National Healthcare Quality and Disparities Report
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- Adverse Drug Events (ADE) (1)
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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 25 of 43 Research Studies DisplayedHoffman JA, Pergjika A, Liu L
Standardizing and improving care for pediatric agitation management in the emergency department.
In the U.S., pediatric mental health emergency department (ED) visits are increasing, with a greater number of visits involving the prescription of medication for acute agitation. Well timed, consistent application of behavioral strategies and medications may decrease the need for physical restraint of pediatric patients. The purpose of this study was to standardize agitation management in a pediatric ED and decrease pediatric patient time in physical restraints. From September 2020 to August 2021, researchers implemented a quality improvement initiative followed by a 6-month maintenance period. A barrier evaluation discovered that agitation triggers were not adequately recognized, there were few activities provided for children during lengthy ED visits, ED staff did not have confidence in techniques for verbally deescalating events, choices for medication were not consistent, and medication administered took time to take effect. Consecutive interventions included the development of a pathway and order set for agitation care, optimization of workflows for child life and psychiatry, implementation of personalized de-escalation plans, and adding the medication droperidol to the ED formulary. The measures utilize din the study included standardization of medication choice for severe agitation and time in physical restraints. The study found that during the intervention and maintenance components, there were 129 ED visits with medication administered for severe agitation and 10 ED visits where physical restraints were used. Among ED visits with medication given for severe agitation, there was an increase from 8% to 88% in standardized medication choice (olanzapine or droperidol), and a decrease in mean minutes in physical restraints from 173 to 71.
AHRQ-funded; HS026385.
Citation: Hoffman JA, Pergjika A, Liu L .
Standardizing and improving care for pediatric agitation management in the emergency department.
Pediatrics 2023 Jul 1; 152(1). doi: 10.1542/peds.2022-059586..
Keywords: Children/Adolescents, Emergency Department, Behavioral Health, Quality Improvement, Quality of Care
Hoffmann JA, Johnson JK, Pergjika A
Development of quality measures for pediatric agitation management in the emergency department.
This study’s objective was to develop quality measures for pediatric emergency department (ED) agitation management informed by multidisciplinary perspectives. A multidisciplinary panel was created to develop quality measures for pediatric ED agitation management through the modified Delphi method. The panelists included 36 physicians, nurses, social workers, security, child life specialists, hospital data analysts, and parents. Measures were ranked by panelists in importance and feasibility on a 9-point scale during 2 survey rounds, with a teleconference discussion between surveys. Consensus was defined at >75% of panelists ranking a quality measure greater or equal to 7 in importance and median feasibility of greater or equal to 4. Consensus was reached on 20 quality measures that incorporated multidisciplinary perspectives.
AHRQ-funded; HS026385.
Citation: Hoffmann JA, Johnson JK, Pergjika A .
Development of quality measures for pediatric agitation management in the emergency department.
J Healthc Qual 2022 Jul-Aug;44(4):218-29. doi: 10.1097/jhq.0000000000000339..
Keywords: Children/Adolescents, Quality Measures, Quality Indicators (QIs), Quality of Care, Emergency Department
Probst MA, Janke AT, Haimovich AD
Development of a novel emergency department quality measure to reduce very low-risk syncope hospitalizations.
The purpose of this study was to develop a new quality measure to apply with very low risk adult emergency department patients under 50 years of age and with no history of heart disease presenting with syncope. The study found that of the 3,292 patients meeting the study criteria, .46% suffered serious adverse events within 30 days after discharge. When the criteria were applied to the 2019 Nationwide Emergency Department Sample (NEDS) to assess its potential effect (assessing for hospital-level factors associated with hospitalization variation), of the 566,031 patients meeting the criteria, 2.7% were hospitalized. The researchers identified factors associated with increased hospitalization rates, which included a yearly ED volume of more than 80,000 and metropolitan teaching status. The study concluded that the novel syncope quality measure developed by the researchers can evaluate variation in low-value hospitalizations for unexplained syncope.
AHRQ-funded; HS022882.
Citation: Probst MA, Janke AT, Haimovich AD .
