National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (5)
- Adverse Events (3)
- Ambulatory Care and Surgery (2)
- Antibiotics (6)
- Antimicrobial Stewardship (1)
- Asthma (3)
- Back Health and Pain (1)
- Behavioral Health (4)
- Care Management (3)
- Children/Adolescents (9)
- Clinical Decision Support (CDS) (2)
- Comparative Effectiveness (1)
- Disparities (1)
- Elderly (2)
- Electronic Health Records (EHRs) (2)
- (-) Emergency Department (36)
- Emergency Medical Services (EMS) (2)
- Evidence-Based Practice (1)
- Guidelines (2)
- Healthcare Utilization (1)
- Health Information Technology (HIT) (3)
- Hospital Discharge (1)
- Hospitalization (3)
- Hospitals (1)
- Infectious Diseases (1)
- Injuries and Wounds (3)
- Inpatient Care (2)
- Medical Errors (1)
- Medical Expenditure Panel Survey (MEPS) (1)
- (-) Medication (36)
- Medication: Safety (4)
- Opioids (15)
- Outcomes (1)
- Pain (7)
- Patient-Centered Healthcare (1)
- Patient-Centered Outcomes Research (4)
- Patient Safety (7)
- Pneumonia (1)
- Practice Patterns (10)
- Prevention (1)
- Provider (4)
- Provider: Clinician (1)
- Provider: Pharmacist (2)
- Provider: Physician (3)
- Quality Improvement (2)
- Quality of Care (3)
- Racial and Ethnic Minorities (2)
- Registries (2)
- Respiratory Conditions (1)
- Sepsis (3)
- Sickle Cell Disease (1)
- Skin Conditions (2)
- Substance Abuse (4)
- Treatments (1)
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 36 Research Studies DisplayedThakrar AP, Faude S, Perrone J
Association of urine fentanyl concentration with severity of opioid withdrawal among patients presenting to the emergency department.
This study’s aim was to determine whether urine fentanyl concentration is associated with severity of opioid withdrawal. The study was conducted in 3 emergency departments in an urban, academic health system from January 1, 2020, to December 31, 2021. It included patients with opioid use disorder, detectable urine fentanyl or norfentanyl, and Clinical Opiate Withdrawal Scale (COWS) recorded within 6 hours of urine drug testing. Primary exposure measured was urine fentanyl concentration stratified as high (>400 ng/mL), medium (40-399 ng/mL), or low (<40 ng/mL). COWS was used to measure opioid withdrawal severity within 6 hours before or after urine specimen collection. A total of 1127 patients were included in the sample, with a mean age (SD) of 40.0 (10.7), 384 (34.1%) identified as female, 332 (29.5%) reported their race/ethnicity as non-Hispanic Black, and 658 (58.4%) reported their race/ethnicity as non-Hispanic White. For patients with high urine fentanyl concentrations, the adjusted mean COWS was 4.4 (3.9-4.8) compared with 5.5 (5.1-6.0) among those with medium and 7.7 (6.8-8.7) among those with low fentanyl concentrations.
AHRQ-funded; HS026372.
Citation: Thakrar AP, Faude S, Perrone J .
Association of urine fentanyl concentration with severity of opioid withdrawal among patients presenting to the emergency department.
J Addict Med 2023 Jul-Aug; 17(4):447-53. doi: 10.1097/adm.0000000000001155..
Keywords: Opioids, Medication, Emergency Department, Substance Abuse
Lee AH, McEvoy DS, Stump T
Implementation of an electronic alert to improve timeliness of second dose antibiotics for patients with suspected serious infections in the emergency department: a quasi-randomized controlled trial.
This study analyzed the influence of clinical decision support (CDS) to prevent delays in second doses of broad-spectrum antibiotics in the emergency department (ED). The authors allocated adult patients who received cefepime or piperacillin/tazobactam in 9 EDs within an integrated health care system to an electronic alert that reminded ED clinicians to reorder antibiotics at the appropriate interval vs usual care. Primary outcome was a median delay in antibiotic administration, and secondary outcomes were rates of intensive care unit (ICU) admission, hospital mortality, and hospital length of stay. A total of 1,113 ED patients treated with cefepime or piperacillin/tazobactam were enrolled in the study, of whom 420 remained under ED care when their second dose was due. The electronic alert system was associated with reduced antibiotic delays, but there were no differences in ICU transfers, inpatient mortality, or hospital length of stay.
