Listed below are some articles and abstracts on topics related to enhancing emergency services. New articles and abstracts will be added to the top as published, and then moved to the appropriate section after one month.
Menchine, M. D., Wiechmann, W.Rudkin, S.
Trends in midlevel provider utilization in emergency departments from 1997 to 2006.
Acad Emerg Med. 2009 Oct;16:963-969.
This study looked at specific parameters related to the expansion of midlevel provider (MLP) practice in U.S. emergency departments. Data were analyzed using the National Hospital Ambulatory Medical Care Survey (NHAMCS). The number of patients seen by MLPs increased sharply, from 5.2 million in 1997 (5.5% of all ED cases) to 15.2 million in 2006 (12.7% of all ED cases). In addition, the number of EDs reporting use of MLPs increased from 28.3% in 1997 to 77.2% in 2006.
Sullivan, A. F., Ginde, A. A., Espinola, J. A. et al.
Supply and demand of board-certified emergency physicians by U.S. state, 2005.
Acad Emerg Med. 2009 Oct;16:1014-1018.
These authors used a model to estimate supply and demand of emergency physicians by state, based on 2005 data. Overall, the supply of emergency medicine board-certfied physicians was 58% of required FTEs to staff all EDs, ranging by state from 10% to 104%. The overall picture quantifies significantly more demand than supply.
Dickson, E. W., Anguelov, Z., Vetterick, D. et al.
Use of lean in the emergency department: a case series of 4 hospitals.
Ann Emerg Med. 2009 Oct;54:504-510.
Many emergency departments are looking at the Lean methodology to improve their processes. These authors describe the effects of using Lean on quality of care in 4 EDs. One year after using Lean, 3 out of 4 EDs had reduced length of stay, despite an increase in volume, with concomitant increase in patient satisfaction. Both leadership and front line commitment to the process were critical to success.
American Academy of Pediatrics, American College of Emergency Physicians, Emergency Nurses Association
Joint Policy Statement- Guidelines for Care of Children in the Emergency Department
Ann Emerg Med. 2009 Oct;54:543-552.
This joint policy statement on pediatric care in EDs was issued by the American Academy of Pediatrics, the American College of Emergency Physicians, and the Emergency Nurses Association. It focuses on the unique needs of children, and should be required reading for any emergency department rendering care to children. There is some great information that is applicable to pediatric care in urgent care centers as well.
Travers, D.A., Waller, A.E., Katznelson J. et al.
Reliability and validity of the emergency severity index for pediatric triage.
Acad Emerg Med. 2009 Sept;16:843-849.
The Emergency Severity Index (ESI) triage scoring system is being increasingly used in emergency departments, but its use in the pediatric population has not been well studied. These authors assessed the reliability and validity of ESI for pediatric triage at 5 sites. Inconsistencies in triage were noted for the most acute and least acute patients, as well as those less than 1 year of age, as well as those with medical (vs trauma) chief complaints. Nurses from dedicated pediatric EDs were 31% less likely to undertriage patients than nurses in general EDs. They conclude that reliability of ESI for pediatric triage is moderate, with several areas in which nurses have difficulty triaging pediatric patients consistently.
Herring, A., Wilper, A., Himmelstein, D. U. et al.
Increasing length of stay among adult visits to U.S. Emergency departments, 2001-2005.
Acad Emerg Med. 2009 Jul;16:609-616.
This study documents what many who practice emergency care already perceive, that length of stay (LOS) is increasing. This was a retrospective study of the NHAMCS database, from 2001-2005. Median LOS increased 3.5% per year, from 132 minutes in 2001 to 154 minutes in 2005. For critically ill patients, which require significantly more resources to manage, LOS increased 7.0% per year, from 185 minutes to 254 minutes. ED LOS was persistently longer for African-American and Hispanic patients, and did not improve over this period.
Carr, B.G., Branas C.C., Metlay J.P., et al.
Access to Emergency Care in the United States.
Ann Emerg Med. 2009 Aug;54:261-269.
For optimal care, rapid access to emergency services is essential. The National Emergency Department Inventories-USA was used to identify location, volume and teaching status of EDs in the US. Overall, 71% of the US population has access to an ED within 30 minutes, and 98% has access within 60 minutes.
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