Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Study objectives were to identify groups of older patients with similar patterns of health care use in the 12 months preceding an index outpatient emergency department (ED) visit and to identify patient-level predictors of group membership. ⋯ In this sample of older ED patients, five groups with distinct patterns of health service use were identified. Further study is needed to determine whether identification of these patient groups can add important information to existing risk-assessment methods.
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This study examines the effect of variations in emergency department (ED) volume on physician work efficiency (new patients per hour) and work profile (patient-related activities, including both direct and indirect patient care) and whether these differ between first- (Postgraduate Year [PGY]1) and third- (PGY3) year residents. The authors also determine if changes in volume are associated with changes in teaching interactions between attending and resident physicians. ⋯ Third-year residents see and carry more patients than do their first-year counterparts. They do so primarily by decreasing the amount of time spent with patients and attendings and working more efficiently overall. However, they are not as capable of altering their work profiles in the face of increased volume as their first-year counterparts. While the length of teaching interactions is decreased as volume increases, the number of those interactions resulting in teaching remains constant regardless of volume.
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This paper reports the results of a consensus conference of the Council of Emergency Medicine Residency Directors (CORD) to discuss the experiential training component of residency education in the emergency department (ED) and to make recommendations on structuring clinical training. Self-selected emergency medicine (EM) educators discussed experiential training focusing on three topic areas: 1) methods to optimize training in the clinical setting, 2) identification of goals and objectives by training year, and 3) determination of measurable behaviors demonstrating achievement of goals and objectives by residents. Topic areas were organized into the following questions: 1) what is the optimal number and evolution of ED shifts for EM residents during their residency training, 2) what clinical skills are expected of a resident at each level of training, and 3) what objective measures should be used to provide evidence of resident competency? Participants attended a lecture on the goals of the conference, the questions to be answered, and the role and implementation of deliberate practice into experiential training. ⋯ After discussion all groups reconvened and reported summaries of discussions and recommendations to ensure group agreement. There were 59 participants representing 42 training programs. Educators agree that essential features of designing the ED clinical experience include the need to: 1) structure and tailor the clinical experience to optimize learning, 2) establish expectations for clinical performance based on year of training, and 3) provide feedback that is explicit to year-specific performance expectations.
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Review
Simulation center accreditation and programmatic benchmarks: a review for emergency medicine.
Simulation-based education has grown significantly over the past 10 years. As a result, more professional organizations are developing or implementing accreditation processes to help define minimum standards and best practices in simulation-based training. However, the benefits and potential pitfalls of sponsoring and implementing such programs have yet to be fully evaluated across specialties. ⋯ This article outlines currently existing and proposed accreditation models and identifies components that support best practices. It then goes on to describe three general programmatic models to better understand how simulation training can be operationalized in EM. Finally, the work group uses this collective information to propose how an accreditation process, in concert with the SAEM Simulation Consultation Service, can enhance and advance EM simulation training.
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Comparative Study
Feasibility and reliability of the SHOT: A short scale for measuring pretreatment severity of alcohol withdrawal in the emergency department.
Use of a symptom-triggered scale to measure the severity of alcohol withdrawal could reduce the rate of seizures and other complications. The current standard scale, the Clinical Institute of Withdrawal Assessment (CIWA), takes a mean (±SD) of 5 minutes to complete, requiring 30 minutes of nursing time per patient when multiple measures are required. ⋯ The SHOT has potential as a feasible and acceptable tool for measuring pretreatment alcohol withdrawal severity in the ED. Further research is needed to validate the SHOT, to assess the utility of serial measurements of the SHOT, and to demonstrate that its use reduces length of stay and improves clinical outcomes.