Sustained Impact: Long-Term Application of Diagnostic Uncertainty Communication Training.

Objectives: More than one-third of discharged emergency department (ED) patients leave without a clear diagnosis for their symptoms. In 2019-2020, we implemented a simulation-based mastery learning curriculum across two academic medical centers to train emergency medicine residents to discuss diagnostic uncertainty during ED discharge, guided by the Uncertainty Communication Checklist (UCC). We sought to assess if this cohort continues to apply skills learned and to obtain trainee insights into the most valuable checklist items.

Teaching the Communication of Diagnostic Uncertainty at Scale: Leveraging a Mobile App for Just-in-Time Instruction.

Diagnostic uncertainty is a reality of clinical care, particularly in emergency medicine. The ability to communicate this uncertainty to patients and families, however, remains underdeveloped in medical education curricula. Traditional simulation training is regarded as the gold standard for teaching difficult conversations, but resource constraints can limit access, especially for larger cohorts of learners.

Targeted EHR-based communication of diagnostic uncertainty (TECU) in the emergency department: Protocol for an effectiveness implementation trial.

Background: At least 37 % emergency department (ED) patients are discharged without a definitive diagnosis, resulting in diagnostic uncertainty. Transitions of care are high-risk periods for patient safety, especially for patients discharged with diagnostic uncertainty. Effective communication between clinicians and patients improves these care transitions.

Emergency Department Vestibular Rehabilitation Therapy for Dizziness and Vertigo: A Nonrandomized Clinical Trial.

Importance: Dizziness symptoms account for nearly 2 million annual emergency department (ED) visits and present a diagnostic challenge for clinicians. Most dizziness research has focused on improving guideline-concordant care among clinicians, with little focus on developing patient-centered interventions to improve dizziness-related disability.

Objective: To examine the feasibility of ED vestibular rehabilitation therapy (ED-VeRT) using a protocolized diagnostic classification algorithm and collection of longitudinal patient-reported outcomes.

Online public response to emergency department diagnostic error report: A qualitative study.

Background: The 2022 study on diagnostic error in the emergency department (ED) published by the Agency for Healthcare Research and Quality (AHRQ) reported that one in every 18 ED patients is misdiagnosed. The report was methodologically critiqued by emergency physicians and researchers. However, little is known about public perception of error in the ED.

Documentation of incidentally noted hepatic steatosis to emergency department patients: A retrospective study.

Background: Hepatic steatosis is a common incidental finding on emergency department (ED) imaging studies, occurring in up to 10% of studies, and carries significant long-term morbidity. Frequently considered an unimportant finding, it is unknown how often ED patients are informed of hepatic steatosis. Our objective was to examine hepatic steatosis inclusion in ED discharge materials.

When the economy falters, hearts suffer: Economic recessions as a social determinant of health in cardiovascular emergencies.

Introduction: While the relationships between cardiovascular disease (CVD), stress, and financial strain are well studied, the association between recessionary periods and macroeconomic conditions on incidence of disease-specific CVD emergency department (ED) visits is not well established.

Objectives: This retrospective observational study aimed to assess the relationship between macroeconomic trends and CVD ED visits.

Methods: This study uses data from the National Hospital Ambulatory Care Survey (NHAMCS), Federal Reserve Economic Database (FRED), National Bureau of Economic Research (NBER), and CVD groupings from National Vital Statistics (NVS) and Center for Medicare and Medicaid Services (CMS) from 1999 to 2020 to analyze ED visits in relation to macroeconomic indicators and NBER defined recessions and expansions.

External Validation of a Tool to Identify Low-Risk Patients With Isolated Subdural Hematoma and Preserved Consciousness.

Study Objective: The SafeSDH Tool was derived to identify patients with isolated (no other type of intracranial hemorrhage) subdural hematoma who are at very low risk of neurologic deterioration, neurosurgical intervention, or death. Patients are low risk by the tool if they have none of the following: use of anticoagulant or nonaspirin antiplatelet agent, Glasgow Coma Score (GCS) <14, more than 1 discrete hematoma, hematoma thickness >5 mm, or midline shift. We attempted to externally validate the SafeSDH Tool.

Observational study of organisational responses of 17 US hospitals over the first year of the COVID-19 pandemic.

Objectives: The COVID-19 pandemic has required significant modifications of hospital care. The objective of this study was to examine the operational approaches taken by US hospitals over time in response to the COVID-19 pandemic.

Design, Setting And Participants: This was a prospective observational study of 17 geographically diverse US hospitals from February 2020 to February 2021.

Patient Perspectives on Seeking Emergency Care for Acute Low Back Pain and Access to Physical Therapy in the Emergency Department.

Study Objective: Low back pain is a common reason for visiting the emergency department (ED), yet little is known about patient motivations for seeking emergency care. The purpose of this study was to explore patient perspectives on visiting the ED for low back pain to inform a more patient-centered approach to emergency care.

Methods: We conducted focus group discussions and individual interviews among patients visiting an urban academic ED for acute low back pain.

