a novel, whole blood educational curriculum.</p><p><strong>Methods: </strong>We used Kern's six-step framework to develop a novel curriculum to provide paramedics the requisite knowledge to safely administer blood in the field. The course included an asynchronous component as well as an in-person, skills competency verification. The asynchronous portion was open to any paramedic, but only paramedic supervisors were eligible for the in-person skills check as they are the ones tasked with administering blood in the field. The course was evaluated through survey and performance outcome measurements.</p><p><strong>Results: </strong>Fifty-three (26.5%) of 200 total paramedics at a combined career and volunteer fire department enrolled in the asynchronous course, and 31 (58.5%) completed the pre- and post-course survey. Of participating paramedic supervisors, 20 of 20 (100%) finished both portions of the course. Survey answers were based on a 5-point Likert scale. We reported results as a mean, with 5 corresponding to \"strongly comfortable\" or \"strongly agree.\" There was a statistically significant increase in the number of respondents who felt overall comfortable in administering blood from 3.51 to 4.16 (P = 0.003). Additionally, there was an increase in the number of paramedics who reported feeling comfortable performing the procedure of a blood transfusion from 3.11 to 4.13 (P = <0.001). Nearly all participants (30/31) would recommend the course to someone else. In the first three months of carrying blood in the field, there were 12 units of blood transfused and no protocol deviations or safety events.</p><p><strong>Conclusion: </strong>This study provides a model for the successful creation and implementation of a prehospital blood transfusion educational program using Kern's framework. The curriculum was implemented in a single EMS system with senior paramedics, which may limit generalizability.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"535-540"},"PeriodicalIF":1.8,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498164","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":"Evaluation of Disparities in Emergency Department Admission and Wait Times for Non-English Preferred Patients.","authors":"John Wong-Castillo, Daniel Berger, Juan Carlos Montoy, Riham Alwan","doi":"10.5811/westjem.21242","DOIUrl":"10.5811/westjem.21242","url":null,"abstract":"<p><strong>Introduction: </strong>Patients who prefer to communicate in a language other than English are vulnerable to the consequences of medical communication barriers. Studies of non-English language preferred (NELP) and English language preferred (ELP) patients have shown differences in rates of hospital admission and wait times-factors known to be related to increased costs and lower patient satisfaction. However, few studies include languages other than Spanish or account for patient acuity level.</p><p><strong>Methods: </strong>We performed a retrospective cohort study at an urban, Level I trauma center from January-December 2020. Patients were grouped by language preference, with NELP languages grouped into three categories: Spanish; Chinese (Mandarin, Cantonese, Taishanese, Taiwanese, and Zhongshan-Chinese dialect); and other (all other remaining languages). We extracted age, sex, race, ethnicity, language preference, emergency department (ED) discharge disposition, and Emergency Severity Index Score (ESI) from the electronic health record. The primary outcome was the hospital admission rate. Secondary outcomes were the time from patient arrival to placement in the treatment room and the time from patient arrival to disposition. We analyzed data with chi-square tests, logistic, and linear regressions.</p><p><strong>Results: </strong>Of the 58,079 unique ED encounters, 26.4% (15,307) patients identified as NELP. Within NELP patient encounters, 75.0% preferred Spanish, 13.9% preferred Chinese, and 11.1% preferred another language. After adjusting for age and acuity, Spanish language- and Chinese language-preferred patients were at 16% and 14% higher odds of admission, respectively (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.10-1.23 and OR 1.14, CI 1.02-1.27 respectively), compared to ELP patients. NELP patients waited an average 5.4 minutes longer to be roomed (95% CI 4.46-6.29) and 15.6 minutes longer until disposition (95% CI 12.62-18.54, P<0.05). This discrepancy was greater for patients triaged at lower acuities, with ESI 5 Spanish language- and Chinese language-preferred patients waiting an average of 50.3 and 90.6 minutes longer than ELP patients until disposition (95% CI 17.67-83.57; and 95% CI 24.31-81.57 respectively).