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Research Forum Abstracts attendance and in-service training examination scores were also negatively correlated (r ⫽ ⫺0.429, p ⫽ 0.007). Conclusions: To our knowledge, this is the first study that has shown that inservice training examination scores are predictive of clinical competence in the ED. Overall resident clinical competence is a subjective measure, and reflects resident proficiency in areas such as systems-based practice, professionalism, interpersonal skills, practice-based learning, medical knowledge and patient care. In-service scores are an objective measure of EM knowledge base. While overall clinical competency measures more than one’s intellect, it is important to note that residents who achieved high scores on their examination also tended to perform at high levels in the ED. It is possible that the knowledge needed to excel on the in-service training examination is also necessary for superior clinical competence in the ED. Of interest, we found that overall conference attendance was negatively correlated with both clinical competence and in-service examination scores. In other words, those residents who attended conference less often tended to have higher in-service scores. Finally, we found that those residents with lower conference attendance had higher clinical competence grades. Certainly, this study should be broadened to other institutions to see if these differences hold true.

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Epidemiology and Etiology of Malpractice Lawsuits in Republic of Korea Emergency Departments and Urgent Care Centers

Park S/Gong-ju Medical Center, Chung Cheong Nam Do Gong-Ju Si, Republic of Korea

Study Objectives: To obtain epidemiologic outcome information about lawsuits that originate in Republic of Korea emergency department and urgent care centers. Methods: We conducted a retrospective study of 71 judicial precedents (civil cases) of district court or high court against emergency department and urgent care centers in South Korea from 1990 through 1999. Results: There were 71 closed judicial precedents reviewed. Of these, 77% originated in the emergency department, and 22% originated in urgent care centers. Suits involved pediatricians in 29%, emergency physicians in 6% and board-certified physicians in 74% of cases. Patients were males in 89%. The average age of patients was 28 years. Common diagnoses involved in the lawsuits were trauma, intestinal obstruction, appendicitis and acute myocardial infarction. The most common misadventure was delay in treatment (31%), and no medical error identified in 37%. In all cases, the plaintiff’s win rate was 63%. The average citation rate of plaintiff’s demand by court was 74%. The average indemnity ranged from US$11,230 for emotional injury US$99,470 for death of the patient. Conclusion: Emergency physicians must have a particular awareness of their great risk exposure for missed diagnosis in pediatric patients and patients with multiple traumas. It is noticeable that the average citation rate of plaintiff’s demand by court tends to increase.

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Quality Assessment of Nurse Triage: Could a Course Improve the Capability to Categorize Correctly Emergency Patients?

Parenti N, Manfredi R, Martini U, Baldisserri C, Lanzoni S, Lenzi T/Santa Maria della Scaletta Hospital, Imola, Italy

Study objectives: We evaluated if a triage course could improve the capability of the triage nurse to categorize correctly emergency patients and its impact on the waiting time for physician examination. Methods: This is an observational longitudinal prospective study of 360 consecutive patients admitted to our ED from Jan. to Dec 2005. All medical records were examined by 4 nurses expert in triage (investigators) and reviewed by two physicians. We excluded patients who needed immediate treatment for lifethreatening conditions. We collected: nurse triage category, time of initial evaluation by a triage nurse and by a physician, physician’s diagnosis, demographic and clinical characteristics. Quality indicators of triage efficiency were: the urgency category (UC) agreement among nurses and investigators; documentation of triage form (date and time of assessment, name of triage officer, chief presenting problem, revelant history and vital signs, initial triage category and assessment area allocated, retriage category); compatibility of triage nurse’s UC and the waiting time to physician examination. We compared the previous quality indicators before and after a two weeks course on triage. All the triage nurses attended the course. The UC were: urgency 1⫽immediate response; urgency 2,3,4 assessment within 20,60,120 minutes. T or chi square test were used to compare 2 groups.

