Recent Research Updates

 

The 2008 SAEM Annual Meeting was held May 28 th to June 1 st, in Washington DC , where we had excellent representation from our department on every day of the conference.

Oral presentation:

Correlation Between Medication Errors and Overcrowding as Measured with a Real-Time EDWIN Score by Rolla Sweis, Ken Kelley, Rishi Sikka, Stewart Reingold, Kathleen Rzechula, Erik Kulstad.

Poster Presentations:

Prediction of Bypass Status Using a Real-Time EDWIN Score by Ken Kelley, Brett Ohlfs, Kathleen Rzechula, and Erik Kulstad.

A Pelvic Ultrasound Simulator Enhances Resident High-Fidelity Simulation Experience And Improves Faculty Evaluation Ability by Jaime Thompson, Herb Zerth, Dan Girzadas Jr., and the the Simulation in U/S Research Group including Robert Harwood, Michael Lambert, Martha Villalba, Lamont Clay, Sudip Bose, Steve Delis, and Michael Antonis.

Innovations in Emergency Medicine Education (IEME)

Incorporation of Audience Participation Technology into Resident Curriculum Review by Christine Kulstad, Dan Girzadas Jr., Elise Lovell, and Brian Sayger.

Simulation in Health Care

Lamont Clay served on the expert panel for the AEM Consensus Conference on “The Science of Simulation in Healthcare: Defining and Developing Clinical Expertise."
Dr. Clay provided guidance towards identifying the most effective approaches to simulation and education on procedural and surgical skills.

Clinico-Pathologic Case Competition

Ken Kelley served as resident presenter for “Shake, Rattle, and Roll”, a case of pediatric hypocalcemia.

Christine Kulstad served as faculty discussant for “ED Seizures”, a case with the diagnosis of tetanus after a dental procedure.

Andrej Urumov served as a judge for the CPC Task Force Committee.

 

The XXVIII International Congress of the European Association of Poisons Centres and Clinical Toxicologists was held 6-9 May 2008, in Seville , Spain .

Congratulations to Rolla Sweis, Brett Ohlfs, and Kate Paquette for their presented abstracts:

• Dystonia secondary to escitalopram use after a dosage change.
• Spontaneous subdural hematoma associated with sildenafil use.

 

The 2008 Advocate Research Forum at Dimensions of Excellence was held Tuesday, May 20th, at the Donald E. Stephens   Convention Center , Rosemont , IL , where we had several abstracts presented.

Congratulations to Rolla Sweis for taking first place honors (and $500) for best poster presentation of Correlation Between Medication Errors and Overcrowding as Measured with a Real-Time EDWIN Score done with coauthors Ken Kelley, Rishi Sikka, Stewart Reingold, Kathleen Rzechula, and Erik Kulstad.

 

The ICEP Spring Symposium was held for the first time at Advocate Christ Medical Center on March 6, 2008. This conference was considered by many ICEP staff and members to have been the best ICEP conference in its history!

Christ hospital had 2 oral presentations:

Colleen Crowe presented Outcome Prediction Using the Mortality in Emergency Department Sepsis (MEDS) Score in Patients Treated with Early Goal Directed Therapy done with coauthors Christine Kulstad, Chintan Mistry, and Erik Kulstad.

Karis Tekwani presented A Prospective Observational Study on the Effect of Etomidate on Septic Patient Mortality and Length of Stay done with coauthors Hannah F. Watts, Cindy W. Chan, Kathleen H. Rzechula, and Erik Kulstad.

And 3 Poster Presentations:

A Pelvic Ultrasound Simulator Enhances Resident High-Fidelity Simulation Experience And Improves Faculty Evaluation Ability by Jaime Thompson, MD, Herb Zerth, MD, Dan Girzadas Jr., and the the Simulation in U/S Research Group including Robert Harwood, Michael Lambert, Martha Villalba, Lemont Clay, Sudip Bose, Steve Delis, and Michael Antonis.  

