RESUMO
The American Board of Emergency Medicine gathers extensive background information on the Accreditation Council of Graduate Medical Education-accredited emergency medicine residency and fellowship programs and the residents and fellows training in those programs. We present the 2023 annual report on the status of physicians training in ACGME-accredited emergency medicine training programs in the United States.
Assuntos
Medicina de Emergência , Internato e Residência , Humanos , Estados Unidos , Bolsas de Estudo , Educação de Pós-Graduação em Medicina , Medicina de Emergência/educação , AcreditaçãoRESUMO
The American Board of Emergency Medicine gathers extensive background information on the Accreditation Council of Graduate Medical Education-accredited emergency medicine residency and fellowship programs, as well as the residents and fellows training in those programs. We present the 2022 annual report on the status of physicians training in Accreditation Council of Graduate Medical Education-accredited emergency medicine training programs in the United States.
Assuntos
Medicina de Emergência , Internato e Residência , Acreditação , Educação de Pós-Graduação em Medicina , Medicina de Emergência/educação , Bolsas de Estudo , Humanos , Estados UnidosRESUMO
The American Board of Emergency Medicine gathers extensive background information on Accreditation Council for Graduate Medical Education (ACGME)-accredited emergency medicine residency and fellowship programs, as well as the residents and fellows training in those programs. We present the 2020 annual report on the status of physicians training in ACGME-accredited emergency medicine training programs in the United States.
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Medicina de Emergência/educação , Bolsas de Estudo/normas , Internato e Residência/normas , Acreditação , Humanos , Sociedades Médicas , Estados UnidosRESUMO
EXECUTIVE SUMMARY: We sought to determine emergency medicine physicians' accuracy in designating patients' disposition status as "inpatient" or "observation" at the time of hospital admission in the context of Medicare's Two-Midnight rule and to identify characteristics that may improve the providers' predictions. We conducted a 90-day observational study of emergency department (ED) admissions involving adults aged 65 years and older and assessed the accuracy of physicians' disposition decisions. Logistic regression models were fit to explore associations and predictors of disposition. A total of 2,257 patients 65 and older were admitted through the ED. The overall error rate in physician designation of observation or inpatient was 36%. Diagnoses most strongly associated with stays lasting less than two midnights included diverticulitis, syncope, and nonspecific chest pain. Diagnoses most strongly associated with stays lasting two or more midnights included orthopedic fractures, biliary tract disease, and back pain. ED physicians inaccurately predicted patient length of stay in more than one third of all patients. Under the Two-Midnight rule, these inaccurate predictions place hospitals at risk of underpayment and patients at risk of significant financial liability. Further work is needed to increase providers' awareness of the financial repercussions of their admission designations and to identify interventions that can improve prediction accuracy.
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Hospitalização , Tempo de Internação/economia , Tempo de Internação/tendências , Medicare/economia , Medicare/legislação & jurisprudência , Mecanismo de Reembolso/economia , Mecanismo de Reembolso/legislação & jurisprudência , Idoso , Serviço Hospitalar de Emergência , Previsões , Humanos , Modelos Logísticos , Auditoria Médica , Estados UnidosRESUMO
The American Board of Emergency Medicine (ABEM) gathers extensive background information on emergency medicine-sponsored residency and fellowship programs, residents and fellows training in those programs, and all fellows for whom ABEM issues subspecialty certifications. We present the 2019 annual report on the status of US emergency medicine training programs.
Assuntos
Medicina de Emergência/educação , Bolsas de Estudo , Humanos , Internato e Residência , Sociedades Médicas , Conselhos de Especialidade Profissional , Estados UnidosRESUMO
The American Board of Emergency Medicine (ABEM) gathers extensive background information on emergency medicine-sponsored residency and fellowship programs, as well as the residents and fellows training in those programs. We present the 2018 annual report on the status of US emergency medicine training programs.
