RESUMEN
OBJECTIVE: To describe the relationship between statewide pediatric facility recognition (PFR) programs and pediatric readiness in emergency departments (EDs) in the US. STUDY DESIGN: Data were extracted from the 2013 National Pediatric Readiness Project assessment (4083 EDs). Pediatric readiness was assessed using the weighted pediatric readiness score (WPRS) based on a 100-point scale. Descriptive statistics were used to compare WPRS between recognized and nonrecognized EDs and between states with or without a PFR program. A linear mixed model with WPRS was used to evaluate state PFR programs on pediatric readiness. RESULTS: Eight states were identified with a PFR program. EDs in states with a PFR program had a higher WPRS compared with states without a PFR program (overall a 9.1-point higher median WPRS; P < .001); EDs recognized in a PFR program had a 21.7-point higher median WPRS compared with nonrecognized EDs (P < .001); and between states with a statewide PFR program, there was high variability of participation within the states. We found state-level PFR programs predicted a higher WPRS compared with states without a PFR program (ß = 5.49; 95% CI 2.76-8.23). CONCLUSIONS: Statewide PFR programs are based on national guidelines and identify those EDs that adhere to a standard level of readiness for children. These statewide PFR initiatives are associated with higher pediatric readiness. As scalable strategies are needed to improve emergency care for children, our study suggests that statewide PFR programs may be one way to improve pediatric readiness and underscores the need for further implementation and evaluation.
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Planificación en Desastres/métodos , Servicio de Urgencia en Hospital/normas , Hospitales Pediátricos/normas , Recolección de Datos , Medicina de Emergencia/organización & administración , Medicina de Emergencia/normas , Servicio de Urgencia en Hospital/organización & administración , Geografía , Hospitales Pediátricos/organización & administración , Internet , Modelos Lineales , Modelos Estadísticos , Enfermeras y Enfermeros , Pediatría/normas , Médicos , Garantía de la Calidad de Atención de Salud , Mejoramiento de la Calidad/normas , Encuestas y Cuestionarios , Estados UnidosRESUMEN
INTRODUCTION: Colombia represents a country in transition, from decades of devastating civil war to a post-conflict era of peace building, to the recent management of the influx of thousands of Venezuelan migrants. Brown University, along with Colombian partners, are leading the way in an international, multi-institutional consortium with the goal of emergency medicine capacitation across Colombia. Program Implementations: Through these collaborative efforts, exchange programs for residents and faculty alike have been successfully established. A baseline assessment of emergency medicine education for medical students is underway. By the end of 2019, the Harvard Humanitarian Initiative (HHI) will launch an online tool in multiple languages, including Spanish, to help medical and nursing educators conduct systematic needs assessments of the way in which conflict has impacted medical and nursing schools. CONCLUSIONS: Successful avenues for collaboration and partnership are described between Brown Emergency physicians and Colombian collaborating universities. These programs help to build capacity in Colombia and also provide education and support for residents and faculty at Brown University. Current work will see these programs grow into the future.
