Academic Emergency Medicine最新文献

{"title":"Communication barriers to optimal access to emergency rooms according to deaf and hard-of-hearing patients and health care workers: A mixed-methods study.","authors":"Carolina Tannenbaum-Baruchi, Paula Feder-Bubis, Limor Aharonson-Daniel","doi":"10.1111/acem.15037","DOIUrl":"10.1111/acem.15037","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to identify communication barriers between health care workers (HCWs) and deaf and hard-of-hearing (DHH) patients. Both perspectives are offered to provide a comprehensive understanding.</p><p><strong>Methods: </strong>Two consecutive studies were conducted from 2018 to 2021. Study 1 comprised mixed methods, employing a cross-sectional survey (n = 288) and in-depth interviews (n = 9) with DHH participants, utilizing accessible tools including sign language. Study 2 involved a cross-sectional survey of health care emergency workers without hearing loss (N = 391).</p><p><strong>Results: </strong>The perceived self-efficacy of DHH patients, and not their hearing loss, was linked with their ability to communicate independently with HCWs. No significant differences in successful communication with these providers were found vis-à-vis mode of communication utilized (sign language, writing, interpreter, etc.). In the qualitative findings, DHH patients noted two urgent care barriers: HCWs' communication unfamiliarity and patients' communication accessibility issues. Quantitative findings indicated a main barrier: difficulties in communicating with HCWs in general (57%) and specifically in the emergency room (ER; 65%). Only 28.8% reported being able to independently communicate with ER staff. Health care providers were not familiar with effective communication strategies when treating these patients. Respondents indicating that communication was not a barrier to care were mainly administrative staff (54.55%), compared to nurses (32.74%) and physicians (22.58%).</p><p><strong>Conclusions: </strong>Communication solutions are needed to improve access to health services, especially in emergencies. Providing medical staff training on effective communication strategies with these patients could simplify interactions and reduce the reliance on hearing family members, potentially improving medical care. Implementing a communication policy for frontline staff, along with the use of visual aids, is crucial. Health care professionals may not realize that small changes can greatly improve communication with DHH patients.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"246-259"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142556783","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":"Leveraging artificial intelligence to reduce diagnostic errors in emergency medicine: Challenges, opportunities, and future directions.","authors":"R Andrew Taylor, Rohit B Sangal, Moira E Smith, Adrian D Haimovich, Adam Rodman, Mark S Iscoe, Suresh K Pavuluri, Christian Rose, Alexander T Janke, Donald S Wright, Vimig Socrates, Arwen Declan","doi":"10.1111/acem.15066","DOIUrl":"10.1111/acem.15066","url":null,"abstract":"<p><p>Diagnostic errors in health care pose significant risks to patient safety and are disturbingly common. In the emergency department (ED), the chaotic and high-pressure environment increases the likelihood of these errors, as emergency clinicians must make rapid decisions with limited information, often under cognitive overload. Artificial intelligence (AI) offers promising solutions to improve diagnostic errors in three key areas: information gathering, clinical decision support (CDS), and feedback through quality improvement. AI can streamline the information-gathering process by automating data retrieval, reducing cognitive load, and providing clinicians with essential patient details quickly. AI-driven CDS systems enhance diagnostic decision making by offering real-time insights, reducing cognitive biases, and prioritizing differential diagnoses. Furthermore, AI-powered feedback loops can facilitate continuous learning and refinement of diagnostic processes by providing targeted education and outcome feedback to clinicians. By integrating AI into these areas, the potential for reducing diagnostic errors and improving patient safety in the ED is substantial. However, successfully implementing AI in the ED is challenging and complex. Developing, validating, and implementing AI as a safe, human-centered ED tool requires thoughtful design and meticulous attention to ethical and practical considerations. Clinicians and patients must be integrated as key stakeholders across these processes. Ultimately, AI should be seen as a tool that assists clinicians by supporting better, faster decisions and thus enhances patient outcomes.