Correlation Between Medication Errors and Overcrowding as Measured with a Real-Time EDWIN Score by Rolla T. Sweis, Ken Kelley, Rishi Sikka, Stewart Reingold, Kathleen Rzechula, and Erik Kulstad

Implementation of a Therapeutic Hypothermia Protocol in a Community Hospital Emergency Department by Christine Kulstad, Karis Tekwani, Michael Anderson, Beth Griffin, Elise Lovell.

 

We had a great showing at the AAEM/JEM Resident Research Forum at the 14th Annual Scientific Assembly held in Amelia Island Plantation, Florida, February 7-9, 2008. An unprecedented 4 out of the total 8 abstracts accepted from around the country were from our department!

Oral presentations included:

Hannah Watts, who received the First Place award for her presentation of The Effect of Single-Bolus Etomidate on Septic Patient Mortality: A Prospective Observational Analysis.

Karis Tekwani with The Effect of Alpha-Blockade on Stone Passage Success in Emergency Department Patients Discharged with Ureterolithiasis: A Retrospective Observational Cohort Study.

Ken Kelley with The Effect of Overcrowding on Time to Percutaneous Coronary Intervention for Acute Myocardial Infarction: A Retrospective Analysis.

Colleen Crowe with Initial implementation of a modified early goal directed therapy protocol for sepsis management in a community hospital Emergency Department: A Retrospective Analysis.  

Poster presentations included:

Cindy Chan with Alpha-blockade is Infrequently Utilized for the Treatment of Ureteral Stones.

Jessica Hugl-Wajek with Domestic Violence: Incidence and Prevalence Detected by a Trained Advocacy Coordinator in an Emergency Department Setting.

AAEM photo submission presentations included:

Cindy Chan and  Steve Nanini, with their submission Post-traumatic eye injury.

Heather Gray, with her submission Mesenteric Ischemia.

 

The American Geriatrics Society meeting was held in April, 2008, in Washington DC, where we had one abstract presented.

Rishi Sikka presented Nursing Home Placement Among Geriatric Admissions for Failure to Thrive, done with co-authors, from outside institutions, Adam Robinett, Adeyinka Adedipe, Supriya Mehta, Joseph Restuccia.  

 

Current Publications

 

Michael Anderson, Colleen Crowe, Christine Kulstad, Mike Lambert, Kate Latouf, Steve Nanini, Asmita Patel, Brian Sayger, Adam Tuite, and Martha Villalba, contributors to Clinical Emergency Radiology, edited by J. Christian Fox, Cambridge press, 2008.

Wang EE, Quinones J, Fitch MT, Dooley-Hash S, Griswold-Theodorson S, Medzon R, Korley F, Laack T, Robinett A, Clay L. Developing Technical Expertise in Emergency Medicine-The Role of Simulation in Procedural Skill Acquisition. Acad Emerg Med. 2008 Sep 10.

Watts H, Tekwani K, Chan C, Rzechula K, Kulstad E. The Effect of Alpha-Blockade in Emergency Department Patients with Ureterolithiasis. Accepted for publication in J Emerg Med, August, 2008.

Tekwani K, Watts H, Rzechula K, Sweis R, Kulstad E. A prospective observational study on the effect of etomidate on septic patient mortality and length of stay. Accepted for publication in Acad Emerg Med, September, 2008.

Chan C, Tekwani K, Watts H, Kulstad E. Emergency physicians report infrequent use of alpha-blockade for the treatment of ureteral stones. Accepted for publication in Am J Emerg Med, June, 2008.

Tekwani K, Watts H, Chan C, Nanini S, Rzechula K, Kulstad E. The effect of single-bolus etomidate on septic patient mortality. Accepted for publication in West J of Emerg Med, May, 2008.

Havelka EG, Rzechula KH, Bryant TO, Anneken SM, Kulstad EB.Correlation between impedance cardiography and B-Type natriuretic peptide levels in dyspneic patients. J Emerg Med. 2008 Sep 12.

Tekwani KL, Girzadas DV, Lambert MJ. Emergency Department Diagnosis of Pericardial Tamponade Aided by Goal-directed Bedside Echocardiography. Acad Emerg Med. 2008 Sep;15(9):872.

