Recent westjem items

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

Sat, 29 Aug 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

Sat, 29 Aug 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...

Traumatic Extremity Amputations in Children: Causes and Outcomes Based on a Regional Experience

Sat, 29 Aug 2026 00:00:00 +0000

Introduction: Pediatric traumatic extremity or digit amputations are preventable causes of morbidity. The object of this study was to evaluate the etiology and outcomes of these injuries in our region. We used the Childhood Opportunity Index to explore the role of social determinants of health.

Methods: We performed a retrospective cohort study at an academic children’s hospital on all pediatric patients younger than 18 years who presented with a traumatic digit or extremity amputation between January 1, 2014, to July 31, 2024. Metrics such as patient demographics, injury severity, prehospital course, hospital events and follow-up were abstracted. The Childhood Opportunity Index assigns a 0-100 composite score of region-based childhood opportunity determined from home ZIP codes. Our primary outcome measure was mechanism of injury. Secondary outcomes included length of stay, need for initial surgical intervention, subsequent operations,...

Changing Risk Factors in Patients Diagnosed with Human Immunodeficiency Virus

Wed, 26 Aug 2026 00:00:00 +0000

Introduction: Since 2019, transmission risk factors among patients diagnosed with HIV have changed, although the trends and reasons behind them have not been fully elucidated. The objective of this study was to assess changes in HIV transmission risk factors among patients newly diagnosed with HIV to inform future targeted HIV testing programs.

Methods: This study site is New England’s largest essential hospital and a major reporter of new HIV cases in Massachusetts. We performed a retrospective chart review of patients diagnosed with HIV infection at our medical center between January 2019 and December 2023. Demographic and clinical variables were collected and analyzed using descriptive and comparative statistics to evaluate trends in primary risk factor for HIV. Our primary outcome measure was incident HIV diagnosis with a primary risk factor of injection drug use (IDU), men who have sex with men (MSM), or heterosexual contact. A...

Emergency Severity Index Stratified by Post-Triage Lactate: Association with In-Hospital Mortality in Admitted Patients

Sun, 23 Aug 2026 00:00:00 +0000

Introduction: The Emergency Severity Index (ESI) is a widely used triage tool in emergency departments (EDs) and is associated with adverse outcomes. Lactate has also been associated with mortality in various ED populations. This study evaluated whether lactate levels measured after triage at the treating physician’s discretion are associated with in-hospital mortality across ESI levels in admitted ED patients.

Methods: This study is a secondary analysis of prospectively collected data from adult patients presenting to the ED of a Swiss tertiary care center in 2013, 2015, 2017, and 2019. The study included admitted patients who underwent post-triage lactate measurement at the treating physician’s discretion. Only the first lactate value measured in the ED was analyzed and categorized as < 2.0, 2.0–3.9, and ≥ 4.0 mmol/L. The primary outcome was in-hospital mortality; secondary outcomes were 30-day mortality and intensive care unit...

From Stress to Strength: Fostering a Positive Learning Climate to Promote Learning, Performance, and Well-Being

Fri, 21 Aug 2026 00:00:00 +0000

From Stress to Strength: Fostering a Positive Learning Climate to Promote Learning, Performance, and Well-Being

From AUC to Action: AI Sepsis Alerts as Quality Improvement Tools in the Emergency Department

Fri, 21 Aug 2026 00:00:00 +0000

From AUC to Action: AI Sepsis Alerts as Quality Improvement Tools in the Emergency Department

Climate Change and Heat-related Illness in Older Adults: Implications for Emergency Medicine

Mon, 17 Aug 2026 00:00:00 +0000

Climate change is increasing the frequency, duration, and intensity of extreme heat events, creating a growing public health threat for older adults. Age-related physiologic decline, comorbid chronic diseases, polypharmacy, and social vulnerability all contribute to reduced heat tolerance and higher rates of heat-related morbidity and mortality. Emergency departments (ED) are increasingly encountering older adults presenting with minor heat illness, heat stroke, and exacerbations of chronic illnesses triggered by heat exposure. This review synthesizes current evidence describing why older adults are disproportionately affected by extreme heat, highlights key social and environmental determinants of vulnerability, and outlines clinical and public health strategies that emergency clinicians and EDs can assist with to reduce risk. As global temperatures rise, proactive prevention, early recognition, and coordinated community interventions are essential to protect this high-risk...

Emergency Department Evaluation and Care of Hepatic Encephalopathy: ACEP Expert Panel Recommendations

Mon, 17 Aug 2026 00:00:00 +0000

Introduction: Patients with hepatic encephalopathy frequently visit the emergency department, and these visits are expected to rise in the coming years due to an increased prevalence of liver disease in the United States. Accordingly, we sought to define a comprehensive and efficient approach for emergency physicians to evaluate, treat, and determine the optimal disposition of patients presenting with possible or confirmed hepatic encephalopathy and its complications.

