Journal of the American College of Emergency Physicians open最新文献

{"title":"Enhancing Care for Critically Ill Patients Boarding in the Emergency Department: A 360° Evaluation of an Emergency Medicine Critical Care Fellow Model.","authors":"Deepa M Patel, Samantha S Strickler, Timothy P Moran, Layne Madden, Maxwell Hockstein, Donald Maberry, Mustafa Rasheed, Katherine Nugent, Seema Tekwani, Jonathan J Ratcliff, Brooks Moore","doi":"10.1016/j.acepjo.2026.100444","DOIUrl":"10.1016/j.acepjo.2026.100444","url":null,"abstract":"<p><strong>Objectives: </strong>Evaluate the impact of an emergency medicine-trained anesthesiology critical care (EM ACC) fellow on the delivery of critical care to patients admitted to the intensive care unit (ICU) and boarding in the emergency department (ED).</p><p><strong>Methods: </strong>This is a mixed methods observational study at a single urban tertiary care center. A second year EM ACC fellow was deployed to the ED for 2 months. We performed a 360° analysis of this pilot program using a cross-sectional staff survey, an analysis of fellow productivity, and a secondary retrospective cohort analysis of patient outcomes.</p><p><strong>Results: </strong>Fellows worked a total of 26 shifts and encountered 101 ICU boarding patients. Surveys were completed by 71 medical professionals: 22 emergency medicine (EM) physicians, 44 EM nurses, and 5 critical care (CC) physicians (n = 107, response rate 66.4%). On a 5-point Likert scale, the EM ACC fellow was reported to be invaluable or very helpful by 91.5% of all respondents. Qualitative analysis of open feedback emphasized improved team communication, coordination of care, timely interventions, and enhanced CC education. Fellows generated 3.1 work relative value unit (wRVU) per hour and 4.9 wRVU per patient while facilitating 11 (10.8%) ICU downgrades and 4 (3.9%) ICU upgrades. There were no significant differences in patient outcomes (ICU length of stay [LOS], hospital LOS, and discharge disposition).</p><p><strong>Conclusion: </strong>This model, using an EM ACC fellow, offers an approach to improve the delivery of CC to ICU patients boarding in the ED and may be modified to fit the resources, needs, and models available at different institutions. At the study institution, integrating EM ACC fellows into the ED garnered widespread support and demonstrated billing feasibility, but did not show difference in patient outcomes.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 4","pages":"100444"},"PeriodicalIF":1.8,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13320995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148371162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smart Dosing, Better Outcomes: An Electronic Medical Record Intervention for Cancer Pain in the Emergency Department.","authors":"Christopher J Coyne, Ryan Miller, Kelly Dong, Anthony S Tadros","doi":"10.1016/j.acepjo.2026.100449","DOIUrl":"10.1016/j.acepjo.2026.100449","url":null,"abstract":"<p><strong>Objectives: </strong>We hypothesized that an electronic medical record (EMR)-based best practice advisory (BPA), offering individualized opioid dosing for cancer patients with high opioid tolerance, would improve pain control and reduce hospital admissions in the emergency department (ED).</p><p><strong>Methods: </strong>We conducted a retrospective cohort study from May 2020 to May 2024 across 2 academic EDs affiliated with a National Comprehensive Cancer Network cancer center. Adult patients with active cancer, a morphine equivalent daily dose (MEDD) ≥100, and an ED opioid order were eligible. The BPA calculated MEDD-based opioid dosing recommendations and provided safety measures. Patients were categorized as BPA+ (recommendation followed) or BPA- (recommendation ignored). The primary outcome was hospital admission. Secondary outcomes included ED length of stay and change in pain scores.</p><p><strong>Results: </strong>Among 1193 patient encounters, 719 (60.3%) received BPA-directed therapy. BPA+ was associated with a lower odds ratio (OR) of admission compared to BPA- (OR, 0.67; 95% CI, 0.49-0.80). The BPA was associated with decreased admission rates in patients with an Eastern Cooperative Oncology Group performance status of 4 (54% vs 80% admitted) and stage 4 cancer (57% vs 68% admitted). BPA+ was also associated with greater median pain improvement (-2 vs -1) and shorter ED stays (8.2 vs 8.9 hours). Among patients receiving multiple opioid doses, greater BPA adherence was associated with sustained pain reduction, while BPA nonadherence showed diminished response.</p><p><strong>Conclusion: </strong>An EMR-integrated BPA for opioid-tolerant cancer patients was associated with improved ED pain management and reduced admissions. These findings support broader use of EMR-based tools to promote guideline-concordant, personalized care for cancer-related pain.