Home About us Contact
|
Home About us Contact | ||
|
|
||
Emergency Physicians (emergency + physician)
Selected AbstractsAdrenaline Storm in the Emergency PhysicianACADEMIC EMERGENCY MEDICINE, Issue 12 2006David C. Cone MD No abstract is available for this article. [source] Emergency Physician,Verified Out-of-hospital Intubation: Miss Rates by ParamedicsACADEMIC EMERGENCY MEDICINE, Issue 6 2004James H. Jones MD Abstract Objectives: To prospectively quantify the number of unrecognized missed out-of-hospital intubations by ground paramedics using emergency physician verification as the criterion standard for verification of endotracheal tube placement. Methods:The authors performed an observational, prospective study of consecutive intubated patients arriving by ground emergency medical services to two urban teaching hospitals. Endotracheal tube placement was verified by emergency physicians and evaluated by using a combination of direct visualization, esophageal detector device (EDD), colorimetric end-tidal carbon dioxide (ETCO2), and physical examination. Results: During the six-month study period, 208 out-of-hospital intubations by ground paramedics were enrolled, which included 160 (76.9%) medical patients and 48 (23.1%) trauma patients. A total of 12 (5.8%) endotracheal tubes were incorrectly placed outside the trachea. This comprised ten (6.3%) medical patients and two (4.2%) trauma patients. Of the 12 misplaced endotracheal tubes, a verification device (ETCO2 or EDD) was used in three cases (25%) and not used in nine cases (75%). Conclusions: The rate of unrecognized, misplaced out-of-hospital intubations in this urban, midwestern setting was 5.8%. This is more consistent with results of prior out-of-hospital studies that used field verification and is discordant with the only other study to exclusively use emergency physician verification performed on arrival to the emergency department. [source] Consent for Emergency Physician,Performed EchocardiographyACADEMIC EMERGENCY MEDICINE, Issue 10 2002Peter J. Mariani MD No abstract is available for this article. [source] Bedside Ultrasound of a Painful Testicle: Before and After Manual Detorsion by an Emergency PhysicianACADEMIC EMERGENCY MEDICINE, Issue 4 2009J. Scott Bomann DO No abstract is available for this article. [source] Patient Protection and Affordable Care Act of 2010: Summary, Analysis, and Opportunities for Advocacy for the Academic Emergency PhysicianACADEMIC EMERGENCY MEDICINE, Issue 7 2010Jeffrey A. Kline MD ACADEMIC EMERGENCY MEDICINE 2010; 17:E69,E74 © 2010 by the Society for Academic Emergency Medicine Abstract The Patient Protection and Affordable Care Bill, commonly referred to as the "Health Care Bill" or the "Health Care Reform Bill," was enacted in March 2010. This article is a review and analysis of the sections of this Act that are relevant to researchers and teachers of emergency care. The purpose of this document is to serve as a citable reference for interested parties and a reference to quickly locate the sections of the Bill relevant to academic emergency physicians. When appropriate, text was copied verbatim from the Bill. The source of the downloaded Act, and the page numbers of the text sections, are provided to help the reader to find the sections described. This review is presented in two parts. Part I presents 11 sections extirpated from the Act, with short interpretations of the significance of each section. Part II presents an analysis of the sections that the authors believe represent opportunities for emergency care researchers and teachers to make the most impact, through active involvement with the various departments and agencies of the federal government that will be charged with interpreting and implementing this Act. The Act contains sections that could lead to new funding opportunities for research in emergency care, especially for comparative clinical trials and clinical studies that focus on integration and efficiency of health care delivery. The Act will establish several new institutes, centers, and committees that will create policies highly relevant to emergency care. The authors conclude that this Act can be expected to have a profound influence on research and training in emergency care. [source] Systematic Review of Emergency Physician,performed Ultrasonography for Lower-Extremity Deep Vein ThrombosisACADEMIC EMERGENCY MEDICINE, Issue 6 2008Patrick R. Burnside MD Abstract Objectives:, The authors performed a systematic review to evaluate published literature on diagnostic performance of emergency physician,performed ultrasonography (EPPU) for the diagnosis and exclusion of deep venous thrombosis (DVT). Methods:, Structured search criteria were used to query MEDLINE and EMBASE, followed by a hand search of published bibliographies. Relevance and inclusion criteria required prospective investigation of emergency department (ED) outpatients with suspected DVT; diagnostic evaluations had to consist of EPPU followed by criterion standard (radiology-performed) imaging. Two authors independently extracted data from included studies; study quality was assessed utilizing a validated tool for quality assessment of diagnostic accuracy studies (QUADAS). Pooled data were analyzed using an unweighted summary receiver-operating-characteristic (SROC) curve; sensitivity and specificity were estimated using a random effects model. Results:, The initial search yielded 1,162 publications. Relevance screening and selection yielded six articles including 936 patients. Four of the six studies reported adequate blinding but a number of other methodologic flaws were identified. A random effects model yielded an overall sensitivity of 0.95 (95% confidence interval [CI] = 0.87 to 0.99) and specificity of 0.96 (95% CI = 0.87 to 0.99). Conclusions:, Systematic review of six studies suggests that EPPU may be accurate for the diagnosis of DVT compared with radiology-performed ultrasound (US). However, given the methodologic limitations identified among the primary studies, the estimates of diagnostic test performance may be overly optimistic. Further research into EPPU for suspected DVT is needed before it can be adopted into routine clinical practice. [source] The Assessment of Emergency Physicians by a Regulatory AuthorityACADEMIC EMERGENCY MEDICINE, Issue 12 2006Jocelyn