AHRQ-funded; HS027170.
Citation: Lee AH, McEvoy DS, Stump T .
Implementation of an electronic alert to improve timeliness of second dose antibiotics for patients with suspected serious infections in the emergency department: a quasi-randomized controlled trial.
Ann Emerg Med 2023 Apr;81(4):485-91. doi: 10.1016/j.annemergmed.2022.10.022.
Keywords: Antibiotics, Medication, Emergency Department, Clinical Decision Support (CDS), Health Information Technology (HIT)
Dutta S, McEvoy DS, Rubins DM
Clinical decision support improves blood culture collection before intravenous antibiotic administration in the emergency department.
This paper discusses the outcomes of using a clinical decision support (CDS) tool that was implemented in emergency departments (EDs) for sepsis patients to remind healthcare staff to take blood cultures before administration of intravenous (IV) antibiotics. The study compared timely blood culture collection outcomes prior to IV antibiotics for 54,538 adult ED patients 1 year before and after a CDS intervention implementation in the electronic health record. The baseline phase found that 46.1% had blood cultures prior to IV antibiotics, compared to 58.8% after the intervention. The CDS improved blood culture collection rates without increasing overutilization.
AHRQ-funded; HS02717.
Citation: Dutta S, McEvoy DS, Rubins DM .
Clinical decision support improves blood culture collection before intravenous antibiotic administration in the emergency department.
J Am Med Inform Assoc 2022 Sep 12;29(10):1705-14. doi: 10.1093/jamia/ocac115..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Antibiotics, Emergency Department, Medication, Sepsis
Schoenfeld EM, Soares WE, Schaeffer EM
"This is part of emergency medicine now": a qualitative assessment of emergency clinicians' facilitators of and barriers to initiating buprenorphine.
Despite evidence demonstrating the safety and efficacy of buprenorphine for the treatment of emergency department (ED) patients with opioid use disorder (OUD), incorporation into clinical practice has been highly variable. In this study, the investigators explored barriers and facilitators to the prescription of buprenorphine, as perceived by practicing ED clinicians. The investigators concluded that while some participants were hesitant to adopt a "new" role in treating patients with medications for OUD, many already had.
AHRQ-funded; HS025701.
Citation: Schoenfeld EM, Soares WE, Schaeffer EM .
"This is part of emergency medicine now": a qualitative assessment of emergency clinicians' facilitators of and barriers to initiating buprenorphine.
Acad Emerg Med 2022 Jan;29(1):28-40. doi: 10.1111/acem.14369..
Keywords: Emergency Department, Opioids, Medication, Substance Abuse, Behavioral Health
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
Goyal MK, Drendel AL, Chamberlain JM
Racial/ethnic differences in ED opioid prescriptions for long bone fractures: trends over time.
The purpose of this study was to investigate whether racial and/or ethnic differences in provision of outpatient opioid prescriptions for children discharged from the ED with long bone fractures have decreased over time. Findings showed that, as provision of opioid prescriptions declined over time, previously marked racial and/or ethnic disparities in opioid
prescription rates at ED discharge decreased.
prescription rates at ED discharge decreased.
AHRQ-funded; HS020270.
Citation: Goyal MK, Drendel AL, Chamberlain JM .
Racial/ethnic differences in ED opioid prescriptions for long bone fractures: trends over time.
Pediatrics 2021 Nov;148(5):e2021052481. doi: 10.1542/peds.2021-052481..
Keywords: Children/Adolescents, Opioids, Emergency Department, Racial and Ethnic Minorities, Injuries and Wounds, Pain, Medication
Hoffmann JA, Pergjika A, Konicek CE
Pharmacologic management of acute agitation in youth in the emergency department.
In this article, the authors reviewed the definition of agitation and pharmacologic management for youth with acute agitation, including common classes of medications, indications for use, and adverse effects. They also discussed the need to integrate the use of medications into a comprehensive strategy for agitation management that begins with proactive prevention of aggressive behavior, creation of a therapeutic treatment environment, and verbal de-escalation strategies.
AHRQ-funded; HS026385.
Citation: Hoffmann JA, Pergjika A, Konicek CE .
Pharmacologic management of acute agitation in youth in the emergency department.