</p><p><strong>Conclusion: </strong>After adjusting for acuity level and age, non-English language preferred patients were at higher odds of admission and experienced disparate wait times, especially at lower acuity levels. Further investigation is needed to understand the causes of these differences and mitigate these health inequities.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"415-424"},"PeriodicalIF":1.8,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498181","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 Blood Pressure Management in Type B Aortic Dissection: An Analysis with Machine Learning.","authors":"Nelson Chen, Jessica V Downing, Jacob Epstein, Samira Mudd, Angie Chan, Sneha Kuppireddy, Roya Tehrani, Isha Vashee, Emily Hart, Emily Esposito, Rose Chasm, Quincy K Tran","doi":"10.5811/westjem.25005","DOIUrl":"10.5811/westjem.25005","url":null,"abstract":"<p><strong>Background: </strong>Acute aortic dissections (AAD) have a high morbidity and mortality rate. Treatment for type B aortic dissection includes strict systolic blood pressure (SBP) and heart rate (HR) control per the American Heart Association (AHA) guidelines. However, predictors of successful emergency department (ED) management of SBP have not been well studied.</p><p><strong>Methods: </strong>We retrospectively analyzed the records of adult patients presenting to any regional ED with type B AAD between 2017-2020 with initial SBP >120 mmHg and HR >60 beats per minute (bpm) and were subsequently transferred to our quaternary center. Primary outcome was SBP <120 mmHg based on both the 2010 and 2022 AHA guidelines and HR <60 bpm (based on the 2010 guideline), or HR <80 (2022 guideline). We used random forest (RF) algorithms, a machine-learning tool that uses clusters of decision trees to predict a categorical outcome, to identify predictors of achieving HR and SBP goals prior to ED departure, defined as the time point at which patients left the referring ED to come to our institution.</p><p><strong>Results: </strong>The analysis included 134 patients. At the time of ED departure, 26 (19%) had SBP <120 mmHg, 96 (67%) received anti-impulse therapy, and 40 (28%) received beta-blocker or vasodilator infusions specifically. The RF algorithm identified higher triage SBP and treatment with intravenous labetalol as the top predictors for SBP >120 mmHg at ED departure, contrary to AHA guidelines. Pain management with higher total morphine equivalent unit, as well as shorter time to computed tomography as predictors for HR <60 bpm and <80 bpm, were in concert with AHA guidelines.</p><p><strong>Conclusion: </strong>Many patients with type B AAD did not achieve hemodynamic parameters in line with 2010 or 2022 AHA guidelines while being in the ED prior to transferring to a quaternary care center for further evaluation and management. Patients with higher heart rate and systolic blood pressure on ED arrival were less likely to achieve goals at the time of departure from the referring EDs. Those receiving more pain medications prior to transfer were more likely to meet certain AHA goals.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"674-684"},"PeriodicalIF":1.8,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498173","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":"Evaluating the Implementation of a \"COVID-19 Test\" Chief Concern in the Emergency Department.","authors":"Collin Michels, Daniel J Hekman, Rebecca J Schwei, Ryan E Tsuchida, Joshua Gauger, Irene Hurst, Joshua Glazer, Jenna Brink, Ciara Barclay-Buchanan, Manish N Shah, Azita G Hamedani, Michael Pulia","doi":"10.5811/westjem.34850","DOIUrl":"10.5811/westjem.34850","url":null,"abstract":"<p><strong>Background: </strong>During the COVID-19 pandemic, rapid, at-home testing for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) was inconsistently available. Consequently, for some patients, emergency departments (ED) became the preferred site to access COVID-19 testing. To improve operational efficiency, our ED implemented a \"COVID-19 Test\" chief concern (CC). Our primary objective in this analysis was to broadly assess the utilization of the new \"COVID-19 Test\" CC and associated clinical care.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of ED encounters from an academic ED and an affiliated, community-based ED of all patients after the establishment of a CC of \"COVID-19 Test\" from October 11, 2021-July 31, 2022. The data were extracted from the electronic health record. We calculated descriptive demographic statistics and ran a univariate and multivariate logistic regression with additional diagnostic or therapeutic interventions (binary) as the outcome variable to generate odds ratios (OR) and 95% confidence intervals (CI).