Development of a novel emergency department quality measure to reduce very low-risk syncope hospitalizations.
Ann Emerg Med 2022 Jun;79(6):509-17. doi: 10.1016/j.annemergmed.2022.03.008..
Keywords: Emergency Department, Quality Measures, Hospitalization, Quality Indicators (QIs), Quality of Care
Parast L, Burkhart Q, Bardach NS
Development and testing of an emergency department quality measure for pediatric suicidal ideation and self-harm.
The authors sought to develop and test a new quality measure assessing timeliness of follow-up mental health care for youth presenting to the emergency department (ED) with suicidal ideation or self-harm. Using Medicaid administrative data, they concluded that this new ED quality measure may be useful for monitoring and improving the quality of care for this vulnerable population; however, they recommended future work in order to establish the measure's predictive validity using more prevalent outcomes such as recurrence of suicidal ideation or deliberate self-harm.
AHRQ-funded; HS025291.
Citation: Parast L, Burkhart Q, Bardach NS .
Development and testing of an emergency department quality measure for pediatric suicidal ideation and self-harm.
Acad Pediatr 2022 Apr;22(3s):S92-s99. doi: 10.1016/j.acap.2021.03.005..
Keywords: Children/Adolescents, Emergency Department, Behavioral Health, Quality Measures, Quality Indicators (QIs), Quality of Care
Cabana MD, Robinson K, Plavin J
Partnering to improve pediatric asthma quality.
The purpose of this article was to explore the need for partnering between emergency departments (Eds) and primary care physicians (PCPs) to improve asthma quality measures, practice level improvements for both PCPs and EDs, and ultimately improve outcomes for children with asthma. Proper and timely management of asthma is thought to prevent ED visits, and the responsibility for addressing improvements in PCP performance should be shared by the PCP practices and health care payors and plans. The ability to measure the drivers of asthma-related visits to the ED may be outside of what a PCP practice can address, and so practices must be able to partner with health plans to successfully measure and develop system-wide interventions for quality and outcomes improvement. Although a child’s asthma may be managed in their PCP office, treatment of asthma issues often takes place in an ED setting or urgent care clinic that may be completely isolated from the patient’s PCP provider and system. Health plans can fill in the missing pieces to provide feedback on performance which can reduce ED visits, improve medication adherence and management, and provide actionable and timely data about hospital visits and discharge to PCP practices for quality improvements. Social determinants and comorbidities play a role in addressing ED visits for asthma. Health plan, public health systems, and provider coordination, integration, and partnerships are required to effectively address those issues and improve outcomes. The authors conclude that a systems approach and thoughtful partnerships across disciplines will be required beyond the PCP practice level to improve the outcomes of children with asthma.
AHRQ-funded; HS025297.
Citation: Cabana MD, Robinson K, Plavin J .
Partnering to improve pediatric asthma quality.
Acad Pediatr 2022 Apr;22(3S):S73-S75. doi: 10.1016/j.acap.2021.06.013..
Keywords: Children/Adolescents, Asthma, Chronic Conditions, Emergency Department, Quality Measures, Quality Improvement, Quality of Care
Vaughan CP, Hwang U, Vandenberg AE
Early prescribing outcomes after exporting the EQUIPPED medication safety improvement programme.
Enhancing quality of prescribing practices for older adults discharged from the Emergency Department (EQUIPPED) aims to reduce the monthly proportion of potentially inappropriate medications (PIMs) prescribed to older adults discharged from the ED to 5% or less. In this paper, the investigator described prescribing outcomes at three academic health systems adapting and sequentially implementing the EQUIPPED medication safety programme.
AHRQ-funded; HS024499.
Citation: Vaughan CP, Hwang U, Vandenberg AE .
Early prescribing outcomes after exporting the EQUIPPED medication safety improvement programme.
BMJ Open Qual 2021 Nov;10(4). doi: 10.1136/bmjoq-2021-001369..
Keywords: Elderly, Medication: Safety, Medication, Patient Safety, Emergency Department, Quality Improvement, Quality of Care
Trent SA, George N, Havranek EP
Established evidence-based treatment guidelines help mitigate disparities in quality of emergency care.
