A5014867872- Emergency and Acute Care Studies
- Acute Myocardial Infarction Research
- Cardiac Arrest and Resuscitation
- Heart Failure Treatment and Management
- Amoebic Infections and Treatments
- Infectious Diseases and Tuberculosis
- ECG Monitoring and Analysis
- Healthcare Policy and Management
- Spinal Dysraphism and Malformations
- Healthcare Systems and Technology
- Primary Care and Health Outcomes
- Medical Malpractice and Liability Issues
- Hospital Admissions and Outcomes
- Spine and Intervertebral Disc Pathology
- Pediatric Pain Management Techniques
- Healthcare cost, quality, practices
- Nursing Roles and Practices
- Anesthesia and Pain Management
- Phonocardiography and Auscultation Techniques
- Palliative Care and End-of-Life Issues
- Case Reports on Hematomas
- Musculoskeletal pain and rehabilitation
- Hate Speech and Cyberbullying Detection
- Trauma and Emergency Care Studies
- Cerebrospinal fluid and hydrocephalus
Oregon Health & Science University
2015-2024
George Washington University
2011-2014
Timely diagnosis of ST-segment elevation myocardial infarction (STEMI) in the emergency department (ED) is made solely by ECG. Obtaining this test within 10 minutes ED arrival critical to achieving best outcomes. We investigated variability timely identification STEMI across institutions and whether performance variation was associated with characteristics, comprehensiveness screening criteria, processes.We examined 7 EDs, missed case rate (MCR) as our primary end point. The MCR proportion...
Introduction: Asynchronous online training has become an increasingly popular educational format in the new era of technology-based professional development. We sought to evaluate impact asynchronous module on ability medical students and emergency medicine (EM) residents detect electrocardiogram (ECG) abnormalities acute myocardial infarction (AMI). Methods: developed ECG testing AMI, with emphasis recognizing ST elevation (MI) early activation cardiac catheterization resources. Study...
Background ST-segment elevation myocardial infarction (STEMI) guidelines recommend screening arriving emergency department (ED) patients for an early ECG in those with symptoms concerning ischemia. Process measures target median door-to-ECG (D2E) time of 10 minutes. Methods and Results This 3-year descriptive retrospective cohort study, including 676 ED-diagnosed STEMI from geographically diverse facilities across the United States, examines alternative approach to quantifying performance:...
Abstract Objective The objective was to conduct a pilot randomized controlled trial assess the feasibility, logistics, and potential effect of monthly provider funnel plot feedback reports from Press Ganey data semiannual face‐to‐face coaching sessions improve patient satisfaction scores. Methods This 25 emergency medicine faculty providers in one urban academic department. We enrolled full‐time clinical with at least 12 months baseline data, who anticipated working ED for additional months....
Significant delays occur in providing adequate pain relief for patients who present to the emergency department (ED) with extremity fractures. The median time medication administration presenting our ED fractures was 72.5 minutes. We used a multidisciplinary approach implement three improvement cycles goal of reducing by 15% over an eight month period. First, we redesigned nursing triage and treatment processes. Second, improved documentation standardization ensure accurate tracking declined...
Cross-sectional cohort study.Cauda equina syndrome (CES) is a neurologic emergency, and delay in diagnosis can result irreversible impairment. Our purpose was to determine the value of physical examination CES patients complaining bladder and/or bowel complications emergency department.Adult at one tertiary academic medical center that endorsed bowel/bladder dysfunction, underwent lumbar magnetic resonance imaging (MRI), received an orthopedic spine surgery consultation from 2008 2017 were...
Disparities remain in survival after out-of-hospital cardiac arrest (OHCA) for women compared to men. Our objective was evaluate differences automated external defibrillator (AED) use before Emergency Medical Services (EMS) arrival and time from initial EMS defibrillation by EMS-assessed gender (women or men).
Background: Delayed intervention for ST-segment elevation myocardial infarction (STEMI) is associated with higher mortality. The association of door-to-ECG (D2E) clinical outcomes has not been directly explored in a contemporary US-based population. Methods: This was three-year, 10-center, retrospective cohort study ED-diagnosed patients STEMI comparing mortality between those who received timely (<10 min) vs. untimely (>10 diagnostic ECG. Among survivors, we left ventricular ejection...
Febrile neutropenia is a potentially life-threatening complication of chemotherapy in pediatric oncology patients. Prompt initiation antibiotic therapy may minimize morbidity and mortality associated with this condition, time to (TTA) administration <60 minutes used as quality benchmark by many institutions. We implemented improvement initiative achieve TTA < 60 >80% eligible patients the emergency department.After collecting baseline data, we employed consecutive PDSA cycles (i) reduce...