</p><p><strong>Results: </strong>A total of 320 patients were assigned a \"COVID-19 Test\" CC by a triage nurse. This was 0.5% of all ED encounters in this time frame. Of those, 45% were found to be SARS-CoV-2 positive. Admission or repeat ED visit at 72 hours occurred in 5.3% of patients. Nearly half (46.9%) of patients assigned a \"COVID-19 Test\" CC underwent additional ED interventions. Patients on Medicaid and those who self-identified as Black or Hispanic/Latino were disproportionately represented in the \"COVID-19 Test\" CC group as compared to the overall ED population. In multivariate analysis, an Emergency Severity Index of 1, 2 or 3 was associated with significantly higher odds of receiving additional interventions compared to ESI of 4 or 5 (adjusted OR: 46.85; 95% CI 13.28-165.26; P <0.001).</p><p><strong>Conclusion: </strong>Patients assigned a chief concern of \"COVID-19 Test\" had a high COVID-19 positivity rate, often underwent additional ED interventions, and were at low risk of return ED visits or admission. Minoritized and low-income patients were disproportionately represented in the \"COVID-19 Test\" CC group, highlighting potential disparities in access to at-home COVID-19 testing and implementation of this CC.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"507-512"},"PeriodicalIF":1.8,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498180","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":"Harnessing Residents' Practice-based Inquiries to Enhance Research Literacy: The Thoughtful Reading of Evidence into Clinical Settings (T-RECS) Initiative.","authors":"Emmagene Worley, Edward H Suh, Liliya Abrukin, Michael DeFilippo, Jonathan J Kamler, Mahesh Polavarapu, Peter C Wyer","doi":"10.5811/westjem.20921","DOIUrl":"10.5811/westjem.20921","url":null,"abstract":"<p><strong>Introduction: </strong>Research literacy is an important competency for all clinicians, but developing resident enthusiasm for it is difficult. At one academic emergency medicine (EM) residency program, we designed an innovative program to help residents improve literacy skills within a community of practice and use research literature to address clinical problems.</p><p><strong>Methods: </strong>A six-member faculty core team surveyed residents to assess their baseline experience with evidence-based medicine (EBM) and level of engagement with the medical literature. Interested residents joined an iterative curriculum development process that drew on previous EBM pedagogical experience and literacy theory. We developed a semi-structured approach that prioritizes using the reference frame of clinical applicability rather than research methodology. We held 90-120 minute sessions three times a year as part of the regular residency didactic conference; post-session evaluations with quantitative and qualitative elements were used to adjust subsequent didactics to refine the approach.</p><p><strong>Results: </strong>An average of 48 residents were in the EM training program during the nine sessions conducted during the study period. At baseline, residents had a high degree of exposure to EBM during medical school (94% of respondents) but low confidence in reading the medical literature (25%) or applying research to practice (10%). In contrast, they reported the novel program equipped them with skills to interpret literature and led to collective practice improvement. We found engagement was highest when residents led sessions based on inquiries that emerged out of their own training experience. Other positive factors included well-facilitated discussions between residents, relating questions to data-driven review of local practice patterns and addressing findings from free open access medical education (FOAMed) sources. The initial stages required significant team effort to design the pilot sessions, but later sessions were developed following the trajectory of resident inquiries using a minimally structured faculty consensus process and required less than 12 total faculty hours of commitment.</p><p><strong>Conclusion: </strong>An innovative program centered on residents' practice-based queries of research literature appears to enhance learner enthusiasm for development of research literacy. Further development is needed to validate the overall effectiveness and generalizability of this approach.