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AEM Early Access 82: Correlation of vital sign centiles with in-hospital outcomes among adults encountered by emergency medical services Mar 16, 2024

In this study, the authors first sought to empirically derive centiles for heart rate (HR), respiratory rate (RR), and systolic blood pressure (SBP) for adults with out-of-hospital emergencies who were transported to an ED. Second, they aimed to evaluate the impact of adjusting for age in the evaluation of centile curves for vital signs to identify practical targets for adjustment of vital signs classification in adult patients based on age categories. Third, they examined the association of both unadjusted and age-adjusted vital signs with hospital admission and in-hospital mortality.

AEM Early Access 81:Initial Treatment of Uninsured Patients with ST-Elevation Myocardial Infarction by Facility PCI Capabilities Mar 07, 2024

Timely reperfusion is necessary to reduce morbidity and mortality in patients with ST-elevation myocardial infarction (STEMI). Initial care by facilities with percutaneous coronary intervention (PCI) capabilities reduces time to reperfusion. The authors sought to examine whether insurance status was associated with initial care at EDs with PCI capabilities amongst adult patients with STEMI.

AEM Education and Training 54: Our responsibility to patients: Maintain competency or stop practicing Feb 15, 2024

Dr. Sally Santen and Dr. Martin Pusic discuss their team's new commentary and perspective piece in AEM Education and Training entitled, "Our responsibility to patients: Maintain competency or ... stop practicing."

AEM Education and Training 53: Brain versus bot: Distinguishing letters of recommendation authored by humans compared with artificial intelligence Feb 14, 2024

The use of generative artificial intelligence (AI) tools, such as ChatGPT, are gaining popularity for a variety of academic writing tasks and offer an innovative solution to relieve the burden of letter writing. The authors conducted a study aimed at determining whether academic physicians can distinguish between AI and human-generated letters of recommendation.

In the podcast the author references a gendered language calculator, which can be found here:

https://slowe.github.io/genderbias/

AEM Early Access 80: The differences in code status conversation approaches reported by emergency medicine and palliative care clinicians: a mixed method study Jan 08, 2024

Conversations about code status in seriously ill patients at end of life is unfortunately a frequent event in the emergency department. Today we are discussing a paper in AEM entitled The differences in code status conversation approaches reported by emergency medicine and palliative care clinicians: a mixed method study. Lead author Dr. Kei Ouchi is here to discuss it with us.

AEM Early Access 79: A Qualitative Analysis of Patients’ Experiences with an ED Diagnosis of GI Cancer Dec 17, 2023

We discuss this new article, A Qualitative Analysis of Patients’ Experiences with an ED Diagnosis of GI Cancer, with senior author Dr. Haejin In.

AEM Education and Training 52: Making decisions “in the dark”: Learning through uncertainty in clinical practice during Covid-19 Dec 13, 2023

Today we are speaking to senior author Dr. Dmitri Papanagnou about his team’s new paper in AEM Education and Training entitled Making decisions “in the dark”: Learning through uncertainty in clinical practice during Covid-19.

AEM Early Access 78: Association of Limited English Proficiency with Emergency Department Irregular Departures and Return Visits: A Cross-sectional Cohort Study in the Upper Midwest Between January 2018 and December 2021 Nov 03, 2023

Patients with (LEP) have been shown to experience disparities in (ED) care. The objectives of this study were to examine the LEP and irregular ED departures and return ED visits. We interview senior author Dr. Derick Jones about this new AEM paper.

AEM Early Access 79: Emergency medicine physician workforce attrition differences by age and gender Oct 26, 2023

Emergency care workforce concerns have gained national prominence given recent data suggesting higher than previously estimated attrition. With little known regarding characteristics of physicians leaving the workforce, this paper sought to investigate the age and number of years since residency graduation at which male and female EM physicians exhibited workforce attrition. We speak with primary author Dr. Cameron Gettel.

AEM Education and Training 51: Perspectives on preparedness for pediatric emergencies after residency: A needs assessment Oct 12, 2023

General emergency physicians provide most pediatric emergency care in the United States yet report more challenges managing emergencies in children than adults. Recommendations for standardized pediatric emergency medicine (PEM) curricula to address educational gaps due to variations in pediatric exposure during emergency medicine (EM) training lack learner input. This study surveyed senior EM residents and recent graduates about their perceived preparedness to manage pedi- atric emergencies to better inform PEM curricula design.

AEM Education and Training 50: I'd Rather See Action: “I’d rather see action”: Application and recruitment experiences of underrepresented in emergency medicine trainees Sep 15, 2023

Dr. Pensa interviews author Dr. Michelle Suh about her teams recent E&T publication, “I’d rather see action”: Application and recruitment experiences of underrepresented in emergency medicine trainees."

AEM Early Access 77: Survival by Time-to-Administration of Amiodarone, Lidocaine, or Placebo in Shock- Refractory Out-of-Hospital Cardiac Arrest Aug 26, 2023

Amiodarone and lidocaine have not been shown to have a clear survival benefit compared to placebo for out-of-hospital cardiac arrest (OHCA). However, randomized trials may have been impacted by delayed administration of the study drugs. Today we’re talking with Dr. Joshua Lupton, first author on a new AEM paper entitled “ Survival by Time-to-Administration of Amiodarone, Lidocaine, or Placebo in Shock-Refractory Out-of-Hospital Cardiac Arrest.”

