Society For Academic Emergency Medicine Research Articles

Is There a Neurologist in the House? A Summary of the Current State of Neurovascular Rotations for Emergency Medicine Residents.

Neurovascular and neurocritical care emergencies constitute a leading cause of morbidity/mortality. There has been great evolution in this field, including but not limited to extended time-window therapeutic interventions for acute ischemic stroke. The intent of this article is to evaluate the goals and future direction of clinical rotations in neurovascular and neurocritical care for emergency medicine (EM) residents. A panel of 13 board-certified emergency physicians from the Society for Academic Emergency Medicine (SAEM) neurologic emergencies interest group (IG) convened in response to a call for publications-three with fellowship training/board certification in stroke and/or neurocritical care; five with advanced research degrees; three who have been authors on national practice guidelines; and six who have held clinical duties within neurology, neurosurgery, or neurocritical care. A mixed-methods analysis was performed including a review of the literature, a survey of Council of Emergency Medicine Residency Directors (CORD) residency leaders/faculty and SAEM neuro-IG members, and a consensus review by this panel of select neurology rotations provided by IG faculty. Thirteen articles for residency neurovascular education were identified: three studies on curriculum, three studies evaluating knowledge, and seven studies evaluating knowledge after an educational intervention. Intervention outcomes included the ability to recognize and manage acute strokes, manage intracerebral hemorrhage, calculate National Institutes of Health Stroke Scale (NIHSS), and interpret images. In the survey sent to CORD residency leaders and neuro-IG faculty, response was obtained from 48 programs. A total of 52.1% indicated having a required rotation (6.2% general neurology, 2% stroke service, 18.8% neurologic intensive care unit, 2% neurosurgery, 22.9% on a combination of services). The majority of programs with required rotations have a combination rotation (residents rotate through multiple services) and evaluations were positive. Variability exists in the availability of neurovascular/neurocritical care rotations for EM trainees. Dedicated clinical time in neurologic education was beneficial to participants. Given recent advancements in the field, augmentation of EM residency training in this area merits strong consideration.

White Paper-Geriatric Emergency Medicine Education: Current State, Challenges, and Recommendations to Enhance the Emergency Care of Older Adults.

Older adults account for 25% of all emergency department (ED) patient encounters. One in five Americans will be 65 or older by 2030. In response to this need, geriatric emergency medicine (GEM) has developed into a robust area of academic and clinical interest, with extensive evidence-based research and guidelines, including clear undergraduate and postgraduate GEM competencies. Despite these developments, GEM content remains underrepresented in curricula and licensing examinations. The complex reasons for these deficits include a perception that care of older adults is not a core emergency medicine (EM) competency, a disjunction between traditional definitions of expertise and the GEM perspective, and lack of curricular capacity. This White Paper, prepared on behalf of the Academy of Geriatric Emergency Medicine, describes the state of GEM education, identifies the challenges it faces, and reviews innovations, including research presented at the 2018 Society for Academic Emergency Medicine (SAEM) Annual Scientific Meeting. The authors propose a number of recommendations. These include recognizing GEM as a core educational priority in EM, enhancing academic support for GEM clinician-educators, using social learning and practical problem solving to teach GEM concepts, emphasizing a whole-person multisystem approach to care of older adults, and identifying ageist attitudes as a hurdle to safe and effective GEM care.

Are Emergency Medicine Residents Prepared to Meet the Ethical Challenges of Clinical Practice? Findings from an Exploratory National Survey.

