Getting back into the emergency department: diversifying general practice while relieving emergency medicine workforce shortages

Background: Knowledge of hand anatomy and pathology is important for final year medical students as it frequently appears in examinations as a short case or in a written paper. Studies have shown that doctors in the Emergency Department have a deficient grasp of musculoskeletal anatomy secondary to a lack of dedicated teaching in medical school. Methods: A questionnaire was handed out to 111 final year medical students. Students were asked to fill it out before and after dedicated upper limb teaching sessions during their rotation. The questionnaire consisted of an anatomical and pathological component. Students were tested on basic anatomy and pathology of several common upper limb conditions. Results: There was a significant improvement in the medical students knowledge after the dedicated hand teaching. The identification of the carpal bones showed the most improvement overall. Conclusions: Basic musculoskeletal knowledge is essential to the practice of medicine. The majority of medical students gravitate towards a career in general practice or emergency medicine and good knowledge of upper limb anatomy is important. We have piloted a new interactive dedicated upper limb teaching module and have shown that there has been a significant improvement in students knowledge.

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Rapid Emergency Medicine Score Can Predict Long-term Mortality in Nonsurgical Emergency Department Patients

Academic Emergency Medicine ◽

10.1197/j.aem.2004.05.027 ◽

2004 ◽

Vol 11 (10) ◽

pp. 1008-1013 ◽

Cited By ~ 19

Author(s):

T. Olsson

Keyword(s):

Emergency Department ◽

Emergency Medicine ◽

Emergency Department Patients ◽

Long Term Mortality

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Emergency medicine airway leads: a rapid response distributed educational model for emergency department COVID-19 airway management

CJEM ◽

10.1007/s43678-020-00042-2 ◽

2021 ◽

Author(s):

Adam Harris ◽

Lorri Beatty ◽

Nicholas Sowers ◽

Sam G. Campbell ◽

David Petrie ◽

...

Keyword(s):

Emergency Department ◽

Emergency Medicine ◽

Airway Management ◽

Rapid Response ◽

Educational Model

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Predictive factors for prolonged hospitalisation in acute pyelonephritis patients admitted to the emergency medicine ward

Hong Kong Journal of Emergency Medicine ◽

10.1177/10249079211000976 ◽

2021 ◽

pp. 102490792110009

Author(s):

Howard Tat Chun Chan ◽

Ling Yan Leung ◽

Alex Kwok Keung Law ◽

Chi Hung Cheng ◽

Colin A Graham

Keyword(s):

Emergency Department ◽

Emergency Medicine ◽

Length Of Stay ◽

Acute Pyelonephritis ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Prolonged Length ◽

Reactive Protein ◽

Prolonged Hospital ◽

Emergency Medicine Ward

Background: Acute pyelonephritis is a bacterial infection of the upper urinary tract. Patients can be admitted to a variety of wards for treatment. However, at the Prince of Wales Hospital in Hong Kong, they are managed initially in the emergency medicine ward. The aim of the study is to identify the risk factors that are associated with a prolonged hospital length of stay. Methods: This was a retrospective cohort study conducted in Prince of Wales Hospital. The study recruited patients who were admitted to the emergency medicine ward between 1 January 2014 and 31 December 2017. These patients presented with clinical features of pyelonephritis, received antibiotic treatment and had a discharge diagnosis of pyelonephritis. The length of stay was measured and any length of stay over 72 h was considered to be prolonged. Results: There were 271 patients admitted to the emergency medicine ward, and 118 (44%) had a prolonged hospital length of stay. Univariate and multivariate analyses showed that the only statistically significant predictor of prolonged length of stay was a raised C-reactive protein (odds ratio 1.01; 95% confidence 1.01–1.02; p < 0.0001). Out of 271 patients, 261 received antibiotics in the emergency department. All 10 patients (8.5%) who did not receive antibiotics in emergency department had a prolonged length of stay (p = 0.0002). Conclusion: In this series of acute pyelonephritis treated in the emergency medicine ward, raised C-reactive protein levels were predictive for prolonged length of stay. Patients who did not receive antibiotics in the emergency department prior to emergency medicine ward admission had prolonged length of stay.

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Subarachnoid hemorrhage in the emergency department

International Journal of Emergency Medicine ◽

10.1186/s12245-021-00353-w ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Sima Patel ◽

Amay Parikh ◽

Okorie Nduka Okorie

Keyword(s):