Pediatr Emerg Care 2021 Aug;37(8):417-22. doi: 10.1097/pec.0000000000002510..
Keywords: Children/Adolescents, Emergency Department, Medication, Care Management
Worsham CM, Woo J, Jena AB
Adverse events and emergency department opioid prescriptions in adolescents.
Understanding the risks associated with opioid prescription in adolescents is critical for informing opioid policy, but the risks are challenging to quantify given the lack of randomized trial data. Using a regression discontinuity design, the investigators exploited a discontinuous increase in opioid prescribing in the emergency department (ED) when adolescents transitioned from "child" to "adult" at age eighteen to estimate the effect of an ED opioid prescription on subsequent opioid-related adverse events.
AHRQ-funded; HS026753.
Citation: Worsham CM, Woo J, Jena AB .
Adverse events and emergency department opioid prescriptions in adolescents.
Health Aff 2021 Jun;40(6):970-78. doi: 10.1377/hlthaff.2020.01762..
Keywords: Children/Adolescents, Emergency Department, Opioids, Medication, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Practice Patterns
McCarthy DM, Kim HS, Hur SI
Patient-reported opioid pill consumption after an ed visit: how many pills are people using?
This study examined opioid use patterns after an emergency department (ED) visit. The study was conducted at an urban academic emergency department and included patients 18 years or older, not chemically using opioids, and had been newly prescribed hydrocodone-acetaminophen. They were asked to complete and return a 10-day medication diary. Two-hundred sixty patients returned completed medication diaries that included treatment for different conditions. The mean age was 45 years and 59% of the sample was female. The median number of pills prescribed was 12. Patients with renal colic used the least number of pills and patients with back pain used the most. Almost all (92.5%) of patients had leftover pills by the end of the 10 days.
AHRQ-funded; HS023459.
Citation: McCarthy DM, Kim HS, Hur SI .
Patient-reported opioid pill consumption after an ed visit: how many pills are people using?
Pain Med 2021 Feb 23;22(2):292-302. doi: 10.1093/pm/pnaa048..
Keywords: Opioids, Medication, Emergency Department, Practice Patterns, Pain
Mohr NM, Pape SG, Runde D
Etomidate use is associated with less hypotension than ketamine for emergency department sepsis intubations: a NEAR cohort study.
The objectives of this study were to describe the current use of etomidate and other induction agents in patients with sepsis and to compare adverse events between etomidate and ketamine in sepsis. Using the National Emergency Airway Registry data set, findings showed that etomidate is used less frequently in sepsis patients than in non-sepsis patients, with ketamine being the most frequently used alternative. Further, ketamine was associated with more postprocedural hypotension than etomidate. Recommendations included future clinical trials to determine the optimal induction agent in patients with sepsis.
AHRQ-funded; HS025753.
Citation: Mohr NM, Pape SG, Runde D .
Etomidate use is associated with less hypotension than ketamine for emergency department sepsis intubations: a NEAR cohort study.
Acad Emerg Med 2020 Nov;27(11):1140-49. doi: 10.1111/acem.14070..
Keywords: Medication, Sepsis, Emergency Department, Registries, Adverse Drug Events (ADE), Adverse Events
Wentz AE, Wang RRC, Marshall BDL
Variation in opioid analgesia administration and discharge prescribing for emergency department patients with suspected urolithiasis.
Previous research has suggested caution about opioid analgesic usage in the emergency department (ED) setting and raised concerns about variations in prescription opioid analgesic usage, both across institutions and for whom they are prescribed. In this study, the investigators examined opioid analgesic usage in ED patients with suspected urolithiasis across fifteen participating hospitals. They found marked hospital-level differences in opioid analgesic administration and prescribing, as well as associations with education, healthcare insurance, and race/ethnicity groups.
AHRQ-funded; HS019312.
Citation: Wentz AE, Wang RRC, Marshall BDL .
Variation in opioid analgesia administration and discharge prescribing for emergency department patients with suspected urolithiasis.
Am J Emerg Med 2020 Oct;38(10):2119-24. doi: 10.1016/j.ajem.2020.07.016..
Keywords: Opioids, Medication, Emergency Department, Practice Patterns, Hospital Discharge
Drendel AL, Brousseau DC, Casper TC
Opioid prescription patterns at emergency department discharge for children with fractures.
