Annals of emergency medicine
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Although the focus of emergency care is on the diagnosis and treatment of acute illnesses and injuries or the stabilization of patients for ongoing treatment, some patients may benefit from a palliative approach. Little is known about delivering palliative care in the emergency department (ED). We explore the attitudes, experiences, and beliefs of emergency providers about palliative care in the ED, using structured qualitative methods. ⋯ Providers ranked improved communication and documentation from outpatient providers as their highest priority for improvement. Attitudinal and structural barriers may need to be overcome to improve palliative care in the ED. Despite targeted recruitment, attending physician participation was low.
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Patient-reported penicillin allergies are often unreliable and can result in unnecessary changes in antibiotic therapy. Although penicillin allergy skin testing is commonly performed in allergy clinics, it has not been used in emergency departments (EDs) to verify self-reported allergies. We hypothesize that ED-based testing is possible and that the false-positive rate of patients with self-reported penicillin allergy are greater than 90%. ⋯ Penicillin skin testing is feasible in the ED setting. A substantial number of patients who self-report a penicillin allergy do not exhibit immunoglobulin E-mediated sensitization to penicillin major and minor determinants. Penicillin testing in the ED may allow the use of more appropriate antibiotics for patients presenting with a history of penicillin allergy.
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Since 2003, the Society of Chest Pain Centers (SCPC) has provided hospital accreditation for acute coronary syndrome care processes. Our objective is to evaluate the association between SCPC accreditation and adherence to the American College of Cardiology/American Heart Association (ACC/AHA) evidence-based guidelines for non-ST-segment elevation myocardial infarction (NSTEMI). The secondary objective is to describe the clinical outcomes and the association with accreditation. ⋯ SCPC-accredited hospitals had higher NSTEMI ACC/AHA evidence-based guideline adherence in the first 24 hours of care on 2 of the 5 measures. No difference in outcomes was observed. Further studies are needed to better understand the association between SCPC accreditation and improved care for patients with acute coronary syndrome.
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Clinical research requires high-quality data collection. Data collected at the emergency department evaluation is generally considered more precise than data collected through chart abstraction but is cumbersome and time consuming. We test whether trained research assistants without a medical background can obtain clinical research data as accurately as physicians. We hypothesize that they would be at least as accurate because they would not be distracted by clinical requirements. ⋯ The relatively fair interrater reliability observed in our study is consistent with previous studies evaluating interrater reliability for cardiovascular disease in the inpatient setting. With respect to research data, we found that prospective ascertainment of clinical data is more often correct when done by research assistants compared with clinicians simultaneously evaluating patients.
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Randomized Controlled Trial
Ultrasonographically guided peripheral intravenous cannulation in emergency department patients with difficult intravenous access: a randomized trial.
We seek to compare ultrasonographically guided peripheral intravenous access to a non-ultrasonographically guided method in a randomized trial of emergency department patients with difficult intravenous access. ⋯ Ultrasonographically guided peripheral intravenous cannulation did not decrease the number of attempts or the time to successful catheterization, nor did it improve patient satisfaction compared with the group that did not use ultrasonography. Superiority of ultrasonographically guided peripheral intravenous cannulation is not supported by this study.