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

Objectives: We evaluated factors associated with the need for full admission (greater than 2 days) for patients with skin and soft tissue infection (SSTI) placed in an emergency department (ED) observation unit (EDOU) in order to inform a new SSTI protocol.

Methods: Retrospective cohort study of adult ED patients assigned to the EDOU for treatment of a SSTI from 2017 to 2018. Data elements included demographics, vital signs, SSTI location and cause, procedures, consults, length of stay, and disposition. Significant relationships identified under univariable analysis were further examined in multivariable logistic regression.

Results: Four hundred eight patient charts were included, of which 100 (24.5%) were admitted. The mean age was 47.3 ± 17.5 years (range, 18-95 years), and 58.0% were men. SSTI complicated by intravenous drug abuse (odds ratio [OR], 1.47; 95% CI, 0.58-3.72) and diabetes (OR, 1.38; 95% CI, 0.41-4.60) had the highest univariable odds of admission for types of infection. Infections treated with a procedure such as incision and drainage had lower odds of admission (OR, 0.56; 95% CI, 0.32-0.98). On multivariate logistic regression, tachycardia (OR, 1.85; 95% CI, 1.09-3.13) was associated with higher odds of admission. SSTI on the torso (OR, 0.23; 95% CI, 0.06-0.80), plan for expert consultation (OR, 0.32; 95% CI, 0.19-0.54), and having a procedure (OR, 0.42; 95% CI, 0.22-0.76) were associated with lower odds of admission. Based on this information, the EDOU protocol for patients with SSTI was updated. In the year after update, admission rate among patients with SSTI was 22.4%.

Conclusion: Tachycardia in the ED may be an early sign of a more complicated SSTI that is more likely to require hospital admission. Adjusting an EDOU protocol to the local population may be helpful for improving EDOU patient selection.

Objectives: To evaluate the rate of return visits to the emergency department (ED) within 72 hours of discharge for patients evaluated in the waiting room. ED crowding challenges throughput, and we hypothesized that some patients may be suitable for the completion of evaluation without rooming.

Methods: This was a single-center retrospective analysis of a tertiary hospital ED. The primary outcome was 72-hour returns following discharge from the ED, stratified by location of initial physician evaluation and discharge: waiting room only, waiting room followed by treatment space, and treatment space only. Categorical data were compared using a chi-squared test and continuous data using a one-way analysis of variance with Bonferroni correction. The primary outcome was analyzed using a chi-squared test adjusting for age, biologic sex, Emergency Severity Index, primary language, time of day, and day of the week using logistic regression.

Results: There was a statistically significant overall difference in return visits within 72 hours of discharge based on the ED location where the evaluation occurred (P < .05; 5.0% in the waiting room only, 4.4% in the waiting room followed by treatment space, and 4.9% in the treatment space only). However, when comparing groups individually, there was a significantly lower rate of 72-hour return only for patients seen in the waiting room followed by a treatment space compared with treatment space only (P = .032). The patients evaluated and discharged from the waiting room tended to be younger, more likely to be male, with lower acuity Emergency Severity Index scores, and typically seen during an evening shift compared with the patients who were evaluated in a treatment space during their visit.

Conclusion: There was no significant increase in the rate of return for those patients seen primarily in the waiting room or for those where the initial work up started in the waiting room compared with those who were placed in a treatment space prior to a physician evaluation.

Objectives: Introducing evidence-based treatment strategies into education for emergency medicine (EM) residents might improve treatment for people with opioid use disorder (OUD). Our objective was to evaluate the impact of an educational initiative in treating OUD with emergency department (ED)-initiated buprenorphine.

Methods: This was a retrospective analysis of an educational initiative using case-based discussions to train EM residents in the treatment of OUD, including ED-initiated buprenorphine, at a single EM residency program. Patients at the corresponding ED who were given an OUD-related diagnosis were screened for the initiation of buprenorphine. We calculated the odds of receiving ED-initiated buprenorphine among eligible patients 6 months before and 6 months after the educational initiative. Patients currently treated with buprenorphine or methadone were excluded from the analysis.

Results: Before the educational initiative, 14% (26/186) of patients with OUD eligible for buprenorphine underwent a novel buprenorphine induction in the ED, which increased to 18% (33/183) after the educational initiative. Following the educational initiative, the odds of receiving ED-initiated buprenorphine compared with the pre-educational initiative was 1.35 (95% CI, 0.77-2.24).

Conclusion: The total number of people with OUD treated with buprenorphine increased after our educational initiative, but the odds ratio was not statistically significant. Complementing educational initiatives, other factors are likely needed to significantly increase the likelihood that a person with OUD is treated with buprenorphine.

Objectives: We developed a mobile web application to help identify nontraumatic abdominal patient-reported symptoms (PRS) in patients who visited the emergency department (ED). Patients can use this during waiting times to facilitate patient history-taking by the physician. The study aimed to evaluate the feasibility and acceptability of PRS usage in the ED by patients.

Methods: A mixed-methods study was conducted at the ED of an academic tertiary hospital in Seoul, Korea. Adult patients aged ≤65 years presenting with abdominal symptoms were enrolled. We assessed PRS completion, time, and help required. Patient surveys and semi-structured interviews with patients and physicians were used to evaluate feasibility and acceptability.

Results: A total of 30 patient surveys were analyzed, and in-depth interviews were conducted with 6 patients and 6 doctors. All participants completed the PRS in an average of 7.6 (SD, 5.0) minutes. Sixteen patients (53.3%) needed help with content, and 15 (50.0%) required technical assistance. The PRS was rated as acceptable based on the diffusion of innovation theory, with an average of 3.9 (SD, 0.76) out of 5. Patients reported that the PRS helped them communicate symptoms clearly but raised concerns about its usability for older patients or those in pain.

Conclusion: In our pilot study, the PRS was feasible to use but required improvements in usability. Patients were acceptable to PRS use in the ED.