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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 15 of 15 Research Studies DisplayedJurlina A, Maul T, Hunsaker P
Changes in bronchiolitis characteristics during the COVID-19 pandemic: a description of pediatric emergency department visits in a community hospital, 2019-2021.
The purpose of this retrospective, cross-sectional study was to describe changes in bronchiolitis characteristics in pediatric emergency department patients in a community hospital during the COVID-19 pandemic. The researchers conducted the study with children with bronchiolitis aged 1 to 24 months during an ED visit between 2019 and 2021. The study found that bronchiolitis cases decreased by 75% from 2019 to 2020 and rose back to prepandemic levels by 2021. Radiographs, steroids, and bronchodilators decreased during the study period. Laboratory studies, viral testing, antibiotic use, and respiratory support were unchanged. The decrease in steroids and bronchodilators was related to a clinical pathway that discouraged their use. Respiratory support remained unchanged.
AHRQ-funded; HS026393.
Citation: Jurlina A, Maul T, Hunsaker P .
Changes in bronchiolitis characteristics during the COVID-19 pandemic: a description of pediatric emergency department visits in a community hospital, 2019-2021.
Clin Pediatr 2024 Jan; 63(1):73-79. doi: 10.1177/00099228231208941..
Keywords: COVID-19, Respiratory Conditions, Children/Adolescents, Emergency Department
Huff NR, Liu G, Chimowitz H
COVID-19 related negative emotions and emotional suppression are associated with greater risk perceptions among emergency nurses: a cross-sectional study.
The objectives of this study were to investigate the relationship between emergency nurses' emotional experiences in response to the COVID-19 pandemic and their perceptions of risk to both patients and themselves, and also to investigate the extent to which the use of suppression and reappraisal processes for emotion management were associated with these perceptions. Nurses' negative emotions in response to the pandemic were associated with greater perceptions of both personal and patient safety risks. Chronic tendencies to suppress emotions uniquely predicted higher perceptions of risk. The authors concluded that understanding the factors that influence perceptions of risk are important, since these perceptions can motivate behaviors that may impact patient safety adversely.
AHRQ-funded; HS025752.
Citation: Huff NR, Liu G, Chimowitz H .
COVID-19 related negative emotions and emotional suppression are associated with greater risk perceptions among emergency nurses: a cross-sectional study.
Int J Nurs Stud Adv 2023 Dec; 5:100111. doi: 10.1016/j.ijnsa.2022.100111.
Keywords: COVID-19, Emergency Department, Provider: Nurse
Kilaru AS, Scheulen JJ, Harbertson CA
Boarding in US academic emergency departments during the COVID-19 pandemic.
The purpose of this retrospective study was to characterize changes in emergency department (ED) boarding among U.S. academic EDs across the duration of the COVID-19 pandemic. From January 2019 to December 2021 the researchers utilized a convenience sample of academic departments of emergency medicine to conduct an analysis of monthly data. The primary outcome was total boarding hours, and secondary outcomes included patient volume stratified by ED disposition. Of the 73 academic departments of emergency medicine contacted, 46.6% participated, a total of 43 individual EDs in 25 states. The study found that the adjusted mean total boarding hours per month were significantly lower during the second quarter of 2020 compared to the first quarter of 2019. Beginning in the second quarter of 2021, total boarding hours were significantly higher than pre-pandemic levels, peaking during the fourth quarter of 2021.
AHRQ-funded; HS026372.
Citation: Kilaru AS, Scheulen JJ, Harbertson CA .
Boarding in US academic emergency departments during the COVID-19 pandemic.
Ann Emerg Med 2023 Sep; 82(3):247-54. doi: 10.1016/j.annemergmed.2022.12.004..
Keywords: COVID-19, Emergency Department, Public Health
Jenkins JL, Hsu EB, Zhang A
Current evidence for infection prevention and control interventions in emergency medical services: a scoping review.
This study’s aim was to summarize current evidence from the United States on the effectiveness of practices and interventions for preventing, recognizing, and controlling occupationally acquired infectious diseases in Emergency Medical Service (EMS) clinicians. A database search was conducted for literature published January 2006 through March 15, 2022 to search for studies in the United States that involved EMS clinicians and firefighters, reported on one or more workplace practices or interventions that prevented or controlled infectious diseases, and included outcome measures. Eleven observational studies reported on infection prevention and control (IPC) practices providing evidence that hand hygiene, standard precautions, mandatory vaccine policies, and on-site vaccine clinics are effective. Less frequent handwashing and less frequent hand hygiene after glove use were positively correlated with nasal colonization of Methicillin-resistant Staphylococcus aureus (MRSA). Lack of personal protective equipment (PPE) or PPE breach were correlated with higher severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seropositivity and virus 2 (SARS-CoV-2) seropositivity. Workers were more likely to be vaccinated against influenza if their employer offered the vaccine. Vaccination rates for H1N1 influenza increased with the use of active, targeted education modules.
