Patients' Understanding of the Roles of Interns, Residents, and Attending Physicians in the Emergency Department

1999 ◽  
Vol 6 (4) ◽  
pp. 339-344 ◽  
Author(s):  
Robin R. Hemphill ◽  
Sally A. Santen ◽  
C. Bart Rountree ◽  
Andrew R. Szmit
Keyword(s):  
Emergency Department ◽  
Attending Physicians

scholarly journals P094: The frequency of stroke risk assessment tools used to assess patients presenting to the emergency department with atrial fibrillation and flutter

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S109-S110
Author(s):  
T. Nikel ◽  
S.W. Kirkland ◽  
S. Campbell ◽  
B.H. Rowe
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Department ◽  
Stroke Risk ◽  
Grey Literature ◽  
Anticoagulation Therapy ◽  
Adult Patients ◽  
Assessment Tools ◽  
Risk Scores ◽  
Atrial Fibrillation And Flutter ◽  
Attending Physicians

Introduction: Acute atrial fibrillation or flutter (AFF) is the most common dysrhythmia managed in the emergency department (ED). A key component of managing AFF in the ED is the prevention of stroke. Predictive indices (e.g., CHADS2 , HAS-BLED) should be used to assess each patient’s risk of stroke and bleeding to determine the appropriate anticoagulation therapy. The frequency of use of these predictive indices in the emergency department to determine appropriate anticoagulation therapy remains unclear. This systematic review is designed to examine the use of risk scores in the ED to determine the management of patients presenting to the ED for atrial fibrillation and flutter. Methods: An extensive search of eight electronic databases and grey literature was conducted. Quasi-experimental studies were eligible for inclusion. Studies had to report on the ED management of adult patients presenting with AFF to be included. Two independent reviewers judged the relevance, inclusion, and risk of bias of the studies. Individual and pooled statistics were calculated as odds ratios (OR) with 95% CI using a random effects model and heterogeneity (I2) was reported. Results: From 1,648 citations, 37 studies were included in this review. Heterogeneity was very high, precluding pooling. Only one of the included studies documented the use of CHADS2 scores by attending physicians; while no studies documented the use of HAS-BLED. There was variability in the ED management strategies of AFF. The utilization of rhythm control in the treatment of AFF ranged considerable (OR: 0.04-9.84) in comparison to rate control. Of the 17 studies reporting cardioversion approaches, chemical (9 {53%}) cardioversion was the most common management strategy of AFF. Conclusion: Our results suggests that either few physicians are documenting stroke risk scores in adult patients with AFF, or that research studies assessing ED management of AFF are not reporting scores documented by the attending physicians. Future research needs to examine the use of stroke risk scores to determine the optimal and appropriate care for patients.

scholarly journals Etiologies of abdominal pain emergencies in pediatrics

2021 ◽  
Author(s):  
Hala Atta Youssef ◽  
Aishah Mohammad Alkhaldi ◽  
Manar Mohammed Alshahrani ◽  
Abdullah Tariq Almalki ◽  
Amjad Ali Alahmari ◽  
...  
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Pediatric Patients ◽  
Surgical Intervention ◽  
Acute Abdominal Pain ◽  
Clinical Importance ◽  
Healthcare Settings ◽  
Common Causes ◽  
The Common ◽  
Attending Physicians

Reports showed that children usually complained of acute abdominal pain, which indicated the presence of severe underlying conditions and can have significant clinical importance. Serious challenges have been reported in healthcare settings where an urgent evaluation of the cases was necessary to adequately manage the patient before developing serious complications that might even end up with death. Some of these conditions included intussusception, appendicitis, volvulus and adhesions. Although estimates indicated that only around 1% of pediatric patients with acute abdominal pain usually required surgical intervention, concerns regarding the overlooking and misdiagnosis of significant conditions that might have severe prognostic outcomes were aroused among the different emergency departments. This study reviewed the common causes of acute abdominal pain among children admitted to the emergency department. Our results indicated that various etiologies can develop acute abdominal pain and therefore, establishing an adequate diagnosis by differentiating between the different etiologies should be done by the attending physicians to enhance the outcomes and adequately manage the admitted patients. Gastrointestinal causes of acute abdominal pain were the commonest to cause admissions to the emergency department. However, care should also be provided to the less common conditions, which might include genitourinary and pulmonary disorders and therefore, a thorough examination of children should be provided not to conduct a misdiagnosis of the underlying condition.

