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Expanded TOC
TABLE of CONTENTS Annals of Emergency Medicine
Volume , . : February
THE PRACTICE OF EMERGENCY MEDICINE e 110 The Financial Burden of Emergency Department Congestion and Hospital Crowding for
Chest Pain Patients Awaiting Admission (Original Research) MD Bayley, JS Schwartz, FS Shofer, M Weiner, FD Sites, KB Traber, JE Hollander What is already known on this topic: Emergency department (ED) congestion and crowding are becoming increasingly burdensome to the US health care system. What question this study addressed: This study examines how prolonged ED stay due to the unavailability of inpatient monitored beds affects hospital length of stay, hospital costs, ED costs, and ED revenues. What this study adds to our knowledge: This case study demonstrates that while prolonged ED stay for chest pain patients awaiting monitored beds in a single ED did not alter total hospital length of stay or hospital costs it adversely affected ED revenue by tying up beds that could be used to see new patients. In 817 patients with chest pain, who accounted for 904 hospitalizations, 91% waited more than 3 hours for their bed. How this might change clinical practice: Case studies such as this one are helpful to emergency physicians and hospital administrators who wish to understand how they can ameliorate crowding and enhance revenue. 118 Unmet Substance Abuse Treatment Need, Health Services Utilization, and Cost: A Population-Based Emergency Department Study (Original Research) IRH Rockett, SL Putnam, H Jia, CF Chang, GS Smith What is already known on this topic: The potential impact of identifying emergency department (ED) patients with chronic substance abuse for intervention and referral is unknown. What question this study addressed: The utilization of health care services (outpatient, ED, and inpatient) and the associated costs for patients seen in the ED with unmet treatment needs for chronic substance abuse were assessed. What this study adds to our knowledge: In Tennessee, these patients had more ED visits and increased health care costs compared with other patients. They were almost twice as likely to need admission to the hospital and had 46% excess utilization of ED services. How this might change clinical practice: This study provides a background for further research into whether providing preliminary drug counseling and referral has the potential to decrease excess ED visits and health care costs for patients with chronic substance abuse. 128 The Effect of In-Room Registration on Emergency Department Length of Stay (Original Research) MH Gorelick, K Yen, HJ Yun What is already known on this topic: Length of emergency department (ED) stay is often a source of patient discontent and frequently the target of interventions, but little data on efficacy of those interventions exist. What question this study addressed: Examining 4 years of ED data, the authors first analyzed factors that affected patient length of stay and then measured length of stay after implementing an in-room registration process. What this study adds to our knowledge: The average daily ED census, hospital census, and hospital occupancy all correlated with a longer ED patient length of stay, whereas emergency physician staffing levels did not. After implementing an in-room registration process, the length of stay decreased a mean of 15 minutes (9.3% of previous length of stay), although still showing variations similar to those of the before-intervention phase. How this might change clinical practice: This methodology could identify local ED length of stay variations and correlates and suggest process changes, including (but not limited to) registration changes to shorten this interval. 134 Comparison of Nasal Tampons for the Treatment of Epistaxis in the Emergency Department: A Randomized Controlled Trial (Original Research) AJ Singer, M Blanda, K Cronin, M LoGiudice-Khwaja, J Gulla, J Bradshaw, A Katz
e designates free full-text access for nonsubscribers at www.mosby.com/AnnEmergMed.
Volume , . : February
Annals of Emergency Medicine 9A
CONTENTS (continued)
What is already known on this topic: Nasal packing is the primary treatment for persistent or severe anterior epistaxis; however, little is known about whether different materials or techniques can affect the discomfort or ease of nasal packing insertion or removal. What question this study addressed: Is a moistened, gel-coated, balloon-inflated nasal tampon less painful on insertion and removal than a dry hydrophilic nasal tampon? What this study adds to our knowledge: In 40 patients, the moistened, gelcoated, balloon-inflated nasal tampon was more comfortable on insertion and removal, and physicians reported greater ease in both insertion and removal compared with the dry hydrophilic tampon. Both devices were effective at initial hemorrhage control, but use of the moistened, gel-coated tampon was associated with less recurrent bleeding after removal. How this might change clinical practice: This study did not address the relative safety and cost of the 2 devices. If these are comparable, this study supports the preferential use of the moistened, gel-coated nasal tampon.