M. Lockyer PhD Abstract Objectives To determine whether it is possible to develop a feasible, valid, and reliable multisource feedback program (360° evaluation) for emergency physicians. Methods Surveys with 16, 20, 30, and 31 items were developed to assess emergency physicians by 25 patients, eight coworkers, eight medical colleagues, and self, respectively, using five-point scales along with an "unable to assess" category. Items addressed key competencies related to communication skills, professionalism, collegiality, and self-management. Results Data from 187 physicians who identified themselves as emergency physicians were available. The mean number of respondents per physician was 21.6 (SD ± 3.87) (93%) for patients, 7.6 (SD ± 0.89) (96%) for coworkers, and 7.7 (SD ± 0.61) (95%) for medical colleagues, suggesting it was a feasible tool. Only the patient survey had four items with "unable to assess" percentages ,15%. The factor analysis indicated there were two factors on the patient questionnaire (communication/professionalism and patient education), two on the coworker survey (communication/collegiality and professionalism), and four on the medical colleague questionnaire (clinical performance, professionalism, self-management, and record management) that accounted for 80.0%, 62.5%, and 71.9% of the variance on the surveys, respectively. The factors were consistent with the intent of the instruments, providing empirical evidence of validity for the instruments. Reliability was established for the instruments (Cronbach's , > 0.94) and for each physician (generalizability coefficients were 0.68 for patients, 0.85 for coworkers, and 0.84 for medical colleagues). Conclusions The psychometric examination of the data suggests that the instruments developed to assess emergency physicians were feasible and provide evidence for validity and reliability. [source] Electrocardiogram Differentiation of Benign Early Repolarization Versus Acute Myocardial Infarction by Emergency Physicians and CardiologistsACADEMIC EMERGENCY MEDICINE, Issue 9 2006Samuel D. Turnipseed MD Abstract Objectives: ST-segment elevation (STE) related to benign early repolarization (BER), a common normal variant, can be difficult to distinguish from acute myocardial infarction (AMI). The authors compared the electrocardiogram (ECG) interpretations of these two entities by emergency physicians (EPs) and cardiologists. Methods: Twenty-five cases (13 BER, 12 AMI) of patients presenting to the emergency department with chest pain were identified. Criteria for BER required four of the following: 1) widespread STE (precordial greater than limb leads), 2) J-point elevation, 3) concavity of initial up-sloping portion of ST segment, 4) notching or irregular contour of J point, and 5) prominent, concordant T waves. Additional BER criteria were 1) stable ECG pattern, 2) negative cardiac injury markers, and 3) normal cardiac stress test or angiography. AMI criteria were 1) regional STE, 2) positive cardiac injury markers, and 3) identification of culprit coronary artery by angiography in less than eight hours of presentation. The 25 ECGs were distributed to 12 EPs and 12 cardiologists (four in academic medicine, four in community practice, and four in community academics [health maintenance organization] in each physician group). The physicians were informed of the patients' age, gender, and race, and they then interpreted the ECGs as BER or AMI. Undercalls (AMI misdiagnosed as BER) and overcalls (BER misdiagnosed as AMI) were calculated for each physician group. Results: Cardiologists correctly interpreted 90% of ECGs, and EPs correctly interpreted 81% of ECGs. The proportion of undercalls (missed AMI/total AMI) was 2.8% for cardiologists (95% confidence interval [CI] = 0.09% to 5.5%) compared with 9.7% for EPs (95% CI = 4.8% to 14.6%) (p = 0.02). The proportion of overcalls (missed BER/total BER) was 17.3% for cardiologists (95% CI = 11.4% to 23.3%) versus 27.6% for EPs (95% CI = 20.6% to 34.6%) (p = 0.03). The mean number of years in practice was 19.8 for cardiologists (95% CI = 19 to 20.5) and 11 years for EPs (95% CI = 10.5 to 12.0) (p < 0.001). Conclusions: Although correct interpretation was high in both groups, cardiologists, who had significantly more years of practice, had fewer misinterpretations than EPs in distinguishing BER from AMI electrocardiographically. [source] Australasian emergency physicians: A learning and educational needs analysis.EMERGENCY MEDICINE AUSTRALASIA, Issue 2 2008Part Three: Participation by FACEM in available CPD: What do they do, do they like it? Abstract Objective: To determine the participation of Emergency Physicians (EP) in currently available continuing professional development opportunities (CPD), their perception of the usefulness of available CPD and their preferred format or method of CPD desired in the future. Method: A mailed survey of Fellows of the Australasian College for Emergency Medicine with 17 Likert type options on educational methods and qualitative analysis grouping volunteered free text responses. Results: The most frequent learning methods reported by EP are on the job contact with other clinicians, formal ED based teaching and reading journals, which were also perceived as useful or very useful learning methods by more than 90% of EP. Less than 15% often or always participate on hospital grand rounds, high fidelity simulation, computer programmes or commercially sponsored events. Increased exposure was desired to high-fidelity simulation center skills training by 58% of respondents with nearly 49% of fellows also wanting more participation in international conferences with around 44% of fellows also wanting more participation in international conferences with around 44% desiring more formal teaching in the ED, more formal feedback on performance, and more meetings with other hospital departments. Over 50% of EP want less or no exposure to commercially sponsored dinners or events. Conclusion: Whilst emergency physicians currently participate in a wide variety of learning methods, the results of this survey suggest EP most appreciate ED based teaching, would like more contact with other departments, along with increased opportunities for simulation based learning and attendance at international conferences. [source] A Comparison of Trauma