Journal of the American College of Emergency Physicians open
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J Am Coll Emerg Physicians Open · Dec 2020
Optimizing the workforce: a proposal to improve regionalization of care and emergency preparedness by broader integration of pediatric emergency physicians certified by the American Board of Pediatrics.
Emergency care in the United States faces notable challenges with regard to children. In some jurisdictions, available resources are not sufficient to meet local needs. Physicians with specialty training in pediatric emergency care are largely concentrated in children's medical centers within larger urban areas. Rural emergency facilities, which are more likely to face ongoing staffing shortages in all specialties, are particularly deficient in pediatric emergency medicine (PEM) physicians. This paper addresses challenges in distribution of pediatric emergency care specialists into suburban and rural health care facilities, and proposes potential local and regional solutions to improve pediatric emergency care capabilities as well as to enhance disaster response in children. ⋯ Recognition that the training of ABP-certified PEM physicians allows for these individuals to safely care for selective adult patients with common disease patterns that extend beyond traditionally assigned arbitrary pediatric age limits has the potential to improve resource dissemination and utilization, allowing for greater access to pediatric emergency physicians in currently underserved settings.
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J Am Coll Emerg Physicians Open · Dec 2020
Microdosing and standard-dosing take-home buprenorphine from the emergency department: A feasibility study.
Emergency department (ED)-initiated buprenorphine may prevent overdose. Microdosing is a novel approach that does not require withdrawal, which can be a barrier to standard inductions. We aimed to evaluate the feasibility of an ED-initiated buprenorphine/naloxone program providing standard-dosing and microdosing take-home packages and of randomizing patients to either intervention. ⋯ ED-initiated take-home standard-dosing and microdosing buprenorphine/naloxone programs are feasible, and a randomized controlled trial would be acceptable to our target population.
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J Am Coll Emerg Physicians Open · Dec 2020
Prediction of emergency department resource requirements during triage: An application of current natural language processing techniques.
Accurate triage in the emergency department (ED) is critical for medical safety and operational efficiency. We aimed to predict the number of future required ED resources, as defined by the Emergency Severity Index (ESI) triage protocol, using natural language processing of nursing triage notes. ⋯ Machine learning of nursing triage notes, combined with clinical data available at ED presentation, can be used to predict the number of required future ED resources. These findings suggest that machine learning may be a valuable adjunct tool in the initial triage of ED patients.
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J Am Coll Emerg Physicians Open · Nov 2020
Design and implementation of a temporary emergency department-intensive care unit patient care model during the COVID-19 pandemic surge.
The ongoing pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in rapid surges of critically ill patients infected with coronavirus disease 2019 (COVID-19) pneumonia presenting to the emergency department (ED) and requiring ICU admission nationwide. Despite adaptations in critical care personnel staffing, bed availability and supply provision, many inpatient ICUs have become acutely crowded, leading to boarding of critically ill patients with COVID-19 and other diseases in the ED. ⋯ Critical care-trained emergency physicians took call and came into the hospital overnight/on weekends to provide bedside treatment to admitted ICU patients boarding for prolonged periods in our ED. In this manuscript, we describe the creation and execution of the ED-ICU service and the characteristics and management of the patients who received care under this model.
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J Am Coll Emerg Physicians Open · Nov 2020
Incidence, delays, and outcomes of STEMI during COVID-19 outbreak: Analysis from the France PCI registry.
The aim of this study was to assess the impact of the coronavirus disease 2019 (COVID-19) outbreak on incidence, delays, and outcomes of ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI) in France. ⋯ According to the multicenter France PCI registry, the COVID-19 outbreak in France was associated with a significant decline in STEMI undergoing PPCI and longer transfer time for patients who presented directly to the ED. Mortality rates doubled, but the difference was not statistically significant.