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 4","pages":"100449"},"PeriodicalIF":1.8,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13325251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148378619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adolescent Substance Use Screening in the Emergency Department.","authors":"Stephen Sandelich, Siraj Amanullah, Isabella Barata, Kathleen Berg, Kathleen Brown, Tabitha Cheng, Corrie Chimptazi, Ilene Claudius, Ann M Dietrich, Sophia Lin, Tim Ruttan, Michael Stoner, Carmen Sulton, Muhammad Waseem","doi":"10.1016/j.acepjo.2026.100447","DOIUrl":"10.1016/j.acepjo.2026.100447","url":null,"abstract":"<p><p>Adolescent substance use remains a major public health concern, and the emergency department (ED) represents a critical point of contact for identification and early intervention. Many adolescents rely on the ED as their primary or sole source of health care, making missed opportunities for screening particularly consequential. Although overall substance use rates among youth have stabilized or declined in recent years, drug-related mortality, especially from illicitly manufactured fentanyl, has risen sharply, highlighting the need for proactive detection and intervention. Professional organizations recommend universal, validated screening for substance use in adolescents, yet implementation in ED settings remains inconsistent due to workflow constraints, confidentiality concerns, and limited provider training. Validated tools, such as the Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) questionnaire, the screening to brief intervention (S2BI) tool, and the brief screener for tobacco, alcohol, and other drugs (BSTAD) tool, allow rapid, developmentally appropriate screening. They can be integrated into electronic health records (EHRs) or self-administered digital formats. Evidence suggests that electronic or kiosk-based screening increases disclosure and detection without adversely affecting throughput. Screening alone is insufficient; pairing detection with brief motivational interventions and facilitated referral to treatment improves short-term outcomes and linkage to care. However, follow-up rates remain suboptimal, underscoring the need for structured referral pathways, behavioral health integration, and technology-enabled supports such as text-based reminders or telehealth. Universal, developmentally tailored screening in the ED, combined with brief intervention and active linkage to outpatient care, offers a practical strategy to reduce substance-related morbidity and improve long-term outcomes for adolescents.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 4","pages":"100447"},"PeriodicalIF":1.8,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13314743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148364291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Miller Fisher Syndrome Should Only be Diagnosed if the Diagnostic Criteria are Met and All Other Differential Diagnoses Have Been Ruled Out.","authors":"Josef Finsterer","doi":"10.1016/j.acepjo.2026.100448","DOIUrl":"10.1016/j.acepjo.2026.100448","url":null,"abstract":"","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 4","pages":"100448"},"PeriodicalIF":1.8,"publicationDate":"2026-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13314731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148364266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scalp Lesions in a Neonate.","authors":"Maxwell Rowley, Dharshana Krishnaprasadh","doi":"10.1016/j.acepjo.2026.100441","DOIUrl":"10.1016/j.acepjo.2026.100441","url":null,"abstract":"","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 4","pages":"100441"},"PeriodicalIF":1.8,"publicationDate":"2026-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13279150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148297643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alignment of United States Emergency Medicine Programs' Pregnancy, Parental Leave, and Lactation Policies With Recent Consensus Recommendations.","authors":"Laura G Shepherd, Michelle D Lall, Shivam Champaneria, Justin Davis, Michael Dinh, Carney Flinn, Kristen Helmsdoerfer, Rasim Kazic, Kellsa Mbah, Alycia N Montgomery, Seyjil Morrow, Jeffery Peters, Ryan Shepherd, Rebecca Sobolewski, Michael Ysit, William Manning, Jin H Han","doi":"10.1016/j.acepjo.2026.100428","DOIUrl":"10.1016/j.acepjo.2026.100428","url":null,"abstract":"<p><strong>Objectives: </strong>Many emergency physicians start families. Consensus recommendations to support physician pregnancy, parental leave, and lactation for emergency medicine (EM) programs were recently developed. This study aimed to determine how well EM programs' existing parental policies align with these recommendations for resident and attending physicians across US emergency departments.</p><p><strong>Methods: </strong>A 53-item REDCap survey evaluated policies for pregnancy, parental leave, and lactation in university- and community-based EM programs with residencies. The survey was emailed to faculty chairs and residency program directors at the 282 programs listed in the Fellowship and Residency Electronic Interactive Database Access database, with at least 4 contact attempts (one by phone) from September 2024 to February 2025.