AEM Early Access 76: Disparities in Emergency Department and Urgent Care Opioid Prescribing Before and After Randomized Clinician Feedback Interventions Jul 16, 2023

Demographic differences in opioid prescribing by patient race and ethnicity have been widely reported; Black and Hispanic patients receive lower rates and dosages of opioid prescriptions for the same conditions and reported pain level as white patients. At the same time, higher dosage opioid prescriptions have been associated with higher rates of new long-term opioid use and high-risk use, and opioid stewardship is being increasingly emphasized. Today we’re talking aout a new study in this area with lead author Aidan Crowley: Disparities in Emergency Department and Urgent Care Opioid Prescribing Before and After Randomized Clinician Feedback Interventions.

AEM Early Access 75: Equity-Relevant Sociodemographic Variable Collection in Emergency Medicine: A Systematic Review, Qualitative Evidence Synthesis & Recommendations for Practice Jun 08, 2023

We speak with lead author Dr. Murdoc Leeies about his team's new AEM paper, "Equity-Relevant Sociodemographic Variable Collection in Emergency Medicine: A Systematic Review, Qualitative Evidence Synthesis & Recommendations for Practice."

AEM Early Access 74: Head Computed Tomography Findings in Geriatric Emergency Department Patients with Delirium, Altered Mental Status, and Confusion: A Systematic Review Jun 02, 2023

Delirium, altered mental status or confusion among older adults are common presentations to the emergency department (ED). We discuss this new AEM paper with author Dr. Shan Liu, whose team aimed to report the proportion of older ED patients presenting with delirium who have acute abnormal findings on head imaging. We also assessed whether anticoagulation, neurological deficits, trauma or headache were associated with head imaging abnormalities in these patients.

AEM Early Access 73: Dizziness as a Missed Symptom of Central Nervous System Pathology: A Review of Malpractice Cases May 03, 2023

Dr. Pensa and author Summer Ghaith discuss her team's new research in AEM entitled "Dizziness as a Missed Symptom of Central Nervous System Pathology: A Review of Malpractice Cases."

AEM Education and Training 49: Development of a lecture evaluation tool rooted in cognitive load theory: A modified Delphi study Apr 07, 2023

Dr. Jaime Jordan joins the podcast to discuss her team's new AEM Education and Training paper, "Development of a lecture evaluation tool rooted in cognitive load theory: A modified Delphi study."

AEM Education and Training 48: Impact and effectiveness of a mandatory competency-based simulation program for pediatric emergency medicine faculty Apr 05, 2023

Dr. Jonathan Pirie discusses his recent AEM Education and Training paper, "Impact and effectiveness of a mandatory competency-based simulation program for pediatric emergency medicine faculty."

AEM Early Access 72: The Effect of Telemental versus In-person Mental Health Consults in the Emergency Department on 30-day Utilization and Processes of Care Apr 05, 2023

Dr. Jin Han joins the podcast to discuss his recent paper in AEM on telemental health care in the VA system.

AEM Early Access 71: Accuracy of “TICS” Ultrasound Protocol in Detecting Simple and Complicated Diverticulitis Mar 11, 2023

Paper abstract: Point-of-care ultrasound (US) has been suggested as the primary imaging in evaluating patients with suspected diverticulitis. Discrimination between simple and complicated diverticulitis may help to expedite emergent surgical consults and determine the risk of complications. This study aimed to: (1) determine the accuracy of an US protocol (TICS) for diagnosing diverticulitis in the Emergency Department (ED) setting and (2) assess the ability of TICS to distinguish between simple and complicated diverticulitis.

AEM Education and Training 47: Creating Master Adaptive Learners During Emergency Medicine Clerkships Feb 16, 2023

The Master Adaptive Learner (MAL) model was developed as an educational framework that teaches learners how to develop adaptive expertise. Dr. Guy Carmelli discusses his recent paper in AEM Education and Training on adapting the EM clerkship to create master adaptive learners.

AEM Education and Training 46: “Faces on a Screen”: A Qualitative Study of the Virtual and In-Person Conference Experience Feb 13, 2023

The strengths and weaknesses of virtual and in-person formats within continuing professional development (CPD) are incompletely understood. This study sought to explore attendees’ perspectives across multiple specialties regarding benefits and limitations of conference formats, and strategies for successful virtual and hybrid (i.e., in-person conferences with a virtual option) conferences.

AEM Early Access 70: Cocaethylene Cardiotoxicity in Emergency Department Patients with Acute Drug Overdose Feb 11, 2023

Cocaine use results in over 500,000 emergency department (ED) visits annually across the U.S. and ethanol co-ingestion is reported in 34% of these. Commingling cocaine with ethanol results in the metabolite cocaethylene (CE), which is metabolically active for longer than cocaine alone. Current literature on the cardiotoxicity of CE compared to cocaine alone is limited and lacks consensus. The present study aims to fill this gap in the literature and examine cardiovascular events in cocaine use as confirmed by urine toxicology versus CE exposure.

AEM Early Access 69: Utility of Head Computed Tomography for Older Adults with Suspected Delirium in the Emergency Department. A Retrospective Observational Study Jan 22, 2023

Dr. Pensa interviews Dr. Brittany Ellis about a new paper in AEM Journal.

AEM Early Access 68: Post-Roe Emergency Medicine: Policy, clinical, training, and individual implications for emergency clinicians Dec 13, 2022

Dr. Pensa interviews Dr. Margaret Samuels-Kalow about her new paper in AEM, "Post-Roe Emergency Medicine: Policy, clinical, training, and individual implications for emergency clinicians."

