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Mazurenko O, Hirsh AT, Harle CA, McNamee C, Vest JR. Health-related social needs information in the emergency department: clinician and patient perspectives on availability and use. BMC Emerg Med 2024; 24:45. [PMID: 38500019 PMCID: PMC10949703 DOI: 10.1186/s12873-024-00959-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/29/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Patient health-related social needs (HRSN) complicate care and drive poor outcomes in emergency department (ED) settings. This study sought to understand what HRSN information is available to ED physicians and staff, and how HRSN-related clinical actions may or may not align with patient expectations. METHODS We conducted a qualitative study using in-depth semi-structured interviews guided by HRSN literature, the 5 Rights of Clinical Decision Support (CDS) framework, and the Contextual Information Model. We asked ED providers, ED staff, and ED patients from one health system in the mid-Western United Stated about HRSN information availability during an ED encounter, HRSN data collection, and HRSN data use. Interviews were recorded, transcribed, and analyzed using modified thematic approach. RESULTS We conducted 24 interviews (8 per group: ED providers, ED staff, and ED patients) from December 2022 to May 2023. We identified three themes: (1) Availability: ED providers and staff reported that HRSNs information is inconsistently available. The availability of HRSN data is influenced by patient willingness to disclose it during an encounter. (2) Collection: ED providers and staff preferred and predominantly utilized direct conversation with patients to collect HRSNs, despite other methods being available to them (e.g., chart review, screening questionnaires). Patients' disclosure preferences were based on modality and team member. (3) Use: Patients wanted to be connected to relevant resources to address their HRSNs. Providers and staff altered clinical care to account for or accommodate HRSNs. System-level challenges (e.g., limited resources) limited provider and staff ability to address patients HRSNs. CONCLUSIONS In the ED, HRSNs information was inconsistently available, collected, or disclosed. Patients and ED providers and staff differed in their perspectives on how HSRNs should be collected and acted upon. Accounting for such difference in clinical and administrative decisions will be critical for patient acceptance and effective usage of HSRN information.
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Affiliation(s)
- Olena Mazurenko
- Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA.
| | - Adam T Hirsh
- Department of Psychology, School of Science, Indiana University- Indianapolis, Indianapolis, IN, USA
| | - Christopher A Harle
- Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
| | - Cassidy McNamee
- Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Joshua R Vest
- Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
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Hsiao KH, Egerton-Warburton D. An example of public health training in emergency medicine. Emerg Med Australas 2019; 31:487-490. [PMID: 30939625 DOI: 10.1111/1742-6723.13277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/14/2019] [Accepted: 02/25/2019] [Indexed: 11/29/2022]
Abstract
There is growing recognition of the vital roles that Emergency Physicians can play in public health. Accordingly, there is a need for emergency medicine trainees to have opportunities to acquire relevant public health skillsets. This article provides an example of such a possibility. It describes the experience of an emergency medicine trainee in undertaking a 6 month training rotation at a Public Health Unit. The example illustrates the feasibility and benefits of a public health rotation for interested trainees, and offers recommendations for establishing such rotations. There are challenges, including eligibility requirements and funding. However, possible approaches exist at the individual and college levels to facilitate such training opportunities so that emergency medicine trainees can acquire necessary and valuable public health skills.
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Affiliation(s)
- Kai Hsun Hsiao
- Public Health Unit, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Diana Egerton-Warburton
- School of Clinical Science at Monash Health, Monash University, Melbourne, Victoria, Australia.,Emergency Department, Monash Health, Monash Medical Centre, Melbourne, Victoria, Australia
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Moffett SE, Shahidi H, Sule H, Lamba S. Social Determinants of Health Curriculum Integrated Into a Core Emergency Medicine Clerkship. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2019; 15:10789. [PMID: 30800989 PMCID: PMC6354789 DOI: 10.15766/mep_2374-8265.10789] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 09/23/2018] [Indexed: 06/01/2023]
Abstract
Introduction Demand that health centers address health inequities has led medical schools to emphasize social determinants of health (SDH). The Emergency Department often serves as first (or sole) point of health care access, making it an ideal environment in which to identify/explore SDH. Yet there are few SDH curricula targeting core emergency medicine (EM) clerkships. We describe implementation and outcomes of a three-part SDH curriculum instituted in a 4-week EM clerkship. Methods We created a longitudinal curriculum aimed at fourth-year medical students in their EM clerkship. Students interviewed patients to discuss social and other influences on their health care and wrote reflections. After this, they discussed their individual cases in small groups, selected one patient, and found literature and strategies/systems to fit the patient's needs. Finally, groups presented their work to student-peers and faculty for discussion. Students were assessed for each activity and surveyed for impact of the curriculum. Results We evaluated the curriculum, with preliminary data showing a wide range of topics covered. On a 5-point scale (1 = Hardly at All, 5 = To a Very High Degree), students responded with means of 4.4 to "I am able to recognize barriers to health that patients and families face from diverse socio-economic backgrounds" and 4.6 to "I feel it is important to recognize and address the social determinants of health as part of whole patient care." Discussion This curriculum introduces SDH, uses metacognitive skills across multiple domains, and is feasible and has been well received in an EM clerkship.
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Affiliation(s)
- Shannon E. Moffett
- Assistant Professor of Emergency Medicine, Rutgers New Jersey Medical School/University Hospital—Newark; EM Clerkship Director/Director of UME, Rutgers New Jersey Medical School/University Hospital—Newark
| | - Hosseinali Shahidi
- Associate Professor of Emergency Medicine, Rutgers New Jersey Medical School/University Hospital—Newark; Chief, Division of Community Medicine and Urban Health, Rutgers New Jersey Medical School/University Hospital—Newark; Chief Collaborating Physician, Rutgers Community Health Center, School of Nursing, Rutgers
| | - Harsh Sule
- Assistant Professor of Emergency Medicine, Rutgers New Jersey Medical School/University Hospital—Newark; Emergency Medicine Residency Program Director, Rutgers New Jersey Medical School/University Hospital—Newark; Associate Director, Rutgers NJMS Office of Global Health, Rutgers New Jersey Medical School/University Hospital—Newark
| | - Sangeeta Lamba
- Professor of Emergency Medicine, Rutgers New Jersey Medical School/University Hospital—Newark; Associate Dean of Education, Rutgers New Jersey Medical School/University Hospital—Newark
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Mir M, Bachani AM, Khawaja H, Afridi S, Ali S, Khan M, Jamali S, Sumalani F, Hyder AA, Razzak JA. The Pakistan National Emergency Department Surveillance Study (Pak-NEDS): Introducing a pilot surveillance. BMC Emerg Med 2015; 15 Suppl 2:S1. [PMID: 26690669 PMCID: PMC4682446 DOI: 10.1186/1471-227x-15-s2-s1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence-based decision making is essential for appropriate prioritization and service provision by healthcare systems. Despite higher demands, data needs for this practice are not met in many cases in low- and middle-income countries because of underdeveloped sources, among other reasons. Emergency departments (EDs) provide an important channel for such information because of their strategic position within healthcare systems. This paper describes the design and pilot test of a national ED based surveillance system suitable for the Pakistani context. METHODS The Pakistan National Emergency Department Surveillance Study (Pak-NEDS) was pilot tested in the emergency departments of seven major tertiary healthcare centres across the country. The Aga Khan University, Karachi, served as the coordinating centre. Key stakeholders and experts from all study institutes were involved in outlining data needs, development of the study questionnaire, and identification of appropriate surveillance mechanisms such as methods for data collection, monitoring, and quality assurance procedures. The surveillance system was operational between November 2010 and March 2011. Active surveillance was done 24 hours a day by data collectors hired and trained specifically for the study. All patients presenting to the study EDs were eligible participants. Over 270,000 cases were registered in the surveillance system over a period of four months. Coverage levels in the final month ranged from 91-100% and were highest in centres with the least volume of patients. Overall the coverage for the four months was 79% and crude operational costs were less than $0.20 per patient. CONCLUSIONS Pak-NEDS is the first multi-centre ED based surveillance system successfully piloted in a sample of major EDs having some of the highest patient volumes in Pakistan. Despite the challenges identified, our pilot shows that the system is flexible and scalable, and could potentially be adapted for many other low- and middle-income settings.
