Correlations among common emergency medicine physician performance measures: Mixed messages or balancing forces?

The increasing complexity of ED physician performance measures has resulted in significant challenges, including duplicative and conflicting measures that fail to account for different ED settings. We performed a cross sectional analysis of correlations between measures to characterize their relationships and determine if differences exist between academic versus non-academic ED settings. Pearson correlations were calculated for 12 measures among 220 ED physicians at 11 EDs. Higher admission rate was strongly correlated with higher CT utilization rate (R = 0.7, p < 0.01) and longer room to discharge time (R = 0.7, p < 0.01). Higher patients per hour was strongly correlated with shorter room to doctor time (R = -0.7, p < 0.01). Stronger measure correlations were found in the academic setting compared to the non-academic setting. Strong correlations between ED measures imply opportunities to reduce competing performance demands on clinicians. Differences in correlations at academic versus non-academic settings suggest that it may be inappropriate to apply the same performance standards across settings.

Design Parameters of Hand Surgery Screws: Measurement Discrepancies and Clinical Implications.

Purpose: The use of self-tapping cortical screws is indicated in patients with metacarpal and phalangeal fractures requiring formal stabilization. The aim of this study was to systematically compare and evaluate the design parameters of 4 commercially available self-tapping screw systems. Methods: We measured various design parameters of self-tapping cortical screws of different lengths from several manufactures using scanning electron microscopy. Screws were obtained in 8, 12, 16, and 20 mm lengths. The measured parameters included screw length, head height, pitch, outer diameter, inner diameter, terminal thread diameter, terminal thread-to-tip distance, thread-to-tip distance of 1 full revolution, and crest width. Data were assessed statistically using 1- and 2-way analysis of variance (ANOVA) tests, and the significance level was set at a P value < .05. Results: There was variability in advertised screw lengths compared with measured screw lengths with 2 manufacturers. There was a statistically significant difference between the thread-to-tip distance and head height between screws while controlling for diameter. Conclusions: Screw sizes and dimensions are critical in order to avoid complications such as prominent hardware and postoperative stiffness. Knowledge of the design parameters presented for each of the different manufacturers may prove useful to hand surgeons when selecting screws for fixation of metacarpal and phalangeal fractures. Clinical relevance: Specific design characteristics of commonly used screws in hand surgery vary slightly by manufacturer and may have clinically relevant implications in fixation of metacarpal and phalangeal fractures.

Less social emergency departments: implementation of workplace contact reduction during COVID-19.

The COVID-19 pandemic has led to rapid changes in community and healthcare delivery policies creating new and unique challenges to managing ED pandemic response efforts. One example is the practice of social distancing in the workplace as an internationally recommended non-pharmaceutical intervention to reduce transmission. While attention has been focused on public health measures, healthcare workers cannot overlook the transmission risk they present to their colleagues and patients. Our network of three EDs are all high traffic areas for both patients and staff, which makes the limitation of close person-to-person contact particularly difficult to achieve. To design, implement and communicate contact reduction changes in the ED workplace, our COVID-19 task force formalised a set of multidisciplinary recommendations that enumerated concrete ways to reduce healthcare worker transmission to coworkers and to patients from ED patient arrival to discharge. We also addressed staff-to-staff contact reduction strategies when not performing direct patient care. We describe our conceptual approach and successful implementation of workplace distancing.

Opisthotonus in neurosyphilis: a case report.

A 40-year-old woman presented via ambulance to our Emergency Department (ED) for decreased level of consciousness. The patient's husband reported declining cognitive ability over the prior 3 months, and a hospital visit for left leg weakness 5 months earlier. In the ED, the patient exhibited recurrent opisthotonus episodes. Old records obtained from another hospital were positive for reactive rapid plasma reagin test and florescent treponemal antibody absorption test (FTA-ABS). The patient's husband confirmed exposure to syphilis 15 years earlier. Subsequently, during hospitalization, the patient had a positive cerebrospinal fluid venereal disease research laboratory test and FTA-ABS, visible changes on a brain magnetic resonance imaging study, and was diagnosed with neurosyphilis.

External monitoring-induced pacemaker-driven tachycardia: a case report.

A 55-year-old African-American woman with a history of end-stage renal disease secondary to systemic lupus erythematosus, dual-chamber pacemaker placement secondary to sick sinus syndrome, and a previous subarachnoid hemorrhage presented via ambulance to our Emergency Department (ED) from an outside hospital with the report of altered mental status, hyperkalemia, and hypoglycemia. In the ED, the patient's initial physical examination revealed a stable, normal heart rate. Reassessment after placement of external monitoring devices found the patient to be tachycardic at approximately 132-135 beats/min, with minimal variation in rate. The patient was also tachypneic during this episode, up to a respiratory rate of 38 breaths/min. When misplaced external monitoring device leads were removed during pacemaker interrogation, the patient's heart rate dropped to the 70s. Reapplication of the external monitoring leads replicated the tachycardia. With permanent repositioning of the leads in the ED, the tachycardia did not return. The placement of the leads was determined to have caused a plethysmography-induced pacemaker-driven tachycardia.