Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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The Office of the Inspector General has the authority to levy fines relating to violations of the Emergency Medicine Treatment and Labor Act (EMTALA) for both medical and psychiatric care. Terp et al. have described the incidence of violations and penalties levied for psychiatric cases and compared them to that for medical. This article reviews that article and the podcast recorded with Dr. Terp and the ensuing discussion in the podcast and online.
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Randomized Controlled Trial Multicenter Study
An Implementation Science Approach to Antibiotic Stewardship in Emergency Departments and Urgent Care Centers.
Antibiotic stewardship efforts have expanded focus from inpatient to include outpatient settings. However, stewardship is urgently needed in acute care ambulatory settings: emergency departments (EDs) and urgent care centers (UCCs). Implementation of antibiotic stewardship in acute ambulatory care settings has been limited. Two major barriers to effective implementation exist: 1) lack of adaptation of successful outpatient stewardship interventions to the acute care ambulatory setting and 2) absence of rigorous measurement of implementation processes in EDs and UCCs in a manner that informs future scale and spread. ⋯ We demonstrate that implementation science approaches can help address the problem of unnecessary antibiotic use in EDs and UCCs with high acceptability and adoption. Similar approaches could be used to tailor quality improvement interventions in these settings.
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Multicenter Study
Can emergency physician gestalt "rule in" or "rule out" acute coronary syndrome: validation in a multi-center prospective diagnostic cohort study.
Chest pain is a common problem presenting to the emergency department (ED). Many decision aids and accelerated diagnostic protocols have been developed to help clinicians differentiate those needing admission from those who can be safely discharged. Some early evidence has suggested that clinician judgment or gestalt alone could be sufficient. ⋯ Clinician gestalt is not sufficiently accurate or safe to either rule in or rule out ACS as a decision-making strategy. This study will enable emergency physicians to understand the limitations of our clinical judgment.