The U.S. health care system is undergoing a major transformation. Clinical delivery systems are now being paid according to the value of they provide, in accordance with Triple Aim, which incorporates improving quality and cost patient experience. Increasingly, financial risk transferred from insurers clinical that become responsible for both episode-based longitudinal patients. Thus, these need develop strategies manage populations. Academic medical centers (AMCs) serve unique role many...
Introduction Advances in ST-segment elevation myocardial infarction (STEMI) management have involved improving the clinical processes connecting patients with timely emergency cardiovascular care. Screening upon department (ED) arrival for an early ECG to diagnose STEMI, however, is not optimal all patients. In addition, degree which screening and diagnosis are associated improved time intervention postpercutaneous coronary outcomes, under more contemporary practice conditions, known....
Transgender people experience discrimination in health care, including reports of avoiding or delaying emergency department (ED) care due to prior negative experiences, fear discrimination, poor accommodations, and inappropriate staff behavior. Emergency physicians receive minimal training on transgender care. This study sought understand the patients when visiting EDs Portland metro area, knowledge Oregon Health & Science University (OHSU) ED staff.
Abstract Introduction Spinal epidural abscess (SEA) is a rare and life-threatening infection with increasing incidence over the past two decades. Delays in diagnosis can cause significant morbidity mortality among patients. Objective The objective of this study was to describe trends time-to-imaging intervention, risk factors, outcomes patients presenting emergency department SEA at single academic medical center Portland, Oregon. Methods This retrospective cohort analyzed data from new...
Implementing a telephone follow-up system after patient's emergency department (ED) visit is challenging, but it may improve patient safety and care. This study's objective was to describe the development implementation of comprehensive ED over 9-year period. Discharged patients who received call within 48 hours their included all pediatric patients, those left without being seen by provider, any adult with "high-risk chief complaint," which defined as headache, visual problem, chest pain,...
Direct medical oversight (DMO), where emergency services (EMS) clinicians contact a physician for real-time direction, is used by many EMS systems across the United States. Our objective was to characterize recommendations made DMO during out-of-hospital cardiac arrests (OHCA) and determine their effect on transport decisions patient outcomes.This secondary analysis of call recordings from OHCA cases in Portland, Oregon metropolitan area January 1, 2018 February 28, 2021. Data extracted...
Abstract Objectives Earlier electrocardiogram (ECG) acquisition for ST‐elevation myocardial infarction (STEMI) is associated with earlier percutaneous coronary intervention (PCI) and better patient outcomes. However, the exact relationship between timely ECG PCI unclear. Methods We quantified influence of door‐to‐ECG (D2E) time on ECG‐to‐PCI balloon (E2B) in this three‐year retrospective cohort study, including patients from 10 geographically diverse emergency departments (EDs) co‐located a...
In 2017, the authors published an article describing experiences of Oregon Health & Science University (OHSU) as it adapted to new challenges changing payment models, imperative manage health populations, and desire compete for statewide contracts. The described Propel Health, a multi-institution partnership created in 2013 deliver tools, methods, support necessary population management. ensuing two years there were considerable changes structure mission ultimately resulting its dissolution...
Background Spinal epidural abscess (SEA) is increasing in incidence; this not-to-miss diagnosis can cause significant morbidity and mortality, particularly if diagnoses are delayed. While some risk factors for SEA subsequent mortality have been identified, the patient population clinically heterogeneous sub-populations not yet characterized literature. The primary objective of project was to identify characteristics subgroups patients with SEA. secondary associations between three clinical...
When a patient is admitted to the hospital from emergency department (ED), ED clinician passes on relevant clinical information admitting team transition care, process known as hand-off and commonly referred ‘calling report’. This exchange between teams not only important for care continuity but also signifies of care. However, there are unique challenges in this given unpredictability busy environment, boarding discontinuity physician, nursing transportation workflows. These create...
Background: AHA/ACC/ESC practice guidelines advise an ECG within 10 minutes for all patients with symptoms suggestive of ST-segment elevation myocardial infarction (STEMI). This facilitates early diagnosis and timely treatment. Earlier treatment, particularly percutaneous coronary intervention (PCI), has been associated better clinical outcomes. Our objective was to quantify the impact delayed screening on treatment determine if there may be race, sex or presenting complaint disparities....
Abstract Background Spinal epidural abscess (SEA) is a rare and life-threatening infection with increased incidence over the past two decades. Delays in diagnosis cause significant morbidity mortality among patients. The objective of this study was to describe average time-to-imaging frequencies intervention, risk factors, outcomes patients SEA presenting an emergency department at single academic health center Portland, Oregon. Methods This retrospective cohort reviewed data from no prior...