Evidence-based guidelines are often cited as a means of ensuring high-quality care for all patients. The objective of this study was to assess whether emergency department (ED) adherence to core evidence-based guidelines differed by patient sex and race/ethnicity and to assess the effect of ED guideline adherence on patient outcomes by sex and race/ethnicity. The investigators concluded that longstanding, nationally reported evidence-based guidelines can help eliminate sex and race/ethnicity disparities in quality of care.
AHRQ-funded; HS022400.
Citation: Trent SA, George N, Havranek EP .
Established evidence-based treatment guidelines help mitigate disparities in quality of emergency care.
Acad Emerg Med 2021 Sep;28(9):1051-60. doi: 10.1111/acem.14235..
Keywords: Evidence-Based Practice, Guidelines, Emergency Department, Disparities, Quality of Care
Griffey RT, Schneider RM, Sharp BR
Description and yield of current quality and safety review in selected US academic emergency departments.
This study examined the impact of current quality and safety reviews used in US academic emergency departments (EDs). The authors hypothesized that current protocols are decades old and inefficient with low yield for identifying patient harm. They conducted a prospective observational study at five academic EDs for a 12-month procedure. Sites used the Institute for Healthcare Improvement’s definition in defining an adverse event and a modified National Coordinating Council for Medication Error Reporting and Prevention (MERP) Index for severity grading of events. They reviewed a total of 4735 cases and identified 381 events, of which 287 were near-misses, and 94 had adverse events (AEs). The overall AE rate was 1.99% (1.24-3.47%) across all sites. Quality concern rate (events without harms) was 6.06% (5.42-6.78%). Forty-seven percent of cases used 72 hour returns as their referral source but with only a 0.81% yield in identifying harm. Other referral sources also had similar low yields. External referrals in the 94 AE cases accounted for 41.49% of cases. The authors concluded that new approaches to quality and safety review in the ED are needed to optimize yield and efficiency for identifying harms and areas for improvement.
AHRQ-funded; HS025052.
Citation: Griffey RT, Schneider RM, Sharp BR .
Description and yield of current quality and safety review in selected US academic emergency departments.
J Patient Saf 2020 Dec;16(4):e245-e49. doi: 10.1097/pts.0000000000000379..
Keywords: Emergency Department, Patient Safety, Quality Improvement, Quality of Care, Provider Performance
Harder VS, Shaw JS, McCulloch CE
Statewide asthma learning collaborative participation and asthma-related emergency department use.
This study looked at outcomes from participation of pediatric practices in a quality improvement (QI) collaborative to decrease asthma-related emergency department (ED) visits. A statewide network of practices participated in the collaborative from 2015 to 2016. Asthma-related ED visit rates per 100 child-years for children ages 3 to 21 was evaluated using the state’s all-payer claims databases. The authors found that in the postintervention year (2017) participating practices’ ED visit rate decreased by 5.8 per 100 child-years, compared to an increase of 1.8 per 100 child-years in non-participating practices. There were no statistically significant differences in asthma-related ED visit rates during 2016, which indicated that it took some time for QI elements to be successfully implemented in pediatric practices.
AHRQ-funded; HS025297.
Citation: Harder VS, Shaw JS, McCulloch CE .
Statewide asthma learning collaborative participation and asthma-related emergency department use.
Pediatrics 2020 Dec;146(6):e20200213. doi: 10.1542/peds.2020-0213..
Keywords: Children/Adolescents, Asthma, Emergency Department, Quality Improvement, Quality of Care, Primary Care, Guidelines
Griffey RT, Schneider RM, Todorov AA
The emergency department trigger tool: validation and testing to optimize yield.
Researchers validated the emergency department trigger tool (EDTT) in an independent sample and compared record selection approaches to optimize yield for quality improvement. In this single-site study of the EDTT, they observed high levels of validity in trigger selection, yield, and representativeness of adverse events, with yields that are superior to estimates for traditional approaches to adverse event detection. Record selection using weighted triggers outperformed a trigger count threshold approach and far outperformed random sampling from records with at least one trigger. They concluded that the EDTT is a promising efficient and high-yield approach for detecting all-cause harm to guide quality improvement efforts in the emergency department.