Intubations Managed by Anesthesiologists and Emergency PhysiciansACADEMIC EMERGENCY MEDICINE, Issue 1 2004Joseph S. Bushra MD Although airway management by emergency physicians has become standard for general emergency department (ED) patients, many believe that anesthesiologists should manage the airways of trauma victims. Objectives: To compare the success and failure rates of trauma intubations performed under the supervision of anesthesiologists and emergency physicians. Methods: This was a prospective, observational study of consecutive endotracheal intubations (ETIs) of adult trauma patients in a single ED over a 46-month period. All ETIs before November 26, 2000, were supervised by anesthesiologists (34 months), and all ETIs from November 26, 2000, onward were supervised by emergency physicians (12 months). Data regarding clinical presentation, personnel involved, medications used, number of attempts required, and need for cricothyrotomy were collected. Study outcomes were: 1) successful intubation within two attempts, and 2) failure of intubation. Failure was defined as inability to intubate, resulting in successful intubation by another specialist, or cricothyrotomy. Odds ratios (ORs) with 95% confidence intervals (95% CIs) were used to compare results between groups. Results: There were 673 intubations during the study period. Intubation within two attempts was accomplished in 442 of 467 patients (94.6%) managed by anesthesiologists, and in 196 of 206 of patients (95.2%) managed by emergency physicians (OR = 1.109, 95% CI = 0.498 to 2.522). Failure of intubation occurred in 16 of 467 (3.4%) patients managed by anesthesiologists, and in four of 206 (1.9%) patients managed by emergency physicians (OR = 0.558, 95% CI = 0.156 to 1.806). Conclusions: Emergency physicians can safely manage the airways of trauma patients. Success and failure rates are similar to those of anesthesiologists. [source] Smallpox Vaccination for Emergency Physicians,ACADEMIC EMERGENCY MEDICINE, Issue 6 2003AAEM/SAEM Smallpox Vaccination Working Group Abstract On December 13, 2002, President Bush formally announced the national smallpox vaccination program. The plan involves vaccinating health care workers who would respond to possible smallpox cases, including emergency physicians. Although not all aspects of the program are clearly established, it appears that vaccination of health care workers will occur in the near future. This joint statement has been used by the American Academy of Emergency Medicine and the Society for Academic Emergency Medicine regarding smallpox vaccination for emergency physicians. [source] Electrocardiographic ST-segment Elevation: Correct Identification of Acute Myocardial Infarction (AMI) and Non-AMI Syndromes by Emergency PhysiciansACADEMIC EMERGENCY MEDICINE, Issue 4 2001William J. Brady MD Abstract. Objective: To determine the emergency physician's (EP's) ability to identify the cause of ST-segment elevation (STE) in a hypothetical chest pain patient. Methods: Eleven electrocardiograms (ECGs) with STE were given to EPs; the patient in each instance was a 45-year-old male with a medical history of hypertension and diabetes mellitus with the chief complaint of chest pain. The EP was asked to determine the cause of the STE and, if due to acute myocardial infarction (AMI), to decide whether thrombolytic therapy (TT) would be administered (the patient had no contraindication to such treatment). Rates of TT administration were determined; appropriate TT administration was defined as that occurring in an AMI patient, while inappropriate TT administration was defined as that in the non-AMI patient. Results: Four hundred fifty-eight EPs completed the questionnaire; levels of medical experience included the following: postgraduate year 2-3, 193 (42%); and attending, 265 (58%). The overall rate of correct interpretation of the study ECGs was 94.9% (4,782 correct interpretations out of 5,038 instances). Acute myocardial infarction with typical STE, ventricular paced rhythm, and right bundle branch block were never misinterpreted. The remaining conditions were misinterpreted with rates ranging between 9% (left bundle branch block, LBBB) and 72% (left ventricular aneurysm, LVA). The overall rate of appropriate thrombolytic agent administration was 83% (1,525 correct administrations out of 1,832 indicated administrations). The leading diagnosis for which thrombolytic agent was given inappropriately was LVA (28%), followed by benign early repolarization (23%), pericarditis (21%), and LBBB without electrocardiographic AMI (5%). Thrombolytic agent was appropriately given in all cases of AMI except when associated with atypical STE, where it was inappropriately withheld 67% of the time. Conclusions: In this survey, EPs were asked whether they would give TT based on limited information (ECG). Certain syndromes with STE were frequently misdiagnosed. Emergency physician electrocardiographic education must focus on the proper identification of these syndromes so that TT may be appropriately utilized. [source] Ultrasound Training for Emergency Physicians, A Prospective StudyACADEMIC EMERGENCY MEDICINE, Issue 9 2000Diku P. Mandavia MD Abstract. Objectives: Bedside ultrasound examination by emergency physicians (EPs) is being integrated into clinical emergency practice, yet minimum training requirements have not been well defined or evaluated. This study evaluated the accuracy of EP ultrasonography following a 16-hour introductory ultrasound course. Methods: In phase I of the study, a condensed 16-hour emergency ultrasound curriculum based on Society for Academic Emergency Medicine guidelines was administered to emergency medicine houseofficers, attending staff, medical students, and physician assistants over two days. Lectures with syllabus material were used to cover the following ultrasound topics in eight hours: basic physics, pelvis, right upper quadrant, renal, aorta, trauma, and echo-cardiography. In addition, each student received eight hours of hands-on ultrasound instruction over the two-day period. All participants in this curriculum received a standardized pretest and posttest that included 24 emergency ultrasound images for interpretation. These images included positive, negative, and nondiagnostic scans in each of the above clinical categories. In phase