American Medical Compliance

FEBRUARY 26, 2023

The Orientation to the Operating Room for Sales Professionals course is designed to educate sales professionals on proper operating room practices. There are several benefits and risks of healthcare industry representatives (HCIRs) being in the operating room. Reach out for other courses by visiting the AMC Course Library.

Operations 52

Operations Best Practices Administration Hospitals 52

EMDocs

SEPTEMBER 4, 2024

Disparities are measured differences in outcomes for people of different backgrounds. Literature shows disparity across the different outcomes, including wait times, triage levels and delivery of pain medications. Dr. Migita noted differences in admission rates for asthma and bronchiolitis based on race. Discuss as often as possible.

Pediatrics 98

Pediatrics Outcomes Operations Hospitals 98

The Skeptics' Guide to EM

DECEMBER 14, 2024

Clinical Question: How accurately can a new clinical decision rule (The Phoenix Sepsis Score) diagnose pediatric sepsis and septic shock in hospitalized children within the first 24 hours? Population: Children less than 18 years of age with suspected sepsis and septic shock who were admitted to one of ten hospitals in five countries.

Sepsis 103

Sepsis Pediatrics Shock Hospitals 103

Don't Forget the Bubbles

MARCH 4, 2024

We have teamed up with the team from the Emergency Department at Bristol Royal Hospital, who have used this as a springboard for their journal club. (It’s The hospital is the Paediatric Major Trauma Centre for the South-West. It’s a great idea and maybe something for other centres to copy!) in lower-resource settings.

Hospitals 78

Hospitals Sepsis Fractures Emergency Department 78

RebelEM

JANUARY 25, 2024

What They Did: Design: Randomized, controlled, blinded-outcome trial Sites: Three emergency departments in Denmark Duration: October 9, 2019 to May 26, 2021. Outcomes: Primary Outcome: Reduction of dyspnea measured on a verbal dyspnea scale (VDS) from 0 to 10 recorded at enrollment, then at 2, 4, and 5 hours after arrival.

Ultrasounds 129

Ultrasounds Outcomes COPD Hospitals 129

RebelEM

FEBRUARY 1, 2024

Limitations : Open label study design Outcome assessments were done via telephone interview. mg/kg, max 25mg) vs. intravenous alteplase (0.09 mg/kg followed by 0.81 vs Alteplase 34.8% Unadjusted risk difference 2.1% [ 95% CI -2.6 mg/kg, max 25mg) vs. intravenous alteplase (0.09 mg/kg followed by 0.81 vs Alteplase 34.8% mg/kg followed by 0.81

Stroke 134

Stroke Blood Transfusions Outcomes EMS 134

American Medical Compliance

JUNE 12, 2024

These goals provide a framework for hospitals to identify and mitigate risks, ensuring that patients receive the safest care possible. This course equips hospital staff to enhance safety protocols, reduce errors, and improve patient outcomes. Ensuring patient safety is a cornerstone of high-quality healthcare.

Patient Safety 52

Patient Safety Hospitals Best Practices Outcomes 52

RebelEM

MAY 27, 2024

The primary outcomes are patient-centered and objectively measured, potentially ensuring relevance and reliability. The unblinded nature of the study could influence outcomes due to observer bias. Employing P-values to compare demographics between groups could mislead interpretations of the data’s relevance to the primary outcomes.

Outcomes 137

Outcomes Research Operations Hospitals 137

EMDocs

DECEMBER 6, 2024

7 Workup other than serum iron concentration at 4 hours after ingestion not shown to accurately predict clinical outcomes or severity of toxicity. 5 Orogastric lavage may also be considered for GI decontamination but likely to be limited by location, size of tablets, and operator familiarity. Antiemetics as needed. 2 L/hr in adults.

Poisoning 98

Poisoning Fluid Resuscitation Seizures Resuscitation 98

PulmCCM

JANUARY 6, 2025

With financial penalties coming for noncompliance with the new rule, hospital administrators rapidly deployed the alerts to fire on all eligible inpatients. A cluster randomized trial using all-cause mortality as an outcome was always needed to determine whether EMR alerts improve outcomes for suspected severe infection.

Sepsis 45

Sepsis Documentation/Coding Hospitals Outcomes 45

The Trauma Pro

OCTOBER 25, 2024

To sum up, both are equally effective in controlling hemorrhage, but the hospital costs for patients undergoing angioembolization are significantly less. This is probably because there is no need to perform repeated operations to insert and remove the preperitoneal packs when angiography is used.

Fractures 113

Fractures Head Injuries Operations Ultrasounds 113

Don't Forget the Bubbles

JANUARY 31, 2024

As a Trauma Unit within the Thames Valley Trauma Network, Wexham Park Hospital hosts trainees from across the spectrum of acute specialties. Two really important patient groups were excluded – those who were admitted to hospital and families who were not fluent in English. How sick the child was did not appear to play a role.

