J Emerg Med
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Prior studies of admitted geriatric syncope patients suggest that diagnostic tests affect management < 5% of the time; whether this is true among all emergency department (ED) patients with syncope remains unclear. ⋯ Although routine testing is prevalent in ED patients with syncope, the diagnostic yield is relatively low. Nevertheless, some testing, particularly echocardiography, may yield critical findings. Current efforts to reduce the cost of medical care by eliminating nondiagnostic medical testing and increasing emphasis on practicing evidence-based medicine argue for more discriminate testing when evaluating syncope.
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Observational Study
Can Emergency Medical Services Use Turnaround Time as a Proxy for Measuring Ambulance Offload Time?
"Offload delay" occurs when the transfer of care from paramedics to the emergency department (ED) is prolonged. Accurately measuring the delivery interval or "offload" is important, because it represents the time patients are waiting for definitive care. Because recording this interval presents a significant challenge, most emergency medical services systems only measure the complete at-hospital time or "turnaround interval," and most offload delay research and policy is based on this proxy. ⋯ The results show that the correlation between the delivery and turnaround intervals is good. However, there remains much to be learned about the at-hospital time intervals and how to use these data to make decisions that will improve resource utilization and patient care. Efforts to establish a method to accurately record the delivery interval and to understand the at-hospital portion of the ambulance response are necessary.
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Ultrasound-assisted lumbar puncture in the pediatric emergency medicine setting has not been well established, but ultrasound could serve as a valuable tool in this setting. ⋯ The use of ultrasound in the pediatric emergency setting can be a valuable adjunct with lumbar puncture.
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For graduating emergency medicine (EM) residents, little information exists as to what attributes department chairs are seeking in hiring new attendings. ⋯ How a physician relates to others was consistently rated as the most important part of the candidate's application. However, finding a job in academic EM is difficult, with graduates having limited job prospects.
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Disclosing potential future malignancy risks from diagnostic tests that expose children to ionizing radiation in the emergency department may be challenging. ⋯ Approximately one-third of pediatric emergency physicians were able to identify the best available estimate of the malignancy risk from a head CT. Although there are some barriers, many PEM physicians report regularly participating in risk-benefit disclosures.