A5039519007- Emergency and Acute Care Studies
- Trauma and Emergency Care Studies
- Sepsis Diagnosis and Treatment
- Cardiac Arrest and Resuscitation
- Innovations in Medical Education
- Healthcare Policy and Management
- Chronic Obstructive Pulmonary Disease (COPD) Research
- Telemedicine and Telehealth Implementation
- Intensive Care Unit Cognitive Disorders
- Chronic Disease Management Strategies
- COVID-19 and healthcare impacts
- Heart Rate Variability and Autonomic Control
- Clinical Reasoning and Diagnostic Skills
- Health Systems, Economic Evaluations, Quality of Life
- Primary Care and Health Outcomes
- Ultrasound in Clinical Applications
- Hospital Admissions and Outcomes
- Respiratory Support and Mechanisms
- Neonatal Respiratory Health Research
- Injury Epidemiology and Prevention
- Infection Control and Ventilation
- Global Health Workforce Issues
- Health Sciences Research and Education
- Mobile Health and mHealth Applications
- Healthcare Systems and Public Health
University of Iowa
2018-2025
NHS Highland
2021-2023
ORCID
2020
University of Iowa Hospitals and Clinics
2020
Faculty of Public Health
2020
Public Health Department
2020
Contrary to advanced cardiac life support guidelines that recommend immediate defibrillation for shockable in-hospital arrest (IHCA), epinephrine administration before first is common and associated with lower survival at a "patient-level." Whether this practice varies across hospitals its association "hospital-level" IHCA remains unknown. The purpose of study was determine hospital variation in rates survival.
OBJECTIVES Sepsis is a time-sensitive condition, and many rural emergency department (ED) sepsis patients are transferred to tertiary hospitals. The objective of this study was determine whether longer transport times during interhospital transfer associated with higher mortality or increased hospital length-of-stay (LOS).
Background: Provider-to-provider emergency department telehealth (tele-ED) has been proposed to improve rural sepsis care. The objective of this study was measure the association between documentation and tele-ED use, treatment guideline adherence, mortality. Methods: This analysis a multicenter (n = 23) cohort patients treated in departments (EDs) that participated network August 2016 June 2019. primary outcome whether documented explicitly clinical note impression local ED, exposure with...
Abstract Objective To determine the use of epinephrine (adrenaline) before defibrillation for treatment in-hospital cardiac arrest due to a ventricular arrhythmia and examine its association with patient survival. Design Propensity matched analysis. Setting 2000-18 data from 497 hospitals participating in American Heart Association’s Get With The Guidelines-Resuscitation registry. Participants Adults aged 18 older an index initial shockable rhythm treated defibrillation. Interventions...
Early recognition and prompt prehospital care is a cornerstone of acute stroke treatment. Residents rural areas have worse access to services than urban residents. The purpose this study was (1) describe US trends in rural-urban mortality (2) identify possible factors associated with case-fatality disparities.This nationwide retrospective cohort admissions. primary exposure rurality patient's residence. outcome death during hospital encounter. secondary discharge facility or home healthcare....
Sepsis is a life-threatening emergency. Together, early recognition and intervention decreases mortality. Protocol-based resuscitation in the emergency department (ED) has improved survival sepsis patients, but guideline-adherent care less common low-volume EDs. This study examined association between provider-to-provider telemedicine adherence with bundle components rural community hospitals.This prospective cohort of adults presenting or septic shock EDs participating networks. The primary...
Introduction: Acute myocardial infarction (AMI) is a time-sensitive condition. Meeting guideline-recommended time metrics for these patients can be challenging in rural emergency departments (EDs). Telemedicine has been shown to improve the quality and timeliness of care areas. The objective this study was evaluate impact telemedicine on AMI presenting EDs with chest pain. Methods: A prospective cohort study, conducted six networks, identified ED pain from November 2015 through December...
Background To assess clinical and epidemiological trends of severe sepsis. Methods Ecological study patients presenting to the emergency department with sepsis or septic shock between 2005 2013. Patients were identified using state-wide hospital administrative database. Key outcomes included incidence rates (IRs) mortality (per 1000 population) by age medically underserved areas (MUAs), case fatality rate (deaths per 100 cases), proportions transfer comorbidities. Results There 154 019 cases...
There are over 300,000 out-of-hospital cardiac arrests (OHCA) annually in the United States (US) and despite many scientific advances field, survival rate remains low. We seek to determine if return of spontaneous circulation (ROSC) is higher when use emergency medical dispatch (EMD) protocols documented for OHCA calls compared no EMD protocol documented. also identify care-related processes that differ protocols.
Background: Access to specialized medical care is often limited in rural emergency departments (EDs). Specialist consultation through telemedicine services could help increase access low-resource areas. Introduction: The objective of this study was better understand providers' perceptions the anticipated impact Midwestern EDs. secondary differences perception and academic providers their views utility telemedicine. Materials Methods: We conducted a survey including physicians, physician...
Sepsis is a life-threatening infection that affects over 1.7 million Americans annually. Low-volume rural hospitals have worse sepsis outcomes, and emergency department (ED)-based telemedicine (tele-ED) has been one promising strategy for improving care. The objective of this study to evaluate the impact tele-ED consultation on care outcomes in ED patients. TELEvISED multicenter (n = 25) retrospective propensity-matched comparative effectiveness patients mature network. Telemedicine-exposed...
To determine the association between potentially avoidable transfers (PATs) and emergency department (ED) pediatric readiness scores score's associated components.This cross-sectional study linked 2012 National Pediatric Readiness Project assessment with individual encounter data from California's statewide ED inpatient databases during years 2011-2013. A probabilistic linkage, followed by deterministic heuristics, pretransfer, post-transfer encounters. Applying previously published...
As the population of older adults increases, appropriate deprescribing becomes increasingly important for emergency geriatric care. Older represent sickest patients with chronic medical conditions, and they are often exposed to high-risk medications. We need provide an evidence-based, standardized program in acute care setting, yet evidence base is lacking medication programs needed.We conducted a qualitative study goal understand perspective healthcare workers, patients, caregivers on...
Sepsis is a common cause of death. The Centers for Medicare and Medicaid Services severe sepsis/septic shock (SEP-1) bundle focused on improving sepsis outcomes, but it unknown which quality improvement (QI) practices are associated with SEP-1 compliance reduced mortality. objectives this study were to compare QI in reporting nonreporting hospitals measure the association between processes, performance, mortality.This linked survey data from Iowa performance Characteristics compared by...
Telemedicine can improve access to emergency stroke care in rural areas, but the benefit of telemedicine across different types and models networks is unknown. The objectives this study were (a) identify impact on department (ED) care, (b) if varied by network (c) describe variation process outcomes EDs.A prospective cohort identified patients four between November 2015 December 2017. Primary exposure was consultation during ED evaluation. Outcomes included: interpretation computed...