Although the Accreditation Council for Graduate Medical Education and the American Board of Emergency Medicine require clinical ethics education in residency training, instruction varies widely. We assessed the educational preparedness of trainees in emergency medicine to address ethics challenges common to their field. The survey assessed two outcomes: 1) knowledge of specific ethical challenges and 2) perceived educational preparedness, across five ethics areas: 1) informed consent and decisional-capacity assessment, 2) surrogate decision making, 3) interpretation of advanced directives, 4) withdrawing and/or withholding life support, and 5) presumed consent for emergency treatment. Clinical vignettes, revised through expert panel review and pilot testing, were utilized to evaluate these areas. The final instrument was administered via Web link to emergency medicine residents and recent graduates through adverts within Emergency Medicine Residency Association and Society for Academic Emergency Medicine (SAEM) newsletters and social media platforms. Additionally, targeted e-mails through the Council of Residency Directors in Emergency Medicine, the Clerkship Directors of Emergency Medicine, and the SAEM Ethics Committee listservs encouraged survey distribution. Analyses involved one-way analysis of variance for overall knowledge scores and chi-square tests for categorical outcomes. Multivariable regression models tested associations between respondent characteristics and outcomes. There were 302 participants of which 34% reported having a dedicated ethics module within their residency curriculum. The mean (±SD) knowledge score was 59.7% (±12.8%); assessing decisional capacity was the most difficult topic for respondents as only 1% both correctly addressed the general issue and identified the correct plan of action. Participants having a dedicated ethics module perceived themselves better prepared, although there was no association between having a dedicated ethics module and knowledge scores. Gaps in clinical ethics knowledge appear prevalent among emergency medicine trainees, and few programs have dedicated ethics modules. Greater study is needed to understand and remedy clinical ethics knowledge shortfalls.

Growing a Geriatric Emergency Department

The concept of the geriatric emergency department is well developed after more than a decade of evolution, and at least nine EDs throughout the country are now accredited by the American College of Emergency Physicians (ACEP) as part of the first wave of geriatric ED accreditations. At AMDA – the Society for Post-Acute and Long-Term Care Medicine’s Annual Conference, the medical director of one of these departments, Marianna Karounos, DO, described the geriatric-focused policies and protocols, quality initiatives, staff education, and operational changes that her geriatric ED has embraced since it launched in 2009. In an interview after the meeting, she told Caring that her institution, St. Joseph’s University Medical Center in Paterson, NJ, has seen significant decreases in returns to the ED and in hospital admissions as a result. The “physical plant” of the geriatric ED should focus on structural changes that promote a quieter, safer, and less chaotic environment: non-slip, non-glare flooring, for instance, as well as uncluttered and wide corridors, hand rails, thicker mattresses, and enhanced lighting. “And the truth is that the physical plant doesn’t have to be a separate space,” Dr. Karounos said at the Society meeting. “You can insert components for the most frail and vulnerable into your current model and make a difference — for them and for everyone.” Staff and provider education that touches upon the physiology of aging, end-of-life issues, geriatric assessment, pharmacology, and delirium is key, she said, as is the integration of geriatric-focused policies and protocols for quality improvement, screening, and transitions of care. At St. Joseph’s they implemented processes for falls risk assessment, for instance. They also use the Beers criteria for inappropriate medications and the “Identification of Seniors at Risk Tool,” which assesses the level of help needed, the state of the patient’s memory and eyesight, and the degree of polypharmacy, among other things. They also implemented screening for depression and delirium and fine-tuned the Emergency Severity Index (ESI) criteria — a triage algorithm used by nurses in the ED — to better capture the severity of illness in geriatric patients. Dr. Karounos said that her geriatric ED has a “robust” medication reconciliation program that engages a pharmacist in reviewing patients who are taking five or more medications a day. “I’m a big proponent of having a pharmacist in the ED,” she said. She also touted her ED’s “two-step call-back program,” in which each patient receives a personalized phone call within 24 to 48 hours after discharge and again on days 4, 7, and 14. “We ask, how are they doing — worse or the same? Have they filled their medications? Have they set up an appointment with their PCP?” she said. “Daily, I learn of at least two or three issues from the call-back nurse, and we intervene. It’s amazing what we can do remotely after we release [them].” The geriatric ED is using hospital resources that “we had before, but almost never traditionally used before,” such as social workers, care managers, physical therapists, pharmacists, and toxicologists. “They weren’t streamlined to be used with ease in the ED,” Dr. Karounos explained. “Now, they’re almost essential.” In addition, Dr. Karounos emphasized, the geriatric ED can offer “the first touch where we can have a discussion about end-of-life care, palliative care, and goals of care,” particularly for patients from the community. She noted that “a lot of patients aren’t getting this in primary care. When we see the fourth congestive heart failure exacerbation in 2 months, it may be time to ask the patients what they want,” she said. ACEP’s new voluntary accreditation includes three levels, similar to trauma designations, with specific criteria and goals. In 2013, guidelines for optimal care in the geriatric ED were developed by ACEP in collaboration with the American Geriatrics Society, the Emergency Nurses Association, and the Society for Academic Emergency Medicine (https://www.acep.org/geda/resources/pdfs/GEDA-Guidelines.pdf). Christine Kilgore is a freelance writer in Falls Church, VA.