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Egerton-Warburton D, Gosbell A, Moore K, Jelinek GA. Public health in Australasian emergency departments: Attitudes, barriers and current practices. Emerg Med Australas 2015; 27:522-528. [DOI: 10.1111/1742-6723.12475] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Diana Egerton-Warburton
- Department of Emergency Medicine; Monash Medical Centre; Melbourne Victoria Australia
- School of Clinical Sciences at Monash Health; Monash University; Melbourne Victoria Australia
| | - Andrew Gosbell
- Policy and Research; Australasian College for Emergency Medicine; Melbourne Victoria Australia
| | - Katie Moore
- Policy and Research; Australasian College for Emergency Medicine; Melbourne Victoria Australia
| | - George A Jelinek
- Neuroepidemiology Unit; Melbourne School of Population and Global Health; The University of Melbourne; Melbourne Victoria Australia
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Victoria Australia
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Raja S, Hasnain M, Hoersch M, Gove-Yin S, Rajagopalan C. Trauma informed care in medicine: current knowledge and future research directions. FAMILY & COMMUNITY HEALTH 2015; 38:216-26. [PMID: 26017000 DOI: 10.1097/fch.0000000000000071] [Citation(s) in RCA: 209] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Traumatic events (including sexual abuse, domestic violence, elder abuse, and combat trauma) are associated with long-term physical and psychological effects. These events may influence patients' health care experiences and engagement in preventative care. Although the term trauma-informed care (TIC) is widely used, it is not well understood how to apply this concept in daily health care practice. On the basis of a synthesis of a review of the literature, the TIC pyramid is a conceptual and operational framework that can help physicians translate TIC principles into interactions with patients. Implications for clinical practice and future research are discussed in this article.
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Affiliation(s)
- Sheela Raja
- Department of Pediatric Dentistry, College of Dentistry (Dr Raja) and Department of Family Medicine (Dr Hasnain), University of Illinois at Chicago; US Department of Health and Human Services, Office on Women's Health, Region V, Chicago, Illinois (Ms Hoersch); Pritzker School of Medicine, Boston Medical Center, Boston, Massachusetts (Dr Gove-Yin); and Rutgers School of Dental Medicine, Newark, New Jersey (Ms Rajagopalan)
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Hsia RY, Nath JB, Baker LC. California emergency department visit rates for medical conditions increased while visit rates for injuries fell, 2005-11. Health Aff (Millwood) 2015; 34:621-6. [PMID: 25847645 PMCID: PMC4507565 DOI: 10.1377/hlthaff.2014.0471] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The emergency department (ED) is the source of most hospital admissions; provides care for patients with no other point of access to the health care system; receives advanced care referrals from primary care physicians; and provides surveillance data on injuries, infectious diseases, violence, and adverse drug events. Understanding the changes in the profile of disease in the ED can inform emergency services administration and planning and can provide insight into the public's health. We analyzed the trends in the diagnoses seen in California EDs from 2005 to 2011, finding that while the ED visit rate for injuries decreased by 0.7 percent, the rate of ED visits for noninjury diagnoses rose 13.4 percent. We also found a rise in symptom-related diagnoses, such as abdominal pain, along with nervous system disorders, gastrointestinal disease, and mental illness. These trends point out the increasing importance of EDs in providing care for complex medical cases, as well as the changing nature of illness in the population needing immediate medical attention.
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Affiliation(s)
- Renee Y Hsia
- Renee Y. Hsia is a professor in the Department of Emergency Medicine at the University of California, San Francisco
| | - Julia B Nath
- Julia B. Nath is a medical student at the University of Chicago Pritzker School of Medicine, in Illinois
| | - Laurence C Baker
- Laurence C. Baker is a professor in health research and policy at Stanford University, in California, and a research associate at the National Bureau of Economic Research in Cambridge, Massachusetts
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Betz ME, Carpenter CR, Genco E, Carr DB. Driving Self-Restriction and Age: A Study of Emergency Department Patients. Inj Epidemiol 2014; 1:18. [PMID: 26413455 PMCID: PMC4580257 DOI: 10.1186/s40621-014-0018-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 06/24/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Driving self-restriction is a well-documented among older drivers but might also occur among younger drivers. Little is known about the driving patterns of emergency department (ED) patients, who may be a high-risk population for motor vehicle crashes (MVCs). We sought to compare the driving patterns and MVCs of younger and older adult ED patients in order to inform development of injury prevention interventions in EDs. METHODS We surveyed English-speaking younger adult (age 25-64) and older adult (age ≥65) ED patients, excluding non-drivers and those who were cognitively-impaired or too sick to participate. We compared drivers by age group and used logistic regression with adjustment for driving frequency to examine factors associated with driving self-restriction. RESULTS Of those eligible, 82% (n=178) of younger adult and 91% (n=134) of older adult patients participated; approximately half were women. Similar proportions of younger and older adult patients reported driving everyday/almost everyday (80%) but also self-restricting driving in inclimate weather (48%), heavy traffic (27%), in unfamiliar places (21%), when travelling with passengers (1.6%) or when alone (1.3%). Fewer younger adult than older adult patients avoided driving at night (22% versus 49%) or on highways (6.7% versus 26%). In multivariable logistic regression, factors significantly associated self-imposed driving restriction in ≥1 driving situation were female gender (Odds Ratio [OR] 2.40; 95%CI 1.42-4.05) and ever feeling "confused, nervous or uncomfortable" while driving (OR 1.87; 95% CI 1.03-3.39). There was a non-significant trend for differences in proportions between younger adult (11%) and older adult (6.8%) drivers reporting ≥1 MVC as a driver in the past 12 months. CONCLUSIONS Similar proportions of younger and older adult ED patients self-restrict driving, albeit in different situations, which has implications for behavioral interventions for injury prevention and for education of patients and medical providers.