II of the study, ultrasound examinations performed by postgraduate-year-2 (PGY2) houseofficers over a ten-month period were examined and the standardized test was readministered. Results: In phase I, a total of 80 health professionals underwent standardized training and testing. The mean ± SD pretest score was 15.6 ± 4.2, 95% CI = 14.7 to 16.5 (65% of a maximum score of 24), and the mean ± SD posttest score was 20.2 ± 1.6, 95% CI = 19.8 to 20.6 (84%) (p < 0.05). In phase II, a total of 1,138 examinations were performed by 18 PGY2 houseofficers. Sensitivity was 92.4% (95% CI = 89% to 95%), specificity was 96.1% (95% CI = 94% to 98%), and overall accuracy was 94.6% (95% CI = 93% to 96%). The follow-up ultrasound written test showed continued good performance (20.7 ± 1.2, 95% CI = 20.0 to 21.4). Conclusions: Emergency physicians can be taught focused ultrasonography with a high degree of accuracy, and a 16-hour course serves as a good introductory foundation. [source] Current Practice, Demographics, and Trends of Critical Care Trained Emergency Physicians in the United StatesACADEMIC EMERGENCY MEDICINE, Issue 3 2010Julie A. Mayglothling MD Abstract Objectives:, Critical care medicine (CCM) is of growing interest among emergency physicians (EPs), but the number of CCM-trained EPs and their postfellowship practice is unknown. This study's purpose was to conduct a descriptive census survey of EPs who have completed or are currently in a CCM fellowship. Methods:, The authors created a Web-based survey, and requests to participate were sent to EPs who have completed or are currently in a CCM fellowship. Responses were collected over a 12-month period. Physicians were located via multiple whom electronic mailing lists, including the Emergency Medicine Section of the Society of Critical Care Medicine, Critical Care Section of the American College of Emergency Physicians, and the Emergency Medicine Residents' Association. The authors also contacted CCM fellowship coordinators and used informal networking. Data were collected on emergency medicine (EM) and other residency training; discipline, duration, and year of CCM fellowship; current practice setting; and board certification status, including the European Diploma in Intensive Care (EDIC). Results:, A total of 104 physicians completed the survey (97% response rate), of whom 73 had completed fellowship at the time of participation, and 31 of whom were in fellowship training. Of those who completed fellowship, 36/73 (49%) practice both EM and CCM, and 45/73 (62%) practice in academic institutions. Multiple disciplines of fellowship were represented: multidisciplinary (39), surgical (28), internal medicine (16), anesthesia (14), and other (4). Together, the CCM fellowships at the University of Maryland R Adams Cowley Shock Trauma Center and the University of Pittsburgh have trained 42% of all EM-CCM physicians, with 38 other institutions training from one to four fellows each. The number of EPs completing CCM fellowships has risen: from 1974 to 1989, 12 EPs; from 1990 to 1999, 15 EPs; and from 2000 to 2007, 43 EPs. Conclusions:, Emergency physicians are entering CCM fellowships in increasing numbers. Almost half of these EPs practice both EM and CCM. ACADAEMIC EMERGENCY MEDICINE 2010; 17:325,329 © 2010 by the Society for Academic Emergency Medicine [source] Evaluation of Emergency Air Evacuation of Critically Ill Patients from Cruise ShipsJOURNAL OF TRAVEL MEDICINE, Issue 6 2001Laurence D. Prina Background: The study objectives were to assess the ship physician's diagnostic accuracy in making the decision to air evacuate critically ill patients from cruise ships, to determine the outcome of these patients, and the overall benefit of air evacuation. Methods: From October 1999 to May 2000, we performed a prospective study of critically ill patients coming from cruise ships in the Caribbean and transported to our institution by air ambulance. Demographics, initial diagnosis, and treatment on board were collected by the triage officer at the time of the cruise physician's first call. In route complications and flight team composition were obtained from the air ambulance monitoring log. Patients were followed-up in the hospital for complications, outcome, and final diagnosis. Results: A consecutive series of 104 patients were considered for analysis. There were 65 men and 39 women (mean age: 68.7 years). Cruise physician's diagnosis was correct in more than 90% of the cases. Internal medicine and surgical conditions represented 80.8% and 19.2% of the cases respectively, falling mainly into three categories: cardiac (34.6%), neurological (20.2%), and digestive (14%). Two cardiac arrests and 1 ventricular fibrillation were successfully resuscitated and 5 of 15 myocardial infarctions received thrombolytic therapy on board. Air transfers were warranted in 96.1% of the cases and physician presence in the flight was considered appropriate in 97.6%. In route complications and mortality rate were 5.8% and 2.9% respectively, related to serious cardiac events. Among the 98 hospitalized patients, 10 patients developed new complications and 5 died. The overall mortality rate was 7.7%. Conclusion: The cruise industry appears off to a good start in the medical treatment of passengers needing air evacuation to a land based medical facility. There is room for improvement and adoption of American College of Emergency Physicians (ACEP) and International Council of Cruise Lines (ICCL) Health Care Guidelines are meaningful first steps. Analysis of Caribbean medical facilities and implementation of active telemedicine conferencing represent alternatives to air evacuation that need to be studied. [source] Bedside Transthoracic Sonography in Suspected Pulmonary Embolism: A New Tool for Emergency PhysiciansACADEMIC EMERGENCY MEDICINE, Issue 9 2010Beatrice Hoffmann MD First page of article [source] The MERC at CORD Scholars Program in Medical Education Research: A Novel Faculty Development Opportunity for Emergency PhysiciansACADEMIC EMERGENCY MEDICINE, Issue 2009Jeffrey N. Love MD Abstract Medical educators are increasingly charged with the development of outcomes-based "best practices" in medical student and resident education and patient care. To fulfill this mission, a cadre of well-trained, experienced medical education researchers is