Management of Acute Coronary Syndromes

Management of Acute Coronary Syndromes

Correction to: 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.

Correction to: 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.

Correction to: Accuracy of Prediction Instruments for Diagnosing Large Vessel Occlusion in Individuals With Suspected Stroke: A Systematic Review for the 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke.

HomeStrokeVol. 49, No. 3Correction to: Accuracy of Prediction Instruments for Diagnosing Large Vessel Occlusion in Individuals With Suspected Stroke: A Systematic Review for the 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Free AccessCorrectionPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessCorrectionPDF/EPUBCorrection to: Accuracy of Prediction Instruments for Diagnosing Large Vessel Occlusion in Individuals With Suspected Stroke: A Systematic Review for the 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Originally published1 Mar 2018https://doi.org/10.1161/STR.0000000000000165Stroke. 2018;49:e139This article corrects the followingAccuracy of Prediction Instruments for Diagnosing Large Vessel Occlusion in Individuals With Suspected Stroke: A Systematic Review for the 2018 Guidelines for the Early Management of Patients With Acute Ischemic StrokeIn the article by Smith et al, “Accuracy of Prediction Instruments for Diagnosing Large Vessel Occlusion in Individuals With Suspected Stroke: A Systematic Review for the 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke,” which published ahead of print January 24, 2018, and appeared in the March 2018 issue of the journal (Stroke. 2018;49:e111–e122. DOI: 10.1161/STR.0000000000000160), a few corrections were needed.On page e111, the text above the byline read:Reviewed for evidence-based integrity and endorsed by the American Association of Neurological Surgeons and Congress of Neurological SurgeonsEndorsed by the Society for Academic Emergency MedicineIt has been updated to read:Reviewed for evidence-based integrity and endorsed by the American Association of Neurological Surgeons and Congress of Neurological SurgeonsEndorsed by the Society for Academic Emergency Medicine and Neurocritical Care SocietyThe American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists.These corrections have been made to the current online version of the article, which is available at http://stroke.ahajournals.org/lookup/doi/10.1161/STR.0000000000000160. Previous Back to top Next FiguresReferencesRelatedDetailsRelated articlesAccuracy of Prediction Instruments for Diagnosing Large Vessel Occlusion in Individuals With Suspected Stroke: A Systematic Review for the 2018 Guidelines for the Early Management of Patients With Acute Ischemic StrokeEric E. Smith, et al. Stroke. 2018;49:e111-e122 March 2018Vol 49, Issue 3 Advertisement Article InformationMetrics © 2018 American Heart Association, Inc.https://doi.org/10.1161/STR.0000000000000165PMID: 29483363 Originally publishedMarch 1, 2018 PDF download Advertisement

Trends in National Emergency Medicine Conference Didactic Lectures Over a 6-Year Period.

National conference didactic lectures have traditionally featured hour-long lecture-based presentations. However, there is evidence that longer lectures can lead to both decreased attention and retention of information. The authors sought to identify trends in lecture duration, lecture types, and number of speakers at four national emergency medicine (EM) conferences over a 6-year period. The authors performed a retrospective analysis of the length, number of speakers, and format of didactic lectures at four different national EM conferences over 6 years. The authors abstracted data from the national academic assemblies for the four largest not-for-profit EM organizations in the United States: American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine. There was a significant yearly decrease in the mean lecture lengths for three of the four conferences. There was an increase in the percentage of rapid fire sessions over the preceding 2 years with a corresponding decrease in the percentage of general educational sessions. There was no significant difference in the mean number of speakers per lecture. An analysis of 4210 didactic lecture sessions from the annual meetings of four national EM organizations over a 6-year period showed significant decreases in mean lecture length. These findings can help to guide EM continuing medical education conference planning and research.