Miller DG, Lovell EO. Antibiotic-induced serotonin syndrome. J Emerg Med. 2008 May 1

Bisaga A, Paquette K, Sabatini L, Lovell EO. A Prevalence Study of Methicillin-Resistant Staphylococcus aureus Colonization in Emergency Department Health Care Workers. Ann Emerg Med. 2008 Nov;52(5):525-8. Epub 2008 Apr 24.

Davis C, Girzadas DV Jr. Laryngeal sarcoidosis causing acute upper airway obstruction. Am J Emerg Med. 2008 Jan;26(1):114.e1-3.

Reingold S, Kulstad E. Impact of human factor design on the use of order sets in the treatment of congestive heart failure. Acad Emerg Med. 2007 Nov;14(11):1097-105. Epub 2007 Aug 10.

Girzadas DV Jr, Clay L, Caris J, Rzechula K, Harwood R. High fidelity simulation can discriminate between novice and experienced residents when assessing competency in patient care. Med Teach. 2007 Jun;29(5):452-6.

Crabb GM, McQuillen KK. Subtle abdominal aortic injury after blunt chest trauma. J Emerg Med. 2006 Jul;31(1):29-31.

Villalba ML, Huynh B, So M, Mackenzie JD, Ledbetter S, Rybicki F. An ovary with a twist: a case of interesting sonographic findings of ovarian torsion. J Emerg Med. 2005 Nov;29(4):443-6.

Peraud PJ, Kulstad EB. Another resident perspective: resident education and the pharmaceutical industry. Ann Emerg Med. 2005 Jan;45(1):32-6.

Girzadas DV Jr, Harwood RC, Davis N, Schulze L. Gender and the council of emergency medicine residency directors standardized letter of recommendation. Acad Emerg Med. 2004 Sep;11(9):988-91.

Konicki PJ, Kulstad EB. Diagnosis of appendicitis with ultrasound: case example. J Emerg Med. 2004 Aug;27(2):187-9.

Kulstad EB, Kulstad CE, Lovell EO. A rapid quantitative turbimetric d-dimer assay has high sensitivity for detection of pulmonary embolism in the ED. Am J Emerg Med. 2004 Mar;22(2):111-4.

Kulstad EB, Pisano MV, Shirakbari AA. Delayed presentation of traumatic diaphragmatic hernia. J Emerg Med. 2003 May;24(4):455-7.

 

Abstracts and Presentations

 

Herb Zerth, MD, gave an oral presentation at the SAEM Regional Meeting in Coralville, Iowa, September, 2008 of "A Pelvic Ultrasound Simulator Enhances Resident High-Fidelity Simulation Experience And Improves Faculty Evaluation Ability" done with coauthors Jaime Thompson, Dan Girzadas Jr., and the the Simulation in U/S Research Group including Robert Harwood, Michael Lambert, Martha Villalba, Lamont Clay, Sudip Bose, Steve Delis, and Michael Antonis. 

Sikka R, Kaucky C, Mehta S, Kulstad E. Correlation of ED Occupancy Rate with Time to Antibiotics for Patients with Pneumonia. Presented by Dr. Kulstad at the SAEM Midwest Regional Meeting in Coralville, IA, September 2008 and by Dr. Sikka at the ACEP Research Forum in Chicago, IL, October 2008.

Kate Latouf, DO, Andy Nelson, MD, Lisa Hardy, MD, Elise Lovell, MD, Evaluation of Racial Bias in Emergency Medicine Residents and Recent Graduates, presented by Dr. Nelson at the ACEP Research Forum in Chicago, IL, October 2008.

Shannon Holt, MD, Chintan Mistry, MD, Robert Harwood, MD, MPH, Erik Kulstad, MD, MS, Use of an Attending Physician Float Shift to Care for Boarding Patients During Overcrowded Conditions Increases Time Available for Resident Education, presented by Dr. Holt at the ACEP Research Forum in Chicago, IL, October 2008.

Christine Kulstad, MD, Karis Tekwani, MD, Michael Anderson, MD, Beth Griffin MD, Aaron Abrahamsen, MD, Elise Lovell, MD, Implementation of a Therapeutic Hypothermia Protocol in a Community Hospital Emergency Department, presented by Dr. Abrahamsen at the ACEP Research Forum in Chicago, IL, October 2008.