</p><p><strong>Results: </strong>A total of 102 (36%) residency program surveys and 83 (29%) attending group surveys were completed. Most respondents limited overnight shifts in the third trimester for resident and attending physicians (69% and 76%), though fewer, did so in the first trimester (39% and 34%). In the postnatal period, nonbirthing parents received compensated leave in 68% and 57% of resident and attending programs, respectively. Access to compensated leave for adoptive parents and parents by surrogate ranged from 43% to 52% for resident programs and 28% to 42% for attending programs, respectively. Most programs had written lactation policies supporting breastfeeding indefinitely, though access to adequate lactation space and the ability to step away from patient care varied. A minority covered assisted reproductive therapies.</p><p><strong>Conclusion: </strong>EM programs' existing parental policies do not consistently align with recently published consensus-driven parental policy recommendations. More work is needed to increase the adoption of recommendations and understand the impact of adherence on parental and fetal outcomes.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 4","pages":"100428"},"PeriodicalIF":1.8,"publicationDate":"2026-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13279154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148297600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Man With Ear Pain.","authors":"Jacob Cabrejas, Wesley Eilbert","doi":"10.1016/j.acepjo.2026.100440","DOIUrl":"10.1016/j.acepjo.2026.100440","url":null,"abstract":"","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 4","pages":"100440"},"PeriodicalIF":1.8,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13277446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148297671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeted Delirium Screening in At-risk Older Adults in the Emergency Department Improves Screening Rates.","authors":"Saket A Saxena, Emily H Weaver, Evelyn C Brady, David Bruckman, McKinsey Muir, Stephen Meldon","doi":"10.1016/j.acepjo.2026.100439","DOIUrl":"10.1016/j.acepjo.2026.100439","url":null,"abstract":"<p><strong>Objectives: </strong>Delirium is prevalent yet underrecognized in the emergency department (ED). Timely identification of delirium is a priority, but results from systematic implementation of targeted delirium screening in the ED are limited.</p><p><strong>Methods: </strong>This study analyzes delirium screening rates, positivity rates, and distribution of screening scores before and after implementation of an electronic medical record (EMR)-based risk stratification at ED triage. In the baseline period, delirium screening was based on age (65+ years) and clinical concern for altered mental status (AMS). In the intervention period, eligibility for delirium screening was based on an automated EMR-based risk stratification. The 4AT was used as a delirium screening tool in both periods.</p><p><strong>Results: </strong>In the baseline period, only 3267 (3.0%) of patient encounters were noted to have AMS and were eligible for delirium screening; 2241 patients received the screening; 1901 screenings resulted in a positive 4AT. In the intervention period using EMR-based targeted screening, 39,065 encounters were eligible for delirium screening; 14,125 patients received the screening, resulting in 2016 positive 4AT.</p><p><strong>Conclusion: </strong>This multicenter study demonstrates the feasibility of EMR-based risk stratification to target encounters for delirium screening at ED triage. The clinical judgment approach resulted in lower screening rates and a greater percentage of high-positive 4AT scores. The risk-stratified approach resulted in a 6-fold increase in number of screenings and identification of low-positive 4AT scores, detecting more patients with subtle delirium. An approach that leverages risk-stratified screening, complemented by screening based on clinical judgment, could capture a wider range of patients with delirium.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 4","pages":"100439"},"PeriodicalIF":1.8,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13277430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148297651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Young Woman Presents With Abdominal Pain.","authors":"Raymond Che, Allyson M Briggs, Alex Hodson, Avery Miller","doi":"10.1016/j.acepjo.2026.100445","DOIUrl":"10.1016/j.acepjo.2026.100445","url":null,"abstract":"","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 4","pages":"100445"},"PeriodicalIF":1.8,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13277431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148297602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Young Man With Sudden Quadriplegia After Neck Massage.","authors":"Xiujiao Wei, Qinghong Duan","doi":"10.1016/j.acepjo.2026.100442","DOIUrl":"10.1016/j.acepjo.2026.100442","url":null,"abstract":"","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 4","pages":"100442"},"PeriodicalIF":1.8,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13277426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148297606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}