AHRQ-funded; 75Q80120D00003.
Citation: Jenkins JL, Hsu EB, Zhang A .
Current evidence for infection prevention and control interventions in emergency medical services: a scoping review.
Prehosp Disaster Med 2023 Jun; 38(3):371-77. doi: 10.1017/s1049023x23000389..
Keywords: COVID-19, Emergency Department, Evidence-Based Practice, Prevention, Public Health, Infectious Diseases
Prasad PA, Correia J, Fang MC
Performance of point-of-care severity scores to predict prognosis in patients admitted through the emergency department with COVID-19.
The purpose of this study was to determine whether sepsis risk stratification scores can predict poor outcomes among hospitalized COVID-19 patients. The researchers retrospectively evaluated a cohort of adults presenting with COVID-19 to 156 Hospital Corporation of America (HCA) Healthcare emergency departments (Eds) from March 2, 2020, to February 11, 2021. The study administered the Quick Sequential Organ Failure Assessment (qSOFA), Shock Index, National Early Warning System-2 (NEWS2), and quick COVID-19 Severity Index (qCSI) at patient presentation. The primary outcome was in-hospital mortality, and secondary outcomes included intensive care unit (ICU) admission, mechanical ventilation, and vasopressors receipt. The study identified 90,376 patients with community-acquired COVID-19. 17.2% of patients died in-hospital, 28.6% went to the ICU, 13.7% received mechanical ventilation, and 13.6% received vasopressors. There were 3.8% qSOFA-positive, 45.1% Shock Index-positive, 49.8% NEWS2-positive, and 37.6% qCSI-positive at ED-triage. NEWS2 exhibited the highest AUROC for in-hospital mortality, followed by ICU admission, mechanical ventilation, and vasopressor receipt. The researchers concluded that sepsis severity scores at presentation have low discriminative power to predict outcomes in COVID-19 patients and are not reliable for clinical use.
AHRQ-funded; HS027369.
Citation: Prasad PA, Correia J, Fang MC .
Performance of point-of-care severity scores to predict prognosis in patients admitted through the emergency department with COVID-19.
J Hosp Med 2023 May; 18(5):413-23. doi: 10.1002/jhm.13106..
Keywords: COVID-19, Emergency Department, Diagnostic Safety and Quality
Shankar LG, Habich M, Rosenman M
Mental health emergency department visits by children before and during the COVID-19 pandemic.
Investigators described pediatric mental health emergency department (ED) visit rates and visit characteristics before and during the COVID-19 pandemic. They found that mental health ED visit rates by children increased during the COVID-19 pandemic.
AHRQ-funded; HS026385.
Citation: Shankar LG, Habich M, Rosenman M .
Mental health emergency department visits by children before and during the COVID-19 pandemic.
Acad Pediatr 2022 Sep-Oct;22(7):1127-32. doi: 10.1016/j.acap.2022.05.022..
Keywords: COVID-19, Children/Adolescents, Emergency Department, Behavioral Health, Healthcare Utilization, Public Health
Cutler GJ, Bergmann KR, Doupnik SK
Pediatric mental health emergency department visits and access to Inpatient care: a crisis worsened by the COVID-19 pandemic.
The purpose of this study was to explore the author’s previous research findings on trends in pediatric emergency department (ED) visits for mental health (MH) vs non-mental health in light of more recent related data corresponding with the COVID-19 pandemic. The study found that recent research supports the dramatic increase in pediatric MH ED visits found in the author’s previous research and provides additional evidence that the increase has been driven by specific MH diagnoses. The researchers conclude that depressive disorders, self-harm behavior, and non-alcohol substance use disorders should be prioritized for the development of ED- and hospital-based strategies, and that EDs, hospitals, health systems, and the government urgently need to increase capacity for MH services and identify innovative solutions to improve access to high quality MH care for children.
AHRQ-funded; HS026385.
Citation: Cutler GJ, Bergmann KR, Doupnik SK .
Pediatric mental health emergency department visits and access to Inpatient care: a crisis worsened by the COVID-19 pandemic.
Acad Pediatr 2022 Aug;22(6):889-91. doi: 10.1016/j.acap.2022.03.015..