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"564-568"},"PeriodicalIF":1.8,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498135","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":"Randomized Controlled Trial of Atorvastatin in Acute Influenza in the Emergency Department.","authors":"Maureen Chase, Michael N Cocchi, Anne V Grossestreuer, Xiaowen Liu, Jacob Vine, Ari L Moskowitz, Michael W Donnino","doi":"10.5811/westjem.33580","DOIUrl":"10.5811/westjem.33580","url":null,"abstract":"<p><strong>Objectives: </strong>We sought to determine whether atorvastatin administration attenuates the inflammatory response and improves clinical outcomes in acute influenza.</p><p><strong>Methods: </strong>We conducted a randomized double-blind trial administering atorvastatin 40 milligrams or placebo to adults with confirmed influenza for five days between December 2013-May 2018. Patients were primarily enrolled in the emergency department (ED) at an urban, tertiary-care center. Serum was obtained at enrollment and 72 hours for the primary outcome, change in interleukin (IL-6). Patients reported severity of influenza symptoms over 10 days. We used linear mixed-effects models for the primary comparisons.</p><p><strong>Results: </strong>Of the 116 enrolled patients, 59 received atorvastatin and 57 received placebo. Groups were well-matched including baseline influenza symptom scores and receipt of an antiviral medication. There was no difference between groups in the change in interleukin-6 (IL-6) levels (P=0.468). However, there were significant differences in the overall influenza symptom scores, favoring faster resolution in the atorvastatin group (P=0.05). For patients presenting within 48 hours of symptom onset, resolution was faster for the overall score (P <0.001) and for the fever (P=0.001), sore throat (P=0.005) and headache (P=0.006) components. No safety concerns were identified.</p><p><strong>Conclusion: </strong>Atorvastatin administration in acute influenza appears safe. We did not find attenuation of IL-6 with atorvastatin. Patients receiving atorvastatin reported improvement in their clinical symptoms at a faster rate than those in the placebo group, particularly in patients presenting within 48 hours of symptom onset. This trial is registered at ClinicalTrials.gov, Identifier: NCT02056340.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"600-608"},"PeriodicalIF":1.8,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498146","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 Physician Assessment of Productivity and Supervision Practices.","authors":"Kraftin Schreyer, Diane Kuhn, Vicki Norton","doi":"10.5811/westjem.19417","DOIUrl":"10.5811/westjem.19417","url":null,"abstract":"<p><strong>Introduction: </strong>Despite a lack of data guiding safe standards for physician productivity and supervision of non-physician practitioners (NPP), legislation dictating supervision ratios for emergency physicians (EP) has been enacted in Florida and elsewhere across the country. To inform future legislation, we aim to identify current productivity and supervision practices among practicing EPs as well as those physicians' safety assessments of their current practices.</p><p><strong>Methods: </strong>We conducted a cross-sectional observational study regarding EPs' perspectives on safe staffing and supervision models. A survey, consisting of 14 questions examining different variables affecting supervision and productivity, was used to determine physicians' opinions on the safety of productivity and supervision models across a range of annual volumes, employers, and years of experience. We coded safety assessments as binary (yes/no) and measured productivity by patients treated per hour. Ratios of physician to supervisee (either resident physician or or NPP) were given as number of supervisees: EP.</p><p><strong>Results: </strong>The survey response rate was 4.8% (196/4,004). On average, most EPs treated 2.6 patients per hour, regardless of years of experience, employment model, or supervision model. More than 80% of EPs felt that their current patients-per- hour practice was safe. Direct supervision represented 59% of total visits and the majority in all employment models except for community contract-management groups (CMG). A minimum of 80% of physicians felt that their current supervision practices were safe across employment models, with the notable exception of community CMGs. Most felt that a safe ratio for direct supervision of NPPs was 1:1. Over 30% reported there was no safe staffing ratio for indirect supervision.