required. The experienced medical educator is in a prime position to fill this need but often lacks the training needed to successfully contribute to such a goal. Towards this end, the Association of American Medical Colleges (AAMC) Group on Educational Affairs developed a series of content-based workshops that have resulted in Medical Education Research Certification (MERC), promoting skills development and a better understanding of research by educators. Subsequently, the Council of Emergency Medicine Residency Directors (CORD) partnered with the AAMC to take MERC a step further, in the MERC at CORD Scholars Program (MCSP). This venture integrates a novel, mentored, specialty-specific research project with the traditional MERC workshops. Collaborative groups, based on a common area of interest, each develop a multi-institutional project by exploring and applying the concepts learned through the MERC workshops. Participants in the inaugural MCSP have completed three MERC workshops and initiated a project. Upon program completion, each will have completed MERC certification (six workshops) and gained experience as a contributing author on a mentored education research project. Not only does this program serve as a multi-dimensional faculty development opportunity, it is also intended to act as a catalyst in developing a network of education scholars and infrastructure for educational research within the specialty of emergency medicine. [source] EMTALA: OIG/HCFA Special Advisory Bulletin Clarifies EMTALA, American College of Emergency Physicians Criticizes ItTHE JOURNAL OF LAW, MEDICINE & ETHICS, Issue 1 2000Jeffrey RowesArticle first published online: 24 JAN 200 No abstract is available for this article. [source] Unique Characteristics of Emergency Care Research: Scope, Populations, and InfrastructureACADEMIC EMERGENCY MEDICINE, Issue 10 2009D. Mark Courtney MD Abstract The National Institutes of Health (NIH) Clinical and Translational Science Awards (CTSA) program and the 2006 Institute of Medicine (IOM) Report on the future of emergency care highlight the need for coordinated emergency care research (ECR) to improve the outcomes of acutely ill or injured patients. In response, the Society for Academic Emergency Medicine (SAEM) and the American College of Emergency Physicians (ACEP) sponsored the Emergency Care Research Network (ECRN) Conference in Washington, DC, on May 28, 2008. The conference objectives were to identify the unique nature of ECR and the infrastructure needed to support ECR networks and to understand the optimal role of emergency medicine (EM) and other acute care specialties in research networks. Prior to the conference, participants responded to questions addressing the relevant issues that would form the basis of breakout session discussions; two of these breakout questions are summarized in this report: 1) what makes EM research unique? and 2) what are the critical components needed to establish and maintain networked ECR? Emergency care research was defined as "the systematic examination of patient care that is expected to be continuously available to diverse populations presenting with undifferentiated symptoms of acute illness, or acutely decompensated chronic illness, and whose outcomes depend on timely diagnosis and treatment." The chain of ECR may extend beyond the physical emergency department (ED) in both place and time and integrate prehospital care, as well as short- and long-term outcome determination. ECR may extend beyond individual patients and have as the focus of investigation the actual system of emergency care delivery itself and its effects on the community with respect to access to care, use of resources, and cost. Infrastructure determinants of research network success identified by conference participants included multidisciplinary collaboration, accurate long-term outcome determination, novel information technology, intellectual infrastructure, and wider network relationships that extend beyond the ED. [source] Supply and Demand of Board-certified Emergency Physicians by U.S. State, 2005ACADEMIC EMERGENCY MEDICINE, Issue 10 2009Ashley F. Sullivan MS Abstract Objectives:, The objective was to estimate the emergency medicine (EM) board-certified emergency physician (EP) workforce supply and demand by U.S. state. Methods:, The 2005 National Emergency Department Inventories-USA provided annual visit volumes for U.S. emergency departments (EDs). We estimated full-time equivalent (FTE) EP demand at each ED by dividing the actual number of visits by the estimated average EP visit volume (3,548 visits/year) and then summing FTEs by state. Our model assumed that at least one EP should be present 24/7 in each ED. The number of EM board-certified EPs per state was provided by the American Board of Medical Specialties (American Board of Emergency Medicine, American Board of Pediatrics) and the American Osteopathic Board of Emergency Medicine. We used U.S. Census Bureau civilian population estimates to calculate EP population density by state. Results:, The supply of EM board-certified EPs was 58% of required FTEs to staff all EDs nationally and ranged from 10% in South Dakota to 104% in Hawai'i (i.e., there were more EPs than the estimated need). Texas and Florida had the largest absolute shortages of EM board-certified EPs (2,069 and 1,146, respectively). The number of EM board-certified EPs per 100,000 U.S. civilian population ranged from 3.6 in South Dakota to 13.8 in Washington, DC. States with a higher population density of EM board-certified EPs had higher percent high school graduates and a lower percent rural population and whites. Conclusions:, The supply and demand of EM board-certified EPs varies by state. Only one state had an adequate supply of EM board-certified EPs to fully staff its EDs. [source] Quality Indicators for Geriatric Emergency CareACADEMIC EMERGENCY MEDICINE, Issue 5 2009Kevin M. Terrell DO Abstract Objectives:, Emergency departments (EDs), similar to other health care environments, are concerned with improving the quality of patient care. Older patients comprise a large, growing, and particularly vulnerable subset of ED users. The project objective was to develop ED-specific quality indicators for older patients to help practitioners identify quality gaps and focus quality improvement