Emergency Medicine-trained Physicians Research Articles

The role of emergency medicine-trained physicians in multidisciplinary pain medicine.

The role of emergency medicine-trained physicians in multidisciplinary pain medicine.

Do Hospitals Providing Telehealth in Emergency Departments Have Lower Emergency Department Costs?

Background: Since 2003, the University of Mississippi Medical Center has operated a robust telehealth emergency department (ED) network, TelEmergency, which enhances access to emergency medicine-trained physicians at participating rural hospitals. TelEmergency was developed as a cost-control measure for financially constrained rural hospitals to improve access to quality, emergency care. However, the literature remains unclear as to whether ED telehealth services can be provided at lower costs compared with traditional in-person ED services. Introduction: Our objective was to empirically determine whether TelEmergency was associated with lower ED costs at rural hospitals when compared with similar hospitals without TelEmergency between 2010 and 2017. Materials and Methods: A panel of data for 2010-2017 was constructed at the hospital level. Hospitals with TelEmergency (n = 14 hospitals; 112 hospital-years) were compared with similar hospitals that did not use TelEmergency from Arkansas, Georgia, Mississippi, and South Carolina (n = 102; 766 hospital-years), matched using Coarsened Exact Matching. The relationship between total ED costs and treatment (e.g., participation in TelEmergency) was predicted using generalized estimating equations with a Poisson distribution, a log link, an exchangeable error term, and robust standard errors. Results: After controlling for ownership type, critical access hospital status, year, and size, TelEmergency was associated with an estimated 31.4% lower total annual ED costs compared with similar matched hospitals that did not provide TelEmergency. Conclusions: TelEmergency utilization was associated with significantly lower total annual ED costs compared with similarly matched hospitals that did not utilize TelEmergency. These findings suggest that access to quality ED care in rural communities can occur at lower costs.

Family Physicians' Contributions to Rural Emergency Care and Urban Urgent Care.

Using 2017 data, we demonstrate a sharp increase in the proportion of family physicians (FPs) working primarily in rural emergency departments and increasing numbers of FPs working in urgent care centers. Despite growth in emergency medicine-trained physicians, FPs are likely to continue to be the backbone of emergency care in rural America.

129 Disaster Education: A Survey Study to Analyze Disaster Medicine Training in Emergency Medicine Residency Programs in the United States

The increase in natural and man-made disasters occurring worldwide and the associated widespread destruction places emergency medicine (EM) physicians at the forefront of responding to these crises. Despite the growing political and educational interest in disaster medicine, it is unclear if resident training has been able to include these educational goals. While there has been data published on the status of Emergency Medical Services (EMS) education in residencies in the United States (US), no data specifically addresses education in disaster medicine. Recent data indicates disaster-preparedness is the most frequently listed component program directors want to add to their curricula. Additionally, there are no clear standardized recommendations or requirements for training programs. This study surveys residencies in the US to clarify the level of education in disaster medicine in EM residencies specifically, identify areas least and most addressed and highlight effective educational models already in place. The authors distributed an online survey tool of multiple-choice and free-response questions to accredited EM residency Program Directors and Chief Residents in the US between February 7, 2014 and April 24, 2014. Questions assessed residency background and details on disaster medicine competencies addressed during training. Out of 183 programs, 64 (35%) responded to the survey and completed all required questions. Of the completed surveys, 68.75% of the respondents are program directors and 31.25% are chief residents. Of the respondents, 76.56% represent 3-year training programs and 20.31% are from 4-year programs. 7.41% of the responding programs note they have an associated disaster medicine fellowship. Almost all programs (95.31%) report having some level of disaster medicine training in their residency, but only 26.42% have a specific track or specialty course. The most common disaster medicine educational competencies taught are patient triage and decontamination, both of which are addressed by 78.1% of responding programs. The most commonly identified methods to teach disaster medicine are drills and lectures/seminars. Program directors report the time spent on disaster medicine training is too little as per 53.70% of respondents, just right as per 42.59% of respondents and too much as per 3.70% of respondents. Commonly identified limitations to providing disaster education are limited time (33.8%) and limited resources (15.4%), though many programs (48.4%) indicate they are not limited in the amount of education they provide. There are no statistically significant differences between 3-and 4-year programs in level of disaster education provided. There are a variety of educational tools used to teach disaster medicine in US residencies today, with a larger focus on the use of lectures and hospital drills. However, there is no indication there is a similar educational approach across all residencies. The better training and background emergency medicine-trained physicians have, the higher chance of success of an emergency department, hospital and community when faced with any level of disaster. This survey highlights the opportunity for the creation of a model for resident education in disaster medicine.