Assuntos
Medicina de Emergência/educação , Bolsas de Estudo , Internato e Residência , Medicina de Emergência/estatística & dados numéricos , Bolsas de Estudo/estatística & dados numéricos , Humanos , Internato e Residência/estatística & dados numéricos , Conselhos de Especialidade Profissional , Estados UnidosRESUMO
BACKGROUND: Scribes are unlicensed professionals trained in medical data entry. Limited data exist on the impact of scribes on provider time management in the emergency department (ED). Time-motion analysis is a tool utilized in business to capture detailed movements and durations to task completion. It offers a means to categorize how providers allocate their time during a clinical shift. OBJECTIVE: Evaluate the impact of scribes on how ED providers spend their time. METHODS: A prospective observational study was conducted to assess scribe impact on provider time utilization. Four research assistants (RAs) observed attending providers on 24 8-h control shifts (without a scribe), and 24 scribed shifts. RAs observed and categorized provider activity. Providers self-reported after-hours documentation times. Two-sample t-tests were used for normally distributed data, and Wilcoxon rank-sum tests were used for skewed data. All tests were two-sided, and p-values < 0.05 were considered statistically significant. RESULTS: Scribes decreased total documentation time both on shift (mean 55.3 vs. 36.4 min, p < 0.001) and post shift (mean 42.5 vs. 23.3 min, p = 0.038). They did not significantly decrease the amount of time spent reviewing the medical records or placing orders, nor did they have an impact on provider time spent at patients' bedside or time spent discussing patient care with team members. CONCLUSION: The presence of scribes decreased provider documentation time but did not change the amount of time spent at the bedside or communicating with other team members. Scribes may be a potential strategy to decrease the clerical burden.
Assuntos
Pessoal Administrativo/estatística & dados numéricos , Pessoal Administrativo/normas , Pessoal de Saúde/estatística & dados numéricos , Gerenciamento do Tempo/métodos , Documentação/métodos , Registros Eletrônicos de Saúde/instrumentação , Registros Eletrônicos de Saúde/estatística & dados numéricos , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Satisfação do Paciente , Estudos Prospectivos , Estudos de Tempo e MovimentoRESUMO
The American Board of Emergency Medicine (ABEM) gathers extensive background information on emergency medicine residency programs and the residents training in those programs. We present the 2017 annual report on the status of US emergency medicine training programs.
Assuntos
Medicina de Emergência/educação , Bolsas de Estudo , Internato e Residência , Adulto , Certificação/estatística & dados numéricos , Medicina de Emergência/estatística & dados numéricos , Bolsas de Estudo/estatística & dados numéricos , Feminino , Humanos , Internato e Residência/estatística & dados numéricos , Masculino , Estados UnidosRESUMO
The American Board of Emergency Medicine (ABEM) gathers extensive background information on emergency medicine residency programs and the residents training in those programs. We present the 2016 annual report on the status of US emergency medicine training programs.
Assuntos
Medicina de Emergência/educação , Internato e Residência/estatística & dados numéricos , Conselhos de Especialidade Profissional , Adulto , Medicina de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos , Adulto JovemRESUMO
OBJECTIVES: Assess the impact of scribes on an academic emergency department's (ED) patient-specific throughput. METHODS: Study design, setting, participants: A prospective cohort design compared throughput metrics of patients managed when scribes were and were not a part of the treatment team during pre-defined study hours in a tertiary academic ED with both an adult and pediatric ED. INTERVENTION: Eight scribes were hired and trained on-site by a physician with experience in scribe implementation. Scribes provided 1-to-1 support for a provider's work shift. An alternating-day pattern in months 2 to 5 post implementation ensured balance between the scribe and non-scribe groups in time of day, day of week, and patient complexity. RESULTS: Adult: Overall length of stay (LOS) was significantly longer for scribed patients (265 vs. 255 minutes, P=.028). The remaining throughput measures analyzed (door to provider, provider to disposition, and patient duration in treatment room) had higher summary values, but were not significant. Subgroup analysis revealed that patients seen by postgraduate year (PGY) 3 residents had significantly shorter LOS when seen with a scribe (244 vs. 262 minutes, P=.021). Pediatric: Overall LOS (163 vs. 151 minutes, P=.011), door to provider (21 vs. 16 minutes, P<.001), and treatment room duration (130 vs. 123 minutes, P=.020) were significantly longer when the treatment team had a scribe. CONCLUSIONS: Scribes failed to improve patient-specific throughput metrics in the first few months post implementation. Future work is needed to understand whether throughput efficiencies may eventually be gained after scribe implementation.