AHRQ-funded; HS025052.
Citation: Griffey RT, Schneider RM, Todorov AA .
The emergency department trigger tool: validation and testing to optimize yield.
Acad Emerg Med 2020 Dec;27(12):1279-90. doi: 10.1111/acem.14101..
Keywords: Emergency Department, Electronic Health Records (EHRs), Health Information Technology (HIT), Medical Errors, Adverse Events, Patient Safety, Quality Improvement, Quality of Care
Mueller KL, Naganathan S, Griffey RT
Counseling on Access to Lethal Means-Emergency Department (CALM-ED): a quality improvement program for firearm injury prevention.
The authors evaluated the feasibility of the Counseling on Access to Lethal Means intervention in the Emergency Department (CALM-ED) by non-physician personnel. Their quality improvement study was conducted in an urban, academic ED with over 90,000 annual patient visits, and considered adult patients who were discharged after presenting to the ED with a suicidal crisis. They found that an ED-based CALM quality-improvement intervention was feasible for implementation by non-physician personnel and was well received by patients and families. They concluded that the intervention has the potential to help saves lives at times of suicide crisis.
AHRQ-funded; HS025052.
Citation: Mueller KL, Naganathan S, Griffey RT .
Counseling on Access to Lethal Means-Emergency Department (CALM-ED): a quality improvement program for firearm injury prevention.
West J Emerg Med 2020 Aug 20;21(5):1123-30. doi: 10.5811/westjem.2020.5.46952.
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Keywords: Emergency Department, Injuries and Wounds, Prevention, Quality Improvement, Quality of Care, Domestic Violence, Behavioral Health
Kaiser SV, Johnson MD, Walls TA
Pathways to improve pediatric asthma care: a multisite, national study of emergency department asthma pathway implementation.
This quality improvement study’s aim was to determine the effects of pediatric asthma pathway implementation in a diverse, national sample of emergency departments (EDs). Desired outcomes included systemic corticosteroid administration within 60 minutes (primary), assessment of severity at ED triage, chest radiograph use, hospital admission or transfer for higher level of care, and ED length of stay. Charts were reviewed each month by EDs for children ages 2-17 years with a primary diagnosis of asthma. A total of 83 EDs were enrolled, with 37 of them children’s hospitals, and 46 community hospitals. Seventy-three percent completed the study (n = 22,963). There was a significant increase in systematic corticosteroid administration within 60 minutes of arrival as well as increased odds of severity assessment at triage and decreased rate of change in odds of hospital admission/transfer. Chest radiograph or ED length of stay was not associated with pathway implementation.
AHRQ-funded; HS024592.
Citation: Kaiser SV, Johnson MD, Walls TA .
Pathways to improve pediatric asthma care: a multisite, national study of emergency department asthma pathway implementation.
J Pediatr 2020 Aug;223:100-07.e2. doi: 10.1016/j.jpeds.2020.02.080..
Keywords: Children/Adolescents, Emergency Department, Asthma, Quality Improvement, Quality of Care, Care Management, Healthcare Delivery, Patient-Centered Outcomes Research, Evidence-Based Practice, Outcomes
Griffey RT, Schneider RM, Todorov AA
The emergency department trigger tool: a novel approach to screening for quality and safety events.
The goal of this study was to develop an automated version of a previously developed emergency department (ED) trigger tool to track the likelihood of an adverse event. Thirty triggers were associated with risk of harm. The authors identified 1,726 records out of 76,894 ED visits with greater than or equal to 1 trigger. They compared the results of the automated tool to the previous version and found it performed well. They began with a broad set of candidate triggers and validated a computerized query that eliminates the need for manual screening of triggers and also identified a refined set of triggers associated with adverse events in the ED.
AHRQ-funded; HS025052.
Citation: Griffey RT, Schneider RM, Todorov AA .