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"327-339"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827196","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 left-without-being-seen rates and impact on disparities after guest services ambassadors implementation.","authors":"Samuel R Wing, Ciara Barclay-Buchanan, Shawn Arneson, Denise Buckley, Daniel J Hekman, Joshua Gauger, Collin Michels, Jenna Brink, Irene Hurst, Daniel R Rutz, Ryan E Tsuchida","doi":"10.1111/acem.15100","DOIUrl":"10.1111/acem.15100","url":null,"abstract":"<p><strong>Background: </strong>The rate of patients who leave without being seen (LWBS) from an emergency department (ED) is a common measurement of quality, operational efficiency, and patient satisfaction. We hypothesized that adding a nonclinical staff role, guest service ambassadors (GSA), to the ED waiting room would decrease LWBS rates and reduce existing differences by race, ethnicity, sex, and primary language for ED patients.</p><p><strong>Methods: </strong>We conducted an observational cohort study at a quaternary care academic ED in the Midwestern United States with approximately 60,000 annual visits between April and December 2022. GSAs were trained to guide patients and visitors through the check-in process and help manage the waiting room. LWBS rates were compared between pre- and postimplementation periods using logistic regression. Using two-sample proportion tests, subgroup analyses were performed to assess differences according to race, ethnicity, sex, and primary language.</p><p><strong>Results: </strong>We analyzed 50,507 ED visits including 9798 during periods of GSA coverage. GSA presence was associated with a reduction in LWBS rate from 3.4% to 2.0% (absolute risk reduction [ARR] of 1.4%, χ² = 17.357, p < 0.001) with an adjusted odds ratio (OR) of 0.65 (95% confidence interval [CI] 0.49-0.85). There was a greater reduction in LWBS for Black, Indigenous, and people of color (BIPOC) patients compared to White patients (BIPOC ARR 1.8%, 95% CI 0.39%-3.14%; White ARR 1.2%, 95% CI 0.48%-1.94%). There was a reduction in LBWS rates for both males and females (female ARR 1.7%, 95% CI 0.80%-2.63%; male ARR 1.0%, 95% CI 0.06%-1.90%). The reduction in LWBS for patients speaking a language other than English and requiring interpreter services did not meet statistical significance (ARR 1.4%, 95% CI -1.04% to 3.85%).</p><p><strong>Conclusions: </strong>Although some disparities remain, our study suggests that GSAs may provide an effective strategy to reduce the overall LWBS rate and reduce disparities across diverse demographic groups including BIPOC and female patients.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"216-225"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254299","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":"Online public response to emergency department diagnostic error report: A qualitative study.","authors":"Timothy J Sanford, Pranav Kaul, Danielle M McCarthy","doi":"10.1111/acem.15047","DOIUrl":"10.1111/acem.15047","url":null,"abstract":"<p><strong>Background: </strong>The 2022 study on diagnostic error in the emergency department (ED) published by the Agency for Healthcare Research and Quality (AHRQ) reported that one in every 18 ED patients is misdiagnosed. The report was methodologically critiqued by emergency physicians and researchers. However, little is known about public perception of error in the ED. We sought to characterize public response to the publication.</p><p><strong>Methods: </strong>A search was conducted for online news articles published December 2022 reporting the diagnostic error study and containing \"public comment\" sections. Verbatim comments and relevant characteristics were collected. Three coders completed content analysis and resolved any differences. Descriptive statistics and themes are reported.</p><p><strong>Results: </strong>Fifteen online articles were reviewed; three had public comment sections (New York Times, DailyMail, and Boston Globe). There were 553 unique user comments; 293 were original comments (53%) and 260 were replies to comments (47%). The 260 replies were in response to 113 original comments, with the remaining original comments having 0 replies (n = 180). Of the 202 commenters who identified a personal role in a health care encounter, 70 (35%) identified as patients and 68 (34%) identified as physicians. Comments centered on seven major themes: (1) negative personal experiences, (2) reframing study conclusions, (3) sense of decline in training standards, (4) internal stressors impeding ED diagnostic accuracy, (5) external stressors impeding ED diagnostic accuracy, (6) suggested solutions, and (7) role of the ED in diagnosis.</p><p><strong>Conclusions: </strong>The news coverage of the diagnostic error study provided individuals a platform to share their perspectives. Many comments reflected a nuanced understanding of the role of emergency care and the stressors of the ED environment. Despite questions about the report's accuracy, there were many individuals who shared personal negative experiences suggesting that the public may feel directly impacted by error in the ED.