Articles: emergency-medicine.
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The Association of American Medical Colleges described 13 Core Entrustable Professional Activities (EPAs) that graduating students should be prepared to perform under indirect supervision on day one of residency. Surgery program directors recently recommended entrustability in these Core EPAs for incoming surgery interns. We sought to determine if graduating students intending to enter surgery agreed they had the skills to perform these Core EPAs. ⋯ Graduating students' self-assessed Core EPAs skills were higher for those intending general surgery than for those intending some other specialties. Our findings can inform collaborative efforts to ensure graduates' acquisition of the skills expected of them at the start of residency.
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Despite projections of an oversupply of residency-trained emergency medicine physicians by 2030 and amidst intensifying national debate over Nurse Practitioner (NP) qualifications to practice independently and unsupervised, NPs are increasingly staffing Emergency Departments (EDs) as hospitals seek to contain costs while simultaneously expanding services. We sought to characterize NP practice in the ED by examining NP independent billing by level of severity of illness, and relationship to practice authority, State Medicaid expansion status, and rurality. ⋯ As a proportion of the providers independently billing in the ED, NPs are increasingly managing higher acuity patients as evidenced by billing percentage of the highest acuity CPT codes (99284 and 99285). During the same time period, ED MDs decreased their billing in the same categories. Current employment of NPs in the ED may not be fulfilling its original vision to care for the lower acuity patients in order to allow MDs to care for the more acutely and critically ill patients, and to increase the services for underserved populations in rural areas, those over age 65, and those with limited English language proficiency. Future research should investigate ED policies resulting in NPs as opposed to MDs seeing patients with greater severity codes.
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Emergency physicians often experience significant cognitive load and task interruptions in the ED. This combination results in cognitive errors and poor patient outcomes. Quality research about this topic is scarce. Raising awareness of personal thinking processes (metacognition) is one way of reducing the unfavourable impact of task interruptions on cognition.
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Emerg Med Australas · Dec 2022
Emergency Department adult presentations from the COVID-19 hotel quarantine program in Victoria, Australia: a retrospective cohort study of admissions and presenting complaints.
The present study aims to describe presentations to the designated ED from the Victorian COVID-19 hotel quarantine program. ⋯ The study demonstrates that the number of ED presentations from quarantine was low (<1 presentation/day). COVID Quarantine Victoria and Alfred Health put significant resources into the program to allow most returned international travellers to be safely cared for within a hotel and thus reduce the burden on the public hospital system.