efforts. Methods:, The Society for Academic Emergency Medicine (SAEM) Geriatric Task Force, including members representing the American College of Emergency Physicians (ACEP), selected three conditions where there are quality gaps in the care of older patients: cognitive assessment, pain management, and transitional care in both directions between nursing homes and EDs. For each condition, a content expert created potential quality indicators based on a systematic review of the literature, supplemented with expert opinion when necessary. The original candidate quality indicators were modified in response to evaluation by four groups: the Task Force, the SAEM Geriatric Interest Group, and audiences at the 2007 SAEM Annual Meeting and the 2008 American Geriatrics Society Annual Meeting. Results:, The authors offer 6 quality indicators for cognitive assessment, 6 for pain management, and 11 for transitions between nursing homes and EDs. Conclusions:, These quality indicators will help researchers and clinicians target quality improvement efforts. The next steps will be to test the feasibility of capturing the quality indicators in existing medical records and to measure the extent to which each quality indicator is successfully met in current emergency practice. [source] "Sim Wars": A New Edge to Academic Residency CompetitionsACADEMIC EMERGENCY MEDICINE, Issue 2009Yasuharu Okuda Introduction: Simulation training is an educational modality that is increasingly being utilized by emergency medicine programs to train and assess residents in core competencies. During a recent national conference, patient simulators were used in a competition to highlight multitasking, teamwork, and patient care skills. The combination of audience participation and an expert panel provided a creative forum for learning. Methods: the Foundation for Education and Research in Neurological Emergencies (FERNE) and the Emergency Medicine Residents' Association (EMRA) sponsored an innovative competition between emergency medicine residencies during the 2008 Scientific Assembly of the American College of Emergency Physicians (ACEP). This competition used high-fidelity simulations to create scenarios on neurologic emergencies. Six teams were selected to participate in the three-hour single-elimination competition. The three-member resident teams were then randomly paired against another institution. Three separate 10 minute scenarios were created for the initial round, allowing paired teams to compete on the same scenario. An expert panel provided commentary and insight on the management by each team. In addition, the experts provided feedback in the areas of communication and team training. Each round's winners were determined by the audience using an interactive system. Results: Based on the immediate feedback from participants, audience members and the expert panelists, this event was an entertaining and successful learning experience for both residents and faculty. Like the Clinical Pathological Cases (CPC) competitions, "Sim Wars" provides a showcase for residencies to demonstrate practice philosophies while providing a unique emphasis on teamwork and communication skills. The ability to expand this program to include regional competitions that lead to a national contest could be the framework for future exciting and educational events. [source] Geriatric Emergency Medicine Educational Module: Abdominal Pain in the Older AdultACADEMIC EMERGENCY MEDICINE, Issue 2009Lowell Gerson The Society for Emergency Medicine (SAEM) Geriatrics Task Force has created an instructional tool to address the complaint of abdominal pain in older adults presenting to the emergency department (ED). This is the first module in a comprehensive, web-based geriatric emergency medicine curriculum that will address common syndromes in older adults presenting to the ED. There is no formal, residency-based curriculum in geriatric emergency medicine and there is a paucity of geriatric Continuing Medical Education (CME) opportunities for practicing emergency physicians. The amount, quality, and convenience of geriatrics training available to emergency physicians is insufficient. This educational gap is particularly concerning given the ever-growing volume of older adult emergency patients. The Task Force chose to focus first on geriatric abdominal pain because a survey of emergency physicians in the mid 1990s found that it is one of the most difficult complaints to evaluate and manage. The module comprises of six clinical cases with a pre- and post-test. Together, these cases encompass the broad differential diagnosis for geriatric abdominal pain and the core medical knowledge pertaining to the subject. The modules will expose the learner, through either content or modeling, to the six Accreditation Council for Graduate Medical Education (ACGME) core competencies and to the Principles of Geriatric Emergency Medicine including rapid evaluation of functional status, communication skills, and consideration of the effect of polypharmacy and co-morbidity on the presenting complaint. This module will be available to residency programs as an "asynchronous educational session" via the Council of Emergency Medicine Residency Directors (CORD) website as well as to practicing emergency physicians via the SAEM and American College of Emergency Physicians (ACEP) websites. [source] The Emergency Informatics Transition Course: A Flexible, Online Course in Health Informatics for Emergency Medicine Clinicians and TraineesACADEMIC EMERGENCY MEDICINE, Issue 2009Michael Wadman Increasing emphasis on health information technology (HIT) as a mechanism to control costs and increase quality in health care is accelerating the diffusion of more advanced health information systems into emergency medicine. This has created an increased demand for informatics-trained emergency physicians to provide clinical input. In response to this need we partnered with the American College of Emergency Physicians (ACEP) to adapt an existing informatics educational program to emergency medicine. The American Medical Informatics Association (AMIA) 10X10 program is an effort to provide formal informatics training to 10,000 clinicians by 2010. Our first AMIA-ACEP 10X10 Emergency Informatics Transition Course matriculated 37 emergency physicians this fall. This 12 week