</p><p><strong>Conclusion: </strong>With the exception of those employed by community contract-management groups, EPs felt that their current productivity and supervision practices were safe; however, average productivity and supervision ratios are much lower than prior estimates and in current legislation governing emergency department practice. Standards of care for both productivity and supervision that take into account current practices and safety assessments should be established and considered when future policies and legislation are developed.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"500-506"},"PeriodicalIF":1.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498177","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":"Epidemiology of 911 Calls for Opioid Overdose in Nogales, Arizona.","authors":"Melody Glenn, Darien Stratton, Keith Primeau, Amber Rice","doi":"10.5811/westjem.18597","DOIUrl":"10.5811/westjem.18597","url":null,"abstract":"<p><strong>Objective: </strong>Drug overdose is the leading cause of unintentional death in the United States, and individuals identifying as BIPOC (Black, indigenous and people of color) and those of low socioeconomic status are over-represented in this statistic. The US-Mexico border faces several unique challenges when it comes to healthcare and the drug overdose crisis, due in large part to health inequities. Although the US Centers for Disease Control and Prevention recommends that overdose prevention programs address health inequities, little is known about opioid overdoses in this rural, primarily Spanish-speaking region. As emergency medical services (EMS) records collect countywide data, they represent a high-quality source for epidemiologic surveillance.</p><p><strong>Methods: </strong>We conducted a retrospective chart review based on a local quality assurance program in which two years of EMS records were reviewed with the primary objective of characterizing patients receiving prehospital care for opioid overdoses in a rural, borderland community, and the secondary objective of characterizing EMS's fidelity to a naloxone distribution protocol. We included electronic patient care records for analysis if they included the EMS clinician's impression of overdose, opiate abuse, or opiate-related disorder from November 1, 2020-October 31,2022. The following data points were abstracted: date; patient initials/gender/age; police presence; response location; bystanders on scene; naloxone administration prior to EMS arrival; distribution of naloxone kit (yes/no); substance reported; and disposition. We analyzed descriptive statistics.</p><p><strong>Results: </strong>A total of 74 cases met inclusion criteria over two years with the majority of cases involving men (82%) with a median age of 28. Almost half of overdoses occurred at private residences (46%), and slightly more than half (57%) reported fentanyl use prior to overdose. Family or friends were usually (64%) on scene, and law enforcement was often (77%) the first 911 to arrive. Naloxone was administered on scene in almost all cases (91%), usually by EMS (44%) or law enforcement (43%). The EMS clinicians distributed naloxone kits at 61% of calls.</p><p><strong>Conclusion: </strong>Opioid overdoses along the US-Mexico border occurred primarily among young men using illicit fentanyl in private residences. Although family/friends were often present, they rarely administered naloxone. Law enforcement was often the first 911 responder to arrive. Emergency medical services is a suitable setting for naloxone distribution programs.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"528-534"},"PeriodicalIF":1.8,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498179","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":"Social Determinants of Health and Health Literacy in Emergency Patients with Diabetic Ketoacidosis.","authors":"Daniel F Suarez, Ryan M Schneider, Margo Girardi, Gina LaRossa, Julianne Yeary, Taylor Kaser, Rachel Ancona, Paulina Cruz Bravo, Richard T Griffey","doi":"10.5811/westjem.35262","DOIUrl":"10.5811/westjem.35262","url":null,"abstract":"<p><strong>Introduction: </strong>Social determinants of health (SDoH) and health literacy have been demonstrated to significantly impact health outcomes. As part of a study of diabetic ketoacidosis (DKA) treatment from the emergency department (ED), we assessed the burden of SDoH and health literacy among patients with DKA to identify potentially modifiable risk factors in the development of DKA.</p><p><strong>Methods: </strong>This was an exploratory, prospective, cross-sectional study of adult patients with DKA in a large urban academic ED from March 2023-March 2024. We administered the Centers for Medicare & Medicaid Services Accountable Health Communities Health-Related Social Needs Screening Tool (SNST) and the Brief Health Literacy Screen (BHLS).