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Servicios Médicos de Urgencia/organización & administración , Medicina de Emergencia/organización & administración , Accesibilidad a los Servicios de Salud/organización & administración , Hospitales Universitarios/organización & administración , Médicos/organización & administración , Guerra , Colombia/epidemiología , Planificación en Desastres/organización & administración , Servicios Médicos de Urgencia/normas , Medicina de Emergencia/normas , Accesibilidad a los Servicios de Salud/normas , Humanos , Cooperación Internacional , Evaluación de Procesos y Resultados en Atención de Salud , Evaluación de Programas y Proyectos de Salud , Refugiados , Rhode Island/epidemiologíaRESUMEN
OBJECTIVES: The objective was to identify the effects of gender and other predictors of change in the salary of academic emergency physicians over a four sequential time period of survey administration, across a sample of physicians within different emergency departments (EDs) and within states representing the four main geographical regions of the United States. METHODS: This was a successive cross-sectional observational study of EDs in the United States using an annual salary survey distributed to all Association of Academic Chairs in Emergency Medicine (AACEM) and Academy of Administrators in Academic Emergency Medicine (AAAEM) members in 2013, 2015, 2016, and 2017 with a sample size of 7,102 respondents over all time periods. The primary variable of interest was the adjusted base salary, calculated to be the full-time effort of the physician without any enhancements (e.g., without stipend, release time, extra hours). Institutional predictive variables included U.S. region that ED was in and if the site was an academic or community academic hybrid ("community") ED. Individual level variables included gender, academic rank, years at academic rank, years at rank within the ED, and primary duty (clinical or other). A series of Wilcoxon tests were conducted to determine if the unadjusted difference in salaries by gender for each year of the survey were significantly different. The effects of relative change in adjusted base salary over time were assessed using a mixed-effects regression model, with institutional- and individual-level predictors included in the model. RESULTS: Data were provided by 81 departments across the four geographic regions of the United States (Northeast, South, West, and Midwest). Most of the survey respondents across the four time periods of administration were male (65%) and reported primary clinical appointments at an academic ED (94%). Overall salaries increased across the four time points of the data with an overall relative 10.8% (95% confidence interval [CI] = 9.6%-12%) change in median salary between 2013 and 2017; the relative percentage change for female respondents was 10.6% (95% CI = 9.4%-11.85%) and 11.1% (95% CI = 10.2%-12%) for males. Within survey years, not adjusting for academic rank, the median salary increase for males was higher ($226,746 in 2013 to $252,000 in 2017) than females ($217,000 in 2013 to $240,000 in 2017), with significance at all four time points (Z = 6.33, p < 0.001), with a median average salary gap of $12,000 in 2017. In the predictive model that adjusted for covariates, gender significantly predicted median adjusted salary, with males earning significantly more than females (F(1) = 22.5, p < 0.001). CONCLUSIONS: Despite previously published data showing an inappropriate gender salary gap in emergency medicine, this gap has remained essentially unchanged over the past 4 years.
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Medicina de Emergencia/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Docentes Médicos/estadística & datos numéricos , Salarios y Beneficios/estadística & datos numéricos , Estudios Transversales , Medicina de Emergencia/organización & administración , Servicio de Urgencia en Hospital/organización & administración , Femenino , Humanos , Masculino , Distribución por Sexo , Encuestas y Cuestionarios , Estados UnidosRESUMEN
In emergency rooms, patients are usually classified using scales for predicting risk, resource usage, and the maximum time for receiving medical care. Emergency Severity Index (ESI) is a frequently used scale in this context. However, every patient with cancer is automatically classified as ESI level 3. In this study, patients with cancer seen at an emergency setting were reclassified using the ESI without the "cancer" parameter to verify whether there would be any change in the classification. Cross-sectional study. A convenience sample of all cancer patients who sought immediate care at a private center in Brazil during a 6-month period was included in the study. After receiving care according to the institution's standards, they were reclassified using the ESI scale without the "cancer" parameter. Times to receiving care and to reaching a diagnosis were recorded. In the study period, 360 patients were reclassified. They sought treatment for infection, pain, and gastrointestinal problems related to chemotherapy. The reclassification led to significant changes in the ESI risk level: 8.8% of the patients initially classified as level 4 had their level changed, as did 10.6% of those at level 3. The number of patients reclassified as level 1 was 3.2% higher than that of the initial classification (p < 0.001). There is a need to create a new scale for the classification of risk that takes the characteristics of patients receiving cancer treatment into account. Specific populations require specific classification scales for better evaluation of risk.