Keywords: Children/Adolescents, COVID-19, Behavioral Health, Emergency Department, Access to Care, Public Health, Inpatient Care
Hinson JS, Klein E, Smith A
Multisite implementation of a workflow-integrated machine learning system to optimize COVID-19 hospital admission decisions.
This study’s objective was to develop, implement, and evaluate an electronic health record (EHR) embedded clinical decision support (CDS) system that leveraged machine learning (ML) to estimate short-term risk for clinical deterioration in patients with or under investigation for COVID-19. The system translates model-generated risk for critical care needs within 24 hours and inpatient care needs within 72 hours into rapidly interpretable COVID-19 Deterioration Risk Levels made viewable within ED clinician workflow. A retrospective cohort of 21,452 ED patients who visited one of five ED study sites was used to derive ML models and were prospectively validated in 15,670 ED visits that occurred before (n = 4322) or after (n = 11,348) CDS implementation. Model performance and numerous patient-oriented outcomes including in-hospital mortality were measured across study periods. ML model performance was excellent under all conditions. AUC ranged from 0.85 to 0.91 for prediction of critical care needs and 0.80-0.90 for inpatient care needs. Total mortality was unchanged across study periods but was reduced among high-risk patients after the implementation.
AHRQ-funded; HS026640.
Citation: Hinson JS, Klein E, Smith A .
Multisite implementation of a workflow-integrated machine learning system to optimize COVID-19 hospital admission decisions.
NPJ Digit Med 2022 Jul 16;5(1):94. doi: 10.1038/s41746-022-00646-1..
Keywords: COVID-19, Clinical Decision Support (CDS), Health Information Technology (HIT), Implementation, Electronic Health Records (EHRs), Emergency Department, Shared Decision Making
Ward MJ, Shuster JL, Mohr NM
Implementation of telehealth for psychiatric care in VA emergency departments and urgent care clinics.
The purpose of this AHRQ-funded, mixed-methods study was to evaluate an emergency telehealth intervention in emergency department (ED) and urgent care clinic (UCC) settings within the Veterans Health Administration (VHA) in March 2020. The Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework was utilized to compare the 3 months preimplementation of the telehealth intervention (December 1, 2019 through February 29, 2020) with the 3 months postimplementation of the telehealth intervention (April 1, 2020 through June 30, 2020), and then assess sustainability through January 31, 2021. Qualitative data from surveys and semistructured interviews were conducted and analyze. The telemental health intervention was used in 83% (319) of unscheduled mental health consultations in the postimplementation phase, with no adverse trends in length of stay, 7-day revisits, or 30-day mortality. In the sustainability phase, use of the intervention was high with 82% (n = 1,010) of all unscheduled mental health consultations performed by telemental health. The study concluded that the use of unscheduled telemental health intervention was highly acceptable and sustainable in ED and UCC settings and did not impact the safety and efficacy of mental health consultations.
AHRQ-funded; HS025753.
Citation: Ward MJ, Shuster JL, Mohr NM .
Implementation of telehealth for psychiatric care in VA emergency departments and urgent care clinics.
Telemed J E Health 2022 Jul;28(7):985-93. doi: 10.1089/tmj.2021.0263..
Keywords: COVID-19, Telehealth, Health Information Technology (HIT), Behavioral Health, Emergency Department
Murray E, Roosevelt GE, Vogel JA
Screening for health-related social needs in the emergency department: adaptability and fidelity during the COVID-19 pandemic.
Researchers sought to evaluate a screening and referral program for health-related social needs (HRSN) in an emergency department. Using the Accountable Health Communities Screening Tool, they found that, during the COVID-19 pandemic, HRSN doubled, likely reflecting the economic impact of the pandemic.
AHRQ-funded; HS023901.
Citation: Murray E, Roosevelt GE, Vogel JA .
Screening for health-related social needs in the emergency department: adaptability and fidelity during the COVID-19 pandemic.
Am J Emerg Med 2022 Apr;54:323.e1-23.e4. doi: 10.1016/j.ajem.2021.09.071..
Keywords: COVID-19, Social Determinants of Health, Emergency Department, Screening, Public Health
Hayden EM, Davis C, Clark S
Telehealth in emergency medicine: a consensus conference to map the intersection of telehealth and emergency medicine.
Through the 2020 Society for Academic Emergency Medicine's annual consensus conference, experts in emergency medicine (EM) and telehealth created a research agenda to explore how EM should intersect with telehealth. The multiyear process resulted in consensus with a final set of 24 important research questions. The primary finding from the process was the breadth of gaps in the evidence for telehealth in EM and telehealth in general. The consensus process identified priority research questions for the use of and evaluation of telehealth in EM to fill the current knowledge gaps.
AHRQ-funded; HS027528.