Kelley K, Ohlfs B, Rzechula K, Kulstad E. Prediction of Bypass Status Using a Real-Time EDWIN Score. Presented by Dr. Kulstad at the SAEM Annual Meeting in Washington, DC, May 2008.

Sweis R, Kelley K, Sikka R, Reingold S, Rzechula K, Kulstad E. Correlation Between Medication Errors and Overcrowding as Measured with a Real-Time EDWIN Score. Presented by Dr. Kulstad both in poster format at the ICEP Spring Symposium, March, 2008, and in oral format at the SAEM Annual Meeting in Washington, DC, May 2008.

Sweis R, Bakker C, Wichter M, Kulstad E. Initial Experience with Thrombolysis for Acute Ischemic Stroke in a Community Hospital Emergency Department. Presented by Dr. Bakker at the SAEM Midwest Regional Meeting in Coralville, IA, September 2008.

Watts H, Morath D, Sikka R, Mecozzi A, Rzechula K, Kulstad E. Service Intensity Provided to Nursing Home Patients is Associated with Disposition from the Emergency Department. Presented by Dr. Watts at the SAEM Midwest Regional Meeting in Coralville, IA, September 2008.

Tekwani K, Mistry C, Sayger B, Kulstad E. Emergency Department Overcrowding is Associated with Reduced Patient Satisfaction Scores. Presented by Dr. Tekwani at the SAEM Midwest Regional Meeting in Coralville, IA, September 2008 and the ICEP Academic Forum in Chicago, IL, October, 2008.

Holt S, Mistry C, Harwood R, Kulstad E. An Attending Physician Float Shift to Care for Boarding Patients During Overcrowded Conditions Increases Time Available for Resident Education. Presented by Dr. Holt at the ACEP Research Forum in Chicago, IL, October 2008.

Kulstad E, Kelley K, Rzechula K. Effect of Overcrowding on Time to Percutaneous Coronary Intervention for Acute Myocardial Infarction. Presented by Dr. Kulstad at the ACEP Research Forum in Chicago, IL, October 2008.

Kulstad E, Waghchoure S, Hart M. Occupancy Rate and EDWIN score Both Correlate Significantly with Number of Patients Leaving the Emergency Department without Being Seen. Presented by Mr. Hart at the SAEM Midwest Regional Meeting in Coralville, IA, September 2008 and by Dr. Kulstad at the ACEP Research Forum in Chicago, IL, October 2008.

Watts H, Doherty J, Kulstad E. Evaluation of the Revised Trauma and Injury Severity Scores in Elderly Trauma Patients. Presented by Dr. Watts at the SAEM Midwest Regional Meeting in Coralville, IA, September 2008 and at the ACEP Research Forum in Chicago, IL, October 2008.

Kulstad C, Crowe C, Mistry C, Kulstad E. Outcome Prediction Using the Mortality in Emergency Department Sepsis (MEDS) Score in Patients Treated with Early Goal Directed Therapy. Presented by Dr. Crowe at the SAEM Midwest Regional Meeting in Coralville, IA, September 2008 and at the ACEP Research Forum in Chicago, IL, October 2008.

Tekwani K, Watts H, Chan C, Rzechula K, Kulstad E. A Prospective Observational Study on the Effect of Etomidate on Septic Patient Mortality and Length of Stay. Presented by Dr. Tekwani at the ICEP Spring Symposium, March, 2008.

Crowe C, Kulstad C, Mistry C, Kulstad E. Outcome Prediction Using the Mortality in Emergency Department Sepsis (MEDS) Score in Patients Treated with Early Goal Directed Therapy. Presented by Dr. Crowe at the ICEP Spring Symposium, March, 2008.

Tekwani K, Watts H, Rzechula K, Kulstad E. The Effect of Alpha-Blockade on Stone Passage Success in Emergency Department Patients Discharged with Ureterolithiasis. Presented by Dr. Tekwani at the AAEM 14th Annual Scientific Assembly in February, 2008.

Watts H, Tekwani K, Chan C, Rzechula K, Nanini S, Kulstad E. The Effect of Etomidate on Septic Patient Mortality and Length of Stay. Presented by Dr. Watts at the AAEM 14 th Annual Scientific Assembly in February, 2008.