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Medicina de Emergencia/métodos , Neoplasias/complicaciones , Neoplasias/terapia , Triaje/métodos , Brasil , Estudios Transversales , Medicina de Emergencia/organización & administración , Servicio de Urgencia en Hospital , Humanos , Oncología Médica/métodos , Oncología Médica/organización & administración , Derivación y Consulta , Medición de Riesgo , Índice de Severidad de la Enfermedad , Triaje/organización & administraciónRESUMEN
OBJECTIVES: To describe the structure of the Spanish emergency medicine research network or networks, researchers' roles, and patterns of collaboration between hospitals. MATERIAL AND METHODS: The search for publications was carried out in the SCOPUS database for the 5-year period of 2010 to 2014. We used network analysis software to map ties between researchers and hospitals that had established at least 5 and 10 relationships, respectively, during the period under study. We calculated indicators of degree of centrality for individual scientists and hospitals and tabulated data for the main authors and centers. RESULTS: We identified 2626 articles with 12 372 different authors at 1134 hospitals in 75 countries. The largest number of international relations were with France, the United States, and the United Kingdom. Authors had established 93 687 connections that allowed us to identify 23 collaborating groups, the largest of which was comprised of 30 individuals. We also found 12 855 connections between hospitals that identified a single subnetwork of collaboration comprised of 19 hospitals, 1 of which was in Switzerland. Measures of centrality, intermediation, and proximity led to classification of the most important members of author and hospital networks. CONCLUSION: This analysis of research networks in emergency medicine has afforded the first details describing the relationships maintained by Spanish scientists and hospitals.
OBJETIVO: Estudio descriptivo que investiga cómo se estructura la red o redes de investigación en Medicina de Urgencias y Emergencias (MUE) en España, establece el rol de cada investigador, así como describe la red de colaboración entre los hospitales españoles dentro de esta especialidad médica. METODO: Se realizó una búsqueda en la base de datos SCOPUS® para el quinquenio 2010-2014. Mediante programas específicos de análisis de redes se dibujaron las redes de investigadores y de hospitales, bajo la condición de haber establecido al menos 5 y 10 relaciones, respectivamente, durante el periodo. Para investigadores y hospitales se calcularon los indicadores de centralidad de grado, cercanía e intermediación, y se tabularon los principales autores y centros. RESULTADOS: Se identificaron 2.626 artículos de 12.372 autores diferentes y 1.134 hospitales distintos de 75 países. El mayor número de relaciones internacionales se establecieron con Francia, Estados Unidos y Reino Unido. Los autores establecieron 93.687 conexiones que permitieron identificar 23 grupos de colaboración, el mayor formado por 30 integrantes. Además, se establecieron 12.855 conexiones entre hospitales, que permitieron identificar una única subred de colaboración formada por 19 hospitales, 1 de ellos suizo. Mediante los indicadores de centralidad, intermediación y cercanía se pudo establecer una clasificación de aquellos elementos más relevantes dentro de las redes de autores y hospitales. CONCLUSIONES: El análisis de redes de la investigación en MUE ha permitido conocer por vez primera al detalle las relaciones que se establecen entre investigadores y hospitales españoles.
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Investigación Biomédica/organización & administración , Medicina de Emergencia/organización & administración , Conducta Cooperativa , Europa (Continente) , Hospitales , Humanos , Rol Profesional , Investigadores/organización & administración , España , Estados UnidosRESUMEN
Emergency physicians (EP) are uniquely suited to provide care in crises as a result of their broad training, ability to work quickly and effectively in high-pressure, austere settings, and their inherent flexibility. While emergency medicine training is helpful to support the needs of crisis-affected and displaced populations, it is not in itself sufficient. In this article we review what an EP should carefully consider prior to deployment.
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Atención a la Salud/organización & administración , Planificación en Desastres/organización & administración , Medicina de Emergencia/organización & administración , Calidad de la Atención de Salud/organización & administración , Sistemas de Socorro/organización & administración , Altruismo , Competencia Clínica , Gestión de Recursos de Personal en Salud/organización & administración , Gestión de Recursos de Personal en Salud/normas , Atención a la Salud/normas , Planificación en Desastres/normas , Desastres , Terremotos , Educación , Educación Médica/normas , Medicina de Emergencia/normas , Haití , Humanos , Misiones Médicas/organización & administración , Misiones Médicas/normas , Evaluación de Necesidades/organización & administración , Evaluación de Necesidades/normas , Rol del Médico , Médicos/organización & administración , Médicos/normas , Calidad de la Atención de Salud/normas , Sistemas de Socorro/normasRESUMEN
Este estudio investiga las causas de demora en los tiempos de respuesta a códigos amarillos en un servicio privado de emergencias médicas de la ciudad de Córdoba, que cuenta con afiliados directos y por convenios, estos últimos representan un 70% del total. Los nivel de prestaciones son diferenciados por códigos según riesgo de vida y/o por tiempo de respuesta en: Verde (consultas o demora hasta 3 horas), Amarillos (urgencias o demora hasta 20 minutos), Rojos (emergencias o demora hasta 12 minutos) Azul (traslados, sin demora establecida)...