online course is an adaption of the Oregon Health & Science University (OHSU) introductory informatics 10X10 course where students complete weekly assignments and participate in online discussions. At the end of the course they meet face-to-face at the ACEP Scientific Assembly where they present their projects and discuss common themes. The online design of the course proved adaptable for a widely varied enrollment. The first class contained students from the United States and four other countries, both large urban and small rural hospitals, and both new and experienced clinicians. Extensive input from the students will assist us in further refining this annual course to better meet the needs of emergency clinicians. We will demonstrate the design of this course, which we believe offers interested residents and fellows in emergency medicine a flexible opportunity to advance their informatics training. [source] The Centers for Medicare and Medicaid Services (CMS) Community-Acquired Pneumonia Core Measures Lead to Unnecessary Antibiotic Administration by Emergency PhysiciansACADEMIC EMERGENCY MEDICINE, Issue 2 2009Bret A. Nicks MD Abstract Objectives:, The objectives were to assess emergency physician (EP) understanding of the Centers for Medicare and Medicaid Services (CMS) core measures for community-acquired pneumonia (CAP) guidelines and to determine their self-reported effect on antibiotic prescribing patterns. Methods:, A convenience sample of EPs from five medical centers in North Carolina was anonymously surveyed via a Web-based instrument. Participants indicated their level of understanding of the CMS CAP guidelines and the effects on their prescribing patterns for antibiotics. Results:, A total of 121 EPs completed the study instrument (81%). All respondents were aware of the CMS CAP guidelines. Of these, 95% (95% confidence interval [CI] = 92% to 98%) correctly understood the time-based guidelines for antibiotic administration, although 24% (95% CI = 17% to 31%) incorrectly identified the onset of this time period. Nearly all physicians (96%; 95% CI = 93% to 99%) reported institutional commitment to meet these core measures, and 84% (95% CI = 78% to 90%) stated that they had a department-based CAP protocol. More than half of the respondents (55%; 95% CI = 47% to 70%) reported prescribing antibiotics to patients they did not believe had pneumonia in an effort to comply with the CMS guidelines, and 42% (95% CI = 34% to 50%) of these stated that they did so more than three times per month. Only 40% (95% CI = 32% to 48%) of respondents indicated a belief that the guidelines improve patient care. Of those, this was believed to occur by increasing pneumonia awareness (60%; 95% CI = 52% to 68%) and improving hospital processes when pneumonia is suspected (86%; 95% CI = 80% to 92%). Conclusions:, Emergency physicians demonstrate awareness of the current CMS CAP guidelines. Most physicians surveyed reported the presence of institutional protocols to increase compliance. More than half of EPs reported that they feel the guidelines led to unnecessary antibiotic usage for patients who are not suspected to have pneumonia. Only 40% of EPs believe that CAP awareness and expedient care resulting from these guidelines has improved overall pneumonia-related patient care. Outcome-based data for non,intensive care unit CAP patients are lacking, and EPs report that they prescribe antibiotics when they may not be necessary to comply with existing guidelines. [source] Comparison of Adverse Events during Procedural Sedation between Specially Trained Pediatric Residents and Pediatric Emergency Physicians in IsraelACADEMIC EMERGENCY MEDICINE, Issue 7 2008Itai Shavit MD Abstract Objectives:, The aim was to compare the rate of procedural sedation,related adverse events of pediatric residents with specific training in "patient safety during sedation" and pediatric emergency physicians (PEPs) who completed the same course or were teaching faculty for it. Methods:, This prospective single-blinded, nonrandomized study was conducted in two university-affiliated pediatric emergency departments (PEDs) in Israel. Pediatric residents who were authorized to perform unsupervised sedations had previously completed a course in patient safety during sedation. Unsupervised sedations by residents were defined as sedations where the entire procedure was performed independently. Study subjects had autonomy in choosing medications for sedation. Adverse events were defined as transient hypoxia (oxygen saturation , 90%) or apnea. Adverse outcomes were situations where intubation or hospitalization directly related to sedation complications would occur. Sedations over 12 consecutive months were recorded, and rates of adverse events in each group were compared. Results:, A total of 984 eligible sedations were recorded, 635 by unsupervised residents and 349 by PEPs. A total of 512 (80.6%) sedations were performed by residents when attending physicians were not in the ED. The total adverse event rate was 24/984 (2.44%). When the two groups used a similar type drugs, residents had 8/635 (1.26%) events, compared to 11/328 (3.35%) by PEPs. There was no statistically significant difference in the rates of hypoxia or apnea between the two groups (p = 0.29 and p = 0.18, respectively). Adverse outcomes did not occur. Conclusions:, Unsupervised pediatric residents with training in patient safety during sedation performed procedural sedations with a rate of adverse events similar to that of PEPs. [source] An Assessment of the Faculty Development Needs of Junior Clinical Faculty in Emergency MedicineACADEMIC EMERGENCY MEDICINE, Issue 7 2008Heather Farley MD Abstract Objectives:, Academic physicians must be able to access the resources necessary to support their ongoing professional development and meet requirements for continued academic advancement. The authors sought to determine the self-perceived career development needs of junior clinical faculty in emergency medicine (EM) and the availability of educational resources to meet those needs. Methods:, An educational "needs assessment" survey was distributed to 954 American College of Emergency Physicians (ACEP) members listed in the ACEP database as being faculty at EM residency programs in the United States and having graduated from an EM residency