Assuntos
Documentação/métodos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Criança , Serviço Hospitalar de Emergência/organização & administração , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recursos HumanosRESUMO
STUDY OBJECTIVE: Emergency department (ED) care for patients with psychiatric complaints has become increasingly challenging given recent nationwide declines in available inpatient psychiatric beds. This creates pressure to manage psychiatric patients in the ED or as outpatients and may place providers and institutions at risk for liability under the Emergency Medical Treatment and Labor Act (EMTALA). We describe the patient characteristics, disposition, and legal outcomes of EMTALA cases involving patients with psychiatric complaints. METHODS: Jury verdicts, settlements, and other litigation involving alleged EMTALA violations related to psychiatric patients between the law's enactment in 1986 and the end of 2012 were collected from 3 legal databases (Westlaw, Lexis, and Bloomberg Law). Details about the patient characteristics, disposition, and reasons for litigation were independently abstracted by 2 trained reviewers onto a standardized data form. RESULTS: Thirty-three relevant cases were identified. Two cases were decided in favor of the plaintiffs, 4 cases were settled, 10 cases had an unknown outcome, and 17 were decided in favor of the defendant institutions. Most patients in these 33 cases were men, had past psychiatric diagnoses, were not evaluated by a psychiatrist, and eventually committed or attempted suicide. The most frequently successful defense used by institutions was to demonstrate that their providers used a standard screening examination and did not detect an emergency medical condition that required stabilization. CONCLUSION: Lawsuits involving alleged EMTALA violations in the care of ED patients with psychiatric complaints are uncommon and rarely successful.
Assuntos
Serviço Hospitalar de Emergência/legislação & jurisprudência , Transtornos Mentais/terapia , Adolescente , Adulto , Feminino , Humanos , Responsabilidade Legal , Masculino , Imperícia/legislação & jurisprudência , Pessoa de Meia-Idade , Estados Unidos , Adulto JovemRESUMO
BACKGROUND: Resident remediation is required for all residents who do not meet minimum standards in one or more of the Accreditation Council for Graduate Medical Education core competencies. The Council of Residency Directors in Emergency Medicine Remediation Taskforce identified the need for case-based examples of remediation efforts. OBJECTIVES: 1) To describe a complicated resident remediation case and employ consensus panel evaluation of the process. 2) To discuss the available assessment tools (including neuropsychologic/medical testing), due process, documentation, reassessment, and relevant barriers to implementation for this and other resident remediations. DISCUSSION: Details of a remediation case were altered to protect resident confidentiality, and then presented to a multidisciplinary group of program directors. The case details, action plan, and course were submitted and the remediation process, action plan, and course are assessed based on a standardized remediation approach. The resident entered remediation for poor organizational skills and an inability to make or follow through with patient care plans. Opportunities for improvement in the applied remediation process are identified and discussed. Legal concerns and utility of neuropsychological assessment of residents are reviewed. CONCLUSIONS: Remediation requires a complicated and detailed effort. This case demonstrates issues that program directors may face when working with residents and provides suggestions for use of specific remediation tools.
Assuntos
Competência Clínica , Medicina de Emergência/educação , Internato e Residência , Ensino de Recuperação/métodos , Educação de Pós-Graduação em Medicina/normas , Avaliação Educacional , HumanosRESUMO
Background: The American Board of Emergency Medicine (ABEM) in-person Oral Certification Examination (OCE) was halted abruptly in 2020 due to the COVID-19 pandemic. The OCE was reconfigured to be administered in a virtual environment starting in December 2020. Objectives: The purpose of this investigation was to determine whether there was sufficient validity and reliability evidence to support the continued use of the ABEM virtual Oral Examination (VOE) for certification decisions. Methods: This retrospective, descriptive study used multiple data sources to provide validity evidence and reliability data. Validity evidence focused on test content, response processes, internal structure (e.g., internal consistency and item response theory), and the consequences of testing. A multifaceted Rasch reliability coefficient was used to measure reliability. Study data were from two 2019 in-person OCEs and the first four VOE administrations. Results: There were 2279 physicians who took the 2019 in-person OCE examination and 2153 physicians who took the VOE during the study period. Among the OCE group, 92.0% agreed or strongly agreed that the cases on the examination were cases that an emergency physician should be expected to see; 91.1% of the VOE group agreed or strongly agreed. A similar pattern of responses given to a question about whether the cases on the examination were cases that they had seen. Additional evidence of validity was obtained by the use of the EM Model, the process for case development, the use of think-aloud protocols, and similar test performance patterns (e.g., pass rates). For reliability, the Rasch reliability coefficients for the OCE and the VOE during the study period were all >0.90. Conclusions: There was substantial validity evidence and reliability to support ongoing use of the ABEM VOE to make confident and defensible certification decisions.
