Recent westjem items

Acceptability of a Novel Prehospital Emergency Care System Evaluation Tool Among Southeast Asian Stakeholders: A Cross-Sectional Survey

Tue, 13 Oct 2026 00:00:00 +0000

Introduction: Prehospital emergency care (PEC) systems vary widely in structure, capacity, and stage of development, and existing evaluation tools are not tailored to the contextual needs of Southeast Asia. To address this gap, the Prehospital Emergency Care System Evaluation Tool (PECSET) was developed as a 32-element, consensus-derived framework to support system assessment, prioritization, and quality improvement. The objective of this study was to evaluate the prospective acceptability of the PECSET framework among Southeast Asian prehospital stakeholders using the theoretical framework of acceptability (TFA) and to identify regional variation in implementation priorities.

Methods: We conducted a cross-sectional survey of PEC professionals from the Philippines, Thailand, Vietnam, Indonesia, and Malaysia between April 2023 and June 2024. Participants were recruited from six resuscitation training conferences and attended a standardized...

Assessment of Combined Food and Nutrition Insecurity Screening in the Emergency Department: A Brief Report

Tue, 13 Oct 2026 00:00:00 +0000

Introduction: Emergency department (ED) food insecurity (FI) screening traditionally identifies insufficient access to food but does not account for diet quality. We evaluated the incremental yield of adding a nutrition insecurity (NI) screener to routine FI screening.

Methods: This single-center observational study enrolled adult ED patients from April–September 2025. Participants completed the 2-item Hunger Vital Sign and a 1-item NI screener. Our primary measure was incremental yield of NI screening beyond FI screening, defined by the number of NI-positive/FI-negative patients identified. Secondary outcome measures included FI and NI prevalence, screening concordance, and number needed to screen. Screening fidelity was supported through structured training of research associates and standardized phrasing.

Results: Of 1,120 patients, 13.6% (95% CI, 11.6–15.7%) screened positive for FI and 11.4% (95% CI,...

Prehospital Buprenorphine: A National Cross-Sectional Analysis

Tue, 13 Oct 2026 00:00:00 +0000

Introduction: Initiation of buprenorphine reduces mortality in people with opioid use disorder. However, patients who decline hospital transport after overdose may not be connected to treatment. To augment treatment engagement, prehospital buprenorphine pilot programs began in 2019. To date, few studies have looked at these programs nationally. Our objective was to evaluate national prehospital buprenorphine usage.

Methods: We conducted a cross-sectional evaluation of emergency medical service (EMS) encounters involving prehospital buprenorphine administration using the 2020-2023 National EMS Information System Public Release Research datasets. Our primary outcome was trends in prehospital buprenorphine usage. Quarterly rates of prehospital buprenorphine were evaluated using joinpoint regression to identify inflection points. The secondary outcome was patient demographics and encounter characteristics, which were analyzed using descriptive...

Factors Associated with Early ED Return Among Patients Discharged After Treatment for Alcohol Withdrawal Syndrome

Tue, 13 Oct 2026 00:00:00 +0000

Introduction: Alcohol withdrawal syndrome (AWS) is a frequent cause of emergency department (ED) visits, and some patients return soon after discharge. Identifying factors associated with short-term ED return may inform targeted interventions. Our primary objective was to identify factors associated with 72-hour ED return and 30-day hospital admission among patients discharged after treatment for AWS.

Methods: We conducted a retrospective review of 318 ED encounters for AWS at a single academic medical center from January 1, 2020, to December 31, 2023. Demographic, psychiatric, housing, insurance, and discharge pharmacology variables were collected. We evaluated ED pharmacologic treatment strategy and discharge taper prescriptions. The primary outcome measure was 72-hour ED return, and the secondary outcome measure was hospital admission within 30 days. We compared groups using chi-square, Shapiro-Wilk, Fisher exact, and Mann–Whitney...

Cumulative Weighted-Average Acuity Level: A Novel Clinician-Level Metric to Detect Emergency Department Surge Conditions in Real Time

Tue, 13 Oct 2026 00:00:00 +0000

Introduction: Emergency department (ED) surge events, defined as the episodic clustering of high-acuity patients that transiently overwhelms available clinician capacity, are associated with delays in care and potential patient harm. Existing crowding metrics do not quantify real-time clinician-level workload. This paper describes the development and preliminary feasibility evaluation of a novel acuity-weighted metric—the cumulative weighted-average acuity level (CWAAL)—to detect physician-level surge conditions in real time.

Methods: This multiphase observational feasibility study was conducted at two rural community EDs. The CWAAL is defined as the sum of weighted acuity scores for all active patients under a single clinician’s management: it incorporates a feasibility threshold derived by combinatorial enumeration. The primary outcome was door-to-doctor time (DDT); secondary outcomes included length of stay (LOS) and CWAAL distribution....

Impact of Increasing Ambient Temperatures on Emergency Department Trauma Presentations at a Level I Trauma Center

Sun, 11 Oct 2026 00:00:00 +0000

Introduction: Global temperatures are increasing because of climate change, affecting human health. Elevated ambient temperature has been shown to increase rates of trauma presentations in emergency departments and to increase antisocial behavior, such as violent crime. To better understand how to reduce the burden on trauma hospitals, we must better understand the relationship between ambient temperature, trauma patients, and intentional injury. We sought to examine the relationship between trauma rates and minimum and maximum daily temperatures and assess whether the assault trauma mechanism had the strongest association between weather and trauma rates.