Summary: This study investuigates the causes of delay in response times to yellow code in a private emergency medical service of the city of Córdoba, which has direct and affiliate agreements, the latter account for 70% of the total. Performance levels are differentiated by codes as life-threatening and/ or response time: Green (queries or delay up to 3 hours), Yellow (emergency or delay up to 20 minutes), Reds (emergencies or delay up to 12 minutes) blue (trasfers, established without delay)...
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Masculino , Femenino , Humanos , Ambulancias , Atención Ambulatoria , Urgencias Médicas , Medicina de Emergencia/organización & administración , Ambulancias/organización & administración , Administración del Tiempo , ArgentinaRESUMEN
The 2015 Academic Emergency Medicine consensus conference, "Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization" was held on May 12, 2015, with the goal of developing a high-priority research agenda on which to base future research. The specific aims of the conference were to (1) understand the current state of evidence regarding emergency department (ED) diagnostic imaging use and identify key opportunities, limitations, and gaps in knowledge; (2) develop a consensus-driven research agenda emphasizing priorities and opportunities for research in ED diagnostic imaging; and (3) explore specific funding mechanisms available to facilitate research in ED diagnostic imaging. Over a 2-year period, the executive committee and other experts in the field convened regularly to identify specific areas in need of future research. Six content areas within emergency diagnostic imaging were identified before the conference and served as the breakout groups on which consensus was achieved: clinical decision rules; use of administrative data; patient-centered outcomes research; training, education, and competency; knowledge translation and barriers to imaging optimization; and comparative effectiveness research in alternatives to traditional computed tomography use. The executive committee invited key stakeholders to assist with the planning and to participate in the consensus conference to generate a multidisciplinary agenda. There were a total of 164 individuals involved in the conference and spanned various specialties, including general emergency medicine, pediatric emergency medicine, radiology, surgery, medical physics, and the decision sciences.
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Investigación Biomédica , Diagnóstico por Imagen/métodos , Medicina de Emergencia/métodos , Investigación sobre Servicios de Salud/métodos , Centros Médicos Académicos , Medicina de Emergencia/organización & administración , Servicio de Urgencia en Hospital , HumanosRESUMEN
While emergency diagnostic imaging use has increased significantly, there is a lack of evidence for corresponding improvements in patient outcomes. Optimizing emergency department (ED) diagnostic imaging has the potential to improve the quality, safety, and outcomes of ED patients, but to date, there have not been any coordinated efforts to further our evidence-based knowledge in this area. The objective of this article is to discuss six aspects of diagnostic imaging to provide background information on the underlying framework for the 2015 Academic Emergency Medicine consensus conference, "Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization." The consensus conference aims to generate a high priority research agenda for emergency diagnostic imaging that will inform the design of future investigations. The six components herein will serve as the group topics for the conference: 1) patient-centered outcomes research; 2) clinical decision rules; 3) training, education, and competency; 4) knowledge translation and barriers to image optimization; 5) use of administrative data; and 6) comparative effectiveness research: alternatives to traditional CT use.
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Congresos como Asunto , Diagnóstico por Imagen/métodos , Medicina de Emergencia/organización & administración , Servicio de Urgencia en Hospital/organización & administración , Consenso , Medicina de Emergencia/educación , Humanos , Guías de Práctica Clínica como Asunto , Estados UnidosRESUMEN
The Centers for Disease Control and Prevention report that among older adults (≥65 years), falls are the leading cause of injury-related death. Fall-related fractures among older women are more than twice as frequent as those for men. Gender-specific evidence-based fall prevention strategy and intervention studies show that improved patient-centered outcomes are elusive. There is a paucity of emergency medicine literature on the topic. As part of the 2014 Academic Emergency Medicine (AEM) consensus conference on "Gender-Specific Research in Emergency Care: Investigate, Understand, and Translate How Gender Affects Patient Outcomes," a breakout group convened to generate a research agenda on priority questions to be answered on this topic. The consensus-based priority research agenda is presented in this article.