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Affiliation(s)
- Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, 12401 E. 17th Ave B-215, Aurora, 80045 Colorado USA
| | - Christopher R Carpenter
- Division of Emergency Medicine, Washington University School of Medicine, Campus Box 8072, 660 S. Euclid Avenue, St. Louis, 63110 MO USA
| | - Emma Genco
- Department of Emergency Medicine, University of Colorado School of Medicine, 12401 E. 17th Ave B-215, Aurora, 80045 Colorado USA
- VISN 19 Mental Illness Research, Education and Clinical Center, Denver, 80220 CO USA
| | - David B Carr
- Department of Medicine and Neurology, Division of Geriatrics and Nutritional Science, Washington University School of Medicine, 4488 Forest Park Ave, St. Louis, 63108 MO USA
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Sharp AL, Cobb EM, Dresden SM, Richardson DK, Sabbatini AK, Sauser K, Kocher KE. Understanding the value of emergency care: a framework incorporating stakeholder perspectives. J Emerg Med 2014; 47:333-42. [PMID: 24881891 DOI: 10.1016/j.jemermed.2014.04.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 12/16/2013] [Accepted: 04/22/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND In the face of escalating spending, measuring and maximizing the value of health services has become an important focus of health reform. Recent initiatives aim to incentivize high-value care through provider and hospital payment reform, but the role of the emergency department (ED) remains poorly defined. OBJECTIVES To achieve an improved understanding of the value of emergency care, we have developed a framework that incorporates the perspectives of stakeholders in the delivery of health services. METHODS A pragmatic review of the literature informed the design of this framework to standardize the definition of value in emergency care and discuss outcomes and costs from different stakeholder perspectives. The viewpoint of patient, provider, payer, health system, and society is each used to assess value for emergency medical conditions. RESULTS We found that the value attributed to emergency care differs substantially by stakeholder perspective. Potential targets to improve ED value may be aimed at improving outcomes or controlling costs, depending on the acuity of the clinical condition. CONCLUSION The value of emergency care varies by perspective, and a better understanding is achieved when specific outcomes and costs can be identified, quantified, and measured. Using this framework can help stakeholders find common ground to prioritize which costs and outcomes to target for research, quality improvement efforts, and future health policy impacting emergency care.
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Affiliation(s)
- Adam L Sharp
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan; Robert Wood Johnson Foundation Clinical Scholars Program, University of Michigan, Ann Arbor, Michigan; Research and Evaluation Department, Kaiser Permanente Southern California, Pasadena, California
| | - Enesha M Cobb
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan; Robert Wood Johnson Foundation Clinical Scholars Program, University of Michigan, Ann Arbor, Michigan
| | - Scott M Dresden
- Department of Emergency Medicine, Northwestern University, Chicago, Illinois; Center for Healthcare Studies, Northwestern University, Chicago, Illinois
| | - Derek K Richardson
- Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon
| | - Amber K Sabbatini
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
| | - Kori Sauser
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan; Robert Wood Johnson Foundation Clinical Scholars Program, University of Michigan, Ann Arbor, Michigan; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Keith E Kocher
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy (CHOP), University of Michigan, Ann Arbor, Michigan
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Lyons MS, Lindsell CJ, Ruffner AH, Wayne DB, Hart KW, Sperling MI, Trott AT, Fichtenbaum CJ. Randomized comparison of universal and targeted HIV screening in the emergency department. J Acquir Immune Defic Syndr 2013; 64:315-23. [PMID: 23846569 PMCID: PMC4241750 DOI: 10.1097/qai.0b013e3182a21611] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Universal HIV screening is recommended but challenging to implement. Selectively targeting those at risk is thought to miss cases, but previous studies are limited by narrow risk criteria, incomplete implementation, and absence of direct comparisons. We hypothesized that targeted HIV screening, when fully implemented and using maximally broad risk criteria, could detect nearly as many cases as universal screening with many fewer tests. METHODS This single-center cluster-randomized trial compared universal and targeted patient selection for HIV screening in a lower prevalence urban emergency department. Patients were excluded for age (<18 and >64 years), known HIV infection, or previous approach for HIV testing that day. Targeted screening was offered for any risk indicator identified from charts, staff referral, or self-disclosure. Universal screening was offered regardless of risk. Baseline seroprevalence was estimated from consecutive deidentified blood samples. RESULTS There were 9572 eligible visits during which the patient was approached. For universal screening, 40.8% (1915/4692) consented with 6 being newly diagnosed [0.31%, 95% confidence interval (CI): 0.13% to 0.65%]. For targeted screening, 37% (1813/4880) had no testing indication. Of the 3067 remaining, 47.4% (1454) consented with 3 being newly diagnosed (0.22%, 95% CI: 0.06% to 0.55%). Estimated seroprevalence was 0.36% (95% CI: 0.16% to 0.70%). Targeted screening had a higher proportion consenting (47.4% vs. 40.8%, P < 0.002), but a lower proportion of ED encounters with testing (29.7% vs. 40.7%, P < 0.002). CONCLUSIONS Targeted screening, even when fully implemented with maximally permissive selection, offered no important increase in positivity rate or decrease in tests performed. Universal screening diagnosed more cases, because more were tested, despite a modestly lower consent rate.
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Affiliation(s)
- Michael S. Lyons
- Department of Emergency Medicine, University of Cincinnati College of Medicine
| | | | - Andrew H. Ruffner
- Department of Emergency Medicine, University of Cincinnati College of Medicine
| | - D. Beth Wayne
- Department of Emergency Medicine, University of Cincinnati College of Medicine
| | - Kimberly W. Hart
- Department of Emergency Medicine, University of Cincinnati College of Medicine
| | - Matthew I. Sperling
- Department of Emergency Medicine, University of Cincinnati College of Medicine
| | - Alexander T. Trott
- Department of Emergency Medicine, University of Cincinnati College of Medicine
| | - Carl J. Fichtenbaum
- Division of Infectious Diseases, University of Cincinnati College of Medicine
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Tan N, Taylor DM. Feasibility and outcomes of screening for cardiovascular risk factors in the emergency department. Emerg Med Australas 2013; 25:175-81. [PMID: 23560969 DOI: 10.1111/1742-6723.12060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2013] [Indexed: 01/13/2023]
Abstract
OBJECTIVES The present study aimed to determine the prevalence of undiagnosed and undertreated hypercholesterolaemia and hypertension (HT) among ED patients and to evaluate the effects of a formal referral back to the general practitioner (GP) for further management. METHODS This was a cross-sectional study of ED patients with follow up, if indicated. Patients aged ≥35 years, without substantial illness or communication difficulties, were enrolled. Data were collected using a researcher-administered questionnaire, a point-of-care Accutrend® Plus System machine (Roche Diagnostic Australia Pty Ltd, Castle Hill, NSW, Australia) and digital sphygmomanometer. Patients with total cholesterol (TC) ≥6.0 mmol/L and/or BP ≥140/90 were given a referral letter and advised to consult their GP. The investigators made follow-up telephone calls 5 weeks later. RESULTS Of 827 presentations, 534 patients were enrolled (mean age 56.7 ± 13.3 years, 300 [56.2%] male). One hundred and eleven patients (20.7%, 95% CI 17.5-24.5) had TC ≥6.0 mmol/L. Patients with/without elevated TC differed significantly (P < 0.05) in regard to age, gender, GP ownership and attendance, and previous screening. Sixty-six patients consulted with their GP. Thirty had their TC levels retested, 18 received dietary/lifestyle advice and four had lipid-lowering medication prescribed or adjusted. Ninety-six patients (18.0%, 95% CI 14.9-21.6) had HT. Whereas 53 consulted their GP, no action was taken in 43 cases. Investigations were ordered for three and nine had antihypertensive medication prescribed or adjusted. CONCLUSION Substantial proportions of ED patients have undiagnosed and undertreated hypercholesterolaemia and/or HT. GP referral initiated interventions for many patients with hypercholesterolaemia, but fewer with HT. The ED has potential as a useful venue for the opportunistic screening of hypercholesterolaemia.