The authors sought to measure the variability in discharge opioid prescription practices for children discharged from the emergency department (ED) with a long-bone fracture. They found that, for children with a long-bone fracture, discharge opioid prescription varied widely by ED site of care. In addition, black patients, Hispanic patients, and patients with government insurance were less likely to be prescribed opioids. This variability in opioid prescribing was not accounted for by patient- or injury-related factors that are associated with increased pain.
AHRQ-funded; HS020270.
Citation: Drendel AL, Brousseau DC, Casper TC .
Opioid prescription patterns at emergency department discharge for children with fractures.
Pain Med 2020 Sep;21(9):1947-54. doi: 10.1093/pm/pnz348..
Keywords: Children/Adolescents, Opioids, Medication, Emergency Department, Injuries and Wounds, Practice Patterns
Cotter JM, Tyler A, Reese J
Steroid variability in pediatric inpatient asthmatics: survey on provider preferences of dexamethasone versus prednisone.
This study looked at pediatric emergency department (ED) inpatient use of dexamethasone versus prednisone by providers for asthma treatment. A survey was distributed to providers who care for inpatient asthmatics. Ninety-two providers completed the survey. When patients received dexamethasone in the ED, 44% continued dexamethasone, 14% switched to prednisone, 2% stopped steroid use, and 40% said it depended on the circumstances. Hospitalists were significantly more likely to continue dexamethasone than pulmonologists (61% versus 15%). Switching to prednisone included factors such as severity of exacerbation (73%) and asthma history (47%). Just over half of providers (5f1%) felt uncomfortable using dexamethasone because of “minimal data to support [its] use inpatient.”
AHRQ-funded; HS026512.
Citation: Cotter JM, Tyler A, Reese J .
Steroid variability in pediatric inpatient asthmatics: survey on provider preferences of dexamethasone versus prednisone.
J Asthma 2020 Sep;57(9):942-48. doi: 10.1080/02770903.2019.1622713..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Medication, Inpatient Care, Care Management, Hospitalization, Emergency Department, Practice Patterns, Provider: Physician, Provider
Fritz SA, Shapiro DJ, Hersh AL
National trends in incidence of purulent skin and soft tissue infections in patients presenting to ambulatory and emergency department settings, 2000-2015.
This study looked at national trends in the incidence of outpatient visits for skin infections from 2000-2015, which peaked in 2010-2013, followed by a plateau in 2014 and 2015. Cephalexin was the most frequently prescribed antibiotic at the beginning of the study, with trimethoprim-sulfamethoxazole then becoming the most frequently prescribed by the end of the study period.
AHRQ-funded; HS021736; HS024269.
Citation: Fritz SA, Shapiro DJ, Hersh AL .
National trends in incidence of purulent skin and soft tissue infections in patients presenting to ambulatory and emergency department settings, 2000-2015.
Clin Infect Dis 2020 Jun 10;70(12):2715-18. doi: 10.1093/cid/ciz977..
Keywords: Skin Conditions, Ambulatory Care and Surgery, Emergency Department, Antibiotics, Medication
Johnson MD, Zorc JJ, Nelson DS
Intravenous magnesium in asthma pharmacotherapy: variability in use in the PECARN Registry.
Researchers examined the use, efficacy, and safety of intravenous magnesium sulfate (IVMg) in children with asthma whose emergency department (ED) management is recorded in the Pediatric Emergency Care Applied Research Network (PECARN) Registry. They found that, in PECARN Registry EDs, administration of IVMg occurred late in ED treatment, for a minority of the children likely to benefit, with variation between sites, which suggested the current clinical role for IVMg in preventing hospitalization was limited. Discharge after IVMg administration would likely be safe. They recommended further research to assess the efficacy and safety of early IVMg administration.
AHRQ-funded; HS020270.
Citation: Johnson MD, Zorc JJ, Nelson DS .
Intravenous magnesium in asthma pharmacotherapy: variability in use in the PECARN Registry.
J Pediatr 2020 May;220:165-74.e2. doi: 10.1016/j.jpeds.2020.01.062..
Keywords: Children/Adolescents, Asthma, Medication, Emergency Department, Registries, Treatments, Patient Safety, Medication: Safety
Goyal MK, Johnson TJ, Chamberlain JM
Racial and ethnic differences in emergency department pain management of children with fractures.