Methods: We conducted a retrospective cohort study of full and partial trauma team activations that presented to a Level I trauma center in New York from 2012 to 2019, inclusive. Daily maximum and minimum temperatures were divided into quintile ranges. Traumas were classified by injury...

WestJEM Full-Text Issue

Sat, 10 Oct 2026 00:00:00 +0000

WestJEM Full-Text Issue

Intubation Practices and Outcomes in Diverse Emergency Departments Within a Single Health System

Fri, 9 Oct 2026 00:00:00 +0000

Introduction: Endotracheal intubation (ETI) is a life-saving procedure commonly performed in emergency departments (ED). Prior research has demonstrated significant variability in ETI experience, practices, and outcomes across EDs. Health systems often include a mix of ED environments, from large academic hospitals to community-based and freestanding EDs. However, little is known about how ETI experiences and outcomes vary within a single health system. Our objective in this study was to compare first-attempt success across three EDs representing different practice environments but within one health system.

Methods: This retrospective observational study used institutional data from 1,659 ETI events between November 2021–January 2025 to compare ETI-related outcomes across three EDs representing a spectrum of settings: an academic Level I trauma center (A); a community teaching hospital (B); and a nonteaching community site (C). Our primary...

Acute Headache Management and Emergency Department Throughput: A Multicenter Retrospective Analysis

Sun, 4 Oct 2026 00:00:00 +0000

Introduction: Headache is a common presentation to the emergency department (ED), requiring both accurate diagnosis and efficient management. Although consensus guidelines exist, real-world treatment practices and their associations with operational outcomes remain variable. We evaluated the association between acute headache management strategies—including medications, diagnostic imaging, and consultations—and ED length of stay (LOS), using both unadjusted and multivariable-adjusted analyses.

Methods: We conducted a multicenter retrospective observational study using data from 79,527 adult ED encounters for headache across 22 EDs in the southwestern and upper Midwestern United States between 2018 and 2024. The primary outcome was ED LOS. Secondary outcomes included LOS differences associated with medication classes, imaging modalities, procedures, and specialty consultations. Length of stay differences by treatment strategy were compared...

Impact of Physician Patient Load on Imaging Use in the Emergency Department

Sun, 4 Oct 2026 00:00:00 +0000

Introduction: Emergency department (ED) crowding may alter physician decision-making, yet little is known about how real-time physician workload affects diagnostic imaging use. We examined the association between physician patient load and the proportion of patients who received diagnostic imaging, including computed tomography (CT), CT with intravenous (IV) contrast, CT without contrast, plain radiography, magnetic resonance imaging (MRI), and ultrasound (US).

Methods: We conducted a retrospective cohort study of all ED visits at an academic tertiary care center (January 2019–December 2024). Physician workload was defined as the sequential patient assignment order per physician per day (range 1–17). Our primary outcome measures were binary indicators of whether each imaging modality was ordered during the ED visit: CT (any); CT with IV contrast; CT without IV contrast; radiograph, MRI; and US. Multivariable logistic regression with...

From De-escalation to Restraint: A Qualitative Study of Emergency Clinician Decision-Making in Patient Agitation

Sun, 4 Oct 2026 00:00:00 +0000

Introduction: Managing agitation in the emergency department (ED) is challenging and frequently involves decisions about physical restraints and emergent medications. While institutional protocols and behavioral response teams exist, little is known about how individual clinicians make decisions about restraint use—decisions with significant implications for safety, ethics, and equity. The objective of the study was to explore how emergency physicians, residents, and nurses make decisions about physical restraint and emergent medication use during episodes of patient agitation in the ED.

Methods: We conducted a qualitative study using semi-structured interviews with 35 emergency clinicians (18 attending physicians, 7 senior residents, and 10 nurses) at an urban academic ED. Interviews were transcribed and analyzed using inductive thematic analysis.

Results: Clinicians described three key factors informing restraint...

Efficiency and Humanism: The Impact of the Humanistic Charting Tool on Patient Experience in the Emergency Department

Sun, 4 Oct 2026 00:00:00 +0000

Introduction: Emphasis on documentation challenges clinicians to strike a balance between efficiency and individualized care, often leading to the depersonalization of patient interactions. The Humanistic Charting Tool (HCT) addresses this by integrating the patient’s voice into the electronic medical record (EHR). The objective of this study was to examine whether use of the HCT during emergency department (ED) visits is feasible and improves key patient experience metrics.

Methods: The study took place in an urban, academic hospital. Patients in the ED completed the HCT while waiting to see a clinician. The patient’s responses were condensed into a two-page summary and uploaded into their EHR. Clinicians were asked whether they used the HCT for each patient at the end of the encounter, and patients completed precare and postcare surveys assessing key experience metrics. Our primary outcome measure was changes in patient experience...

Impact of Secure Electronic Health Record Chat on Physician Communication in the Emergency Department