Kerwin C, Patel G, Kulstad E. A brief training module improves recognition of echocardiographic wall motion abnormalities by emergency medicine physicians. Presented by Dr. Kerwin at the ACEP Scientific Assembly, Seattle, WA, October 2007.

Tekwani K, Watts H, Rzechula K, Kulstad E. Does alpha-blockade reduce stone passage time or return visits to the emergency department for ureterolithiasis? Presented by Dr. Watts at the 4 th Mediterranean Emergency Medicine Congress in Sorrento, Italy, September, 2007, and at the ICEP Spring Symposium, March 2007, Chicago, IL.

Chan C, Tekwani K, Watts H, Kulstad E. Alpha-blockade is infrequently utilized for the treatment of ureteral stones. Presented by Dr. Chan at the 4 th Mediterranean Emergency Medicine Congress in Sorrento, Italy, September, 2007.

Tekwani K, Chan C, Watts H, Nanini S, Rzechula K, Kulstad E. The effect of single-bolus etomidate on septic patient mortality. Presented by Dr. Watts at the 4th Mediterranean Emergency Medicine Congress in Sorrento, Italy, September, 2007.

Marr A, Kurz M, Stern J, Kulstad E., Confidence Intervals are inconsistently reported in emergency medicine literature. Abstract presented by Dr. Marr at the 3 rd Mediterranean Emergency Medicine Congress in Nice, France, September, 2005.

Bilkovski R, Kulstad E, Guth S, Bohmer J. BNP is not consistently elevated in pulmonary embolism; a prospective evaluation. Abstract presented by Dr. Kulstad at the ICEP Academic Forum, April 2004, and displayed at the SAEM Midwest Regional Meeting September, 2004.

Kulstad E, Velez L, Roth B, Shepherd G. Inhalational methanol poisoning during pregnancy treated twice with fomepizole. Abstract displayed at EAPCCT, Barcelona, Spain, May 2001 and published in J Tox Clin Tox 2001;39(3)288-289.

Awards

Joshua Eastvold, MD, won Best Resident Oral Presentation at the SAEM Regional Meeting in Coralville, Iowa, September, 2008 for "The Role Of Pre-hospital Electrocardiograms In The Recognition Of ST-Elevation Myocardial Infarctions And Reperfusion Times" done with coauthors DeAnn Faragoi, Sean Motzny, and Diana Strasburger.

Elise Lovell, MD, won Best Faculty Oral Presentation at the SAEM Regional Meeting in Coralville, Iowa, September, 2008 for "Evaluation of Racial Bias in Emergency Medicine Residents and Recent Graduates" done with coauthors Kate Latouf, Andy Nelson, Lisa Hardy.

Aaron Abrahamsen, MD won Best Resident Poster Presentation at the SAEM Regional Meeting in Coralville, Iowa, September, 2008 for "Implementation of a Therapeutic Hypothermia Protocol in a Community Hospital Emergency Department" done with coauthors Christine Kulstad, Karis Tekwani, Michael Anderson, Beth Griffin, and Elise Lovell.

Cindy Bakker, PharmD, won Honorable Mention at the SAEM Regional Meeting in Coralville, Iowa, September, 2008 for the poster presentation of "Initial Experience with Thrombolysis for Acute Ischemic Stroke in a Community Hospital Emergency Department" done with coauthors Rolla Sweis, Melvin Wichter, and Erik Kulstad. 

Congratulations to Karis Tekwani, MD, for receiving 2nd place in the Illinois College of Emergency Physicians annual Resident Research Competition held this past week at Northwestern Memorial Hospital as part of the ICEP 2008 Academic Forum for her presentation of "Emergency Department Overcrowding is Associated with Reduced Patient Satisfaction Scores" done with co-authors Chintan Mistry, Brian Sayger, and Erik Kulstad. 

Hannah Watts won Best Poster Presentation at the 2007 ICEP Spring Symposium for presenting the work "Does Alpha-Blockade Reduce Stone Passage Time or Return Visits to the Emergency Department for Ureterolithiasis?" with co-authors Karis Tekwani, Kathy Rzechula and Erik Kulstad.