AEM Education and Training 45: A Consensus List of Ultrasound Competencies for Graduating Emergency Medicine Residents Dec 07, 2022

Dr. Pensa discusses the new paper "A Consensus List of Ultrasound Competencies for Graduating Emergency Medicine Residents" with lead author Dr. David Haidar.

AEM Education and Training 44: Bridging the Gap: Development of an Experiential Learning- Based Health Disparities Curriculum Dec 02, 2022

Dr. Pensa speaks to Dr. Holly Caretta-Weyer about her new AEM Education and Training Journal paper, "Bridging the Gap: Development of an Experiential Learning- Based Health Disparities Curriculum."

AEM Early Access 67: Increased Identification of Cannabis Users Drivers Involved in Motor Vehicle Collisions Using an Expanded Cannabis Inventory Nov 17, 2022

We discuss the new AEM article, "Increased Identification of Cannabis Users Drivers Involved in Motor Vehicle Collisions Using an Expanded Cannabis Inventory" with author Dr. Esther Choo.

AEM Education and Training 43: Differences in Faculty Feedback for High, Expected, and Below-Expected Clinically Performing Emergency Medicine Residents Nov 08, 2022

Author Dr. Coughlin and Dr. Pensa discuss his team's AEM Education and Training article, "Differences in Faculty Feedback for High, Expected, and Below-Expected Clinically Performing Emergency Medicine Residents."

AEM Early Access 66: Restrictive Fluids Versus Standard Care in Adults with Sepsis in the Emergency Department (REFACED) – a Multicenter, Randomized Feasibility Trial Oct 26, 2022

We speak to first author Dr. Marie Jessen about a new paper in AEM entitled "Restrictive Fluids Versus Standard Care in Adults with Sepsis in the Emergency Department (REFACED) – a Multicenter, Randomized Feasibility Trial."

AEM Education and Training 42: Coaching models, theories, and structures: an overview for teaching faculty in the emergency department and educators in the offices Oct 22, 2022

We discuss a new article in AEM Education and Training called “Coaching models, theories, and structures: an overview for teaching faculty in the emergency department and educators in the offices” with lead author Dr. Nicole Deiorio.

AEM Early Access 65: Physician Gestalt for Emergency Department Triage: A Prospective Videotaped Study Oct 04, 2022

Appropriate triage of patients in the ED is sometimes challenging, and today we’re discussing a new article in AEM entitled “Physician Gestalt for Emergency Department Triage: A Prospective Videotaped Study.” This paper from an academic ED in Taiwan compared physician gestalt versus the Taiwan Triage and Acuity Scale (TTAS), which is standard computerized triaging software used in Taiwan.

AEM Education and Training 41: Hopes and Fears: A Qualitative Analysis of the Intern Perspective at the Start of EM Residency Aug 27, 2022

Dr. Korie Zink discusses this new qualitative study in AEM Education and Training on fears and hopes at the start of EM orientation.

AEM Early Access 64: Epidemiology and Management of Abdominal Injuries in Children Aug 15, 2022

Although more guideline-adherent care has been described in pediatric compared to adult trauma centers, we aimed to provide a more detailed characterization of management and resource utilization of children with intra-abdominal injury (IAI) within pediatric centers. Our primary objective was to describe the epidemiology, diagnostic evaluation, and management of children with IAI across U.S. children’s hospitals. Our secondary objective was to describe the inter-hospital variation in surgical management of children with IAI.

AEM Education and Training 40: Does direct observation influence the quality of workplace- based assessment documentation? Aug 15, 2022

Competency-based medical education (CBME) is a topic we have discussed often on this podcast series, and today we are discussing a critical part of it; direct observation of trainees. But as most of us know, direct observation also has its challenges in a busy ED. Today we’re discussing a new paper in AEM Education and Training entitled "Does direct observation influence the quality of workplace-based assessment documentation?" First author Dr. Jeffrey Landreville is here to discuss it with us.

AEM Early Access 63: Can RV assessments improve triaging of low risk pulmonary embolism? Jul 26, 2022

We talk to Dr. Jaron Raper about a new article in AEM entitled "Can right ventricular assessments improve triaging of low risk pulmonary embolism?"

AEM Early Access 62: Racial differences in low-value pediatric emergency care in general emergency departments Jul 05, 2022

We discuss this paper with first author Dr Joyce Li. They sought to evaluate racial and ethnic differences in pediatric patients across a broad range of low-value imaging studies in the general ED setting.

AEM Education and Training 39: Implementation of a Pilot Novel Objective Peer comparison evaluation system in an emergency medicine residency program Jul 02, 2022

Most emergency medicine educators are familiar with the Milestones, the current evaluation system for emergency medicine residents, and these have been shown to be imperfect and highly subjective. Ath the same time, EM residents need to achieve competency in patient safety and quality improvement processes, Today we’re talking about a recent paper in AEM Education and training journal, “Implementation of a Pilot Novel Objective Peer comparison evaluation system in an emergency medicine residency program.” First author Dr Kraftin Schreyer, MD MBA is here to discuss it with us.

AEM Education and Training 38: “The Content Expert Program: A Structured Approach to Increase Emergency Medicine Resident Scholarly Activity Jul 02, 2022

The ACGME requires residents to participate in scholarship, and programs are required to provide an environment conducive to the production of scholarship and acquiring the necessary skills involved. Today we are talking to Dr Kraftin Schreyer about a recent paper in AEM Education and Training entitled “The Content Expert Program: A Structured Approach to Increase Emergency Medicine Resident Scholarly Activity.”