RESUMO
Consolidation of healthcare in the US has resulted in integrated organizations, encompassing large geographic areas, with varying services and complex patient flows. Profound changes in patient volumes and behavior have occurred during the SARS Cov2 pandemic, but understanding these across organizations is challenging. Network analysis provides a novel approach to address this. We retrospectively evaluated hospital-based encounters with an index emergency department visit in a healthcare system comprising 18 hospitals, using patient transfer as a marker of unmet clinical need. We developed quantitative models of transfers using network analysis incorporating the level of care provided (ward, progressive care, intensive care) during pre-pandemic (May 25, 2018 to March 16, 2020) and mid-pandemic (March 17, 2020 to March 8, 2021) time periods. 829,455 encounters were evaluated. The system functioned as a non-small-world, non-scale-free, dissociative network. Our models reflected transfer destination diversification and variations in volume between the two time points - results of intentional efforts during the pandemic. Known hub-spoke architecture correlated with quantitative analysis. Applying network analysis in an integrated US healthcare organization demonstrates changing patterns of care and the emergence of bottlenecks in response to the SARS Cov2 pandemic, consistent with clinical experience, providing a degree of face validity. The modelling of multiple influences can identify susceptibility to stress and opportunities to strengthen the system where patient movement is common and voluminous. The technique provides a mechanism to analyze the effects of intentional and contextual changes on system behavior.
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COVID-19 , Síndrome Respiratória Aguda Grave , COVID-19/epidemiologia , Cuidados Críticos , Atenção à Saúde , Humanos , Pandemias , Estudos RetrospectivosRESUMO
PURPOSE: To report outcomes of patients presenting to the emergency department (ED) with new-onset visual flashes and/or floaters following implementation of a formalized triage protocol allowing eligible patients to be discharged for prompt outpatient ophthalmic examination. DESIGN: Retrospective consecutive case series. METHODS: Patient characteristics, protocol eligibility, and clinical outcomes were recorded for adult patients triaged within a formal "flashes and floaters" protocol at a single academic ED. RESULTS: A total of 457 patients presented for 471 unique ED encounters with a chief complaint of visual flashes and/or floaters between October 2014 and May 2018. In all, 61% of patient encounters (287/471) met protocol criteria for prompt outpatient ophthalmic examination, of whom 94% (269/287) were examined within 48 hours. Final diagnoses of protocol-eligible patients were posterior vitreous detachment only (73%, 197/269), retinal break(s) (10%, 26/269), migraine (5%, 14/269), and no cause or new cause found (10%, 27/269). No protocol-eligible patients had retinal detachment or diagnoses requiring emergent diagnostic or therapeutic care (0%, 95% CI = 0%-1.1%). Final diagnoses following 175 encounters not meeting criteria for deferred examination included posterior vitreous detachment only (25%, 43/175), retinal break(s) (19%, 33/175), macula-involving retinal detachment (13%, 22/175), macula-sparing retinal detachment (11%, 19/175), retinal arterial occlusion (2%, 3/175), and stroke (0.6%, 1/175). The Cohen kappa for agreement on protocol eligibility between the ED physician and ophthalmologist was 0.85. CONCLUSIONS: A formalized ED "flashes and floaters" triage protocol may help identify patients for whom prompt outpatient ophthalmic examination may be more safely considered.