Researchers tested the hypotheses that minority children with long-bone fractures are less likely to receive analgesics, to receive opioid analgesics, and to achieve pain reduction. Using data from the Pediatric Emergency Care Applied Research Network Registry, they found that there are differences in process and outcome measures by race and ethnicity in the emergency department management of pain among children with long-bone fractures. Although minority children are more likely to receive analgesics and achieve reduction in pain, they are less likely to receive opioids and achieve optimal pain reduction.
AHRQ-funded; HS020270.
Citation: Goyal MK, Johnson TJ, Chamberlain JM .
Racial and ethnic differences in emergency department pain management of children with fractures.
Pediatrics 2020 May;145(5):e20193370. doi: 10.1542/peds.2019-3370..
Keywords: Children/Adolescents, Racial and Ethnic Minorities, Emergency Department, Pain, Injuries and Wounds, Medication, Opioids, Disparities
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
Baxa J, McCreary E, Schulz L
Finding the niche: an interprofessional approach to defining oritavancin use criteria in the emergency department.
This study’s purpose was to identify a population of emergency department (ED) patients with cellulitis who would be the most appropriate to receive oritavancin which is a novel, broad-spectrum antibiotic. This antibiotic is given in one dose for the entire treatment course. A retrospective cohort study of cellulitis patients was conducted at a Midwest healthcare system with 2 EDs. All adult patients admitted from the ED to an inpatient ward were reviewed over a 1-year period. Potentially avoidable admissions (PAAs) were identified and characterized. Out of 86 patients, nine were deemed a PAA. The majority had at last one risk factor for treatment failure (55% with diabetes mellitus) and they were significantly younger than the non-PAA group. In other respects there was no difference between the two groups for non-age demographics and other risk factors or length of stay.
AHRQ-funded; HS024342.
Citation: Baxa J, McCreary E, Schulz L .
Finding the niche: an interprofessional approach to defining oritavancin use criteria in the emergency department.
Am J Emerg Med 2020 Feb;38(2):321-24. doi: 10.1016/j.ajem.2019.158442..
Keywords: Emergency Department, Skin Conditions, Antibiotics, Medication
Horng S, Joseph JW, Calder S
Assessment of unintentional duplicate orders by emergency department clinicians before and after implementation of a visual aid in the electronic health record ordering system.
The purpose of this cohort study was to determine whether a simple visual aid was associated with a reduction in duplicate ordering of tests and medications. An interrupted time series model was used to analyze a series of consecutive patients who visited the emergency department of a large volume academic hospital. The researchers conclude that passive visual cues that provided just-in-time decision support were associated with reductions in unintentional duplicate orders for laboratory and radiology tests but not in unintentional duplicate medication orders.
AHRQ-funded; HS024288.
Citation: Horng S, Joseph JW, Calder S .
Assessment of unintentional duplicate orders by emergency department clinicians before and after implementation of a visual aid in the electronic health record ordering system.
JAMA Netw Open 2019 Dec 2;2(12):e1916499. doi: 10.1001/jamanetworkopen.2019.16499..
Keywords: Electronic Health Records (EHRs), Emergency Department, Health Information Technology (HIT), Patient-Centered Outcomes Research, Medication
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
Kim HS, Kaplan SH, McCarthy DM
A comparison of analgesic prescribing among ED back and neck pain visits receiving physical therapy versus usual care.
Researchers used a retrospective cohort study to examine whether physical therapy (PT) is associated with lower analgesic prescribing in the emergency department (ED) setting. They found that, in this single center study, ED back and neck pain visits receiving PT were no less likely to receive an opioid prescription and were more likely to receive a benzodiazepine than visits receiving usual care. They conclude that, although prior studies demonstrated that PT may reduce opioid utilization in the subsequent year, these results indicated that analgesic prescribing is not reduced at the initial ED encounter.
AHRQ-funded; HS023011.
Citation: Kim HS, Kaplan SH, McCarthy DM .
A comparison of analgesic prescribing among ED back and neck pain visits receiving physical therapy versus usual care.
Am J Emerg Med 2019 Jul;37(7):1322-26. doi: 10.1016/j.ajem.2018.10.009..