AEM Early Access 61: Predictive accuracy of adding shock index to the American College of Surgeons’ minimum criteria for full trauma team activation May 07, 2022

The American College of Surgeons requires trauma centers to use six minimum criteria (ACS-6) for full trauma team activation: hypotension, gunshot wound to the neck or torso, Glasgow Coma Scale (GCS) score < 9, respiratory compromise, transfers receiving blood transfusion, or physician discretion. Our goal was to evaluate the effect of adding varying shock index (SI) thresholds to the ACS-6 in an adult trauma population with the hypothesis that SI would significantly improve sensitivity at the expense of an acceptable decrease in specificity

AEM Education and Training 37: Qualitative description of sexual harassment and discrimination of women in emergency medicine: Giving the numbers a voice May 04, 2022

Gender disparities in medicine are well documented; however, little qualitative data exist. This study sought to provide a qualitative assessment of harassment and discrimination experienced by female physicians in emergency medicine (EM) specifically by colleagues or supervisors.

AEM Education and Training 36: The Journal Club 3.0: A qualitative, multisite study examining a new educational paradigm in the era of open educational resources Apr 21, 2022

The journal club is a ubiquitous and time-honored tradition within medical education. However, in recent years, open educational resources (OERs) have become increasingly influential in how physicians interact with the medical literature across multiple specialties. The authors sought to explore how emergency medicine (EM) resident physicians reconcile different perspectives across OERs into their educational experience at the journal club.

AEM Early Access 60: Intubation practice and outcomes among pediatric emergency departments: A report from National Emergency Airway Registry for Children (NEAR4KIDS) Apr 06, 2022

Tracheal intubation (TI) practice across pediatric emergency departments (EDs) has not been comprehensively reported. We aim to describe TI practice and outcomes in pediatric EDs in contrast to those in intensive are units (ICUs) and use the data to identify quality improvement targets.

AEM Early Access 59: Patient values and preferences in pulmonary embolism testing in the emergency department Mar 13, 2022

Patient-centered care is concordant with patient values and preferences. There is a lack of research on patient values and preferences for pulmonary embolism (PE) testing in the emergency department (ED), and a poor physician understanding of patient-specific goals. Our aim was to map patient-specific values, preferences, and expectations regarding PE testing in the ED.

AEM Early Access 58: Ketamine administration for acute painful sickle cell crisis: A randomized controlled trial Mar 01, 2022

The objective was to evaluate the efficacy and safety of single-dose ketamine infusion in adults with sickle cell disease (SCD) who presented with acute sickle vasoocclusive crisis (VOC).

AEM Education and Training 35: Moving beyond personal factors: A national study of wellness interventions in emergency medicine residency programs Jan 27, 2022

In 2017, the Accreditation Council for Graduate Medical Education (ACGME) revised its Common Program Requirements to support trainees and faculty by mandating programs to provide dedicated wellness resources and education. Emergency medicine may benefit from this change due to high burnout rates within the specialty. However, the current state of wellness interventions in emergency medicine (EM) residency programs has not yet been well described. Understanding current practices is necessary to assess unmet needs and inform the development and evaluation of future interventions that aim to improve trainee wellness.

AEM Education and Training 34: Factors influencing emergency medicine residency choice: diversity, community, and recruitment red flags Jan 22, 2022

Prior studies have demonstrated that EM applicants consider geography as well as modifiable/non- modifiable program factors. Less attention, however, has been paid to underrepresented groups. Additionally, the prevalence and characteristics of “red flags,” or factors that may lead an applicant to lower a program’s rank or not rank it at all, remains unknown in EM.

AEM Early Access 57: Cerebrovascular Disease Hospitalizations following Emergency Department Headache Visits: A Nested Case-Control Study Dec 28, 2021

Delayed diagnosis of cerebrovascular disease (CVD) among patients can result in substantial harm. If diagnostic process failures can be identified at emergency department (ED) visits that precede CVD hospitalization, interventions to improve diagnostic accuracy can be developed.

AEM Early Access 56: Histories of trauma: A qualitative analysis of lifetime traumatic experiences among emergency department patients Dec 06, 2021

Emergency medicine clinicians are excellent at identifying and treating physical trauma as a chief complaint, but are often unaware of patients’ previous experiences of trauma. The purpose of this study was to describe emergency department (ED) patients’ lifetime experiences of trauma.

AEM Early Access 55: A randomized controlled trial of ibuprofen versus ketorolac versus diclofenac for acute, nonradicular low back pain Oct 27, 2021

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-line medication for acute low back pain (LBP). It is unclear if the choice of NSAID impacts outcomes. We compared ibuprofen, ketorolac, and diclofenac for the treatment of acute, nonradicular LBP.

AEM Education and Training 32: Implementation of Holistic Review into Emergency Medicine Residency Application Screening to Improve Recruitment of Underrepresented In Medicine Applicants Oct 11, 2021

Increasing the diversity of the emergency medicine (EM) workforce is imperative, with more diverse teams showing improved patient care and increased innovation. Holistic review, adapted from the Association of American Medical Colleges (AAMC), focuses on screening applicants with a balanced method, valuing their experiences, attributes, and academic metrics equally. A core tenet to holistic review is that diversity is essential to excellence.