Assuntos
Descolamento Retiniano , Doenças Retinianas , Perfurações Retinianas , Descolamento do Vítreo , Adulto , Serviço Hospitalar de Emergência , Humanos , Descolamento Retiniano/diagnóstico , Doenças Retinianas/complicações , Perfurações Retinianas/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Triagem , Transtornos da Visão/complicações , Descolamento do Vítreo/diagnósticoAssuntos
Angiografia/métodos , Eletrocardiografia , Ruptura Cardíaca Pós-Infarto/diagnóstico , Infarto do Miocárdio/complicações , Idoso , Ponte Cardiopulmonar , Oxigenação por Membrana Extracorpórea , Evolução Fatal , Ruptura Cardíaca Pós-Infarto/diagnóstico por imagem , Ruptura Cardíaca Pós-Infarto/fisiopatologia , Ventrículos do Coração , Humanos , Masculino , Infarto do Miocárdio/fisiopatologiaRESUMO
BACKGROUND: Videotaped recordings of simulation-based performance may allow learners the opportunity to review, evaluate, and reflect upon their own performance. OBJECTIVES: To determine the accuracy of resident performance self-assessment after a simulation-based encounter; compare low- and high-scoring residents' abilities to evaluate their performance; and determine if video-assisted performance review improves self-assessment accuracy. METHODS: Emergency Medicine residents participated in a videotaped simulation-based assessment. Residents evaluated their performance immediately after completing simulated cases, and after reviewing the session's video. Self-ratings were compared to the faculty observers, and scores were divided based on the median. RESULTS: Seventeen residents participated, providing 270 self-ratings before, and 269 after, video review. Before video review, residents accurately graded their performance in 73.7% of the items. High- and low-scoring residents accurately self-assessed 83.9% and 62.2% of items, respectively. The odds of a high scorer accurately rating their own performance were 3.2 times that of a low scorer (95% confidence interval [CI] 1.9-5.2, p<0.001). After video review, resident self-assessments were accurate for 73.6% of the items. High scorers were accurate in their post-video self-assessment in 83.3% of the items, vs. 62.4% for low scorers. After video review, the odds of a high scorer accurately self-rating their performance were 3.0 times that of a low scorer (95% CI 2.1-4.1, p<0.001). CONCLUSIONS: Residents' abilities to self-assess vary, and performance quality may influence self-assessment. Video review did not significantly increase self-assessment accuracy. Improving self-assessment skills may assist residents in identifying practice gaps, thereby allowing them to focus their energy toward filling that gap.
Assuntos
Competência Clínica , Educação Baseada em Competências/métodos , Medicina de Emergência/educação , Internato e Residência , Simulação de Paciente , Autoavaliação (Psicologia) , Estudos de Coortes , Educação de Pós-Graduação em Medicina/métodos , Avaliação Educacional/métodos , Humanos , Gravação em VídeoRESUMO
INTRODUCTION: Dermatologic complaints are a common reason for emergency department visits. METHODS: Retrospective chart review from 1 January 2015 to 31 December 2019. Patients in the Mayo Clinic Emergency Department receiving dermatology consultation were included. RESULTS: Dermatitis (24.7%, n = 113), infection (20.4%, n = 93), and drug reaction (10.3%, n = 47) accounted for the majority of diagnoses. Emergency department providers often provide no diagnosis (38%) or a differential diagnosis (22%), and dermatology consultation frequently alters diagnosis (46%) and treatment (83%). Patients receiving in-person consultations are admitted more frequently than those receiving teledermatology consultations (40% vs. 16%, p < 0.001). Primary diagnostic concordance with subsequent dermatology evaluation is high for in-person (94%) and teledermatology (88%) consultations. DISCUSSION: This is the largest study of emergency department dermatology consultations in the United States and the first to compare in-person and teledermatology emergency department consultation utilization in clinical practice. These modalities are utilized in a complementary fashion at our institution, with severe dermatologic diagnoses seen in-person. The valuable role of emergency department dermatologists is highlighted by frequent changes to diagnosis and treatment plans that result from dermatology consultation. Furthermore, our data suggest that teledermatology is an effective modality with the potential to expand access to dermatologic expertise in the emergency department setting.