Keywords: Opioids, Medication, Practice Patterns, Emergency Department, Patient-Centered Outcomes Research, Pain, Back Health and Pain, Outcomes, Evidence-Based Practice
Vijay A, Rhee TG, Ross JS
U.S. prescribing trends of fentanyl, opioids, and other pain medications in outpatient and emergency department visits from 2006 to 2015.
This retrospective study tracked US prescribing trends of fentanyl, opioids, and other pain medications in outpatient and emergency department (ED) visits from 2006 to 2015. Data from the 2006-2015 National Ambulatory Medical Care Surveys and National Hospital Ambulatory Medical Care Surveys was used. During that time period, 17.4% of office-based outpatient visits and 45% of ED visits listed a pain medication prescription. There was an increase of about 5% from 2006-2007 to 2014-2015 for outpatient visits in which any pain medication was prescribed. Fentanyl prescription rates remained stable but doubled at EDs. There was also an increase in non-opioid pain medications in both settings.
AHRQ-funded; HS022882; HS025164.
Citation: Vijay A, Rhee TG, Ross JS .
U.S. prescribing trends of fentanyl, opioids, and other pain medications in outpatient and emergency department visits from 2006 to 2015.
Prev Med 2019 Jun;123:123-29. doi: 10.1016/j.ypmed.2019.03.022..
Keywords: Ambulatory Care and Surgery, Emergency Department, Hospitals, Medication, Opioids, Pain, Practice Patterns
Trent SA, Havranek EP, Ginde AA
Effect of audit and feedback on physician adherence to clinical practice guidelines for pneumonia and sepsis.
This study examined the effect of feedback with blinded peer comparison on emergency physician adherence to guidelines for appropriate antibiotic administration for inpatient pneumonia and completion of the 3-hour Surviving Sepsis Bundle for patients with severe sepsis. A quasi-experiment was conducted with attending physicians randomized into 6 clusters at a single urban safety net hospital. Feedback with blinded peer comparison significantly improved guideline adherence from 52% to 65% with feedback.
AHRQ-funded; HS022400.
Citation: Trent SA, Havranek EP, Ginde AA .
Effect of audit and feedback on physician adherence to clinical practice guidelines for pneumonia and sepsis.
Am J Med Qual 2019 May/Jun;34(3):217-25. doi: 10.1177/1062860618796947..
Keywords: Antibiotics, Emergency Department, Guidelines, Infectious Diseases, Inpatient Care, Medication, Pneumonia, Provider, Provider: Physician, Sepsis
Mistry RD, May LS, Pulia MS
Improving antimicrobial stewardship in pediatric emergency care: a pathway forward.
In this commentary, the authors discuss a study in this same issue. Recent multidisciplinary teams have used novel methods to successfully engage with and intervene in urgent care, pediatric, and general–emergency department antibiotic prescribing. Antibiotic stewardship programs are recommended, as well as emergency department experts continuing to collaborate and formulate thoughtful solutions to this important patient-safety and public-health issue.
AHRQ-funded; HS024342.
Citation: Mistry RD, May LS, Pulia MS .
Improving antimicrobial stewardship in pediatric emergency care: a pathway forward.
Pediatrics 2019 Feb;143(2). doi: 10.1542/peds.2018-2972..
Keywords: Antimicrobial Stewardship, Antibiotics, Children/Adolescents, Emergency Department, Medication, Patient Safety
Knight LMJ, Onsomu EO, Bosworth HB
Exploring emergency department provider experiences with and perceptions of weight-based versus individualized vaso-occlusive treatment protocols in sickle cell disease.
This study compared perceptions of nurses and physicians on protocols to treat sickle cell disease vaso-occlusive episodes (VOEs) in emergency rooms (ERs). Two different protocols were used for VOEs: weight –based and individualized vaso-occlusive. Nurses were less satisfied with clarity of the protocols than physicians. Pain management protocol perceptions differed widely between physicians, residents, physician assistants, nurse practitioners and nurses.
AHRQ-funded; HS024501.
Citation: Knight LMJ, Onsomu EO, Bosworth HB .
Exploring emergency department provider experiences with and perceptions of weight-based versus individualized vaso-occlusive treatment protocols in sickle cell disease.
Adv Emerg Nurs J 2019 Jan/Mar;41(1):86-97. doi: 10.1097/tme.0000000000000232..
Keywords: Emergency Department, Medication, Opioids, Pain, Provider, Sickle Cell Disease