April Bisaga won the Best Poster Award at the 2007 Advocate Dimensions of Excellence conference with the poster “Eradication of Community-Associated MRSA Carriage in ED Healthcare Workers is Limited with Mupirocin” done with Kate Paquette, Linda Sabatini, and Elise Lovell.

Asmita Patel, Kathleen Rzechula, Veta Zikos, and Kemedy McQuillen, were honored as submitting one of the top 50 abstracts to the 4 th Mediterranean Emergency Medicine Congress with "T he accuracy of pediatric weight in the emergency department(ED): Do caregiver weight estimates measure up?"

Karis Tekwani managed to place 4 th as a presenter in the 4 th Mediterranean Emergency Medicine Congress CPC competition, despite being the only resident presenter in a large, international group of very experienced attending discussants.

Kate McQuillen and coauthors were awarded a Plenary Session presentation at the SAEM Annual Meeting with their study "A Double Blind Randomized Controlled Trial Comparing Nebulized Epinephrine and Albuterol in the Emergency Department Treatment of Bronchiolitis".

Greg Roslund was awarded Outstanding Resident Presentation at SAEM for his presentation of the abstract “The Emergency Department Role of Oral Ondansetron in the Oral Rehydration of Children with Gastroenteritis-related Vomiting” done with co-authors Terri Hepps and Kate McQuillen.

Colleen Crowe won 2 nd place at the 2007 Fall ICEP Academic Forum for the presentation of her study "Implementation of a Modified Early Goal Directed Therapy for Sepsis in a Community Hospital Emergency Department" done with Kathleen Rzechula, Christine Kulstad, and Chintan Mistry.

Erik Kulstad was named a Senior Peer Reviewer for the Annals of Emergency Medicine.

Sudip Bose was presented with the ACEP 2007 National Faculty Teaching Award at the ACEP Scientific Assembly in Seattle.

Daniel Girzadas Jr. was honored with the 2007 Assistant Residency Director Award by the Emergency Medicine Residents Association (EMRA) at the SAEM Annual Meeting in Chicago.

Robert Harwood was awarded the 2007 AAEM Program Director of the Year at the AAEM 13th Annual Scientific Assembly in Las Vegas.

Christine Kulstad was awarded the EMRA Robert J. Doherty EMF/ACEP Teaching Fellowship Scholarship at the SAEM Annual Meeting in Chicago.

 

Grants

 

Kulstad, E (PI) 7/1/07-6/30/08

Emergency Medicine Foundation EMBRS Research Grant Award

The effect of overcrowding on time sensitive emergency department protocols.

The major goal of this study is to prospectively determine the effects of overcrowding as measured with a real-time standardized measurement known as the Emergency Department Work Index (EDWIN) score on the time to reach specific goals required for diagnosis and treatment of acute myocardial infarction.

Amount: $5000

Tekwani, K (PI) 7/1/08-6/30/09

Emergency Medicine Foundation Resident Research Grant Award

The effect of etomidate on hospital length of stay after a single-bolus dose.

The major goal of this study is to prospectively determine the effects of etomidate on hospital length of stay and mortality in septic patients and compare these outcomes to septic patients given midazolam for induction during rapid sequence intubation in the emergency department.

Amount: $5000

 

Current Research Activity

Department of Emergency Medicine

Analysis of the outcomes of septic patients given etomidate for rapid sequence intubation.

• Observational study suggests that surviving sepsis patients given etomidate in the ED may have longer stays in the hospital when compared to patients given alternative agents such as midazolam. 
• Currently in mid-stage of a randomized, controlled, double-blind study comparing etomidate to midazolam to further investigate possible adverse effects from etomidate.

Outcomes of patients with acute CVA treated with thrombolysis.

• Follow up of patients treated within the last 2.5 years shows a much higher intracranial hemorrhage rate (32%) and mortality (14%) than expected.