AEM Education and Training 33: A critical race theory curriculum for emergency medicine learners Oct 11, 2021

The authors developed a series of five virtual workshop sessions in 2019 that were held over Zoom in June and July 2020 in the setting of the COVID-19 pandemic. Eight learners completed the curriculum. Prior to each session, learners were provided pre-session materials including podcasts, recorded lectures, and readings. Thought-provoking questions were also provided with pre-session materials to facilitate discussion during sessions. Materials were curated to provide foundational knowledge on CRT and U.S. history as well as local history of the San Francisco Bay Area.

AEM Education and Training 31: A qualitative assessment of emergency medicine residents’ receptivity to feedback Oct 05, 2021

Effective feedback is the cornerstone of competency-based education. The emergency department (ED) is a unique learning and feedback environment. Developing our understanding of emergency medicine (EM) residents’ experiences around feedback will improve resident training and inform EM faculty development programs. This qualitative study explores the feedback culture and practices in EM and resident's experiences and attitudes toward feedback in this specific training environment.

AEM Early Access 53: COVID-19 Vaccine Hesitancy Among Patients in Two Urban Emergency Departments Sep 15, 2021

Widespread vaccination is an essential component of the public health response to the COVID-19 pandemic, yet vaccine hesitancy remains pervasive. This prospective survey investigation aimed to measure the prevalence of vaccine hesitancy in a patient cohort at two urban Emergency Departments (EDs) and characterize underlying factors contributing to hesitancy.

AEM Early Access 53: Racial and Ethnic Disparities in the Delayed Diagnosis of Appendicitis Among Children Sep 14, 2021

Appendicitis is the most common surgical condition in pediatric emergency department (ED) patients. Prompt diagnosis can reduce morbidity, including appendiceal perforation. The goal of this study was to measure racial/ethnic differences in rates of 1) appendiceal perforation, 2) delayed diagnosis of appendicitis, and 3) diagnostic imaging during prior visit(s).

AEM Education and Training 30: Academic Springboard: The Chief Resident Position Correlates with Career Path in Emergency Medicine Aug 27, 2021

The chief resident role often includes additional administrative and educational experiences beyond those of nonchief senior residents. It is unclear to what extent these experiences influence the postresidency career path of those selected as chief residents. The objective of this study was to evaluate the association of chief resident status on immediate postresidency career characteristics relative to nonchief residents in emergency medicine (EM).

AEM Early Access 52: Nonfatal firearm injuries: Utilization and expenditures for children pre- and postinjury Aug 06, 2021

Firearm injuries are one of the leading preventable causes of morbidity and mortality among children. Limited information exists about the impact of nonfatal firearm injuries on utilization and expenditures. Our objective was to compare health care encounters and expenditures 1 year before and 1 year following a nonfatal firearm injury.

AEM Education and Training 29: Purpose, pleasure, pace and contrasting perspectives: Teaching and learning in the Emergency Department Jul 02, 2021

Teaching and learning in the clinical setting are vital for the training and development of emergency physicians. Increasing service provision and time pressures in the Emergency Department (ED) have led to junior trainees’ perceptions of a lack of teaching and a lack of support during clinical shifts. We sought to explore the perceptions of learners and supervisors in our emergency department regarding teaching within this diverse and challenging context.

AEM Education and Training 28: Multi-institutional implementation of the National Clinical Assessment Tool in Emergency Medicine (NCAT-EM) Jun 20, 2021

Uniformly training physicians to provide safe, high-quality care requires reliable assessment tools to ensure learner competency. The consensus-derived National Clinical Assessment Tool in Emergency Medicine (NCAT-EM) has been adopted by clerkships across the country. Analysis of large-scale deidentified data from a consortium of users is reported.

AEM Early Access 51: Most emergency department patients meeting sepsis criteria are not diagnosed with sepsis at discharge Jun 20, 2021

Effective sepsis resuscitation depends on useful criteria for prompt identification of eligible patients. These criteria should reliably predict a discharge diagnosis of sepsis, ensuring that interventions are triggered for those who need it while avoiding potentially harmful interventions in those who do not. We sought to determine the proportion of patients meeting sepsis criteria in the emergency department (ED) that was ultimately diagnosed with sepsis and to quantify the subset of nonseptic patients with risk factors for harm from fluid resuscitation.

AEM Early Access 50: Suicidal ideation is insensitive to suicide risk after ED discharge May 27, 2021

We interview Dr. Scott Simpson about his recent AEM article describing the Columbia-Suicide Severity Rating Scale (C-SSRS)-Clinical Practice Screener's ability to predict suicide and emergency department (ED) visits for self-harm in the year following an ED encounter.

AEM Early Access 49: A Qualitative Study of ED Patients Who Survived an Opioid Overdose May 18, 2021

Little is known about patient perspectives to effectively engage patients immediately following opioid overdose. Our objective was to explore patients’ perspectives on substance use treatment, perceived needs, and contextual factors that shape the choice of patients seen in the emergency department (ED) to engage with treatment and other patient support services in the acute post–opioid overdose period.

AEM Early Access 48: Vaccination rates and acceptance of SARS‐CoV‐2 vaccination among U.S. ED health care personnel Mar 24, 2021

The COVID‐19 Evaluation of Risk in Emergency Departments (COVERED) project is a multicenter, prospective cohort surveillance project at 20 geographically diverse, high‐volume urban U.S. academic medical centers. The project's primary aim was to estimate the attributable risk of occupational acquisition of COVID‐19 in ED personnel during a 20‐week follow‐up. At completion we surveyed participants regarding receipt of vaccines, feelings of personal safety after vaccination, personal protective equipment (PPE) use and, if applicable, reasons for declining vaccination.