within the past 7 years. Respondents were asked to rank the importance of 22 areas of faculty development to their own professional growth and then to indicate whether educational resources in each area were available to them. Respondents were also asked to note the educational formats they prefer. A search for currently available resources in each topic area was undertaken and compared to the survey results. Results:, A total of 240 responses were received. Self-perceived career development needs were identified in the following areas: bedside teaching, lecture development, business skills, managerial skills, educational research, mentorship and career counseling, interpersonal skills, leadership skills, scholarly writing skills, physician wellness, and knowledge of the faculty development process. While a review of currently available educational resources revealed lectures, conferences, and online materials pertinent to most of these topics, a relative lack of resources in the areas of mentorship and physician wellness was identified. Conclusions:, Junior clinical faculty in EM perceive a lack of educational resources in a number of areas of faculty development. The academic community of EM should strive to improve awareness of and access to currently existing resources and to develop additional resources to address the area of physician wellness. The lack of mentorship in academic EM continues to be a problem in search of a solution. [source] Improving Rural Access to Emergency PhysiciansACADEMIC EMERGENCY MEDICINE, Issue 6 2007Daniel A. Handel MD The recent Institute of Medicine report entitled The Future of Emergency Care in the United States Health System acknowledges workforce issues in rural America but does not adequately address the current shortage of emergency medicine residency,trained and board-certified emergency physicians in rural America. Areas worthy of further attention to ameliorate this threat include 1) government and hospital support of emergency medicine resident educational debt load, 2) modification of residency review committee for emergency medicine guidelines to permit modified training programs that are rural focused, and 3) support of pilot projects designed to modify the delivery of rural emergency care under remote supervision by academic medical center,based practitioners. The authors discuss these potential solutions to help guide policy makers seeking to enhance rural emergency care delivery through a stronger emergency medicine workforce. [source] Differences in the Annual Incomes of Emergency Physicians Related to GenderACADEMIC EMERGENCY MEDICINE, Issue 5 2007William B. Weeks MD ObjectivesTo examine the association between physician gender and income for emergency physicians (EPs) after correcting for factors likely to influence income. MethodsThe authors used survey responses collected during the 1990s from 392 actively practicing white EPs. Linear regression modeling was used to determine the association between provider gender and annual income after controlling for workload, provider characteristics, and practice characteristics. ResultsWhite female EPs reported seeing 7% fewer visits but worked 3% more annual hours than their white male counterparts. White female EPs had practiced medicine for fewer years than white male EPs, although the distribution of respondents across categories of years practicing medicine was not dramatically different. Female EPs were more likely to be employees, as opposed to having an ownership interest in the practice. Female EPs were less likely than their male counterparts to be board certified. After adjustment for work effort, provider characteristics, and practice characteristics, the mean annual income of white female EPs was 193,570, or 47,854 (20%) lower than that for white male EPs (95% confidence interval =,82,710 to ,12,997; p = 0.007). ConclusionsDuring the 1990s, female gender was associated with lower annual income among EPs. These findings warrant further exploration to determine what factors might cause the gender-based differences in income that were found. [source] Comparison of Pediatric Emergency Physicians' and Surgeons' Evaluation and Diagnosis of AppendicitisACADEMIC EMERGENCY MEDICINE, Issue 2 2008Anupam B. Kharbanda MD Abstract Objectives:, To compare the interexaminer reliability and ability to predict appendicitis between pediatric emergency physicians (EPs) and senior surgical residents. Methods:, The authors conducted a prospective cohort study of children aged 3 to 18 years of age with signs and symptoms suspicious for appendicitis. Patients were initially examined by a pediatric EP attending and then by a consulting senior surgical resident. Physicians reported the presence or absence of specific historical and physical exam findings and predicted the likelihood the patient had appendicitis. Interexaminer reliability of historical and physical exam findings was compared (kappa statistic). Distributions and median probabilities of appendicitis were calculated for pediatric EP and surgeon predictions. Results:, The authors evaluated 350 patients with acute abdominal pain. Historical questions revealed slight to very good agreement (kappa statistic range 0.33,0.82) between physician types, whereas physical examination findings exhibited poor to fair agreement (range 0.14,0.48). Physicians predicted similar median probabilities of appendicitis for patients who were ultimately diagnosed with appendicitis (75% vs. 70%; p = 0.73) and patients without appendicitis (25% vs. 30%; p = 0.59). For a subset of patients given a , 90% predicted probability of appendicitis, pediatric EPs and senior surgical residents had similar accuracy (80% vs. 79%; p = 0.92). Similarly, among patients with , 10% predicted probability, pediatric EPs were correct in 95% and senior surgical residents correct in 94% of patients (p = 0.63). Conclusions:, Pediatric EPs and senior surgical residents elicit historical findings from patients with suspected appendicitis with a greater degree of similarity than physical examination findings, which exhibit a wide degree of variability. Pediatric EPs and senior surgical residents do not differ in their ability to clinically predict appendicitis. These findings may be helpful in developing institutional management protocols. [source] | ||||||||||