The Role of Physician Assistants in a Pediatric Emergency Department

The objectives of this study were to outline the clinical conditions presenting to a Canadian pediatric emergency department (ED), survey the opinions of physician assistants (PAs) and emergency pediatricians to determine which conditions they consider could be managed by PAs, and to estimate the proportion of the total pediatric ED volume that PAs could potentially manage. We reviewed the 2007 British Columbia Children's Hospital database of ED visits to identify clinical presentation and chief complaint of all patients seen. International Classification of Diseases, 10th Revision codes were used to categorize the presenting complaint of each ED visit. Following categorization, the results were discussed by a focus group composed of pediatric emergency medicine-trained physicians and PAs, to review the list of chief complaints. We then surveyed via e-mailed questionnaire a group of emergency pediatricians (n = 17) and PAs (n = 5) to seek their opinion on the categories of clinical presentation appropriate for PA management. Of 38,722 visits, 9.2% were triaged as "resuscitation" or "emergent." We sorted the remaining 35,077 ED visits into 57 clinical categories. More than 85% of respondents selected 30 clinical categories for PA management with physician supervision, representing 74% of the total ED volume. Of these, 3 were also deemed appropriate for PA management without direct physician supervision. There were statistically significant differences in mean length of stay, waiting time, and admission rates between the clinical conditions selected for PA involvement. However, the difference in waiting time was not clinically meaningful. A large proportion of pediatric ED visits are designated as semiurgent or nonurgent. Clinicians (ED physicians and PAs) thought that the majority of these ED visits could be managed by PAs.

Exploring Differences in the Clinical Management of Pediatric Mental Health in the Emergency Department

: We examine psychiatric and pediatric clinical management of pediatric mental health in the emergency department (ED). : We conducted a retrospective review of health care delivery with a random sample of all pediatric mental health presentations (≤18 years) to 2 urban tertiary care EDs between 2004 and 2006 (N = 580). : The EDs differed significantly in services offered. General emergency medicine-trained physicians provided care at 1 site (54.6%) with a number of visits also managed by a psychiatric crisis team (45.4%). Care at the other ED was delivered by pediatric emergency medicine-trained physicians (99.4%) with no regular on-site psychiatric services. The most common assessment provided across sites and all presentations was for suicidality (66.2%). After controlling for potential confounders, receipt of clinical assessment for homicidality, mood, or reality testing differed between EDs (P = 0.044, P = 0.006, and P = 0.002) with more assessments documented at the psychiatric-resourced ED. Brief counseling was lacking for visits (absence of documentation: 56.1% pediatric-resourced, 23.1% psychiatric-resourced ED); there was no evidence of site differences in provision. More psychiatric consultation was provided at the psychiatric-resourced ED (34.1% vs 27.4%, P = 0.030). Discharge recommendations were lacking in both EDs but were more incomplete for pediatric-resourced ED visits (P = 0.035). : Consistent and comprehensive clinical management of pediatric mental health presentations was lacking in EDs that had pediatric and psychiatric resources. Prospective evaluations are needed to determine the effect of current clinical ED practices on patient and family outcomes, including symptom reduction and stress, as well as subsequent system use.

Nurse Practitioners in Emergency Care

Nurse Practitioners in Emergency Care

Viewpoint: Midlevel Providers Arenʼt the Solution to the EP Workforce Shortage

Viewpoint: Midlevel Providers Arenʼt the Solution to the EP Workforce Shortage

Emergency Traumatologists as Partners in Trauma Care: The Future Is Now

Decreasing manpower available to care for trauma patients both in and out of the ICU has led to a number of proposed solutions, including increasing involvement of emergency medicine-trained physicians in the care of these patients. We performed a descriptive comparative study in an effort to define the role of fellowship-trained emergency medicine physicians as full-time traumatologists. We performed a retrospective review of concurrent and prospectively collected data comparing process of care and outcomes for the resuscitative phase of trauma patients cared for by full-time fellowship-trained trauma surgeons (TS), a fellowship-trained emergency medicine physician (ET), and a first-year fellowship-trained trauma surgeon (TS1). Patient age, Revised Trauma Score, and Injury Severity Score were similar between groups. Process of care, defined by transfusion of uncrossmatched blood, prevalence of hypotension in patients receiving uncrossmatched blood, time spent in the emergency department, frequency of ICU admission, severity of injury for ICU admission, and time between emergency department and operating room for patients requiring surgery, was equivalent between groups. Outcomes evaluated by mortality and length of stay in the hospital and ICU did not differ between groups, and provider group was not predictive of mortality in stepwise logistic regression. These data suggest that emergency traumatologists can provide trauma care effectively within a defined scope of practice and may provide an effective solution to manpower issues confronting trauma centers.