AEM Early Access 48: The Effect of Trauma Center Verification Level on Outcomes in TBI patients undergoing Inter-facility Transfer Feb 25, 2021

Previous literature demonstrates increased mortality for Traumatic Brain Injury (TBI) with transfer to a Level II versus Level I trauma center. Our objective is to determine the effect of the most recent American College of Surgeons-Committee on Trauma (ACS-COT) Resources for the Optimal Care of the Injured Patient resources manual (“The Orange Book”) on outcomes after severe TBI afterinterfacility transfer to Level I vs Level II center.

AEM Early Access 47: Emergency Physicians and Personal Narratives Improve the Perceived Effectiveness of COVID-19 Public Health Recommendations on Social Media Feb 10, 2021

Containment of the coronavirus disease 2019 (COVID-19) pandemic requires the public to change behavior under social distancing mandates. Social media are important information dissemination platforms that can augment traditional channels communicating public health recommendations. The objective of the study is to assess the effectiveness of COVID-19 public health messaging on Twitter when delivered by emergency physicians and containing personal narratives.

AEM Education & Training 27: Learner Perceptions of Electronic End-of-Shift Evaluations on an Emergency Medicine Clerkship Jan 18, 2021

As students on an emergency medicine (EM) rotation work with different faculty on a daily basis, EM clerkships often incorporate an end‐of‐shift evaluation to capture sufficient student performance data. Electronic shift evaluations have been shown to increase faculty completion compliance. This study aimed to examine learner perceptions of their individualized feedback during an EM clerkship following the adoption of an electronic evaluation tool.

AEM Education and Training 26: The Teacher, The Assessor, and the Patient Protector Jan 05, 2021

In this study, we examined how the context of the emergency department (ED) shapes the ways in which emergency physicians reconcile their competing roles in patient care and clinical supervision to optimize learning and ensure patient safety.

AEM Early Access 46: Identifying Maltreatment in Infants and Young Children Presenting With Fractures Dec 21, 2020

Child abuse is a significant cause of morbidity and mortality in preverbal children who cannot explain their injuries. Fractures are among the most common injuries associated with abuse but of themselves fractures may not be recognized as abusive until a comprehensive child abuse evaluation is completed, often prompted by other signs or subjective features. We sought to determine which children presenting with rib or long‐bone fractures should undergo a routine abuse evaluation based on age.

AEM Early Access 45: Identification of the Physiologically Difficult Airway in the Pediatric Emergency Department Nov 17, 2020

The risk factors for peri‐intubation cardiac arrest in critically ill children are incompletely understood. The study objective was to derive physiologic risk factors for deterioration during tracheal intubation in a pediatric emergency department (PED).

AEM Education and Training 25: Videotaped Unannounced Standardized Patient Encounters to Evaluate Interpersonal and Communication Skills in Emergency Medicine Residents Nov 05, 2020

Communication and interpersonal skills are important for effective patient care but are difficult to measure. Unannounced standardized patient encounters (USPEs) have the benefit of providing a standardized situation and provide a representation of usual care rather than best behavior, while also allowing for video recording without violating patient privacy. We conducted a feasibility pilot study to examine the use of videotaped USPEs in resident education of interpersonal and communication skills and specifically empathy.

AEM Early Access 44: Opioid-induced Euphoria Among Emergency Department Patients With Acute Severe Pain Oct 29, 2020

Parenteral opioids are commonly used to treat acute severe pain. We measured pleasurable sensations in patients administered intravenous analgesics to determine if these sensations were associated with receipt of an opioid, after controlling for relief of pain. Pleasurable sensations not accounted for by relief of pain were considered opioid-induced euphoria.

AEM Education and Training 24: AEM Education & Training: Emergency Medicine Resident Education on Caring for Patients with Disabilities: A Call to Action Oct 19, 2020

People with disabilities constitute a marginalized population who experience significant health care disparities resulting from structural, socioeconomic, and attitudinal barriers to accessing health care. It has been reported that education on the care of marginalized groups helps to improve awareness, patient-provider rapport, and patient satisfaction. Yet, emergency medicine (EM) residency education on care for people with disabilities may be lacking.

AEM Early Access 43: Disparities in Care: The Role of Race on the Utilization of Physical Restraints in the Emergency Setting Sep 28, 2020

Race‐based bias in health care occurs at organizational, structural, and clinical levels and impacts emergency medical care. Limited literature exists on the role of race on patient restraint in the emergency setting. This study sought to examine the role of race in physical restraint in an emergency department (ED) at a major academic medical center.

AEM Early Access 42: Diagnostic Performance of Emergency Physician Gestalt for Predicting Acute Appendicitis in Patients Age 5 to 20 Years Aug 14, 2020

Pediatric appendicitis remains a challenging diagnosis in the emergency department (ED). Available risk prediction algorithms may contribute to excessive ED imaging studies. Incorporation of physician gestalt assessment could help refine predictive tools and improve diagnostic imaging decisions.

AEM Education and Training 23: ACGME Changes to Common Program Requirements and Protected Faculty Time Jul 28, 2020

The Accreditation Council for Graduate Medical Education (ACGME), which regulates residency and fellowship training in the United States, recently revised the minimum standards for all training programs. These standards are codified and published as the Common Program Requirements. Recent specific revisions, particularly removing the requirement ensuring protected time for core faculty, are poised to have a substantial impact on emergency medicine training programs.