The emergency department trigger tool: a novel approach to screening for quality and safety events.
Ann Emerg Med 2020 Aug;76(2):230-40. doi: 10.1016/j.annemergmed.2019.07.032..
Keywords: Emergency Department, Patient Safety, Adverse Events, Medical Errors, Quality of Care, Risk
Jaffe TA, Goldstein JN, Yun BJ
Impact of emergency department crowding on delays in acute stroke care.
This study examined the relationship between emergency department (ED) crowding and timely delivery of emergency stroke care. The authors prospectively collected data from their own institution’s Get with the Guidelines-Stroke registry to identify consecutive acute ischemic stroke patients who came to their urban academic ED from July 2016-August 2018. ED conditions were categorized as normal capacity, high ED crowding, and severe crowding. Of the 1379 patients presenting with ischemic stroke during the study period, 78% presented at normal, 15% during high ED crowding, and 7% during severe crowding times. Outcomes of interest were door-to-imaging (DIT) time. There were no significant delays in stroke care delivery associated with ED crowding.
AHRQ-funded; HS024561.
Citation: Jaffe TA, Goldstein JN, Yun BJ .
Impact of emergency department crowding on delays in acute stroke care.
West J Emerg Med 2020 Jul 8;21(4):892-99. doi: 10.5811/westjem.2020.5.45873..
Keywords: Emergency Department, Stroke, Cardiovascular Conditions, Healthcare Delivery, Quality of Care
Marcin JP, Romano PS, Dayal P
Provider-level and hospital-level factors and process measures of quality care delivered in pediatric emergency departments.
The objective of this study was to determine whether process measures of quality of care delivered to patients receiving care in children's hospital emergency departments were associated with physician-level or hospital-level factors. Subjects were children under 18 years old who presented to any of the 12 emergency departments that participated in the Pediatric Emergency Care Applied Research Network (PECARN).he researchers found that process measures of quality of care delivered to children was higher among patients treated at freestanding children's hospitals but lower among patients treated at higher volume emergency departments.
AHRQ-funded; HS019712.
Citation: Marcin JP, Romano PS, Dayal P .
Provider-level and hospital-level factors and process measures of quality care delivered in pediatric emergency departments.
Acad Pediatr 2020 May-Jun;20(4):524-31. doi: 10.1016/j.acap.2019.11.007..
Keywords: Children/Adolescents, Emergency Department, Hospitals, Quality Measures, Quality of Care
Griffey RT, Schneider RM, Todorov AA
Adverse events present on arrival to the emergency department: the ED as a dual safety net.
This study examined the prevalence of adverse events due to medication-related or patient care-related events that present on arrival (POA) to the emergency department (ED). This retrospective observation study tested the ED Trigger Tool from data at an urban academic medical center. Adults who completed an ED visit were eligible (N=92,859). A total of 5,582 visits gave a trigger. The majority of AEs (1,181) identified were from patients who were white and older. In total, POA AEs accounted for an estimated 7.65% of ED visits.
AHRQ-funded; HS025052.
Citation: Griffey RT, Schneider RM, Todorov AA .
Adverse events present on arrival to the emergency department: the ED as a dual safety net.
Jt Comm J Qual Patient Saf 2020 Apr;46(4):192-98. doi: 10.1016/j.jcjq.2019.12.003..
Keywords: Adverse Events, Adverse Drug Events (ADE), Emergency Department, Medication, Patient Safety, Quality of Care
Kocher KE, Arora R, Bassin BS
Baseline performance of real-world clinical practice within a statewide emergency medicine quality network: the Michigan Emergency Department Improvement Collaborative (MEDIC).
The Michigan Emergency Department Improvement Collaborative (MEDIC) has baseline performance data to identify practice variation across 15 diverse emergency departments on key emergency care quality indicators. The authors assessed MEDIC quality measures and found that performance varied greatly, with demonstrated opportunity for improvement. They conclude that MEDIC provides a robust platform for emergency physician engagement across emergency department practice settings to improve care and is a model for other states.
AHRQ-funded; HS024160.
Citation: Kocher KE, Arora R, Bassin BS .