scholarly journals Factors Affecting Length of Stay in the Emergency Department in Patients Who Presented with Abdominal Pain

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Ar-aishah Dadeh ◽  
Pitshaya Phunyanantakorn
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Length Of Stay ◽  
Final Diagnosis ◽  
Chief Complaint ◽  
Factors Affecting ◽  
Examination Time ◽  
Baseline Characteristics ◽  
Attending Physicians ◽  
Significant Factors

Objective. We aimed to identify factors affecting length of stay in the emergency department in patients who presented with abdominal pain. Methods. A retrospective cohort study was conducted from 1 January 2017 to 31 December 2017. The medical records were reviewed from 217 patients older than 15 years with the chief complaint of abdominal pain. The patients were divided into emergency department length of stay (EDLOS) < 4 hours and ≥4 hours. The two groups were compared in terms of baseline characteristics, physical examination, time of presenting, attending physicians, interdepartmental consultations, investigations, ED disposition, final diagnosis, and mortality. The significant factors affecting longer EDLOS were examined using univariate and multivariate analyses by logistic regression. Results. Factors affecting longer EDLOS were age ≥50 (odds ratio (OR) 3.17, 95% confidence interval (CI) 1.36–7.42), interdepartmental consultation ≥2 specialists (OR 71.82, 95% CI 5.67–909.51), blood testing ≥2 rounds (OR 85.6, 95% CI 4.22–1734.6), and ultrasonography (OR 8.28, 95% CI 1.84–37.26). Conclusion. The study found that the statistically significant factors that prolonged EDLOS in patients with the chief complaint of abdominal pain were age, rounds of blood test, interdepartmental consultation, and the need for ultrasonography.

scholarly journals Effect of Real-Time Surveys on Patient Satisfaction Scores in the Emergency Department

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Julia Sobel ◽  
Jessica Bates ◽  
Vivienne Ng ◽  
Matthew Berkman ◽  
Tomas Nuño ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Satisfaction ◽  
Real Time ◽  
Physician Behavior ◽  
Resident Physicians ◽  
Patient Satisfaction Scores ◽  
Behavior Modifications ◽  
Satisfaction Measures ◽  
Attending Physicians ◽  
Satisfaction Surveys

Background. Patient satisfaction surveys have become increasingly important as their results help to determine Centers for Medicare and Medicaid Services (CMS) reimbursement. However, these questionnaires have known sources of bias (self-selection, responder, attribution, and nonresponse). Objective. We developed a real-time (RT) survey delivered in the hospital ED to evaluate the effect of implementing RT patient satisfaction surveys on physician behavior and hypothesized that the timing of patient satisfaction survey delivery would significantly impact the results. Method. Data from real-time patient satisfaction surveys were collected in phases from 12/2015 to 5/2017. Hospital-sponsored (HS) surveys were administered after discharge from 12/2015 to 12/2016. Results. For RT surveys, resident physicians were significantly more likely to write their names on the whiteboard (p=0.02) and sit down (p=0.01) with patients. Behavior modifications by attending physicians were not significant. Patient satisfaction measures did not improve significantly between periods for RT or HS surveys; however, RT survey responders were significantly more likely to recommend the ED to others. Conclusion. The timing of survey administration did significantly alter resident physician’s behavior; however, it had no effect on patient satisfaction scores. RT responders were significantly more likely to recommend the emergency department to others.