AEM Early Access 41:MI Can Be Safely Excluded by hsTn I Testing 3 Hrs After ED Presentation Jul 22, 2020

The accuracy and speed by which acute myocardial infarction (AMI) is excluded are an important determinant of emergency department (ED) length of stay and resource utilization. While high‐sensitivity troponin I (hsTnI) >99th percentile (upper reference level [URL]) represents a “rule‐in” cutpoint, our purpose was to evaluate the ability of the Beckman Coulter hsTnI assay, using various level‐of‐quantification (LoQ) cutpoints, to rule out AMI within 3 hours of ED presentation in suspected acute coronary syndrome (ACS) patients.

AEM Early Access 40: Shared Decision Making in Uncomplicated Ureterolithiasis Jun 23, 2020

The objective of this study was to develop a decision aid (DA) to facilitate shared decision making (SDM) around whether to obtain computed tomography (CT) imaging in patients presenting to the emergency department (ED) with suspected uncomplicated ureterolithiasis.

AEM Early Access 39: Access to Comprehensive Stroke Care in the Face of Traffic May 26, 2020

Early access to specialized stroke care is critically important in the treatment of suspected acute stroke, but access to dedicated stroke centers is unequal and varies geographically. Among the different levels of hospitals providing stroke care, the comprehensive stroke center (CSC) is the highest designation. In many systems of stroke care, if transport to a CSC is expected to take less than a certain number of minutes, the patient is taken to the CSC even if a non-CSC hospital is closer. Transport time–based decisions like these, however, could be significantly impacted during times of heavy traffic. This study examines this potential in LA County.

AEM Education and Training 22: Facilitating Observational Measurement in Highly Variable Clinical Settings May 12, 2020

Translational research in medical education requires the ability to rigorously measure learner performance in actual clinical settings; however, current measurement systems cannot accommodate the variability inherent in many patient care environments. This is especially problematic in emergency medicine, where patients represent a wide spectrum of severity for a single clinical presentation. Our objective is to describe and implement EBAM, an event‐based approach to measurement that can be applied to actual emergency medicine clinical events.

AEM Early Access 38: Outcomes With the Use of Bag–Valve–Mask Ventilation During Out‐of‐hospital Cardiac Arrest in the Pragmatic Airway Resuscitation Trial Apr 25, 2020

While emergency medical services (EMS) often use endotracheal intubation (ETI) or supraglottic airways (SGA), some patients receive only bag–valve–mask (BVM) ventilation during out‐of‐hospital cardiac arrests (OHCA). Our objective was to compare patient characteristics and outcomes for BVM ventilation to advanced airway management (AAM) in adults with OHCA.

AEM Education and Training 21: The Implementation of a National Multi-Faceted Emergency Medicine Resident 2 Wellness Curriculum Is Not Associated with Changes in Burnout Apr 08, 2020

The Accreditation Council for Graduate Medical Education Common Program Requirements effective 2017 state that programs and sponsoring institutions have the same responsibility to address well‐being as they do other aspects of resident competence. The authors sought to determine if the implementation of a multifaceted wellness curriculum improved resident burnout as measured by the Maslach Burnout Inventory (MBI).

AEM Education and Training 20: Rethinking Residency Conference in the Era of COVID19 Apr 07, 2020

The COVID-19 pandemic requires a substantial change to the traditional approach to conference didactics. Switching to a virtual medium for conference sessions presents several challenges, particularly with regard to aspects that rely heavily upon in-person components (e.g., simulation, ultrasound). We interview Dr. Michael Gottlieb about this paper, discussing the challenges and strategies to address them for conference planning in the era of COVID-19.

AEM Early Access 37: Application of Different Commercial Tourniquets by Laypersons Mar 22, 2020

The White House “Stop the Bleed” campaign has renewed interest in public‐access bleeding kits and the use of tourniquets by the lay public. The objective of this study was to determine which type of tourniquet could be applied most effectively by the lay public using only manufacturer instructions included with each tourniquet.

AEM Early Access 36: Emergency Providers' Familiarity with Firearms: A National Survey Feb 22, 2020

Emergency providers (EPs) are uniquely placed to advocate for firearm safety and have been shown to be at risk of exposure to firearms in the emergency department (ED). We sought to characterize EPs’ knowledge of firearms, frequency of encountering firearms in the ED and level of confidence with safely removing firearms from patient care settings.

AEM Education and Training 19: 'Swarming' as a New Model in the Academic ED Feb 16, 2020

Academic emergency medicine is a constant balance between efficiency and education. The authors developed a new model called swarming, where the bedside nurse, resident, and attending/fellow simultaneously evaluate the patient, including initial vital signs, bedside triage, focused history and physical examination, and discussion of the treatment plan, thus creating a shared mental model.

Video vs Augmented Direct Laryngoscopy in ED Adult Intubations: a NEAR Study Jan 21, 2020

This study compared first attempt intubation success using direct laryngoscopy augmented by laryngeal manipulation, ramped patient positioning and use of a bougie (A-DL) with unaided video laryngoscopy (VL) in adult emergency department intubations.

Video laryngoscopy used without any augmenting maneuver, device or technique resulted in higher first attempt success than does direct laryngoscopy that is augmented by use of a bougie, external laryngeal manipulation, ramping, or combinations thereof.

AEM Education and Training 18: Correlation Between EM Residents' Grit and Achievement Jan 11, 2020

This was a one-year prospective, multicenter trial involving ten EM residencies from 2017 to 2018. Subjects were PGY 1-4 EM residents. Grit-S scores, MCAT percentile, remediation rates, ITE scores, and the ITE score’s prediction of passing the ABEM Qualifying Examination were collected. Correlation coefficients were computed to assess the relationship between residents’ grit and achievement.

