Effective Emergency Department Research Articles

Identifying trigger concepts to screen emergency department visits for diagnostic errors.

The diagnostic process is a vital component of safe and effective emergency department (ED) care. There are no standardized methods for identifying or reliably monitoring diagnostic errors in the ED, impeding efforts to enhance diagnostic safety. We sought to identify trigger concepts to screen ED records for diagnostic errors and describe how they can be used as a measurement strategy to identify and reduce preventable diagnostic harm. We conducted a literature review and surveyed ED directors to compile a list of potential electronic health record (EHR) trigger (e-triggers) and non-EHR based concepts. We convened a multidisciplinary expert panel to build consensus on trigger concepts to identify and reduce preventable diagnostic harm in the ED. Six e-trigger and five non-EHR based concepts were selected by the expert panel. E-trigger concepts included: unscheduled ED return to ED resulting in hospital admission, death following ED visit, care escalation, high-risk conditions based on symptom-disease dyads, return visits with new diagnostic/therapeutic interventions, and change of treating service after admission. Non-EHR based signals included: cases from mortality/morbidity conferences, risk management/safety office referrals, ED medical director case referrals, patient complaints, and radiology/laboratory misreads and callbacks. The panel suggested further refinements to aid future research in defining diagnostic error epidemiology in ED settings. We identified a set of e-trigger concepts and non-EHR based signals that could be developed further to screen ED visits for diagnostic safety events. With additional evaluation, trigger-based methods can be used as tools to monitor and improve ED diagnostic performance.

Implementation of a triage system in Pakistan: the need of the hour.

In today's world, an effective emergency department (ED) cannot function properly without having a triage system. Though available in various forms, this essentially categorises patients according to the seriousness of their condition and the priority of their need.Pakistan is yet to introduce this system and where it exists, it is in its infancy. A disaster-prone country such as ours, which is frequently faced with both man-made and natural calamities, could benefit tremendously from its introduction. The activity of EDs would be streamlined and precious lives would be saved.

Teaching and Assessing ED Handoffs: A Qualitative Study Exploring Resident, Attending, and Nurse Perceptions.

IntroductionThe Accreditation Council for Graduate Medical Education requires that residency programs ensure resident competency in performing safe, effective handoffs. Understanding resident, attending, and nurse perceptions of the key elements of a safe and effective emergency department (ED) handoff is a crucial step to developing feasible, acceptable educational interventions to teach and assess this fundamental competency. The aim of our study was to identify the essential themes of ED-based handoffs and to explore the key cultural and interprofessional themes that may be barriers to developing and implementing successful ED-based educational handoff interventions.MethodsUsing a grounded theory approach and constructivist/interpretivist research paradigm, we analyzed data from three primary and one confirmatory focus groups (FGs) at an urban, academic ED. FG protocols were developed using open-ended questions that sought to understand what participants felt were the crucial elements of ED handoffs. ED residents, attendings, a physician assistant, and nurses participated in the FGs. FGs were observed, hand-transcribed, audio-recorded and subsequently transcribed. We analyzed data using an iterative process of theme and subtheme identification. Saturation was reached during the third FG, and the fourth confirmatory group reinforced the identified themes. Two team members analyzed the transcripts separately and identified the same major themes.ResultsED providers identified that crucial elements of ED handoff include the following: 1) Culture (provider buy-in, openness to change, shared expectations of sign-out goals); 2) Time (brevity, interruptions, waiting); 3) Environment (physical location, ED factors); 4) Process (standardization, information order, tools).ConclusionKey participants in the ED handoff process perceive that the crucial elements of intershift handoffs involve the themes of culture, time, environment, and process. Attention to these themes may improve the feasibility and acceptance of educational interventions that aim to teach and assess handoff competency.

45 Assessment of Clinical Teaching During Oral Case Presentations in a Busy Academic Emergency Department

Significant impediments to effective emergency department (ED) teaching compromise what could otherwise be an excellent learning environment. Attending physicians must balance the need to quickly devise patient assessments and plans with their responsibility to devote time toward teaching students. There is little literature to guide faculty development around specific emergency medicine teaching techniques. The purpose of this study was: 1) describe the frequency and nature of various teaching styles used by attending physicians; 2) determine if there is an inverse relationship between effective teaching and clinical demands; and 3) quantify the frequency of interruptions by the training physician that occur when students and residents do oral case presentations (OCPs) in the ED.

Creating Effective Learning in Today's Emergency Departments: How Accomplished Teachers Get It Done

Significant impediments to effective emergency department (ED) teaching compromise what could otherwise be an excellent learning milieu. There is little literature to guide faculty development around specific emergency medicine teaching techniques. We determine what recognized experts in emergency medicine teaching consider to be the important clinical teaching behaviors that make them good teachers, the main impediments to good teaching in EDs, and important prerequisites for a good ED teacher. This was a structured telephone survey with qualitative grounded-theory analysis. Participants were current Canadian emergency medicine teaching faculty who have won awards, been promoted, or received persistent excellent evaluations according to their ED teaching. Participants underwent a 45- to 60-minute standardized structured telephone interview. Interviews were transcribed and independently coded by 2 investigators using a grounded-theory approach. The codes were merged by consensus, and the data were recoded. Twenty percent of data were then coded by both investigators to estimate interrater reliability of final coding. Discrepancies were resolved by agreement. Of 43 potential participants, 33 were still in practice, available, and willing to participate. Twelve ED-specific, practical, implementable strategies representing the general themes of learner-centeredness, active learning, individual relevance, and efficiency emerged. Participants collectively identified 6 significant impediments to teaching and 9 prerequisites to being an effective ED teacher. Accomplished emergency medicine teaching faculty identify with common impediments to ED teaching yet are able to describe practical, easily implemented strategies that they believe make them good teachers. They also take advantage of basic prerequisites for good teaching.