The Pediatric Internship as a Teaching Technique: A Comparison of Learning Experiences in Five Hospitals

PEDIATRICS ◽  
1975 ◽  
Vol 56 (2) ◽  
pp. 239-245
Author(s):  
Klaus Roghmann ◽  
Philip Pizzo ◽  
Elinor Graham ◽  
David Graham ◽  
Bernard Guyer ◽  
...  
Keyword(s):  
Emergency Department ◽  
Child Care ◽  
Physical Examination ◽  
Collaborative Study ◽  
Learning Experiences ◽  
Demographic Characteristics ◽  
Respiratory Problems ◽  
Well Child Care ◽  
Teaching Technique ◽  
Attending Physicians

Five interns joined in a collaborative study to assess their learning experiences during the internship year. A 3x5-inch data form was completed for each patient for whom the intern was responsible. Information was gathered on demographic characteristics of the patient, the teaching that involved this patient, and what skills were acquired. Nearly 30% of the patients were under 1 year of age; 55% were boys. More than one half of the contacts were in an outpatient or emergency department. Over 80% of the patients had not been seen before; continuity patients made up less than 9% of the contacts. Well-child care was the largest care category (19%), followed by respiratory problems (15%) and injuries (9%). About 40% of the contacts involved a teaching input, mainly from residents, attending physicians, and faculty. Care skills most frequently acquired were physical examination (49%), reading (15%), and interviewing (11%). Crosstabulations showed that most learning was reported for inpatients, for patients with rare diseases, and when some teaching was involved.

Communication about opioid versus nonopioid analgesics in the emergency department

2015 ◽  
Vol 11 (3) ◽  
pp. 229 ◽  
Author(s):  
Danielle M. McCarthy, MD, MS ◽  
Kenzie A. Cameron, PhD, MPH ◽  
D. Mark Courtney, MD, MS ◽  
James G. Adams, MD ◽  
Kirsten G. Engel, MD
Keyword(s):  
Emergency Department ◽  
Adverse Effects ◽  
Medical Center ◽  
Academic Medical Center ◽  
Multivariable Analysis ◽  
Secondary Analysis ◽  
Academic Medical ◽  
Frequency Of Use ◽  
Nonopioid Analgesics ◽  
Attending Physicians

Objective: The Medication Communication Index (MCI) was used to compare counseling about opioids to nonopioid analgesics in the Emergency Department (ED) setting.Design: Secondary analysis of prospectively collected audio recordings of ED patient visits.Setting: Urban, academic medical center (>85,000 annual patient visits). Participants: Patient participants aged >18 years with one of four low acuity diagnoses: ankle sprain, back pain, head injury, and laceration. ED clinician participants included resident and attending physicians, nursing staff, and ED technicians.Main outcome measures: The MCI is a five-point index that assigns points for communicating the following: medication name (1), purpose (1), duration (1), adverse effects (1), number of tablets (0.5), and frequency of use (0.5). Recording transcripts were scored with the MCI, and total scores were compared between drug classes.Results: The 41 patients received 56 prescriptions (27 nonopioids, 29 opioids). Nonopioid median MCI score was 3 and opioid score was 4.5 (p = 0.0008). Patients were counseled equally about name (nonopioid 100 percent, opioid 96.6 percent, p = 0.34) and purpose (88.9 percent, 89.7 percent, p = 0.93). However, patients receiving opioids were counseled more frequently about duration of use (nonopioid 40.7 percent, opioid 69.0 percent, p = 0.03) and adverse effects (18.5 percent, 93.1 percent, p < 0.001). In multivariable analysis, opioids (β = 0.54, p = 0.04), number of medications prescribed (β = −0.49, p = 0.05), and time spent in the ED (β = 0.007, p = 0.006) were all predictors of total MCI score.Conclusions: The extent of counseling about analgesic medications in the ED differs by drug class. When counseling patients about all analgesic medications, providers should address not only medication name and purpose but also the less frequently covered topics of medication dosing, timing, and adverse effects.