Emergency Medicine Clinician Experiences Addressing Uncertainty in First-Trimester Bleeding.

The purpose of this work is to understand Emergency Department (ED) clinicians' experiences in communicating uncertainty about first-trimester bleeding (FTB) and their need for training on this topic. This cross-sectional study surveyed a national sample of attending physicians and advanced practice providers (APPs). The survey included quantitative and qualitative questions about communicating with patients presenting with FTB.

Communicating Diagnostic Uncertainty at Emergency Department Discharge: A Simulation-Based Mastery Learning Randomized Trial.

Purpose: There are no standardized approaches for communicating with patients discharged from the emergency department with diagnostic uncertainty. This trial tested efficacy of the Uncertainty Communication Education Module, a simulation-based mastery learning curriculum designed to establish competency in communicating diagnostic uncertainty.

Method: Resident physicians at 2 sites participated in a 2-arm waitlist randomized controlled trial from September 2019 to June 2020.

Unintentional Opioid Overdose Death Characteristics in Illinois Before and During the COVID-19 Era, 2017 to 2020.

This cross-sectional study characterizes Illinois unintentional opioid overdose deaths from July 2017 through June 2020 using data from the Centers for Disease Control and Prevention State Unintentional Drug Overdose Reporting System.

Impact of the COVID pandemic on emergency department CT utilization: where do we go from here?

Purpose: To analyze the impact of the coronavirus disease (COVID) pandemic on emergency department (ED) computed tomography (CT) utilization.

Methods: A retrospective observational study was conducted assessing seven hospitals' ED imaging volumes between Jan. 6, 2019, and Feb.

Pediatric Return Visits to the Emergency Department: The Time to Return Curve.

Objective: Although 72-hour return visits are a frequently reported metric for pediatric patients discharged from the emergency department (ED), the basis for this metric is not established. Our objective was to statistically derive a cutoff time point for the characterization of pediatric return visits.

Methods: We performed a retrospective cohort study using data of patients discharged from any of 44 pediatric EDs.

Antibiotic and antitussive prescribing among urgent care and emergency department visits for respiratory diagnoses in a large health system.

Objective: Urgent care centers (UCs) commonly evaluate patients with respiratory infections, and patients increasingly prefer UCs to emergency departments (EDs) because of their customer-centric approach. The aim of this study is to describe antibiotic and opioid prescribing among UC and ED visits with respiratory diagnoses.

Methods: This is a cross-sectional study of visits to 7 EDs and 6 UCs in the greater Chicago area.

Embedded emergency department physical therapy versus usual care for acute low back pain: a protocol for the NEED-PT randomised trial.

Introduction: Low back pain is a common problem and a substantial source of morbidity and disability worldwide. Patients frequently visit the emergency department (ED) for low back pain, but many experience persistent symptoms at 3 months despite frequent receipt of opioids. Although physical therapy interventions have been demonstrated to improve patient functioning in the outpatient setting, no randomised trial has yet to evaluate physical therapy in the ED setting.

A mixed methods analysis of caller-emergency medical dispatcher communication during 9-1-1 calls for out-of-hospital cardiac arrest.

Objective: Recognition of out-of-hospital cardiac arrest (OHCA) during 9-1-1 calls is critically important, but little is known about how laypersons and emergency medical dispatchers (EMDs) communicate. We sought to describe 9-1-1 calls for OHCA.

Methods: We performed a mixed-methods, retrospective analysis of 9-1-1 calls for OHCA victims in a large urban emergency medical services (EMS) system using a random sampling of cases containing the term "cardiopulmonary resuscitation" (CPR) in the EMS electronic report.

"Unfortunately, I don't have an answer for you": How resident physicians communicate diagnostic uncertainty to patients during emergency department discharge.

Objective: To describe how emergency medicine resident physicians discuss diagnostic uncertainty during a simulated ED discharge discussion.

Methods: A secondary content analysis of simulated clinical encounter audiotapes completed by emergency medicine residents across two sites.

Results: When discussing lack of diagnosis, residents explained the evaluation revealed no cause for symptoms, noted concerning diagnoses that were excluded, and acknowledged both symptoms and patients' feelings.

There's an app for that: Teaching residents to communicate diagnostic uncertainty through a mobile gaming application.

Background: Clear communication is integral to good clinical care; however, communication training is cost and time intensive. Mobile applications (apps) may provide a useful adjunct to traditional simulation skills training.

Objective: To evaluate (1) use of an app for teaching communication skills about diagnostic uncertainty, (2) feedback on app use, and (3) the association between use and skill mastery.

Emergency Department Patient Experiences During the COVID-19 Pandemic.

Emergency department (ED) utilization changed notably during the coronavirus disease 2019 (COVID-19) pandemic in the United States. The purpose of the study was to gain a more thorough understanding of ED patient experience during the early stages of the COVID-19 pandemic. This study used the consensual qualitative approach to analyze open-ended responses from post-ED patient experience surveys from February through July 2020.