Scholarship in the Appropriateness Criteria® Process and Updates on Gaps and Harmonization

Scholarship in the Appropriateness Criteria® Process and Updates on Gaps and Harmonization

Society for Academic Emergency Medicine Statement on Plagiarism.

The integrity of the research enterprise is of the utmost importance for the advancement of safe and effective medical practice for patients and for maintaining the public trust in health care. Academic societies and editors of journals are key participants in guarding scientific integrity. Avoiding and preventing plagiarism helps to preserve the scientific integrity of professional presentations and publications. The Society for Academic Emergency Medicine (SAEM) Ethics Committee discusses current issues in scientific publishing integrity and provides a guideline to avoid plagiarism in SAEM presentations and publications.

380TF The Emergency Medicine Research Rotation

The Residency Review Committee for Emergency Medicine (EM) requires that all residents a scholarly project prior to graduation. This curriculum is intended to provide EM residents with baseline knowledge and skills to design and conduct a research project and to provide protected time for residents to design the scholarly project that they will complete over the remainder of the tenure in residency. At the end of this rotation, the resident will be able to 1) demonstrate proficiency in basic research methodology and study design, 2) formulate a testable research question, 3) construct a study to answer that question, 4) perform a preliminary literature search on the research topic, 5) construct a one-page research proposal document During the beginning of the second post-graduate year (PGY), three residents at a time are scheduled for the research rotation. The rotation takes place over five consecutive weekdays during which residents are free of all clinical duties. Residents use online modules in statistics, epidemiology and research design. They also participate in moderated small-group brainstorming sessions to scope their research question. Experiential learning includes attending a workshop run by medical librarians on searching the literature and using bibliography software and spending a half day enrolling patients in clinical trials with department research associates. Residents are provided with office space and computers and have access to departmental research coordinators. At the end of the curriculum, residents must submit a one-page research proposal document that is graded by departmental research faculty according to a rubric modified from the Society for Academic Emergency Medicine. The rubric includes assessment of the project’s clarity, applicability of methods and metrics, approach, feasibility, significance, innovation and presentation. Residents are also given the opportunity to evaluate the curriculum via an anonymous online survey. Completing a research rotation during the beginning of PGY2 year allows residents time to a scholarly project by graduation. An intensive experience using mixed learning methods introduces tools that residents can reference throughout residency to aid in successful completion of the scholarly project. Residents find the sessions helpful and enjoyable, but the results of the grading rubric demonstrate that residents often develop research projects that are too large in scope to be completed during residency.

Global Health and Emergency Care: Defining Clinical Research Priorities.

Despite recent strides in the development of global emergency medicine (EM), the field continues to lag in applying a scientific approach to identifying critical knowledge gaps and advancing evidence-based solutions to clinical and public health problems seen in emergency departments (EDs) worldwide. Here, progress on the global EM research agenda created at the 2013 Academic Emergency Medicine Global Health and Emergency Care Consensus Conference is evaluated and critical areas for future development in emergency care research internationally are identified. A retrospective review of all studies compiled in the Global Emergency Medicine Literature Review (GEMLR) database from 2013 through 2015 was conducted. Articles were categorized and analyzed using descriptive quantitative measures and structured data matrices. The Global Emergency Medicine Think Tank Clinical Research Working Group at the Society for Academic Emergency Medicine 2016 Annual Meeting then further conceptualized and defined global EM research priorities utilizing consensus-based decision making. Research trends in global EM research published between 2013 and 2015 show a predominance of observational studies relative to interventional or descriptive studies, with the majority of research conducted in the inpatient setting in comparison to the ED or prehospital setting. Studies on communicable diseases and injury were the most prevalent, with a relative dearth of research on chronic noncommunicable diseases. The Global Emergency Medicine Think Tank Clinical Research Working Group identified conceptual frameworks to define high-impact research priorities, including the traditional approach of using global burden of disease to define priorities and the impact of EM on individual clinical care and public health opportunities. EM research is also described through a population lens approach, including gender, pediatrics, and migrant and refugee health. Despite recent strides in global EM research and a proliferation of scholarly output in the field, further work is required to advocate for and inform research priorities in global EM. The priorities outlined in this paper aim to guide future research in the field, with the goal of advancing the development of EM worldwide.