Baseline performance of real-world clinical practice within a statewide emergency medicine quality network: the Michigan Emergency Department Improvement Collaborative (MEDIC).
Ann Emerg Med 2020 Feb;75(2):192-205. doi: 10.1016/j.annemergmed.2019.04.033..
Keywords: Emergency Department, Quality Improvement, Quality Indicators (QIs), Quality Measures, Quality of Care, Imaging, Diagnostic Safety and Quality
Colton K, Richards CT, Pruitt PB
Early stroke recognition and time-based emergency care performance metrics for intracerebral hemorrhage.
This study compared time for early stroke recognition for intracerebral hemorrhage for hospitals with and without stroke teams. An observational cohort study was conducted at an urban comprehensive stroke center from 2009 to 2017 with 204 cases included. Stroke team activation resulted in faster emergency care compared to no activation. This process resulted in shorter onset-to-arrival times, higher NIH Stroke Scale scores, and higher Glasgow Coma Scale scores.
AHRQ-funded; HS023437.
Citation: Colton K, Richards CT, Pruitt PB .
Early stroke recognition and time-based emergency care performance metrics for intracerebral hemorrhage.
J Stroke Cerebrovasc Dis 2020 Feb;29(2):104552. doi: 10.1016/j.jstrokecerebrovasdis.2019.104552..
Keywords: Stroke, Emergency Department, Provider Performance, Diagnostic Safety and Quality, Quality Improvement, Quality Indicators (QIs), Patient-Centered Outcomes Research, Outcomes, Quality of Care, Evidence-Based Practice, Hospitals
Andereck JW, Reuter QR, Allen KC
A quality improvement initiative featuring peer-comparison prescribing feedback reduces emergency department opioid prescribing.
This study compared opioid prescribing rates in emergency departments before and after a quality improvement initiative featuring peer-comparison feedback. All 117 ED prescribers at an urban academic medical center were provided regular feedback on their opioid prescribing rate compared to their de-identified peers. Pre-intervention rates were 8.6% compared to post-intervention at 4.8%.
AHRQ-funded; HS023011.
Citation: Andereck JW, Reuter QR, Allen KC .
A quality improvement initiative featuring peer-comparison prescribing feedback reduces emergency department opioid prescribing.
Jt Comm J Qual Patient Saf 2019 Oct;45(10):669-79. doi: 10.1016/j.jcjq.2019.07.008..
Keywords: Emergency Department, Opioids, Medication, Practice Patterns, Quality Improvement, Quality of Care
Sabbatini AK, Wright B, Kocher K
Postdischarge unplanned care events among commercially insured patients with an observation stay versus short inpatient admission.
Observation stays are composing an increasing proportion of unscheduled hospitalizations in the United States, with unclear consequences for the quality of care. This study used a nationally representative data set of commercially insured patients hospitalized from the emergency department (ED) to compare 30-day postdischarge unplanned care events after an observation stay versus a short inpatient admission.
AHRQ-funded; HS024160.
Citation: Sabbatini AK, Wright B, Kocher K .
Postdischarge unplanned care events among commercially insured patients with an observation stay versus short inpatient admission.
Ann Emerg Med 2019 Sep;74(3):334-44. doi: 10.1016/j.annemergmed.2018.10.002..
Keywords: Emergency Department, Hospitalization, Quality of Care
Ingraham AM, Ayturk MD, Kiefe CI
Adherence to 20 emergency general surgery best practices: results of a national survey.
The authors used a hybrid questionnaire to examine national adherence to emergency general surgery (EGS) best practices. They found that there was substantial room for performance improvement, and that adopting an acute care surgery model predicts better performance. They conclude that this novel overview of adherence to EGS best practices will enable surgeons and policymakers to address variations in EGS care nationally.
AHRQ-funded; HS022694.
Citation: Ingraham AM, Ayturk MD, Kiefe CI .
Adherence to 20 emergency general surgery best practices: results of a national survey.
Ann Surg 2019 Aug;270(2):270-80. doi: 10.1097/sla.0000000000002746..