The effects of hospital overcrowding on:

• Medication errors in the ED
• Analysis in our ED suggests a positive and significant correlation between overcrowding and the frequency of medication errors occurring in the department.
• Time to diagnosis and treatment of acute myocardial infarction
• Data from our hospital shows a correlation between overcrowding and increased times to diagnose and treat acute myocardial infarction.
• Patient satisfaction
• Correlation of Press Ganey surveys with crowding data showed decreased patient satisfaction when crowding indicators increase.
• Patient "left without being seen" rate
• Two crowding metrics currently in use (occupancy rate and EDWIN score) both correlate positively with, and have excellent discriminatory power for, the number of patients who leave the emergency department without being seen by a physician.
• Time to antibiotic administration for pneumonia
• Analysis of 336 patients suggests time to antibiotics increases with occupancy rate (Spearman’s rho = .15, p=.01), with an increase of 0.5 minutes seen for each percent increase in occupancy rate, and that an ED occupancy rate greater than the median was associated with decreased odds of receiving antibiotics within 4 hours (OR 0.41, 95% CI .21 to .80).

Prediction of bypass status with an electronically implemented EDWIN score.

• Using data obtained through our externally funded investigation of crowding, we’ve developed receiver operating characteristic (ROC) curves that show that the EDWIN score has good predictive capabilities for the ED being on bypass status.

Implementation of early goal directed therapy in a community hospital ED.

• Analysis of outcomes of patients treated with our early goal directed therapy (EGDT) protocol suggests that although we obtain a similar overall mortality to the originally described protocol (30%), we do not appear to significantly improve mortality.

B ias in emergency medicine residents and recent graduates.

• With many recent studies suggesting differences in workup and treatment between patients of different races, we are tracking residents' unconscious, or implicit, bias over time using the Race Implicit Association Test (IAT) available on-line (www.implicit.harvard.edu).

Utilization of simulation in medicine.

• With the increased utilization of simulation for the training of residents, our simulation investigator group is undertaking a number of studies to help further characterize and quantify benefits and outcomes of simulation training.
• A study analyzing a high fidelity pelvic ultrasound simulation model found an improved resident educational experience and an enhanced ability of faculty to evaluate trainees.
• Real-time measurement of participant heart rates suggest that stress levels do not vary markedly with role played during simulation scenario.

Alpha blockade in ureterolithiasis.

• Follow-up of patients contacted after being discharged suggests that alpha blockade using tamsulosin significantly increases the success rate of stone passage.

Utility of bedside ultrasound in the diagnosis of appendicitis.

• Ongoing study attempting to quantify the sensitivity and specificity of bedside ultrasound in the diagnosis of appendicitis.

Analysis of the mortality in emergency department sepsis (MEDS) score.

• A severity of illness scoring system utilizing variables readily available shortly after presentation to the ED has recently been described; application of this scoring system to patients in our ED treated with our modified EGDT protocol suggests an adequate predictive ability for mortality in this patient population.

Trauma severity and survival in the elderly.

• Analysis of 347 patients 65 years of age and older treated in our hospital suggests that the Injury Severity Score (ISS) and the Revised Trauma Score (RTS) correlate positively with hospital length of stay and have fair ability to predict the outcome of mortality in elderly trauma patients [ROC for ISS of 0.78 (95% CI .71 to .84) and RTS of .81 (95% CI .75 to .87)].

Therapeutic hypothermia after cardiac arrest.

• Analysis of outcomes of patients treated with therapeutic hypothermia protocol after return of spontaneous circulation from resuscitated cardiac arrest suggests that including all presenting rhythms appears safe and may be effective in a community hospital ED setting.

Effect of a domestic violence advocacy coordinator in the ED.

• Analysis of one year of screening data suggests improved detection of intimate partner violence in patients presenting to the ED when screened by a full-time domestic violence advocacy coordinator.

Effect of prehospital EKGs on time to percutaneous coronary intervention.

• Patients who receive pre-hospital EKGs have shorter door-to-balloon times (n=26, mean 66 min, 95% CI: 53 to 79) compared to control patients (n=19, mean 79 min, 95% CI: 67 to 90, p < 0.05); patients who have pre-arrival cath lab activations exhibit further decreases in door-to-balloon times (n=12, mean 58 min, 95% CI: 48 to 68, p <0.05) compared to controls.

 

Updated 12/1/2008