Evolution of the Model of the Clinical Practice of Emergency Medicine: 1979 to Present.

The Model of the Clinical Practice of Emergency Medicine (the EM Model) is a three-dimensional representation of the clinical practice of emergency medicine. It is a product of successful collaboration involving the American Board of Emergency Medicine (ABEM), the American College of Emergency Physicians (ACEP), the Society for Academic Emergency Medicine (SAEM), the Emergency Medicine Residents' Association (EMRA), the Council of Emergency Medicine Residency Directors (CORD), the Residency Review Committee for Emergency Medicine (RRC-EM), and the American Academy of Emergency Medicine (AAEM). In 2017, the most recent update and revision of the EM Model will be published. This document will represent the culmination of nearly 40 years of evolution, from a simple listing of presenting patient complaints, clinical symptoms, and disease states into a three-dimensional representation of the clinical practice of emergency medicine. These dimensions include conditions and components, physician tasks, and patient acuity. In addition, over the years, two other documents have been developed, the Knowledge, Skills, and Abilities (KSAs) and the Emergency Medicine Milestones. Both serve as related and complementary educational and assessment tools. This article will review the development of the EM Model from its inception in 1979 to today.

"From Tears to Transparency: A Conversation Can Change an Outcome. A Conversation Can Change a Life™ ": Reflections From Patient Advocates.

The Society for Academic Emergency Medicine (SAEM) consensus conference provided many platforms for patient advocates to share their experiences and demonstrate the powerful contribution they have to offer to the decision-making process. One such platform was the presentation of a film "The Faces of Medical Error: From Tears to Transparency," shared by Patricia (Patty) and David Skolnik. In this article the Skolniks build on their story shared at the SAEM consensus conference and panel discussion. They provide further insight drawn from 9 years of experience as advocates for patient safety, including their reflections on working with, training, and educating medical professionals, lawmakers, and consumers in shared decision making and informed consent.

Goal-directed Focused Ultrasound Milestones Revised: A Multiorganizational Consensus.

In 2012 the Accreditation Council for Graduate Medical Education and the American Board of Emergency Medicine released the emergency medicine milestones. The Patient Care 12 (PC12) subcompetency delineates staged and progressive accomplishment in emergency ultrasound. While valuable as an initial framework for ultrasound resident education, there are limitations to PC12. This consensus paper provides a revised description of criteria to define the subcompetency. A multiorganizational task force was formed between the American College of Emergency Physicians Ultrasound Section, the Council of Emergency Medicine Residency Directors, and the Academy of Emergency Ultrasound of the Society for Academic Emergency Medicine. Representatives from each organization created this consensus document and revision.

An Alternative Narrative.

An Alternative Narrative.

Clinical and Research Considerations for Patients With Hypertensive Acute Heart Failure: A Consensus Statement from the Society for Academic Emergency Medicine and the Heart Failure Society of America Acute Heart Failure Working Group

Management approaches for patients in the emergency department (ED) who present with acute heart failure (AHF) have largely focused on intravenous diuretics. Yet, the primary pathophysiologic derangement underlying AHF in many patients is not solely volume overload. Patients with hypertensive AHF (H-AHF) represent a clinical phenotype with distinct pathophysiologic mechanisms that result in elevated ventricular filling pressures. To optimize treatment response and minimize adverse events in this subgroup, we propose that clinical management be tailored to a conceptual model of disease that is based on these mechanisms. This consensus statement reviews the relevant pathophysiology, clinical characteristics, approach to therapy, and considerations for clinical trials in ED patients with H-AHF.