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Affiliation(s)
- Natalie Tan
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Rabe GL, Wellmann J, Bagos P, Busch MA, Hense HW, Spies C, Weiss-Gerlach E, McCarthy W, Gareca Arizaga MJ, Neuner B. Efficacy of emergency department-initiated tobacco control--systematic review and meta-analysis of randomized controlled trials. Nicotine Tob Res 2013; 15:643-55. [PMID: 23024250 DOI: 10.1093/ntr/nts212] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
AIM Systematic review and meta-analysis of randomized controlled trials evaluating the efficacy of emergency department-initiated tobacco control (ETC). METHODS Literature search in 7 databases and gray literature sources. Point prevalence tobacco abstinence at 1-, 3-, 6-, and/or 12-month follow-up was abstracted from each study. The proportionate effect (relative risk) of ETC on tobacco abstinence was calculated separately for each study and follow-up time and pooled, at different follow-up times, by Mantel-Haenszel relative risks. The effects of ETC on combined point prevalence tobacco abstinence across all follow-up times were calculated using generalized linear mixed models. RESULTS Seven studies with overall 1,986 participants were included. The strongest effect of ETC on point prevalence tobacco abstinence was found at 1 month: Relative risk (RR) = 1.47 (3 studies) (95% confidence interval [CI]: 1.06-2.06), while the effect at 3, 6, and 12 months was RR = 1.24 (6 studies) (95% CI: 0.93-1.65); 1.13 (5 studies) (95% CI: 0.86-1.49); and 1.25 (1 study) (95% CI: 0.91-1.72). The benefit on combined point prevalence tobacco abstinence was RR = 1.33 (7 studies) (95% CI: 0.96-1.83), p = .08; with RR = 1.33 (95% CI: 0.92-1.92), p = .10, for the 5 studies combining motivational interviewing and booster phone calls. CONCLUSIONS ETC combining motivational interviewing and booster phone calls showed a trend toward increased episodically measured tobacco abstinence up to 12 months. More methodologically rigorous trials are needed to effectively evaluate the impact of ETC.
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Affiliation(s)
- Gwen Lisa Rabe
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
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Betz ME, Bernstein SL, Gutman DC, Tibbles CD, Joyce NR, Lipton RI, Schweigler LM, Fisher J. Public health education for emergency medicine residents. Am J Prev Med 2011; 41:S242-50. [PMID: 21961671 PMCID: PMC4531839 DOI: 10.1016/j.amepre.2011.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 06/02/2011] [Accepted: 06/05/2011] [Indexed: 11/29/2022]
Abstract
Emergency medicine (EM) has an important role in public health, but the ideal approach for teaching public health to EM residents is unclear. As part of the national Regional Public Health-Medicine Education Centers-Graduate Medical Education initiative from the CDC and the American Association of Medical Colleges, three EM programs received funding to create public health curricula for EM residents. Curricula approaches varied by residency. One program used a modular, integrative approach to combine public health and EM clinical topics during usual residency didactics, one partnered with local public health organizations to provide real-world experiences for residents, and one drew on existing national as well as departmental resources to seamlessly integrate more public health-oriented educational activities within the existing residency curriculum. The modular and integrative approaches appeared to have a positive impact on resident attitudes toward public health, and a majority of EM residents at that program believed public health training is important. Reliance on pre-existing community partnerships facilitated development of public health rotations for residents. External funding for these efforts was critical to their success, given the time and financial restraints on residency programs. The optimal approach for public health education for EM residents has not been defined.
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Affiliation(s)
- Marian E Betz
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA
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Public health and clinical impact of increasing emergency department-based HIV testing: perspectives from the 2007 conference of the National Emergency Department HIV Testing Consortium. Ann Emerg Med 2011; 58:S151-9.e1. [PMID: 21684395 DOI: 10.1016/j.annemergmed.2011.03.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Understanding perceived benefits and disadvantages of HIV testing in emergency departments (EDs) is imperative to overcoming barriers to implementation. We codify those domains of public health and clinical care most affected by implementing HIV testing in EDs, as determined by expert opinion. METHODS Opinions were systematically collected from attendees of the 2007 National ED HIV Testing Consortium meeting. Structured evaluation of strengths, weaknesses, opportunities, and threats analysis was conducted to assess the impact of ED-based HIV testing on public health. A modified Delphi method was used to assess the impact of ED-based HIV testing on clinical care from both individual patient and individual provider perspectives. RESULTS Opinions were provided by 98 experts representing 42 academic and nonacademic institutions. Factors most frequently perceived to affect public health were (strengths) high volume of ED visits and high prevalence of HIV, (weaknesses) undue burden on EDs, (opportunities) reduction of HIV stigma, and (threats) lack of resources in EDs. Diagnostic testing and screening for HIV were considered to have a favorable impact on ED clinical care from both individual patient and individual provider perspectives; however, negative test results were not perceived to have any benefit from the provider's perspective. The need for HIV counseling in the ED was considered to have a negative impact on clinical care from the provider's perspective. CONCLUSION Experts in ED-based HIV testing perceived expanded ED HIV testing to have beneficial impacts for both the public health and individual clinical care; however, limited resources were frequently cited as a possible impediment. Many issues must be resolved through further study, education, and policy changes if the full potential of HIV testing in EDs is to be realized.
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Holliman CJ, Mulligan TM, Suter RE, Cameron P, Wallis L, Anderson PD, Clem K. The efficacy and value of emergency medicine: a supportive literature review. Int J Emerg Med 2011; 4:44. [PMID: 21781295 PMCID: PMC3158547 DOI: 10.1186/1865-1380-4-44] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Accepted: 07/22/2011] [Indexed: 11/10/2022] Open
Abstract
Study objectives The goal of this study was to identify publications in the medical literature that support the efficacy or value of Emergency Medicine (EM) as a medical specialty and of clinical care delivered by trained emergency physicians. In this study we use the term "value" to refer both to the "efficacy of clinical care" in terms of achieving desired patient outcomes, as well as "efficiency" in terms of effective and/or cost-effective utilization of healthcare resources in delivering emergency care. A comprehensive listing of publications describing the efficacy or value of EM has not been previously published. It is anticipated that the accumulated reference list generated by this study will serve to help promote awareness of the value of EM as a medical specialty, and acceptance and development of the specialty of EM in countries where EM is new or not yet fully established. Methods The January 1995 to October 2010 issues of selected journals, including the EM journals with the highest article impact factors, were reviewed to identify articles of studies or commentaries that evaluated efficacy, effectiveness, and/or value related to EM as a specialty or to clinical care delivered by EM practitioners. Articles were included if they found a positive or beneficial effect of EM or of EM physician-provided medical care. Additional articles that had been published prior to 1995 or in other non-EM journals already known to the authors were also included. Results A total of 282 articles were identified, and each was categorized into one of the following topics: efficacy of EM for critical care and procedures (31 articles), efficacy of EM for efficiency or cost of care (30 articles), efficacy of EM for public health or preventive medicine (34 articles), efficacy of EM for radiology (11 articles), efficacy of EM for trauma or airway management (27 articles), efficacy of EM for using ultrasound (56 articles), efficacy of EM faculty (34 articles), efficacy of EM residencies (24 articles), and overviews and editorials of EM efficacy and value (35 articles). Conclusion There is extensive medical literature that supports the efficacy and value for both EM as a medical specialty and for emergency patient care delivered by trained EM physicians.