Hospitals 72

Hospitals Ultrasounds Emergency Department Pediatrics 72

Taming the SRU

MARCH 12, 2024

The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis): Impacts on ED operational metrics. ED visits per 1000 adults with diabetes based on 2018 data resulting in over 500,000 annual hospital days. This amounts to annual hospital costs of $5.1 Secondary outcomes included fidelity to and safety of the intervention.

Operations 97

Operations Hospitals Best Practices Wellness 97

The Trauma Pro

OCTOBER 4, 2024

Clinical outcomes assessed at 60 days included an unplanned return to the emergency department (ED), re-admission, complications, and development of new bleeding confirmed by surgery, ultrasound, or computed tomography (CT) at 60 days post-injury. Adherence to guidelines was assessed by a follow-up phone call two months after injury.

Pediatrics 113

Pediatrics Outcomes Operations Emergency Department 113

RebelEM

NOVEMBER 20, 2023

Comparator: The control group received standard care provided at a major trauma center, including intubation, blood product transfusion, interventions like tourniquet application, and early operative or endovascular hemorrhage control. Outcome: Primary Outcome: All-cause mortality at 90 days.

Resuscitation 91

Resuscitation Operations Outcomes Hospitals 91

The Skeptics' Guide to EM

MARCH 2, 2024

He is the Vice Chair of the Emergency Department at Nassau University Medical Center in East Meadow, NY, the safety net hospital for Nassau County. Arrangements are made for him to be transferred stat to the tertiary hospital while he is still stable. It is described as a ripping sensation that radiates to his back.

Emergency Department 132

Emergency Department Stroke Operations Hospitals 132

Emergency Medicine Journal

NOVEMBER 28, 2023

Background The regional emergency medical service (EMS) in Lombardy (Italy) developed clinical algorithms based on operator-based interviews to detect patients with COVID-19 and refer them to the most appropriate hospitals. Results The training set includes 264 976 patients, median age 74 (IQR 55–84).

Operations 52

Operations EMS Hospitals Outcomes 52

Don't Forget the Bubbles

NOVEMBER 29, 2023

A retrospective cohort analysis of the ED portion of the National Hospital Ambulatory Medical Care Survey from 2006 to 2009 in the US revealed that less than one-half of patients undergoing ETI in the ED received sedative drugs while in the ED. When there is an immediate threat to life (e.g., What are the potential physiological sequelae?

Airway Management 135

Airway Management Emergency Department Resuscitation Psychiatric 135

ACEP Now

JANUARY 5, 2025

1 The primary outcome was the frequency of observed hypoxemia, defined as any pulse oximetry reading below 85 percent. Serious patient-oriented outcomes such as cardiac arrest were rare, but almost all occurred in the oxygen mask cohort. The obvious winner was NIPPV, whose 9.1 3 The machine learning model trailed just behind.

Sepsis 40

Sepsis Research Airway Management Stroke 40

ACEP Now

JULY 7, 2023

Out-of-hospital cardiac arrest is a commonly encountered entity in U.S. emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. Out-of-hospital cardiac arrest is a commonly encountered entity in U.S.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

RebelEM

JUNE 19, 2023

PMID: 37314244 Clinical Question: In advanced trauma systems, does prehospital administration of TXA increase the rate of survival with a favorable neurologic outcome in patients at risk for trauma-induced coagulopathy? Primary Results Patients enrolled from 15 emergency medical services at 21 hospitals across 3 countries over 7 years.

Blood Transfusions 105

Blood Transfusions Outcomes Administration Hyperthermia / Hypothermia 105

PulmCCM

OCTOBER 16, 2024

Animal studies have suggested that the body could be prepped or trained to better withstand ischemic-reperfusion injury, by inducing mild ischemia in another tissue bed before the operation. This is a remarkable example of the differences between societies, which might influence the processes of clinical trials and their outcomes.

Outcomes 52

Outcomes Operations Research Hospitals 52

Emergency Medicine Journal

JULY 22, 2024

Methods Adult patients transported to a single ED by ambulances and subsequently admitted to the hospital between 1 January 2019 and 18 April 2019 were eligible for inclusion. The discriminative ability of the EWS scores was assessed using the area under the receiver operating characteristic curve (AUROC). male, mean age 68.7±17.5

Ambulance Services 52

Ambulance Services Hospitals Operations Emergency Department 52

Don't Forget the Bubbles

JUNE 26, 2023

Whilst waiting for an operation, they need to be managed medically. Staged reconstructions are a topic in itself (click here for a nice summary by Children’s Hospital of Philadelphia), but here we focus on Stage 1. Six hours post-operatively, they become more mottled, with weak pulses – signs of poor systemic perfusion.