A Model Longitudinal Observation Medicine Curriculum for an Emergency Medicine Residency.

The role of observation services for emergency department patients has increased in recent years. Driven by changing health care practices and evolving payer policies, many hospitals in the United States currently have or are developing an observation unit (OU) and emergency physicians are most often expected to manage patients in this setting. Yet, few residency programs dedicate a portion of their clinical curriculum to observation medicine. This knowledge set should be integrated into the core training curriculum of emergency physicians. Presented here is a model observation medicine longitudinal training curriculum, which can be integrated into an emergency medicine (EM) residency. It was developed by a consensus of content experts representing the observation medicine interest group and observation medicine section, respectively, from EM's two major specialty societies: the Society for Academic Emergency Medicine (SAEM) and the American College of Emergency Physicians (ACEP). The curriculum consists of didactic, clinical, and self-directed elements. It is longitudinal, with learning objectives for each year of training, focusing initially on the basic principles of observation medicine and appropriate observation patient selection; moving to the management of various observation appropriate conditions; and then incorporating further concepts of OU management, billing, and administration. This curriculum is flexible and designed to be used in both academic and community EM training programs within the United States. Additionally, scholarly opportunities, such as elective rotations and fellowship training, are explored.

If At First You Don't Succeed: The Fate of Manuscripts Rejected by Academic Emergency Medicine.

The purpose of this study was to characterize the publication fate of a recent 2-year sample of manuscripts declined by Academic Emergency Medicine (AEM), the journal of the Society for Academic Emergency Medicine. This was a retrospective analysis of manuscripts submitted to AEM in 2010 and 2011 that were declined by the AEM editorial review process. An online search was conducted for each declined paper, to determine whether or not it was published in another clinical/scientific journal after being declined by AEM. The investigators used Scopus and Google Scholar, using the submitting author's name, the verbatim title, and key words and phrases from the title, to search for subsequent publication of each paper. Of 1,542 manuscript submissions to the journal in 2010 and 2011, 1,052 papers were declined. Of these, 693 (65.9%) were subsequently published elsewhere, in a total of 229 journals: 362 papers in 22 different EM journals, 81 in 14 EM subspecialty journals, 237 in 185 non-EM journals, and 13 in eight nursing journals. Papers were published a median of 16.7 months (interquartile range [IQR] = 11.8 to 22.0 months) after being declined at AEM. Of the 229 journals, 19 do not have h-indices. The median h-index of the remaining 210 journals is 36 (IQR = 17 to 64; maximum = 229; AEM's h-index is 78). Thirty of these 210 journals, publishing 43 papers, have higher h-indices than AEM; the other 650 papers were published in journals either with lower h-indices than AEM's (n = 180 journals) or in journals without h-indices (n = 19 journals). U.S. and non-U.S. authors had similar rates of subsequent publication (65.3% vs 66.6%, p = 0.69) for papers initially declined by AEM. Papers in the educational advances category were less likely to be subsequently published than those in the original contributions (p < 0.0001) and brief reports (p = 0.0137) categories. Nearly two-thirds of manuscripts declined by SAEM's journal are eventually published elsewhere, in a large number and wide variety of both EM and non-EM journals, in a median of 16.7 months. Authors of manuscripts declined by AEM should consider submission elsewhere, as subsequent publication of these manuscripts in another journal is probable.

Tackling Communication Barriers Between Long-Term Care Facility and Emergency Department Transfers to Improve Medication Safety in Older Adults.

In 2013, the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic Emergency Medicine created geriatric emergency department guidelines, making recommendations for staffing/administration, follow up and transitions of care, education, quality improvement, equipment/supplies, and other policies, procedures, and protocols to be implemented. Awareness of these guidelines, as well as communication barriers, can help improve the delivery of care for older adults during transitions in care, particularly regarding medication safety.