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Affiliation(s)
- C James Holliman
- The Center for Disaster and Humanitarian Assistance Medicine, Uniformed Services University of the Health Sciences, and George Washington University School of Medicine and Health Sciences, Bethesda, MD, USA.
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Are emergency department visits really a teachable moment? Smoking cessation promotion in emergency department. Eur J Emerg Med 2010; 17:73-9. [DOI: 10.1097/mej.0b013e32832e67d6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Boudreaux ED, Cydulka R, Bock B, Borrelli B, Bernstein SL. Conceptual models of health behavior: research in the emergency care settings. Acad Emerg Med 2009; 16:1120-3. [PMID: 20053231 PMCID: PMC5103302 DOI: 10.1111/j.1553-2712.2009.00543.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article provides recommendations for incorporating conceptual models of health behavior change into research conducted in emergency care settings. The authors drafted a set of preliminary recommendations, which were reviewed and discussed by a panel of experienced investigators attending the 2009 Academic Emergency Medicine consensus conference. The original recommendations were expanded and refined based on their input. This article reports the final recommendations. Three recommendations were made: 1) research conducted in emergency care settings that focuses on health behaviors should be grounded in formal conceptual models, 2) investigators should clearly operationalize their outcomes of interest, and 3) expected relations between theoretical constructs and outcomes should be made explicit prior to initiating a study. A priori hypothesis generation grounded in conceptual models of health behavior, followed by empirical validation of these hypotheses, is needed to improve preventive and public health-related interventions in emergency care settings.
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Affiliation(s)
- Edwin D Boudreaux
- Departments of Emergency Medicine and Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA.
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Bernstein SL, D'Onofrio G. Public health in the emergency department: Academic Emergency Medicine consensus conference executive summary. Acad Emerg Med 2009; 16:1037-9. [PMID: 20053218 DOI: 10.1111/j.1553-2712.2009.00548.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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D'Onofrio G, Goldstein AB, Denisco RA, Hingson R, Heffelfinger JD, Post LA. Emergency medicine public health research funded by federal agencies: progress and priorities. Acad Emerg Med 2009; 16:1065-71. [PMID: 20053224 DOI: 10.1111/j.1553-2712.2009.00555.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The emergency department (ED) visit provides an opportunity to impact the health of the public throughout the entire spectrum of care, from prevention to treatment. As the federal government has a vested interest in funding research and providing programmatic opportunities that promote the health of the public, emergency medicine (EM) is prime to develop a research agenda to advance the field. EM researchers need to be aware of federal funding opportunities, which entails an understanding of the organizational structure of the federal agencies that fund medical research, and the rules and regulations governing applications for grants. Additionally, there are numerous funding streams outside of the National Institutes of Health (NIH; the primary federal health research agency). EM researchers should seek funding from agencies according to each agency's mission and aims. Finally, while funds from the Department of Health and Human Services (HHS) are an important source of support for EM research, we need to look beyond traditional sources and appeal to other agencies with a vested interest in promoting public health in EDs. EM requires a broad skill set from a multitude of medical disciplines, and conducting research in the field will require looking for funding opportunities in a variety of traditional and not so traditional places within and without the federal government. The following is the discussion of a moderated session at the 2009 Academic Emergency Medicine consensus conference that included panel discussants from the National Institutes of Mental Health, Drug Abuse, and Alcoholism and Alcohol Abuse and the Centers for Disease Control and Prevention (CDC). Further information is also provided to discuss those agencies and centers not represented.
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Affiliation(s)
- Gail D'Onofrio
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA.
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Betz ME, Fisher J. The Trail-making Test B and driver screening in the emergency department. TRAFFIC INJURY PREVENTION 2009; 10:415-420. [PMID: 19746304 DOI: 10.1080/15389580903132819] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Emergency departments (EDs) rarely screen for older driving safety. The Trail-Making Test B (TMT-B) is a neuropsychological test that may predict ability to drive. We sought to examine the driving patterns of older ED patients and the feasibility of screening patients in the ED using the TMT-B. METHODS At a single ED at a tertiary care center, we administered the TMT-B and a survey of health status and driving habits to a convenience sample of adult (age 18 and older) ED patients. We excluded those with altered mentation, critical illness, or language barriers. The TMT-B, scored by the time of first attempt, requires connection of letters and numbers in sequence on paper, and a time > or = 180 s may suggest elevated driving risk. We compared time to complete the TMT-B among ED patients to published norms. RESULTS Of 144 patients ages 18 to 95, 95 (72.2%) were current drivers, and 91.4 percent of drivers were able to complete the TMT-B; 47.1 percent of drivers were older (65+), and 88.8 percent of older drivers rated their ability as good or excellent. In multivariate logistic regression, neither TMT-B performance nor being older predicted a recent collision. The mean TMT-B completion time was 66.1 (SD = 36.3, median = 56) s among drivers under age 65 and 117.5 (SD = 79.2, median = 95) s among those 65 or older. Approximately 1.9 percent (95% CI: 0.04-10.2) of drivers under 65 and 14.0 percent (95% CI: 5.3-27.9%) of drivers 65 or older required 180 s or more for the TMT-B. Using unpaired T-tests, study TMT-B times were not significantly different from previously published norms except among 25- to 34-year-olds (79.2 versus 50.7 s; p < 0.05) and 80- to 84-year-olds (223.9 versus 146.8 s; p < 0.01). CONCLUSIONS Many older ED patients drive, and relatively healthy ED patients are able to complete the TMT-B with results similar to standard nomograms. The TMT-B may prove useful as part of targeted driver screening programs in EDs.
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Affiliation(s)
- Marian E Betz
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA.
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The prevalence of injury of any type in an urban emergency department population. ACTA ACUST UNITED AC 2009; 66:1688-95. [PMID: 19509633 DOI: 10.1097/ta.0b013e31817db0f1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND National estimates of injury prevalence in the Emergency Department (ED) are based on medical record review and vary considerably. By using a more robust approach to surveillance, we (1) determine the prevalence of injury of any type in an urban ED population and (2) explore the association between violence-related injury and personal characteristics of injury victims. METHODS This cross-sectional study was performed at an urban level I trauma center from June to August, 2005. We prospectively screened 4,246 consecutive ED patients for injury during a randomized schedule of shifts totaling 336 hours. The ED record of each injured patient was reviewed to catalogue injury type and intent (International Classification of External Causes of Injury, Short Form) as well as to estimate injury severity (New Injury Severity Score). We interviewed noncritically injured, adult patients who provided consent to collect demographic (race, income, and education) and personal information (substance abuse, domestic violence, handgun ownership, and homelessness). We sought independent associations between these variables and violence-related injury in an exploratory analysis using multivariate logistic regression. RESULTS Injury contributed to 1,036 of 4,246 ED visits (24.4%, 95% confidence interval [CI], 23.1-25.7%). Eleven percent of injured patients were admitted to the hospital and two patients died in the ED. The majority of patients (75%) suffered minor injury. Among the 434 injured patients consenting to interview, the prevalence of established injury risk factors, such as substance use or handgun ownership, varied by gender. The adjusted odds of violence-related injury among this subset of patients were increased for males (odds ratio [OR], 2.22; 95% CI, 1.17-4.23), patients with an annual income less than $5,000 (OR, 2.85; 95% CI, 1.64-4.97), those reporting a history of domestic violence (OR, 2.69; 95% CI, 1.43-5.07), and heavy alcohol users (OR, 1.79; 95% CI, 1.01-3.19). CONCLUSION One in four ED visits to this urban, county hospital is due, at least in part, to injury. Patient characteristics associated with violence-related injury may generate hypotheses for further study.