Pediatric Emergency Medicine Fellowships: Faculty and Resident Training Profiles

The objective of this study was to evaluate the faculty and graduate training profiles of Pediatric Emergency Medicine (PEM) fellowship training programs. An electronic 10-point questionnaire was sent to 57 PEM fellowship directors, with a 70% response rate. Analysis of the individual certification of faculty members in PEM training programs demonstrated that the largest represented training types were general pediatricians and pediatricians with PEM sub-certification (29% and 62% representation, respectively). The remaining faculty types consistently showed < 5% overall involvement. Reported estimates on faculty delivery of clinical training, didactic training, and procedural skills demonstrated that pediatricians sub-board certified in PEM consistently administered the highest percentage of these skill sets (74%, 68%, and 68%, respectively). Emergency Medicine-trained physicians showed a relative increase of involvement in fellowship programs administered by Emergency Medicine departments and in those programs located within adult hospitals. Yet, this involvement still remained substantially lower than that of the pediatric-type faculty. Program directors of fellowships within pediatric hospitals and those administered by Pediatric programs demonstrated a preference for general pediatricians with sub-board certification in PEM to improve their faculty pools. Program directors of fellowship programs located in adult hospitals and those administered by departments of EM demonstrated no preference in training type. Lastly, program directors report that 95% of past graduates received their primary board certification through Pediatrics and only 5% received their primary board certification through Emergency Medicine. There are currently many more pediatric-trained physicians among PEM fellowship faculty and graduates. This survey has demonstrated that there has been a decline in EM-trained physicians involved in PEM fellowships since 2000.

A Survey of Oregon Emergency Physicians to Assess Mandatory Reporting Knowledge and Reporting Patterns Regarding Intoxicated Drivers in the State of Oregon

To assess emergency physician reporting patterns in Oregon before and after the passage of a mandatory intoxicated driving reporting law. A one-page survey was mailed to 504 emergency physicians in Oregon in April 2004. Data on reporting frequency were collected using a four-point ordinal scale regarding motor vehicle crash-involved drivers (MIDs) and intoxicated persons attempting to drive away from the emergency department (DAEDs). Paired observations were assessed for a stated increase in reporting activity following passage of the law using the Wilcoxon signed-rank test. Associations of postlaw reporting and demographic and knowledge factors were sought using Spearman rank correlation analysis. Of the 504 surveys mailed, 298 (59%) were adequate for analysis. Many respondents (57%) were already aware of the law. Most (92%) agreed that physicians should be mandated to report some crimes. MIDs were always reported by 18% of physicians before the law and by 47% afterward, whereas DAEDs were always reported by 56% of physicians before the law and by 69% afterward. Emergency medicine-trained physicians, higher emergency department census, and increased years of experience were associated with a significantly higher increase in reporting pattern after passage of the law for both MIDs and DAEDs. Although 44% of responding emergency physicians in Oregon were unaware of a mandated reporting law for intoxicated drivers presenting to the ED, most physicians stated an increase in their reporting practice.

Emergency physician practices and requirements regarding the medical screening examination of psychiatric patients.

To describe the testing requirements and practices of emergency physicians (EPs) when conducting a medical screening examination of psychiatric patients. An anonymous survey was developed and mailed to 500 EPs randomly selected through American College of Emergency Physicians membership rolls. Two hundred ninety surveys were returned (58%). Eighty-five percent of the respondents were male, 70% practiced in a community setting and 28% in an academic setting, 58% were emergency medicine (EM) residency-trained, and 88% were EM board-certified or board-eligible. Ninety-eight percent stated they were actively involved with the psychiatric medical screening exam (PMSE). Routine testing was required by 35% of the respondents, with 16% being required by ED protocol, and 84% by the psychiatrist/psychiatric institute. Of those with required testing, tests required were: complete blood cell count (56%), electrolytes (56%), serum alcohol (85%), serum toxicology screen (31%), urine toxicology screen (86%), electrocardiogram (18%), liver function test (16%), blood urea nitrogen (45%), and creatinine (40%). Many clinicians believed that certain tests were unnecessary as part of a PMSE. There was no statistical difference between the opinions of the physicians required to test and those not required to test in terms of which tests they thought were a necessary part of a PMSE regardless of the patient's clinical presentation. The EM-trained physicians were also found to be significantly less likely to think certain tests were necessary for the PMSE when compared with the non-EM-trained physicians. Routine testing was required as part of the medical screening examination of psychiatric patients for only one-third of the respondents. Few respondents believed that any of these tests were necessary. Emergency medicine-trained physicians were less likely to feel that routine testing was necessary.