</p><p><strong>Results: </strong>Of 126 identified ED patients with confirmed DKA, 57 completed the SNST and 72 completed the BHLS. Nearly all patients (56 patients, 98%) reported at least one unmet SDoH need, and 32 (56%) patients reported five or more. The most frequently reported SDoH needs were physical activity (77%), mental health (63%), financial strain (60%), substance use (54%), and food insecurity (51%). Seventy-two patients completed the BHLS, which demonstrated high levels of health literacy, with median responses ranging from 4-5 on a Likert scale with 5 corresponding to highest health literacy.</p><p><strong>Conclusion: </strong>Social determinants of health needs are prominent among patients who develop DKA, highlighting an opportunity for ED-based interventions to address specific SDoH factors to prevent the development of this disease. Self-reported health literacy scores were high in this patient population.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"381-386"},"PeriodicalIF":1.8,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208091/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498170","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":"Case Study of How Alleviating \"Pebbles in the Shoe\" Improves Operations in the Emergency Department.","authors":"Diana Savitzky, Yash Chavda, Suchismita Datta, Alexandra Reens, Elizabeth Conklin, Matthew Scott, Christopher Caspers","doi":"10.5811/westjem.24990","DOIUrl":"10.5811/westjem.24990","url":null,"abstract":"<p><strong>Objectives: </strong>Addressing minor yet significant frustrations, or \"pebbles,\" in the workplace can reduce physician burnout, as noted by the American Medical Association. These \"pebbles\" are small workflow issues that are relatively easy to fix but can significantly improve the workday when resolved. This quality improvement project aimed to enhance clinician well-being in an emergency department (ED) affiliated with an academic institution through human-centered design by actively engaging clinicians to identify these \"pebbles\" and for a dedicated team to address them.</p><p><strong>Methods: </strong>A task force comprised of three emergency physicians collaborating with emergency medicine leadership was established. After educating clinicians about \"pebbles,\" clinicians were able to anonymously submit pebbles based on recall of frustrations in a baseline survey at the start of the project, as well as submit pebbles in real time by a QR code that was placed in easily noticeable areas. The task force met bimonthly to categorize, prioritize, and assign ownership of the pebbles. Progress was communicated to staff via a monthly \"stop light\" report. An anonymous survey assessed the impact on clinician well-being among 68 emergency clinicians within seven months of starting the project.</p><p><strong>Results: </strong>Over seven months, 284 pebbles were submitted (approximately 40 per month). The feasibility of addressing pebbles was characterized by a color scale: green (easy to fix): 149 (53%); yellow (more complex): 111 (39%); and red (not feasible, \"boulder\"): 24 (8%). Categories of pebbles included the following: equipment/supply: 115 (40%); nursing/clinical: 86 (30%); process: 64 (23%); and information technology/technology: 19 (7%). A total of 214 pebbles (75%) were completed. Among 51 respondents (75% response rate), the self-reported impact on well-being of having pebbles addressed was as follows: extremely effective: 16 (31%); very effective: 25 (49%); moderately effective: 8 (16%); slightly effective: 2 (4%); and not effective 0 (0%).</p><p><strong>Conclusion: </strong>In addition to improving personal resilience, improving well-being in the ED involves addressing efficiency of practice. This project highlights the positive impact of resolving small, feasible issues identified by clinicians, which resulted in 80% of respondents rating the project as very to extremely effective in improving their well-being. Most pebbles were related to equipment and easily fixed, while issues involving human interactions (eg, communications between consultants and EM) were more challenging. Regular meetings and accountability facilitated progress. This approach is replicable across medical specialties and practice settings, offering a low-cost method to enhance clinician work environments and well-being.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"523-527"},"PeriodicalIF":1.8,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498156","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}