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Neuner B, Weiss-Gerlach E, Miller P, Martus P, Hesse D, Spies C. Emergency department-initiated tobacco control: a randomised controlled trial in an inner city university hospital. Tob Control 2009; 18:283-93. [PMID: 19528043 PMCID: PMC2709908 DOI: 10.1136/tc.2008.028753] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objectives: Emergency department (ED) patients show high smoking rates. The effects of ED-initiated tobacco control (ETC) on 7-day abstinence at 12 months were investigated. Methods: A randomised controlled intention-to-treat trial (trials registry no.: ISRCTN41527831) was conducted with 1044 patients in an urban ED. ETC consisted of on-site counselling plus up to four telephone booster sessions. Controls received usual care. Analysis was by logistic regression. Results: In all, 630 (60.7%) participants were males, the median age was 30 years (range 18–81) and the median smoking intensity was 15 (range 1–60) cigarettes per day. Overall, 580 study participants (55.6%) were unmotivated, 331 (31.7%) were ambivalent and 133 (12.7%) were motivated smokers. ETC (median time 30 (range 1–99) min) was administered to 472 (91.7% out of 515) randomised study participants. At follow-up, 685 study participants (65.6% of 1044) could be contacted. In the ETC group, 73 out of 515 (14.2%) in the ETC group were abstinent, whereas 60 out of 529 (11.3%) controls were abstinent (OR adjusted for age and gender = 1.31 (95% CI 0.91 to 1.89, p = 0.15). Stratified for motivation to change behaviour, the adjusted ORs for ETC versus usual care were OR = 1.00 (95% CI 0.57 to 1.76) in unmotivated smokers, respectively OR = 1.37 (95% CI 0.73 to 2.58) in ambivalent smokers and OR = 2.19 (95% CI 0.98 to 4.89) in motivated smokers, p for trend = 0.29. Conclusions: ETC, in the form of on-site counselling with up to four telephone booster sessions, showed no overall effect on tobacco abstinence after 12 months. A non-significant trend for a better performance of ETC in more motivated smokers was observed.
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Affiliation(s)
- B Neuner
- Charité - Universitaetsmedizin Berlin, Department of Anesthesiology and Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Charitéplatz 1, Berlin, Germany.
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Affiliation(s)
- Michael A Gittelman
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, USA
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Bernstein SL, Haukoos JS. Public health, prevention, and emergency medicine: a critical juxtaposition. Acad Emerg Med 2008; 15:190-3. [PMID: 18275450 DOI: 10.1111/j.1553-2712.2008.00055.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Steven L Bernstein
- Department of Emergency Medicine Albert Einstein College of Medicine and Montefiore Medical Center Bronx, NY, USA.
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Lyons MS, Raab DL, Lindsell CJ, Trott AT, Fichtenbaum CJ. A novel emergency department based prevention intervention program for people living with HIV: evaluation of early experiences. BMC Health Serv Res 2007; 7:164. [PMID: 17937817 PMCID: PMC2194768 DOI: 10.1186/1472-6963-7-164] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2006] [Accepted: 10/15/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV prevention is increasingly focused on people living with HIV (PLWH) and the role of healthcare settings in prevention. Emergency Departments (EDs) frequently care for PLWH, but do not typically endorse a prevention mission. We conducted a pilot exploratory evaluation of the first reported ED program to address the prevention needs of PLWH. METHODS This retrospective observational cohort evaluation reviewed program records to describe the first six months of participants and programmatic operation. Trained counselors provided a risk assessment and counseling intervention combined with three linkage interventions: i) linkage to health care, ii) linkage to case management, and iii) linkage to partner counseling and referral. RESULTS Of 81 self-identified PLWH who were approached, 55 initially agreed to participate. Of those completing risk assessment, 17/53 (32%, 95 CI 20% to 46%) reported unprotected anal/vaginal intercourse or needle sharing in the past six months with a partner presumed to be HIV negative. Counseling was provided to 52/53 (98%). For those requesting services, 11/15 (73%) were linked to healthcare, 4/23 (17%) were coordinated with case management, and 1/4 (25%) completed partner counseling and referral. CONCLUSION Given base resources of trained counselors, it was feasible to implement a program to address the prevention needs for persons living with HIV in an urban ED. ED patients with HIV often have unmet needs which might be addressed by improved linkage with existing community resources. Healthcare and prevention barriers for PLWH may be attenuated if EDs were to incorporate CDC recommended prevention measures for healthcare providers.
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Affiliation(s)
- Michael S Lyons
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Smith JP, Shokoohi H, Holliman JC. The Search for Common Ground: Developing Emergency Medicine in Iran. Acad Emerg Med 2007. [DOI: 10.1111/j.1553-2712.2007.tb01808.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kisuule F, Minter-Jordan M, Zenilman J, Wright SM. Expanding the roles of hospitalist physicians to include public health. J Hosp Med 2007; 2:93-101. [PMID: 17427252 DOI: 10.1002/jhm.185] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Several years after the inception of the hospitalist movement, hospitalist roles have evolved in breadth and sophistication. Although public health is not formally recognized or previously described as an arena for hospitalists, hospitalists are often engaged in public health practice. This article attempts to alert hospitalists to the potential to make contributions to the field of public health and defines the public health skills that can positively affect the lives of their patients and the communities they serve. In a public health role, hospitalists may improve the quality of inpatient care. This article reviews how public health and hospital-based practices have already intersected and proposes further development within this discipline. In our ever-changing health care system, hospitalists play key roles in the central public health domains of assessment, assurance, and policy development. Insightful hospitalists will recognize and embrace these responsibilities in caring for patients and society.
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Affiliation(s)
- Flora Kisuule
- Department of Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21224, USA.
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Bernstein SL, Boudreaux ED, Cydulka RK, Rhodes KV, Lettman NA, Almeida SL, McCullough LB, Mizouni S, Kellermann AL. Tobacco control interventions in the emergency department: a joint statement of emergency medicine organizations. J Emerg Nurs 2007; 32:370-81. [PMID: 16997023 DOI: 10.1016/j.jen.2006.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2005] [Revised: 02/08/2006] [Accepted: 02/14/2006] [Indexed: 11/30/2022]
Abstract
Smoking is the leading cause of preventable death and illness in the United States. National practice guidelines call for all health care providers to "ask" all patients about tobacco use, and to "advise, assess, assist, arrange" when smokers want to quit smoking (the "5 As"). Emergency departments (EDs) have not been an important locus of tobacco control efforts, although ED patients typically smoke at rates exceeding that of the general population, are interested in quitting, and often have limited access to primary care. To address the role of emergency medicine in tobacco control, the American College of Emergency Physicians convened a task force of representatives of major emergency medicine professional organizations. Funded by the Robert Wood Johnson Foundation, the group met in 2004 and 2005. This article represents a summary of the task force's recommendations for tobacco control practice, training, and research. We call on emergency care providers to routinely assess patients' smoking status, offer brief advice to quit, and refer patients to the national smokers' Quitline (800-QUIT-NOW) or a locally available program. Given the global burden of tobacco-related illness, the task force considers it essential for emergency physicians to conduct research into the efficacy of ED-based interventions and to place tobacco control into the training curriculum for emergency medicine residencies. Tobacco control fits within the traditions of other ED-based public health practices, such as injury control. ED-based tobacco control would allow the specialty to help fulfill the Healthy People 2010 mandate to reduce the prevalence of smoking among US citizens.