Operations 128

Operations Research Hyperthermia / Hypothermia Hospitals 128

EMDocs

AUGUST 10, 2023

Study design: Multicenter open label randomized control trial Enrolled patients from 41 tertiary care hospitals in China Assessing for statistically significant difference in modified Rankin score at 90 days PICO: Population: 206 patients were enrolled with 107 in the intervention group and 99 in the control. N Engl J Med.

Stroke 95

Stroke Outcomes Operations Hospitals 95

ALiEM

OCTOBER 30, 2024

Clinical impact: Rather than arguing with the patient about the likelihood of this phenomenon occurring and whether this is a true allergy, the patient is informed that they do not need to immediately start treatment to receive care in the hospital. Your patient ultimately is diagnosed with a spinal epidural abscess requiring operative care.

Emergency Department 64

Emergency Department Operations Psychiatric Hospitals 64

RebelEM

AUGUST 12, 2024

What They Did: Double-blind, randomized, placebo controlled trial that ran from October 2019 through January 2024 Multinational study conducted at 22 centers in three European countries 3512 patients were enrolled and before surgery eligible patients were randomly assigned to one of the following two groups Amino Acid Group: 10% Isopuramin at a dose (..)

Outcomes 81

Outcomes Hospitals Operations Shock 81

Don't Forget the Bubbles

JUNE 30, 2023

The primary outcome measure was chest drain failure, i.e., retained haemothorax requiring a secondary interventional procedure. They stratified patients according to the ratio of FFP: PRBC received (1:1, 1:2, 1:3 and 1:3+) and performed logistic regression analyses for various outcomes. These procedures require an experienced operator.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

Taming the SRU

SEPTEMBER 25, 2023

Specifically, EM physicians should be able to recognize fractures that will likely require operative management and facilitate close follow up, such as a Maisonneuve fracture. Disruption of these structures yields an unstable ankle fracture, thus making close follow up for operative management imperative. screws for medial malleolus.

Fractures 101

Fractures Operations Emergency Department EMS 101

RebelEM

APRIL 17, 2023

While operator dependent, the dynamic ability of POCUS augments bedside diagnosis and can assist with drainage. Additionally, potential increases in resource utilization, healthcare expense, and ED length of stay are also essential considerations. Ultrasound has become an extended part of our physical exam.

Ultrasounds 130

Ultrasounds Radiology Radiology Operations 130

ACEP Now

SEPTEMBER 3, 2024

Hahnemann University Hospital in Philadelphia closed in 2019, a year and a half after it was acquired along with St. Christopher’s Hospital for Children by private equity (PE) firm Paladin Healthcare Capital for 170 million dollars. Christopher’s was able to find a buyer prior to bankruptcy but Hahnemann could not.

Hospitals 113

Hospitals Radiology Radiology Emergency Department 113

ACEP Now

JUNE 21, 2023

The lack of differences in the observed outcomes do not suggest one EM training length is superior. The additional year may improve career trajectory or longevity, entrance into fellowship or academic practice, or other longer-term outcomes including successful development of a niche in the specialty. 11 What should we take away?

EMS 114

EMS Academics Telemedicine Operations 114

RebelEM

AUGUST 22, 2024

hours of symptom onset appears to be the most promising approach for improving visual outcomes, supported by multiple studies and meta-analyses. Moreover, there are multiple operational and patient-specific barriers rendering timely thrombolytic administration difficult. Paper: Lema GMC, De Leacy R, Fara MG, et al.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

Taming the SRU

NOVEMBER 3, 2023

The primary outcome in this study was a change in pain score at rest 60 minutes after block. Secondary outcomes were changes in pain scores at rest at 15 minutes, during incentive spirometry at both time points and then change in maximum vital capacity. Mean and median pain score at rest prior to SAPB were 5.4 (SD SD 3.28) and 6.5,

Fractures 98

Fractures Ultrasounds Research Outcomes 98

RebelEM

APRIL 29, 2024

Many clinicians don’t consider IO placement while others consider it a last resort or only a pre-hospital procedure. Intravenous vs.intraosseous vascular access during out-of-hospital cardiac arrest – protocol for a randomized clinical trial. PMID: 33350794 10 Meilandt C. Resusc Plus. 2023 PMID: 37502742 11 Schwalbach KT et al.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

Emergency Medicine Journal

MAY 23, 2023

We validated the score in a large patient data set and constructed a model that allows early prediction of the probability of clinical outcomes based on the individual’s NEWS+L Score. The outcomes were hospital death or a composite of hospital death and intensive care unit admission at 24 hours, 48 hours and 72 hours.

Outcomes 40

Outcomes Emergency Department Academics Operations 40

Don't Forget the Bubbles

JUNE 19, 2024

Children in the validation cohort were admitted to the intensive care unit or operating room less frequently than those in the derivation cohort. This may limit the generalisability of the results in regional/community hospital settings. Were the predictor variables and the outcome evaluated in a blinded fashion?

CPR 124

CPR Research Documentation/Coding Outcomes 124