A novel use of telemedicine during a hospital mass casualty drill

2019 ◽  
pp. 1357633X1989387
Author(s):  
Brenna Farmer ◽  
Lauren Stoerger ◽  
Medha Vyavahare ◽  
Rahul Sharma
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Care Service ◽  
Quality Care ◽  
Rapid Assessment ◽  
Mass Casualty ◽  
Telemedicine Service ◽  
Lower Manhattan ◽  
Attending Physicians

During a mass casualty disaster drill at NewYork-Presbyterian’s Lower Manhattan Hospital in April 2019, the Emergency Department (ED) used telemedicine to see low-acuity ‘walking wounded’ patients. This telemedicine service is provided every day as ED Express Care Service and staffed by off-site, board-certified Emergency Medicine attending physicians. This novel use of the ED Express Care Service allowed the ED to provide timely, safe, quality care while expanding resources and ED capacity through rapid assessment, treatment and discharge of the low-acuity patients.

scholarly journals Impact of Attending Physicians' Comments on Residents’ Workloads in the Emergency Department: Results from Two J(^o^)PAN Randomized Controlled Trials

PLoS ONE ◽  
2016 ◽  
Vol 11 (12) ◽  
pp. e0167480 ◽  
Author(s):  
Akira Kuriyama ◽  
Noriyuki Umakoshi ◽  
Jun Fujinaga ◽  
Toshie Kaihara ◽  
Seigo Urushidani ◽  
...  
Keyword(s):  
Emergency Department ◽  
Randomized Controlled Trials ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Attending Physicians

Point-of-care naloxone distribution in the emergency department: A pilot study

2021 ◽  
Vol 78 (4) ◽  
pp. 360-366
Author(s):  
P Quincy Moore ◽  
Navneet Cheema ◽  
Laura E Celmins ◽  
Alisha Patel ◽  
Sarah Follman ◽  
...  
Keyword(s):  
Emergency Department ◽  
Recent Literature ◽  
Point Of Care ◽  
Opioid Overdose ◽  
Discharge Instructions ◽  
Heroin Use ◽  
Training Video ◽  
Patient Screening ◽  
Resident Physicians ◽  
Attending Physicians

Abstract Purpose Opioid overdose education and naloxone distribution (OEND) for use by laypersons has been shown to be safe and effective, but implementation in the emergency department (ED) setting is challenging. Recent literature has shown a discouragingly low rate of obtainment of naloxone that is prescribed in the ED setting. We conducted a study to evaluate the feasibility of point-of-care (POC) distribution of naloxone in an ED, hypothesizing a rate of obtainment higher than prescription fill rates reported in previous studies. Summary A multidisciplinary team of experts, including pharmacists, physicians, nurses, and case management professionals used an iterative process to develop a protocol for POC OEND in the ED. The protocol includes 5 steps: (1) patient screening, (2) order placement in the electronic health record (EHR), (3) a patient training video, (4) dispensing of naloxone kit, and (5) written discharge instructions. The naloxone kits were assembled, labeled to meet requirements for a prescription, and stored in an automated dispensing cabinet. Two pharmacists, 30 attending physicians, 65 resident physicians, and 108 nurses were trained. In 8 months, 134 orders for take-home naloxone were entered and 117 naloxone kits were dispensed, resulting in an obtainment rate of 87.3%. The indication for take-home naloxone kit was heroin use for 61 patients (92.4%). Conclusion POC naloxone distribution is feasible and yielded a rate of obtainment significantly higher than previous studies in which naloxone was prescribed. POC distribution can be replicated at other hospitals with low rates of obtainment.

scholarly journals Emergency Department Resource Use by Supervised Residents vs Attending Physicians Alone

JAMA ◽  
2014 ◽  
Vol 312 (22) ◽  
pp. 2394 ◽  
Author(s):  
Stephen R. Pitts ◽  
Sofie R. Morgan ◽  
Justin D. Schrager ◽  
Todd J. Berger
Keyword(s):  
Emergency Department ◽  
Resource Use ◽  
Attending Physicians
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