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Affiliation(s)
- Steven L Bernstein
- Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.
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Abstract
As part of the broader "science of surge" consensus initiative sponsored by Academic Emergency Medicine, this report addresses the issues of detection and situational awareness as they relate to surge in the practice of emergency medicine. The purpose of this report, and the breakout group that contributed to its content, was to provide emergency physicians and other stakeholders in the emergency medicine community a sense of direction as they plan, prepare for, and respond to surge in their practice.
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Affiliation(s)
- John McManus
- U.S. Army Institute of Surgical Research, 3400 Rawley E. Chambers Avenue, Fort Sam Houston, TX 78234-6513, USA.
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Abstract
This chapter addresses past successes and challenges and then elaborates on the potential for further advances in three areas that bridge emergency medicine and the broader public health and health services research agenda: (1) monitoring health care access; (2) surveillance of diseases, injuries, and health risks; and (3) delivering clinical preventive services. This article also suggests ways to advance policy-relevant research on systems of health and social welfare that impact the health of the public.
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Affiliation(s)
- Karin V Rhodes
- Department of Emergency Medicine, School of Social Policy & Practice, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Bernstein SL, Boudreaux ED, Cydulka RK, Rhodes KV, Lettman NA, Almeida SL, McCullough LB, Mizouni S, Kellermann AL. Tobacco Control Interventions in the Emergency Department: A Joint Statement of Emergency Medicine Organizations. Ann Emerg Med 2006; 48:e417-26. [PMID: 16997678 DOI: 10.1016/j.annemergmed.2006.02.018] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2005] [Revised: 02/08/2006] [Accepted: 02/14/2006] [Indexed: 11/25/2022]
Abstract
Smoking is the leading cause of preventable death and illness in the United States. National practice guidelines call for all health care providers to "ask" all patients about tobacco use, and to "advise, assess, assist, arrange" when smokers want to quit smoking (the "5 As"). Emergency departments (EDs) have not been an important locus of tobacco control efforts, although ED patients typically smoke at rates exceeding that of the general population, are interested in quitting, and often have limited access to primary care. To address the role of emergency medicine in tobacco control, the American College of Emergency Physicians convened a task force of representatives of major emergency medicine professional organizations. Funded by the Robert Wood Johnson Foundation, the group met in 2004 and 2005. This article represents a summary of the task force's recommendations for tobacco control practice, training, and research. We call on emergency care providers to routinely assess patients' smoking status, offer brief advice to quit, and refer patients to the national smokers' Quitline (800-QUIT-NOW) or a locally available program. Given the global burden of tobacco-related illness, the task force considers it essential for emergency physicians to conduct research into the efficacy of ED-based interventions and to place tobacco control into the training curriculum for emergency medicine residencies. Tobacco control fits within the traditions of other ED-based public health practices, such as injury control. ED-based tobacco control would allow the specialty to help fulfill the Healthy People 2010 mandate to reduce the prevalence of smoking among US citizens.
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Affiliation(s)
- Steven L Bernstein
- Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.
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Bernstein SL, Cannata M. Nicotine dependence, motivation to quit, and diagnosis in emergency department patients who smoke. Addict Behav 2006; 31:288-97. [PMID: 15993546 DOI: 10.1016/j.addbeh.2005.05.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2005] [Accepted: 05/09/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To assess the effect of diagnosis on motivation to quit in adult smokers in an emergency department (ED). METHODS A survey of patients visiting two EDs from September to November, 2003. Patients screening positive for smoking completed a Fagerstrom Test for Nicotine Dependence and Ladder of Contemplation. ICD9 codes and disposition status were recorded. Smoking-related diagnoses were drawn from standard sources. Data were analyzed with parametric and non-parametric statistics. RESULTS Five hundred and eighty-five were interviewed, median age 40 (interquartile range 29-50); 323 (55%) were female. Ninety percent of all patients were non-White; 69% were uninsured or had Medicaid. Of 152 patients with smoking-related diagnoses, the median Fagerstrom score was 4.7 vs. 4.1 for patients with a non-smoking-related diagnosis (p=0.02, 95% CI for the difference 0.2, 0.9). Patients with smoking-related and non-smoking-related diagnoses had similar levels of motivation to quit (Ladder score, respectively, 5.5 vs. 5.1, p=0.03, 95% CI for difference 0.03, 0.8). CONCLUSIONS Adult ED smokers exhibit mild-moderate levels of nicotine addiction and interest in quitting. ED-based tobacco control should target all smokers.
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Affiliation(s)
- Steven L Bernstein
- Department of Emergency Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th St. Bronx, NY 10467, USA.
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Lyons MS, Lindsell CJ, Ledyard HK, Frame PT, Trott AT. Health department collaboration with emergency departments as a model for public health programs among at-risk populations. Public Health Rep 2005; 120:259-65. [PMID: 16134565 PMCID: PMC1497724 DOI: 10.1177/003335490512000307] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Accessing at-risk and underserved populations for intervention remains a major obstacle for public health programs. Emergency departments (EDs) care for patients not otherwise interacting with the health care system, and represent a venue for such programs. A variety of perceived and actual barriers inhibit widespread implementation of ED-based public health programs. Collaboration between local health departments and EDs may overcome such barriers. The goal of this study was to assess the effectiveness of a health department-funded, ED-based public health program in comparison with other similar community-based programs through analysis of data reported by health department-funded HIV counseling and testing centers in one Ohio county. METHOD Data for HIV counseling and testing at publicly funded sites in southwestern Ohio from January 1999 through December 2002 were obtained from the Ohio Department of Health. Demographic and risk-factor profiles were compared between the counseling and testing program located in the ED of a large, urban teaching hospital and the other publicly funded centers in the same county. RESULTS A total of 26,382 patients were counseled and tested; 5,232 were ED patients, and 21,150 were from community sites. HIV positivity was 0.86% (95% confidence interval [CI] 0.64%, 1.15%) in the ED and 0.65% (95% CI 0.55%, 0.77%) elsewhere. The ED program accounted for 19.8% of all tests and 24.7% of all positive results. The ED notified 77.3% of individuals testing positive and 84.4% of individuals testing negative. At community program centers, 88.3% of patients testing positive and 63.8% of patients testing negative were notified of results. All ED patients notified of positive status were successfully referred to infectious disease specialists. CONCLUSIONS Public health programs can operate effectively in the ED. EDs should have a rapidly expanding role in the national public health system.
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Affiliation(s)
- Michael S Lyons
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Abstract
EM initiatives are gaining global acceptance as a result of emergency physicians; local advocates; national, transnational, and international EM organizations; and governmental leadership, organizations, and agencies involved in international health and an evolving global health agenda. Spanning the spectrum from basic initiatives to improve acute care services to mature EM specialty development, all countries acknowledge the need for emergency care. The level of EM development in a country is fluid and depends on many variables, including status of health development, burden of disease,resources, advocacy, available expertise, and public demand. Emergency physicians should support the promotion of EM in the context of essential public health and primary care initiatives in these developing countries. Additionally, emergency physicians should work closely with stakeholders, health policy experts, health economics, and international organizations involved in health care to promote the advancement of EM worldwide.
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Affiliation(s)
- Jeffrey Smith
- Department of Emergency Medicine, George Washington University Medical Center, 2300 Eye Street NW, Washington, DC 20037, USA.
