Annals of emergency medicine最新文献

英文中文

Result Push Notifications Improve Time to Emergency Department Disposition: A Pragmatic Observational Study 结果推送通知可缩短急诊科处理时间：一项实用观察研究。

IF 5 1区医学 Q1 EMERGENCY MEDICINE

Annals of emergency medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.annemergmed.2024.07.010

Sayon Dutta MD, MPH , Lisette Dunham MSPH, MPS , Dustin S. McEvoy BS , Rebecca E. Cash PhD , Melissa A. Meeker PhD , Benjamin A. White MD

Study objective

Emergency department (ED) crowding has multiple causative factors, including delayed patient throughput. Patient care efficiency may be improved by addressing delays in decisionmaking following diagnostic testing results. We examined the influence of sending subscribed result push notifications to ED clinicians' smartphones on reducing the time to disposition decision.

Results

All ED patient visits between October 2022 and October 2023 with a laboratory or imaging result during the ED visit and a disposition within 6 hours of the last result were included. We identified whether the last resulted study before the ED disposition decision had a subscribed push notification by the clinician who dispositioned the patient. The primary outcome was the time between the last study result and the first disposition decision. Generalized estimating equation analysis was used to control for variables including patient demographics, clinical factors, and discharging clinician.

Results

The final study population included 237,872 encounters. The median patient age was 50 years, and 55.6% of patients were women. During the study period, 27.1% of clinicians used push notifications at least once. Of unique orders, 1.5% had a subscribed result push notification, including 0.9% of laboratory orders and 4.7% of imaging orders. The time between last result to disposition decision was 18 minutes (95% confidence interval [CI] 15 to 21) faster when a push notification was requested.

Conclusion

Elective push notification of test results was associated with reduced time between the last laboratory or imaging result and ED disposition decision. Further study is needed to determine its effect on overall ED throughput.

研究目的急诊科（ED）拥挤有多种致病因素，包括患者吞吐量延迟。解决诊断检测结果决策延迟问题可以提高患者护理效率。我们研究了向急诊科临床医生的智能手机发送订阅结果推送通知对缩短处置决策时间的影响。结果纳入了 2022 年 10 月至 2023 年 10 月期间所有急诊科患者就诊情况，这些患者在急诊科就诊期间接受了实验室或成像结果检查，并在最后一次结果出来后 6 小时内进行了处置。我们确定了在急诊室做出处置决定前的最后一次结果是否已被处置患者的临床医生订阅推送通知。主要结果是最后一次研究结果与首次处置决定之间的时间间隔。采用了广义估计方程分析来控制包括患者人口统计学、临床因素和出院临床医生在内的变量。患者年龄中位数为 50 岁，55.6% 的患者为女性。在研究期间，27.1% 的临床医生至少使用过一次推送通知。在唯一订单中，1.5% 的订单订阅了结果推送通知，其中包括 0.9% 的实验室订单和 4.7% 的影像订单。结论选择性推送检验结果通知与缩短实验室或影像学最后结果与 ED 处置决定之间的时间有关。需要进一步研究以确定其对整个急诊室吞吐量的影响。

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引用次数: 0

Managing Awake Intubation 管理清醒插管。

IF 5 1区医学 Q1 EMERGENCY MEDICINE

Annals of emergency medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.annemergmed.2024.07.017

Benjamin J. Sandefur MD, MHPE , Brian E. Driver MD , Brit Long MD

引用次数: 0

In reply 在回答。

IF 5 1区医学 Q1 EMERGENCY MEDICINE

Annals of emergency medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.annemergmed.2024.08.007

Nicholas R. Pettit DO, PhD, Kathleen A. Lane MS, Leslie Gibbs NP, Paul Musey MD, MSC, Xiaochun Li PhD, Joshua R. Vest PhD, MPH

引用次数: 0

Assessment of Prognostic Scores for Emergency Department Patients With Upper Gastrointestinal Bleeding 评估急诊科上消化道出血患者的预后评分。

IF 5 1区医学 Q1 EMERGENCY MEDICINE

Annals of emergency medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.annemergmed.2024.06.024

Pierre-Clément Thiebaud MSc , Eliana Wassermann PhD , Mathilde de Caluwe , Clément Prebin , Florent Noel MD , Agnès Dechartres PhD , Pierre-Alexis Raynal MD , Judith Leblanc PhD , Youri Yordanov PhD

Study objective

Early prognostic stratification could optimize the management of patients with upper gastrointestinal bleeding and reduce unnecessary hospitalizations. The aim of this study was to assess and compare the performance of existing prognostic scores in predicting therapeutic intervention and death.