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Results: 180 patients were included in the before-course (period 1) and 180 in the aftercourse (period 2) group, mean age 48,7 and 56 yrs (p⫽0.007). The 2 groups had similar demographic and clinical characteristics (p⬎ 0.05). In the after-course group there were more patients in urgency category 3 (68.3% vs 61.1% ; p⬎ 0.05). After the course there were more cases of full agreement among the UC assigned by nurses and investigators: 81.7% vs 76.7% (p⬎ 0.05), but there were fewer triage forms with a complete documentation: 98.3% vs 98.8% [p⬎ 0.05]. In period 1, we found that 70% of patients in UC 2 were examined by a physician within 20 min., instead in period 2 all patients (100%) in UC 2 were examined by a physician within 20 min. (p ⬍ 0.01). Almost all (98%) the patients in categories 1, 3, 4 were examined within the expected time, in both periods. There was significant difference between the average waiting time for physician examination in UC 2 before and after the course : 33.2 min. vs 18.5 min (p ⬍ 0.05). Conclusion: Our study suggests that our triage course can improve the capability of the triage nurse to categorize correctly emergency patients but it isn’t able to improve the documentation quality indicators. Moreover the course had a strong impact on the waiting time for physician examination mainly in category 2 patients. Study limitations are: few patients and statistical power of results.

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A Survey of Emergency Physicians’ Neurological Emergencies Clinical Practice and Learning Preferences: The FERNE Experience

Sloan EP, Bunney E/FERNE/Univ of Illinois Dept of Emergency Medicine, Chicago, IL

Study Objectives: The Foundation for the Education and Research in Neurological Emergencies (FERNE) is a nonprofit foundation dedicated to improving the emergency care of patients who present to the ED with acute neurological emergencies. This survey was conducted in order to learn more about the use of protocols for neurological emergency patients and learning preferences of those who attend FERNE educational sessions. Methods: A survey was distributed to FERNE session attendees at the 2006 AAEM Scientific Assembly and the 2006 ACEP Spring and Pediatric Assemblies. This abstract reports the preliminary results from the 2006 AAEM meeting. The presented abstract will include data from these three meetings and the 2006 SAEM Annual Meeting. Results: A total of 93 respondents provided data for this survey. The majority had attended prior AAEM FERNE educational sessions, 87% were attending physicians, 62% worked in community hospitals, and 39% in an academic setting. Although 88% stated they were aware of protocols for the use of tPA in stroke patients, only 22% utilized any protocols for the management of status epilepticus or traumatic brain injury patients. Regarding the reason for attending a FERNE symposium, 70% stated it was to learn more in general about neurological emergencies, and 68% stated it was to learn more about stroke and ICH specifically. Regarding what had been learned at the FERNE symposia, 49% stated that they had an increased awareness of clinical polices and practice guidelines, and 45% stated that they had learned clinically relevant facts that would change their clinical practice. The preferred method for learning was attending plenary, lunch, or breakfast sessions at national congresses (1.9 on a 1 to 5 point scale, 1 being most important), these same sessions at a regional meeting (2.3), use of the EMedHome.com website (2.3), and case-based CD-ROM educational tools (2.4). FERNE’s educational activities were rated 1.8, CME was reported to be important to learners (1.9), and industry support for these symposia was not found to adversely impact learning (3.6 of 5). Conclusions: The FERNE educational symposia are presented to Emergency Medicine practitioners from both academic and community practice, with learning of clinically relevant information and enhanced awareness of clinical guidelines. This improved guideline awareness is important given the absence of protocol use for some neurological emergencies. This data will be more broadly generalizable after the data from the 2006 ACEP Spring and Pediatric congresses is included, which will increase the sample size to over 400 respondents.

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Does Medicaid Disenrollment Correlate with Increased Emergency Department Utilization Among the Uninsured?

Heavrin BS, Aronsky D, Bihun J, Han JH/Vanderbilt University Medical Center, Nashville, TN

Study Objectives: The State of Tennessee recently disenrolled 191,000 individuals over the age of 18 from TennCare, the state’s Medicaid Managed Care Program. The disenrollment went into effect August 1, 2005. This research examines

Annals of Emergency Medicine S115