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Barthell EN, Aronsky D, Cochrane DG, Cable G, Stair T. The frontlines of medicine project progress report: standardized communication of emergency department triage data for syndromic surveillance. Ann Emerg Med 2004; 44:247-52. [PMID: 15332067 DOI: 10.1016/j.annemergmed.2004.01.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This article reports progress since the original publication of the Frontlines of Medicine Project. This project is a collaborative effort of emergency medicine (including emergency medical services and clinical toxicology), public health, other government agencies involved in health care and preparedness, law enforcement, and informatics to develop nonproprietary, standardized methods for reporting emergency department patient data. These data may be used for a variety of public health or clinical care initiatives, including syndromic surveillance for chemical and biological terrorism. This article reviews the outcome of the Project meeting in April 2002. Also, the article describes a Delphi Survey process to define the data elements in a triage surveillance report and to define a set of codified values for the chief complaint data element. An initial retrospective validation of the codified chief complaint values is provided, and prospective study of the proposed Frontlines' standards is encouraged.
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Affiliation(s)
- Edward N Barthell
- Department of Emergency Medicine, St. Mary's Hospital Ozaukee, Mequon, WI, USA.
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Adams AL, Southwick KL, Jui J, Loveless MO, Kohn MA. Electronic Reporting of Pelvic Inflammatory Disease From an Emergency Department. Sex Transm Dis 2004; 31:327-30. [PMID: 15167639 DOI: 10.1097/00007435-200406000-00001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Pelvic inflammatory disease (PID) is a clinically diagnosed condition that is preventable and underreported. We developed an electronic emergency department (ED) PID reporting system by using an automatic and secure system to send computerized clinician PID diagnoses to the state health department. GOAL The goal of this study was to assess if electronic transmission of ED PID data could enhance the completeness and timeliness of PID surveillance. STUDY DESIGN We conducted a retrospective chart review. METHODS To validate electronic ED diagnoses, we reviewed charts of 157 women with 7 clinicians' diagnoses compatible with PID. We determined which women met the Centers for Disease Control and Prevention (CDC) PID surveillance case definition and determined the positive predictive values of electronic ED diagnoses of PID. We compared completeness of electronic PID reporting with state sexually transmitted disease surveillance. RESULTS Three diagnoses were appropriate for electronic PID surveillance. Information on women with these diagnoses is sent daily to the health department with no extra effort needed from ED clinicians. Less than 10% of women who met the CDC PID case definition were reported within 6 months through conventional methods. CONCLUSIONS Electronic ED surveillance will improve completeness and timeliness of PID reporting.
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Affiliation(s)
- Annette L Adams
- Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon, USA
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Lyons MS, Lindsell CJ, Trott AT. Emergency Department Pelvic Examination and Pap Testing: Addressing Patient Misperceptions. Acad Emerg Med 2004. [DOI: 10.1111/j.1553-2712.2004.tb01462.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lyons MS, Lindsell CJ, Trott AT. Emergency department pelvic examination and Pap testing: addressing patient misperceptions. Acad Emerg Med 2004; 11:405-8. [PMID: 15064218 DOI: 10.1197/j.aem.2003.10.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Failure to obtain cervical cancer screening can be precipitated by limited knowledge. This study describes understanding of Papanicolaou (Pap) smear testing among women undergoing emergency department (ED) pelvic examination and tests the feasibility of educating patients in the ED. METHODS Patients undergoing pelvic examination in an urban, tertiary care ED were surveyed about Pap smear screening. Among the initial cohort, no education was provided prior to survey administration. Subsequently, a pilot study of scripted information provided by physicians alone or both physicians and counselors was conducted. RESULTS There were 81 patients in the non-intervention cohort and 32 patients in the intervention cohort. Of the 32 intervention patients, 16 received physician-administered intervention, and 16 received reinforced counseling (physician + counselor). Of 113 total patients, 90 (82%) were African American; mean age was 26 years (SD +/- 7.7 years). Of the 81 non-intervention patients, six (7%; 95% CI = 3% to 15%) said they were told that a Pap test was not done, and 60 (74%; 95% CI = 64% to 82%) mistakenly believed they had a Pap test. Sixty-six (81.5%; 95% CI = 72% to 88%) patients stated they knew the purpose of a Pap test; only 17 (26%; 95% CI = 17% to 37%) of these correctly identified the Pap test as a test for cervical cancer. All 32 intervention patients were surveyed after physician counseling. Compared with the non-intervention group, fewer (56%; 95% CI = 39% to 72%) thought they had a Pap test, and more (31%; 95% CI = 18% to 49%) said they were told they did not receive a Pap test. All 16 reinforced intervention patients correctly denied receiving a Pap test after counselor education. CONCLUSIONS Knowledge of Pap testing among women undergoing ED pelvic examination is poor; most mistakenly believe they receive a Pap test during ED evaluation. Educating patients may be feasible and effective in the ED setting.
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Affiliation(s)
- Michael S Lyons
- Department of Emergency Medicine, University of Cincinnati College of Medicine, University Medical Center, PO Box 670769, 231 Albert Sabin Way, Cincinnati, OH 45267-0769, USA.
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Magnuson JA, Klockner R, Ladd-Wilson S, Zechnich A, Bangs C, Kohn MA. Security Aspects of Electronic Data Interchange Between a State Health Department and a Hospital Emergency Department. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2004; 10:70-6. [PMID: 15018344 DOI: 10.1097/00124784-200401000-00012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Electronic emergency department reporting provides the potential for enhancing local and state surveillance capabilities for a wide variety of syndromes and reportable conditions. The task of protecting data confidentiality and integrity while developing electronic data interchange between a hospital emergency department and a state public health department proved more complex than expected. This case study reports on the significant challenges that had to be resolved to accomplish this goal; these included application restrictions and incompatibilities, technical malfunctions, changing standards, and insufficient dedicated resources. One of the key administrative challenges was that of coordinating project security with enterprise security. The original project has evolved into an ongoing pilot, with the health department currently receiving secure data from the emergency department at four-hour intervals. Currently, planning is underway to add more emergency departments to the project.
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Affiliation(s)
- J A Magnuson
- Office of Disease Prevention and Epidemiology, Oregon Department of Human Services, Portland 97232, USA.
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Barthell EN, Cordell WH, Moorhead JC, Handler J, Feied C, Smith MS, Cochrane DG, Felton CW, Collins MA. The Frontlines of Medicine Project: a proposal for the standardized communication of emergency department data for public health uses including syndromic surveillance for biological and chemical terrorism. Ann Emerg Med 2002; 39:422-9. [PMID: 11919529 DOI: 10.1067/mem.2002.123127] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The Frontlines of Medicine Project is a collaborative effort of emergency medicine (including emergency medical services and clinical toxicology), public health, emergency government, law enforcement, and informatics. This collaboration proposes to develop a nonproprietary, "open systems" approach for reporting emergency department patient data. The common element is a standard approach to sending messages from individual EDs to regional oversight entities that could then analyze the data received. ED encounter data could be used for various public health initiatives, including syndromic surveillance for chemical and biological terrorism. The interlinking of these regional systems could also permit public health surveillance at a national level based on ED patient encounter data. Advancements in the Internet and Web-based technologies could allow the deployment of these standardized tools in a rapid time frame.
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Affiliation(s)
- Edward N Barthell
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
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