Methods

A systematic search of the literature identified existing prognostic scores. A multicenter retrospective cohort study included adult patients hospitalized for upper gastrointestinal bleeding from January 1, 2019, to December 31, 2020. The primary outcome was a composite including therapeutic intervention within 7 days (blood transfusion, endoscopic, surgical, or interventional radiology hemostasis) and/or 30-day death. Discrimination performance was estimated by the area under the curve (AUC). The ability to identify low-risk patients was analyzed using sensitivity and negative predictive value (NPV) for defined thresholds.

Results

The systematic search identified 39 prognostic scores, 12 of which could be analyzed. Among the 990 patients included, therapeutic intervention and/or death occurred in 755 (76.4%) patients. Scores with the highest discriminative performance to predict the primary composite outcome were Glasgow-Blatchford score (GBS) (AUC 0.869 [0.842 to 0.895]), modified GBS (AUC 0.872 [0.847 to 0.898]) and modified GBS 2 (AUC 0.855 [0.827 to 0.884]). The best performance to identify low-risk patients was for GBS≤1 (sensitivity 0.99 [0.99 to 1.00], NPV 0.89 [0.75 to 0.97]) and modified GBS=0 (sensitivity 0.99 [0.98 to 1.00], NPV 0.84 [0.71 to 0.94]).

Conclusions

The GBS and the modified GBS are the 2 best performing scores because they achieve both key objectives: stratifying patients based on their risk of therapeutic intervention and/or death and identifying low-risk patients who may qualify for outpatient management.

研究目的早期预后分层可优化上消化道出血患者的治疗，减少不必要的住院治疗。本研究旨在评估和比较现有预后评分在预测治疗干预和死亡方面的表现：方法：对文献进行系统检索，确定了现有的预后评分。一项多中心回顾性队列研究纳入了2019年1月1日至2020年12月31日期间因上消化道出血住院的成年患者。主要结果是包括 7 天内治疗干预（输血、内镜、手术或介入放射止血）和/或 30 天内死亡的综合结果。根据曲线下面积（AUC）估算识别性能。使用规定阈值的灵敏度和阴性预测值（NPV）分析识别低风险患者的能力：结果：系统性搜索确定了 39 个预后评分，其中 12 个可以进行分析。在纳入的 990 例患者中，755 例（76.4%）患者接受了治疗干预和/或死亡。格拉斯哥-布拉奇福德评分（GBS）（AUC 0.869 [0.842 至 0.895]）、改良 GBS（AUC 0.872 [0.847 至 0.898]）和改良 GBS 2（AUC 0.855 [0.827 至 0.884]）是预测主要综合结果的判别性能最高的评分。GBS≤1（灵敏度0.99 [0.99至1.00]，净现值0.89 [0.75至0.97]）和改良GBS=0（灵敏度0.99 [0.98至1.00]，净现值0.84 [0.71至0.94]）在识别低危患者方面表现最佳：结论：GBS 和改良 GBS 是性能最好的两种评分，因为它们同时实现了两个关键目标：根据治疗干预和/或死亡风险对患者进行分层，以及识别符合门诊治疗条件的低风险患者。

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引用次数: 0

Treating Violence: An Emergency Room Doctor Takes on a Deadly American Epidemic 治疗暴力：急诊室医生承担致命的美国流行病

IF 5 1区医学 Q1 EMERGENCY MEDICINE

Annals of emergency medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.annemergmed.2024.08.512

Nikita Joshi MD, Jordana Haber MD

引用次数: 0

Physician Experiences With Implementing a Virtual Observation Unit in Emergency Medicine. 急诊医学虚拟观察室的临床实践

IF 5 1区医学 Q1 EMERGENCY MEDICINE

Annals of emergency medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.annemergmed.2024.11.013

Olivia S Jung, Xi Zhu, Lauren M Nentwich, Benjamin A White, Emily M Hayden

Study objective: Physician experiences with new care models like the virtual observation unit in emergency departments (EDs) can offer important insights. Virtual observation unit leverages telehealth, remote monitoring, and mobile integrated health to enable home-based ED-level care. We explored physicians' experience with delivering care in the virtual observation unit and perceived effect of this new model.