Citation: Hayden EM, Davis C, Clark S .
Telehealth in emergency medicine: a consensus conference to map the intersection of telehealth and emergency medicine.
Acad Emerg Med 2021 Dec;28(12):1452-74. doi: 10.1111/acem.14330..
Keywords: Telehealth, Health Information Technology (HIT), Emergency Department, COVID-19
Welsh M, Chimowitz H, Nanavati JD
A qualitative investigation of the impact of coronavirus disease 2019 (COVID-19) on emergency physicians' emotional experiences and coping strategies.
Throughout the coronavirus disease 2019 (COVID-19) pandemic, emergency physicians in the United States have faced unprecedented challenges, risks, and uncertainty while caring for patients in an already vulnerable healthcare system. As such, the pandemic has exacerbated high levels of negative emotions and burnout among emergency physicians, but little systematic qualitative work has documented these phenomena. The purpose of this qualitative investigation was to study emergency physicians' emotional experiences in response to COVID-19 and the coping strategies that they employed to navigate the pandemic.
AHRQ-funded; HS025752.
Citation: Welsh M, Chimowitz H, Nanavati JD .
A qualitative investigation of the impact of coronavirus disease 2019 (COVID-19) on emergency physicians' emotional experiences and coping strategies.
J Am Coll Emerg Physicians Open 2021 Oct;2(5):e12578. doi: 10.1002/emp2.12578..
Keywords: COVID-19, Emergency Department, Provider: Physician
Smulowitz PB, O'Malley AJ, Khidir H
National trends In ED visits, hospital admissions, and mortality for Medicare patients during the COVID-19 pandemic.
Concerns about avoidance or delays in seeking emergency care during the COVID-19 pandemic are widespread, but national data on emergency department (ED) visits and subsequent rates of hospitalization and outcomes are lacking. In this study, the investigators examined trends in ED visits and rates of hospitalization and thirty-day mortality conditional on an ED visit for non-COVID-19 conditions during several stages of the pandemic and for areas that were considered COVID-19 hot spots versus those that were not.
AHRQ-funded; HS025408.
Citation: Smulowitz PB, O'Malley AJ, Khidir H .
National trends In ED visits, hospital admissions, and mortality for Medicare patients during the COVID-19 pandemic.
Health Aff 2021 Sep;40(9):1457-64. doi: 10.1377/hlthaff.2021.00561..
Keywords: COVID-19, Public Health, Emergency Department, Hospitalization
Choi KR, Martinez-Hollingsworth A, Mead M
Adolescent psychiatric emergencies precipitated by the COVID-19 pandemic.
The purpose of this retrospective case series was to describe adolescent psychiatric emergencies precipitated by the coronavirus disease 2019 (COVID-19) pandemic. Findings showed that COVID-19-precipitated admissions were 24% of total admissions from March 15 to May 31, 2020; however, total admissions during this time period were reduced from the same time period in prior years. The COVID-19 pandemic and corresponding shelter-in-place orders may precipitate psychiatric emergencies among adolescents both with and without existing mental health disorders.
AHRQ-funded; HS026407.
Citation: Choi KR, Martinez-Hollingsworth A, Mead M .
Adolescent psychiatric emergencies precipitated by the COVID-19 pandemic.
J Psychosoc Nurs Ment Health Serv 2021 Jul;59(7):17-21. doi: 10.3928/02793695-20201203-05..
Keywords: Children/Adolescents, COVID-19, Behavioral Health, Emergency Department
Joshi RP, Pejaver V, Hammarlund NE
A predictive tool for identification of SARS-CoV-2 PCR-negative emergency department patients using routine test results.
This retrospective case-control study investigated whether the use of a prediction tool based on complete blood count results and patient sex can better allocate testing for SARS-CoV-2 PCR testing in hospital emergency departments. Participants were emergency department patients who had concurrent complete blood counts and SARS-CoV-2 PCR testing in Northern California, Seattle, Washington, Chicago Illinois, and South Korea. A hypothetical scenario of 1000 patients requiring testing was developed, but in this scenario testing resources are limited to 60% of patients. This tool would allow a 33% increase in properly allocated resources.
AHRQ-funded; HS026385.
Citation: Joshi RP, Pejaver V, Hammarlund NE .
A predictive tool for identification of SARS-CoV-2 PCR-negative emergency department patients using routine test results.
J Clin Virol 2020 Aug;129:104502. doi: 10.1016/j.jcv.2020.104502..
Keywords: Emergency Department, COVID-19, Pneumonia, Respiratory Conditions, Diagnostic Safety and Quality, Clinical Decision Support (CDS)