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Accidentes por Caídas/prevención & control , Accidentes por Caídas/estadística & datos numéricos , Servicio de Urgencia en Hospital/organización & administración , Servicio de Urgencia en Hospital/estadística & datos numéricos , Factores de Edad , Anciano , Centers for Disease Control and Prevention, U.S. , Consenso , Medicina de Emergencia/organización & administración , Femenino , Identidad de Género , Investigación sobre Servicios de Salud , Humanos , Masculino , Prevalencia , Factores de Riesgo , Caracteres Sexuales , Factores Sexuales , Estados UnidosRESUMEN
STUDY OBJECTIVE: We investigate the effect of admission process policies on patient flow in the emergency department (ED). METHODS: We surveyed an advisory panel group to determine approaches to admission process policies and classified them as admission decision is made by the team of providers (attending physicians, residents, physician extenders) (type 1) or attending physicians (type 2) on the admitting service, team of providers (type 3), or attending physicians (type 4) in the ED. We developed discrete-event simulation models of patient flow to evaluate the potential effect of the 4 basic policy types and 2 hybrid types, referred to as triage attending physician consultation and remote collaborative consultation on key performance measures. RESULTS: Compared with the current admission process policy (type 1), the alternatives were all effective in reducing the length of stay of admitted patients by 14% to 26%. In other words, patients may spend 1.4 to 2.5 hours fewer on average in the ED before being admitted to internal medicine under a new admission process policy. The improved flow of admitted patients decreased both the ED length of stay of discharged patients and the overall length of stay by up to 5% and 6.4%, respectively. These results are framed in context of teaching mission and physician experience. CONCLUSION: An efficient admission process can reduce waiting times for both admitted and discharged ED patients. This study contributed to demonstrating the potential value of leveraging admission process policies and developing a framework for pursuing these policies.
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Servicio de Urgencia en Hospital/organización & administración , Medicina Interna/organización & administración , Admisión del Paciente , Flujo de Trabajo , Centros Médicos Académicos/organización & administración , Medicina de Emergencia/organización & administración , Humanos , Tiempo de Internación , Modelos Organizacionales , Estudios de Casos Organizacionales , Política Organizacional , Pennsylvania , TriajeAsunto(s)
Investigación Biomédica/organización & administración , Cuidados Críticos/organización & administración , Medicina de Emergencia/educación , Docentes Médicos/organización & administración , Política Organizacional , Pediatría/educación , Facultades de Medicina/organización & administración , Adolescente , Investigación Biomédica/educación , Investigación Biomédica/estadística & datos numéricos , Niño , Preescolar , Educación de Postgrado en Medicina/métodos , Educación de Postgrado en Medicina/organización & administración , Educación de Postgrado en Medicina/estadística & datos numéricos , Medicina de Emergencia/organización & administración , Humanos , Lactante , Recién Nacido , Neonatología/educación , Neonatología/organización & administración , Pediatría/organización & administración , Apoyo a la Investigación como Asunto , Facultades de Medicina/estadística & datos numéricos , Estados UnidosRESUMEN
PURPOSE: The decision to amputate is always difficult but becomes even harder in emergency situations, which usually present extra complicating factors. MSF EXPERIENCE: These include human factors (related to both the surgeon and the patient); poor or nonexistent medical facilities, especially in war conditions or resource-poor countries; and cultural and religious considerations. Médecins Sans Frontières (MSF) has developed a quick medical and logistical response that relies on surgical protocols adapted to emergency situations, together with complete "kits" of medical equipment, supplies and inflatable facilities. CONCLUSION: Our response to Haiti's 2010 earthquake relied on these tools but also highlighted the need to develop more detailed protocols that will help our teams on the ground.