Methods: We conducted semistructured in-depth interviews with 10 emergency physicians who staffed the newly launched virtual observation unit in an academic hospital. We conducted a thematic analysis, which involved identifying and examining codes that describe important themes in the data.

Results: Three themes emerged in terms of emergency physicians' experience with the virtual observation unit: (1) forming a deeper connection with patients as the virtual observation unit allowed them to spend more time with patients and care for patients in the patients' home environment; (2) increased appreciation for interprofessional and interspecialty care as the virtual observation unit presented opportunities to work closely with nurses, paramedics, and primary care physicians; and (3) (surmountable) programmatic challenges related to dealing with multipronged technology and finding the right patient with an appropriate clinical condition and acceptance of home-based care. These experiences then contributed to positive perceptions of patient-physician interactions and increased job satisfaction among physicians who participated in the virtual observation unit.

Conclusion: Physicians who staffed the virtual observation unit in our context reported largely positive experiences. Policymakers and administrators should consider benefits to physician wellbeing and cultivating interprofessional and interspecialty care when making decisions about funding telehealth and care models like the virtual observation unit.

研究目的：医生在急诊虚拟观察单元等新型护理模式中的经验可以提供重要的见解。虚拟观察单元利用远程医疗、远程监测和移动综合医疗来实现基于家庭的ed级护理。我们探讨了医生在虚拟观察室提供护理的经验和这种新模式的感知效果。方法：我们对一家学术医院新成立的虚拟观察室的10名急诊医生进行了半结构化的深度访谈。我们进行了主题分析，其中包括识别和检查描述数据中重要主题的代码。结果：急诊医生在虚拟观察室的体验中出现了三个主题：(1)与患者形成了更深的联系，因为虚拟观察室使他们能够花更多的时间与患者在患者的家庭环境中护理患者；(2)增加了对跨专业和跨专业护理的欣赏，因为虚拟观察单元提供了与护士、护理人员和初级保健医生密切合作的机会；(3)（可克服的）程序性挑战，涉及处理多管齐下的技术，找到具有适当临床条件的合适患者，并接受家庭护理。然后，这些经历对参与虚拟观察单元的医生的医患互动产生了积极的看法，并提高了他们的工作满意度。结论：在我们的研究中，配备虚拟观察单元的医生报告了大部分积极的经历。决策者和管理者在决定是否为虚拟观察室等远程医疗和护理模式提供资金时，应考虑对医生健康和培养跨专业和跨专业护理的好处。

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引用次数: 0

In reply 在回答。

IF 5 1区医学 Q1 EMERGENCY MEDICINE

Annals of emergency medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.annemergmed.2024.08.001

Minoru Hayashi MD, Norio Yamamoto MD, Akihiro Shiroshita MD, MPH

引用次数: 0

Policy Statements 政策声明。

IF 5 1区医学 Q1 EMERGENCY MEDICINE

Annals of emergency medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.annemergmed.2024.09.004

引用次数: 0

Increases in Imported Malaria Cases—Three Southern US Border Jurisdictions, 2023 输入性疟疾病例的增加——2023年美国南部边境三个司法管辖区

IF 5 1区医学 Q1 EMERGENCY MEDICINE

Annals of emergency medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.annemergmed.2024.10.006

Matthew A. Waxman MD, DTMH (Commentator)

引用次数: 0

Sugammadex Should Not be Used to Routinely Reverse Rocuronium for Patients in the Emergency Department 急诊科患者不应常规使用舒格马定逆转罗库溴铵。

IF 5 1区医学 Q1 EMERGENCY MEDICINE

Annals of emergency medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.annemergmed.2024.08.513

Kyle M. DeWitt PharmD, Alicia E. Mattson PharmD

引用次数: 0

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