A Quality Framework to Address Racial and Ethnic Disparities in Emergency Department Care.

The emergency department serves as a vital source of health care for residents in the United States, including as a safety net. However, patients from minoritized racial and ethnic groups have historically experienced disproportionate barriers to accessing health care services and lower quality of services than White patients. Quality measures and their application to quality improvement initiatives represent a critical opportunity to incentivize health care systems to advance health equity and reduce health disparities. Currently, there are no nationally recognized quality measures that track the quality of emergency care delivery by race and ethnicity and no published frameworks to guide the development and prioritization of quality measures to reduce health disparities in emergency care. To address these gaps, the American College of Emergency Physicians (ACEP) convened a working group of experts in quality measurement, health disparities, and health equity to develop guidance on establishing quality measures to address racial and ethnic disparities in the provision of emergency care. Based on iterative discussion over 3 working group meetings, we present a summary of existing emergency medicine quality measures that should be adapted to track racial and ethnic disparities, as well as a framework for developing new measures that focus on disparities in access to emergency care, care delivery, and transitions of care.

Major vascular injury after laparoscopic tubal ligation.

Laparoscopy has become an established approach with diverse applications in both diagnostic and therapeutic surgical procedures. In general, the procedure is safe and effective and offers the advantage of being less invasive than conventional surgery. Complications after laparoscopy are uncommon but among them major vascular injury is potentially the most fatal, with recognition or mortality typically occurring intra-operatively or in the immediate post-operative period. We report the case of a delayed emergency department presentation of a major vascular injury after an elective laparoscopic tubal ligation. The prevalence, diagnosis, pathophysiolgy and management of major vascular injury after laparoscopic surgery is discussed.