AEM Early Access 34: ECG Monitoring in Syncope (The SyMoNE Multicenter Study) Dec 26, 2019

Arrhythmia is one of the most worrisome causes of syncope. Electrocardiographic (ECG) monitoring is crucial for the management of non–low risk patients in the emergency department (ED). However, its diagnostic accuracy and optimal duration are unknown. We aimed to assess the diagnostic accuracy of ECG monitoring in non–low risk patients with syncope in the ED.

AEM Early Access 33: A multi-faceted intervention to increase patient knowledge and safe use of opioids Nov 21, 2019

Despite increased focus on opioid prescribing, little is known about the influence of prescription opioid medication information given to patients in the emergency department (ED). The study objective was to evaluate the effect of an Electronic Medication Complete Communication (EMC 2 ) Opioid Strategy on patients’ safe use of opioids and knowledge about opioids.

AEM Education and Training 17: A Scoping Review of Coaching and Mentoring for Practice Improvement Nov 18, 2019

Graduate medical education (GME) bodies are beginning to mandate coaching as an integral part of the learning process, in addition to current requirements for mentorship. Once an Emergency Medicine physician transitions beyond graduate training, there is no requirement and little focus on coaching as a method of improving or maintaining clinical practice. Our objective was to understand and describe the current state of the published literature with regards to the use of coaching and mentorship for both GME and practicing physicians.

AEM Education and Training 16: The EM InTraining Exam vs Resident Clinical Experiences Nov 06, 2019

The American Board of Emergency Medicine Model of the Clinical Practice of Emergency Medicine (ABEM Model) serves as a guide for resident education and the basis for the resident In-training Examination (ITE) and the Emergency Medicine Board Qualification Examinations. The purpose of this study was to determine how closely resident–patient encounters in the authors' emergency departments (EDs) matched the ABEM Model as presented in the specifications of the content outline for the ITE.

AEM Early Access 32: Freestanding ED's and Market-Level Spending on Emergency Care Oct 10, 2019

Freestanding emergency departments (FrEDs) could reduce wait times in overcrowded emergency departments, but they might also increase usage and overall spending for emergency care. We investigate the relationship between the number of FrEDs entering a local market and overall spending on emergency care.

AEM Early Access 31: A Novel Metric for Quantifying Use of ED Imaging Sep 25, 2019

The ED imaging h‐index allows identification of patients who undergo significant ED imaging, based on a single‐digit patient‐specific metric that incorporates both annual ED visit number and medical imaging resource intensity per visit. While ED patients with an ED imaging h‐index ≥ 2 represented a minuscule fraction of privately insured individuals, they were associated with one‐fifth of all ED imaging resources.

AEM Early Access 30: The Newly Homeless in the ED Aug 19, 2019

Emergency departments (EDs) frequently care for patients who are homeless or unstably housed. One promising approach taken by the homeless services system is to provide interventions that attempt to prevent homelessness before it occurs. Experts have suggested that health care settings may be ideal locations to identify and intervene with patients at risk for homelessness, yet little is known even about the basic characteristics of patients who might benefit from such interventions. This qualitative study examines themes that may lead to homelessness.

AEM Education and Training 15: Science Policy Training for a New Physician Leader Aug 18, 2019

We describe a novel GME fellowship in climate and health science policy, designed to train a new generation of clinicians to provide the necessary perspective and skills for effective leadership in this field.

AEM Education and Training 14: EM Resident Efficiency and ED Crowding Aug 11, 2019

Provider efficiency has been reported in the literature but there is a lack of efficiency analysis among EM residents. This paper aims to compare efficiency of EM residents of different training levels and determine if EM resident efficiency is affected by ED overcrowding.

AEM Early Access 29: Do Financial Incentives Change LOS Performance in EDs? Jul 19, 2019

Pay-for-performance (P4P) programs have been implemented in various forms to reduce emergency department (ED) patient length of stay (LOS). This retrospective study investigated to what extent the timing of patient disposition in Metro Vancouver EDs was influenced by a LOS-based P4P program.

AEM Early Access 28: Compassion Fatigue, Compassion Satisfaction and Burnout in PEM Jun 28, 2019

Discussing: "A cross-sectional analysis of compassion fatigue, burnout and compassion satisfaction in pediatric emergency medicine physicians in the US"

This study examined the prevalence of compassion fatigue, burnout, and compassion satisfaction, and sought to identify potential personal and professional predictors of these phenomena in pediatric critical care providers. Dr. Gita Pensa interviews authors Dr. Andrea Weintraub and Jeanie Gribben.

AEM E&T 12: Attitudes, Behavior, and Comfort of Emergency Medicine Residents in Caring for LGBT Patients: What Do We Know? Jun 13, 2019

Although lesbian, gay, bisexual, and transgender (LGBT) patients are ubiquitous in emergency medicine (EM), little education is provided to EM physicians on LGBT health care needs and disparities. There is also limited information on EM physician behavior, comfort, and attitudes toward LGBT patients. The objective of this study was to assess EM residents behavior, comfort, and attitudes in LGBT health.

AEM Early Access 27: Capturing Emergency Department Discharge Quality With the Care Transitions Measure May 30, 2019

Capturing Emergency Department Discharge Quality With the Care Transitions Measure: A Pilot Study

Dr. Chana Rich interviews Dr. Amber Sabbatini about this pilot study in the June issue of Academic Emergency Medicine.

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