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"300-308"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142611981","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":"How do triage nurses use their Know-Who to make decisions? A pilot exploratory study.","authors":"Yoann Noiré, Thomas Schmutz, Vincent Ribordy, Alexandra Cansé, Thierry Pelaccia","doi":"10.1111/acem.15049","DOIUrl":"10.1111/acem.15049","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"348-350"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142685745","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":"Diagnosis through prisms: Unraveling its complexity.","authors":"Pat Croskerry, Mike Clancy","doi":"10.1111/acem.15120","DOIUrl":"10.1111/acem.15120","url":null,"abstract":"<p><p>Following a review of accepted submissions for this special issue of the Society for Academic Emergency Medicine (SAEM)'s collected papers on diagnosis, we offer a commentary on the variety of reports. We use the metaphor of Newton's demonstration that a complex percept like the rainbow can be broken down by prisms, into a collection of different wavelengths of light. Like Feynman, we believe that the beauty of something may be revealed and augmented by reducing it to its constituent parts.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"200-203"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254288","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":"Handoffs in the ED: Risk factor or safety net?","authors":"Yonathan Freund, Anne-Laure Philippon","doi":"10.1111/acem.15117","DOIUrl":"10.1111/acem.15117","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"369-370"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143187904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring public reactions and challenges in emergency department diagnostic errors: A qualitative study.","authors":"Benjamin Tangkamolsuk, Quang La","doi":"10.1111/acem.70005","DOIUrl":"10.1111/acem.70005","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"377"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143424654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abortion care in the emergency department: A national survey of emergency physicians' perspectives.","authors":"Abigail M Kempf, Miriam R Singer, Maetal Haas-Kogan, Andrea Pelletier, Ari B Friedman, Sarah Rae Easter, Deborah Bartz","doi":"10.1111/acem.70002","DOIUrl":"https://doi.org/10.1111/acem.70002","url":null,"abstract":"<p><strong>Objective: </strong>The emergency department (ED) is an essential setting for diagnosis of pregnancy, confirmation of pregnancy location, and management of pregnancy loss and other complications. This health care service delivery is especially important for patients with limited or complicated access into reproductive health care elsewhere. We seek to assess emergency physicians' knowledge, training, attitudes, and practices related to pregnancy options counseling, reproductive health referrals, and provision of medical- and procedural-induced abortion.</p><p><strong>Methods: </strong>We surveyed a sample of emergency physicians in person at a U.S. national medical meeting regarding knowledge, attitudes, and practices related to reproductive health care delivery. Wilcoxon rank sum tests were used to evaluate differences between abortion-restrictive and -permissive states and chi-square tests were used to compare proportions between the two groups and Wilcoxon signed rank was used to compare median scores between questions. Thematic analysis was used to review qualitative responses.</p><p><strong>Results: </strong>Of the 295 emergency physicians approached, 252 (85.4%) completed study procedures. The majority (n = 218, 86.5%) practiced in abortion-permissive states. Most (n = 178, 70.6%) supported abortion provision in the ED if legally allowed, though only about half (n = 131, 52.0%) reported ever prescribing medication abortion pills. Despite higher proportions reporting training in services, a small minority responded they could still independently provide pregnancy options counseling (25.1%), direct referrals for abortion (34.9%), medical management for early pregnancy loss (15.1%) or induced abortion (10.7%), or uterine aspiration for any pregnancy indication (1.6%). Training and knowledge were similar, though practice patterns and attitudes differed when comparing abortion-restrictive to -permissive states.</p><p><strong>Conclusions: </strong>This national survey demonstrates that, while most emergency physicians support the provision of abortion care in this setting, they do not routinely provide this care due to a variety of factors including lack of knowledge, lack of training, and legal and institutional restrictions.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation and assessment of a one-month sabbatical program for faculty in an academic emergency department.","authors":"Kian D Samadian, Joshua N Goldstein, Ali S Raja, Joshua J Baugh","doi":"10.1111/acem.70011","DOIUrl":"https://doi.org/10.1111/acem.70011","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143475919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}