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

Objectives: We previously implemented the subcutaneous (SQ) insulin in diabetic ketoacidosis (DKA) (SQuID) protocol, demonstrating safe, effective treatment of low to moderate (LTM) severity DKA in a non-intensive care unit setting. SQuID replaces intravenous (IV) insulin with SQ injections and reduces glucose checks from hourly to every 2 hours. We are not aware of any data on patient satisfaction with treatment in DKA. Our objective was to compare satisfaction in patients treated with IV insulin to that in patients treated with the SQ protocol.

Methods: We conducted a cross-sectional study in an urban academic hospital (March 2023 to March 2024) of emergency department patients treated for LTM DKA with SQ or IV insulin. Patients were contacted by phone in the hospital after the resolution of DKA. We used the validated 21-item Diabetic Treatment Satisfaction Questionnaire-Inpatient tool (DTSQ-IP) using 7-tier Likert-style options (0 = negative; 6 = positive) to assess patient satisfaction with treatment. We computed the DTSQ-IP composite treatment satisfaction score (using 15 of the 21 items), assessing differences between groups.

Results: Of the 60 patients contacted, 52 (87%) completed the questionnaire. Median DTSQ-IP satisfaction scores for SQuID and IV insulin patients were 86.0 (IQR, 79.0, 88.0) and 81.0 (IQR, 77.0, 88.0), respectively. We found no difference in satisfaction between groups (difference 5.0; 95% CI, -3.0, 10.0).

Conclusion: In this single-center study, patient satisfaction with DKA care was high, with no differences observed between patients treated with SQ vs IV insulin protocols. This is the first study we are aware of on patient satisfaction with treatment in DKA or treatment with SQ insulin. Though the sample size is small, these findings suggest that patient satisfaction should not represent a barrier to the implementation of SQ protocols for LTM severity DKA.

Objectives: Communication errors are the main cause of adverse events in emergency medicine, underscoring the importance of patient handover conversations. This study aims to assess the impact of implementing the ISOBAR handover protocol for patient transfer between emergency medical services and emergency department (ED) personnel.

Methods: We conducted a single-center implementation trial to evaluate the ISOBAR handover protocol efficacy in a German university hospital ED. We observed and analyzed 651 handover conversations involving adult patients, comparing those using the ISOBAR protocol to those following standard procedure without the protocol. Direct observation of handover processes was employed during alternating interventional periods across 6 trial phases. Primary outcome measure was the "Key Information Transfer Efficiency" score (KITE), a higher score indicating a more efficient patient handover conversation. Secondary outcome measure was the retention of key information by ED personnel, indicating successfully conveyed information.

Results: The KITE score was significantly higher in the ISOBAR group (difference 0.12, 95% CI 0.02-0.22), showing a notable increase from baseline without ISOBAR to the final trial phase using ISOBAR (difference 0.16, 95% CI 0.02-0.34). Key information retention increased significantly: +18% for physicians (95% CI 9-28) and +19% (95% CI 10-28) for nurses. The number of questions asked after handover decreased by 29% (95% CI 5.81-41.46). The adherence to ISOBAR had no notable effect on outcome measures.

Conclusion: The implementation of ISOBAR can enhance information transfer during handover. However, adherence to ISOBAR was not crucial, highlighting the importance of focusing on quality of communication during patient handover.

Objectives: Sleep disturbance and burnout are common in emergency department health care workers (HCWs), and the 2 are linked. This cross-sectional study evaluated whether gender, race/ethnicity, and clinical roles moderate the association between sleep quality and burnout among emergency department HCWs (N = 129).

Methods: Sleep was assessed with the Pittsburgh Sleep Quality Index (Pittsburgh Sleep Quality Index > 5: poor sleep) and Insomnia Severity Index (Insomnia Severity Index > 8: insomnia). The abbreviated Maslach Burnout Inventory-9 assessed the burnout dimensions of emotional exhaustion, depersonalization , and reduced personal accomplishment . Emotional exhaustion > 9 and either (or both) depersonalization > 6 or personal accomplishment < 9 indicated burnout. Logistic regressions were computed for the association of poor sleep and insomnia with burnout for gender, race/ethnicity, and job role separately.

Results: Poor sleep quality, insomnia, and burnout were seen in 64%, 59%, and 24% of participants, respectively. Poor sleep was more frequently reported in Black, Indigenous, and People of Color (BIPOC) HCWs vs non-BIPOC (72.9% vs 52.5%, P = .017). Overall, poor (vs not poor) sleep quality was associated with burnout (odds ratio [OR], 3.14; 95% CI, 1.14-8.64). There was a significant poor sleep-burnout relationship in women (OR, 4.52; 95% CI, 1.10-18.60) that was not seen in men. The poor sleep-burnout relationship was significantly stronger in attending physicians (OR, 6.92; 95% CI, 1.44-33.24) vs registered nurses (OR, 0.28; 95% CI, 0.03-2.30; P value for group ∗ predictor interaction term = .021).

Conclusion: BIPOC HCWs had worse sleep quality than non-BIPOC HCWs, and the relationship between sleep quality and burnout was affected by gender and clinical role. These findings highlight the importance of person-level factors in the sleep-burnout relationship in HCWs.

Bee stings are very common worldwide. About 5% to 15% of those afflicted have a large local reaction, defined as a skin reaction around the sting site with edema, erythema, itching, and an injury diameter >10 cm. Standard treatments for large local reactions include ice, nonsteroidal anti-inflammatory medications, antihistamine medications, and topical or systemic corticosteroids, none of which immediately treat the pain associated with the symptoms nor initiate immediate treatment of the allergic and inflammatory response. We present a dramatic and rapid reversal of a periorbital large local reaction treated with subcutaneous and intradermal injection of 1% lidocaine with epinephrine into the sting area. The lidocaine rapidly reversed the symptoms of pain and pressure, and the low dose of epinephrine, within 2 hours, significantly reversed the allergic periorbital and eyelid edema. No further symptoms evolved, suggesting that the epinephrine terminated the allergic cascade.

Emergency physicians are well-positioned to take a leadership role in telehealth, particularly in emerging categories such as triage, direct acute unscheduled care, and virtual observation. However, the growth of telehealth has outpaced curricular development in emergency medicine (EM) residency programs. This manuscript presents a model longitudinal telehealth curriculum, developed by the consensus of education experts, including representatives from the telehealth interest groups from EM's two primary specialty societies: the American College of Emergency Physicians and the Society for Academic Emergency Medicine. The curriculum describes overarching goals and components that may serve as a foundation for individual institutions seeking to train future operational and academic leaders in telehealth.