Methods: We reached consensus recommendations through a structured literature review and a modified Delphi technique, informing an expert panel of academic and community emergency physicians convened by the American College of Emergency Physicians.

Results: We created the assess, look, treat, evaluate risk, reassess, disposition (ALTERD) framework as a digital point-of-care tool to support clinicians in guiding key bedside steps involved in the diagnosis...

Evaluating the Impact of a Sustainability Education Intervention on Emergency Medicine Residents

Mon, 10 Aug 2026 00:00:00 +0000

Introduction: Healthcare is a significant contributor to global greenhouse gas emissions, with emergency departments being among the most resource-intensive settings. Despite increasing awareness of climate change and its health implications, structured sustainability education remains lacking in emergency medicine graduate medical education training. We evaluated the impact of a brief, educational intervention on emergency medicine (EM) residents’ knowledge, attitudes, and self-reported behaviors related to sustainability.

Methods: We conducted a prospective pre/post interventional study at two community-based EM residency programs. Emergency medicine residents completed a baseline survey assessing sustainability-related knowledge, attitudes, and self-reported behaviors, followed by a video on sustainable clinical practice and a peer-reviewed paper on the environmental impact of inhalers. Immediate postcourse and one-month follow-up...

Implementation Science to Advance Equity in Climate-Driven Disaster Response

Mon, 10 Aug 2026 00:00:00 +0000

Climate hazards are causing increasingly frequent and severe disasters. The populations most impacted by the health and social costs of disasters include language minorities, displaced individuals, and low-income communities. This commentary explores three key issues. First, climate hazards lead to displacement and increase vulnerability by disrupting housing, livelihoods, and access to care. Second, current emergency and disaster frameworks often overlook equity in communication, access to care, and recovery. Third, practical solutions can prioritize equity across mitigation, preparedness, response, and recovery. We review evidence on climate displacement, legal protections, and the roles of the health system. We highlight recurring operational opportunities, such as language access, navigation barriers, and fragmented recovery efforts. We also propose feasible strategies aligned with implementation science, including multilingual warning systems, interpreter-ready triage,...

Hepatitis C Care Cascade in Opioid-Dependent Emergency Department Patients

Thu, 6 Aug 2026 00:00:00 +0000

Introduction: Emergency departments (ED) have become important venues for hepatitis C (HCV) screening. Similarly, EDs have had increasing engagement in the management and treatment of opioid use disorder (OUD). Persons with OUD are at disproportionate risk for acquiring HCV. We sought to assess the intersection between OUD and HCV care through observing the uptake of HCV screening and subsequent steps in the HCV care cascade in an ED-OUD cohort.

Methods: This retrospective cohort study analyzed patients enrolled in an ED-OUD treatment program as a convenience sample subgroup of a larger institutional ED opt-out HCV screening program conducted at a single urban site in Alabama between July 2019–June 2022. Opt-out, nonfocused HCV screening provision was standardized at triage, excluding pregnant and incarcerated individuals. Descriptive analyses were conducted to ascertain screening uptake, positive screening, confirmatory testing, linkage...

Impact of a Rapid Assessment Zone on Patient Throughput in an Urban Pediatric Emergency Department

Thu, 6 Aug 2026 00:00:00 +0000

Introduction: The rapid assessment zone is a newer model for optimizing emergency department (ED) throughput. Similar models implemented in adult ED settings have shown improvements in throughput parameters. However, few studies have taken place in the pediatric ED setting. Our study objective was to assess the impact of implementing a rapid assessment zone on throughput in an urban pediatric ED. We hypothesized that length of stay (LOS), time to bed placement, and time to see a clinician would decrease after the intervention and remain sustainable over long-term follow-up.

Methods: This retrospective study assessed the effect of rapid implementation from May 2012–April 2018 on LOS for ED visits for three two-year time periods: pre- and post-rapid assessment zone and post-follow-up. Our primary outcome measures were LOS, time from registration to bed, and time from registration to first clinician evaluation. Secondary outcome measures...

Effect of Real-time Feedback on the Quality of Cardiopulmonary Resuscitation for Medical Studentsin Colombia

Tue, 4 Aug 2026 00:00:00 +0000

Introduction: High-quality cardiopulmonary resuscitation (CPR) is essential to improve survival in cases of cardiac arrest. However, skill acquisition based solely on instructor observation has proven to be limited. In this context, real-time feedback devices emerge as promising tools to optimize CPR training.
Objective: In this study our goal was to evaluate the effect of using a real-time feedback device on the quality of CPR performed by medical students at a public university in Colombia.

Methods: This was an experimental study with fourth-year medical students, randomly assigned to two groups. Both groups received the same initial theoretical and practical training in basic CPR. Subsequently, the intervention group practiced with a real-time feedback device, while the control group trained without technological feedback. The primary outcome measure was the target of chest compressions, simultaneously meeting both a rate of 100-120...

Clinical Characteristics of an Emergency Department-led Asynchronous Care Platform