Keywords: Surgery, Emergency Department, Guidelines, Quality of Care, Quality Improvement
Lauerman MH, Herrera AV, Albrecht JS
Interhospital transfers with wide variability in emergency general surgery.
This study examined modern hospital practices for interhospital transfers of emergency general surgery patients. A retrospective review of the Maryland Health Services Cost Review Commission database was conducted from 2013 to 2015. The majority of patients (94.1%) were not transferred with only 3.2% transferred to a hospital and 2.7% transferred from a hospital. For individual hospitals, there was a range of 0-30.5% of encounters transferred to a hospital, 0.02-14.62% transferred from a hospital and 69.25-99.95% not transferred.
AHRQ-funded; HS024560.
Citation: Lauerman MH, Herrera AV, Albrecht JS .
Interhospital transfers with wide variability in emergency general surgery.
Am Surg 2019 Jun;85(6):595-600..
Keywords: Emergency Department, Healthcare Delivery, Hospitalization, Hospitals, Outcomes, Quality of Care, Surgery, Transitions of Care
Batt RJ, Kc DS, Stats BR
The effects of discrete work shifts on a nonterminating service system.
The authors showed that in emergency departments (EDs), the patients’ rate of service completion varies over the course of the physician shift. Furthermore, patients that have experienced a physician handoff have a higher rate of service completion than non-handed-off patients. The authors also demonstrated that patients that have been handed off are more likely to revisit the ED within three days, which suggests that patient handoffs lower clinical quality. Finally, the authors used simulation to demonstrate that shift length and new‐patient cutoff rules can be used to reduce handoffs, but at the expense of system throughput.
AHRQ-funded; HS024558.
Citation: Batt RJ, Kc DS, Stats BR .
The effects of discrete work shifts on a nonterminating service system.
Prod Oper Manag 2019 Jun;28(6):1528-44. doi: 10.1111/poms.12999..
Keywords: Emergency Department, Healthcare Delivery, Quality of Care, Workflow
Rosenman ED, Vrablik MC, Brolliar SM
Targeted simulation-based leadership training for trauma team leaders.
Effective team leadership is linked to better teamwork, which in turn is believed to improve patient care. Simulation-based training provides a mechanism to develop effective leadership behaviors. Traditionally, healthcare curricula have included leadership as a small component of broader teamwork training, with very few examples of leadership-focused curricula. The objective of this work was to describe a novel simulation-based team leadership curriculum that easily adapts to individual learners.
AHRQ-funded; HS022458.
Citation: Rosenman ED, Vrablik MC, Brolliar SM .
Targeted simulation-based leadership training for trauma team leaders.
West J Emerg Med 2019 May;20(3):520-26. doi: 10.5811/westjem.2019.2.41405..
Keywords: TeamSTEPPS, Teams, Simulation, Training, Emergency Department, Education: Continuing Medical Education, Quality Improvement, Quality of Care
Terp S, Wang B, Burner E
Civil monetary penalties resulting from violations of the Emergency Medical Treatment and Labor Act (EMTALA) involving psychiatric emergencies, 2002 to 2018.
This study analyzed civil monetary penalties resulting from Emergency Medical and Treatment Act (EMTALA) violations involving psychiatric emergencies from 2002 to 2018. Psychiatric treatment settlements are larger with the average settlement being $85,488 compared to $32,004 for non-psychiatric-related cases. Five of six of the largest settlements during the study period were psychiatric-related. The penalties were for failure to provide appropriate medical screening examinations, receive stabilizing treatment, or arrange appropriate transfer. Almost half (41%) occurred in the Southeast Region and 20% in the Central region.
AHRQ-funded; HS022402; HS025281.
Citation: Terp S, Wang B, Burner E .
Civil monetary penalties resulting from violations of the Emergency Medical Treatment and Labor Act (EMTALA) involving psychiatric emergencies, 2002 to 2018.
Acad Emerg Med 2019 May;26(5):470-78. doi: 10.1111/acem.13710..
Keywords: Emergency Department, Medical Errors, Medical Liability, Behavioral Health, Quality of Care