Emergency Department ◽

Emergency Medicine ◽

Subarachnoid Hemorrhage ◽

Early Management ◽

Vast Number ◽

Emergency Medicine Physician ◽

Medicine Physician ◽

Diagnostic Modalities ◽

Poor Outcomes ◽

Subarachnoid Hemorrhages

Abstract Background Subarachnoid hemorrhage accounts for more than 30,000 cases of stroke annually in North America and encompasses a 4.4% mortality rate. Since a vast number of subarachnoid hemorrhage cases present in a younger population and can range from benign to severe, an accurate diagnosis is imperative to avoid premature morbidity and mortality. Here, we present a straightforward approach to evaluating, risk stratifying, and managing subarachnoid hemorrhages in the emergency department for the emergency medicine physician. Discussion The diversities of symptom presentation should be considered before proceeding with diagnostic modalities for subarachnoid hemorrhage. Once a subarachnoid hemorrhage is suspected, a computed tomography of the head with the assistance of the Ottawa subarachnoid hemorrhage rule should be utilized as an initial diagnostic measure. If further investigation is needed, a CT angiography of the head or a lumbar puncture can be considered keeping risks and limitations in mind. Initiating timely treatment is essential following diagnosis to help mitigate future complications. Risk tools can be used to assess the complications for which the patient is at greatest. Conclusion Subarachnoid hemorrhages are frequently misdiagnosed; therefore, we believe it is imperative to address the diagnosis and initiation of early management in the emergency medicine department to minimize poor outcomes in the future.

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The International Federation for Emergency Medicine report on emergency department crowding and access block: a brief summary

International Journal of Emergency Medicine ◽

10.1186/s12245-020-00312-x ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

A. P. Javidan ◽

◽

K. Hansen ◽

I. Higginson ◽

P. Jones ◽

...

Keyword(s):

Emergency Department ◽

Emergency Medicine ◽

Task Force ◽

Video Conferencing ◽

International Federation ◽

Emergency Physicians ◽

Emergency Department Crowding ◽

Comprehensive Guidance ◽

The World ◽

Ed Crowding

Abstract Objective To develop comprehensive guidance that captures international impacts, causes, and solutions related to emergency department crowding and access block Methods Emergency physicians representing 15 countries from all IFEM regions composed the Task Force. Monthly meetings were held via video-conferencing software to achieve consensus for report content. The report was submitted and approved by the IFEM Board on June 1, 2020. Results A total of 14 topic dossiers, each relating to an aspect of ED crowding, were researched and completed collaboratively by members of the Task Force. Conclusions The IFEM report is a comprehensive document intended to be used in whole or by section to inform and address aspects of ED crowding and access block. Overall, ED crowding is a multifactorial issue requiring systems-wide solutions applied at local, regional, and national levels. Access block is the predominant contributor of ED crowding in most parts of the world.

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Colpocephaly Diagnosed in a Neurologically Normal Adult in the Emergency Department

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2019.9.44646 ◽

2019 ◽

Vol 3 (4) ◽

pp. 421-424

Author(s):

Christopher Parker ◽

Wesley Eilbert ◽

Timothy Meehan ◽

Christopher Colbert

Keyword(s):

Emergency Department ◽

Emergency Medicine ◽

Clinical Symptoms ◽

Normal Adult ◽

Lateral Ventricles ◽

Asymptomatic Adult ◽

Neurologically Normal ◽

Made In

Colpocephaly is a form of congenital ventriculomegaly characterized by enlarged occipital horns of the lateral ventricles with associated neurologic abnormalities. The diagnosis of colpocephaly is typically made in infancy. Its diagnosis in adulthood without associated clinical symptoms is exceptionally rare. We report a case of colpocephaly diagnosed incidentally in an adult without neurologic abnormalities in the emergency department. To our knowledge, this is only the ninth reported case in an asymptomatic adult and the first to be described in the emergency medicine literature.

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A Structured Curriculum for Interprofessional Training of Emergency Medicine Interns

Western Journal of Emergency Medicine ◽

10.5811/westjem.2019.11.44139 ◽

2019 ◽

Vol 21 (1) ◽

pp. 149-151 ◽

Cited By ~ 1

Author(s):

Ashley Rider ◽

Tiffany Anaebere ◽

Mariko Nomura ◽

David Duong ◽

Charlotte Wills

Keyword(s):

Emergency Department ◽

Emergency Medicine ◽

Interprofessional Education ◽

Hospital Setting ◽

Scope Of Practice ◽

Registered Nursing ◽

Interprofessional Training ◽

Before And After ◽

Team Based Care ◽

Improve Health

Interprofessional education (IPE) has been shown to improve health outcomes and patient satisfaction. IPE is now represented in the Accreditation Council for Graduate Medical Education’s emergency medicine (EM) milestones given the team-based nature of EM. The Highland Allied Health Rotation Program (H-AHRP) was developed by residents to enhance and standardize IPE for EM residents in a single hospital setting. H-AHRP was incorporated into the orientation month for interns starting in the summer of 2016. EM interns were paired with emergency department preceptors in registered nursing (RN), respiratory therapy (RT), pharmacy (PH), laboratory (LAB), and social work (SW) in either a four-hour shadowing experience (RN, RT, PH) or lecture-based overview (LAB, SW). We conducted a survey before and after the program. Overall, the EM interns reported an improved understanding of the scope of practice and day-to-day logistics after working with the preceptors. They found the program helpful to their future as physicians and would recommend it to other residencies. The H-AHRP program allows for the early incorporation of IPE into EM training, enhances interns’ understanding of both the scope and logistics of their colleagues, and is a well-received effort at improving team-based care.

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