INJURY PREVENTION 140 Student Drivers: A Study of Fatal Motor Vehicle Crashes Involving 16-Year-Old Drivers (Original Research) MM Gonzales, LM Dickinson, C DiGuiseppi, SR Lowenstein What is already known on this topic: Motor vehicle crashes are the leading cause of death for US teenagers. Studies in a variety of locales have shown that fatal crashes involving novice drivers involve circumstances and behaviors different than those among more experienced drivers. What question this study addressed: This study sought to confirm the findings of other studies and better characterize the circumstances in which novice drivers have fatal accidents. What this study adds to our knowledge: In this cross-sectional study of the Colorado Fatality Analysis Reporting System database, 158 fatal accidents involved 16-year-old drivers and 2,262 fatal accidents had drivers aged between 25 and 49 years. Novice drivers were more likely to be speeding or driving recklessly; more likely to be in a rollover, run-off-road, and/or a single-vehicle crash; and more likely to have 2 or more passengers in their vehicle than experienced drivers. However, 16-year-old drivers were less likely to be involved in a fatal crash caused by alcohol or adverse weather. Nonuse of safety belts was high in both groups. How this might change clinical practice: The study will not change clinical practice, but it has important policy implications, including the need for educational programs and laws for novice drivers that are informed by the findings of this and related studies. 147 Graduated Driver Licensing in Utah: Is It Effective? (Original Research) LK Hyde, LJ Cook, S Knight, LM Olson What is already known on this topic: Motor vehicle crashes are the most common cause of injury and death in US teenagers. In some states, graduated driver license restrictions have successfully decreased the number and severity of novice driver accidents. What question this study addressed: Did enactment of a graduated driver licensing system in Utah lead to a decrease in the number and severity of crashes involving 16-year-old drivers? What this study adds to our knowledge: The study examined 2 years of data after enactment of minimum driving practice requirements and nighttime restrictions, and shorter periods after enactment of primary enforcement of seat belt use and passenger limitations. During this time, the overall crash rate per 1,000 licensed 16-year-old drivers decreased by 5%, a reduction smaller than that reported in other states that invoked similar programs. How this might change clinical practice: The study will not change clinical practice, but may inform implementation of programs to reduce vehicular accidents in novice drivers. 155 Teen Crash Victims: Who Are These People and Why Are They Here? (Editorial) R Martinez 157 Not Enough Children Ages Four Through Eight Using Booster Seats (NHTSA Notes) 157 Commentary: Child Occupant Safety in Vehicles: A Great Story That Needs a Boost (NHTSA Notes) HG Garrison
10A Annals of Emergency Medicine
Volume , . : February
Volume , . : February
THE PRACTICE OF EMERGENCY MEDICINE e 110 The Financial Burden of Emergency Department Congestion and Hospital Crowding for
Chest Pain Patients Awaiting Admission (Original Research) MD Bayley, JS Schwartz, FS Shofer, M Weiner, FD Sites, KB Traber, JE Hollander What is already known on this topic: Emergency department (ED) congestion and crowding are becoming increasingly burdensome to the US health care system. What question this study addressed: This study examines how prolonged ED stay due to the unavailability of inpatient monitored beds affects hospital length of stay, hospital costs, ED costs, and ED revenues. What this study adds to our knowledge: This case study demonstrates that while prolonged ED stay for chest pain patients awaiting monitored beds in a single ED did not alter total hospital length of stay or hospital costs it adversely affected ED revenue by tying up beds that could be used to see new patients. In 817 patients with chest pain, who accounted for 904 hospitalizations, 91% waited more than 3 hours for their bed. How this might change clinical practice: Case studies such as this one are helpful to emergency physicians and hospital administrators who wish to understand how they can ameliorate crowding and enhance revenue. 118 Unmet Substance Abuse Treatment Need, Health Services Utilization, and Cost: A Population-Based Emergency Department Study (Original Research) IRH Rockett, SL Putnam, H Jia, CF Chang, GS Smith What is already known on this topic: The potential impact of identifying emergency department (ED) patients with chronic substance abuse for intervention and referral is unknown. What question this study addressed: The utilization of health care services (outpatient, ED, and inpatient) and the associated costs for patients seen in the ED with unmet treatment needs for chronic substance abuse were assessed. What this study adds to our knowledge: In Tennessee, these patients had more ED visits and increased health care costs compared with other patients. They were almost twice as likely to need admission to the hospital and had 46% excess utilization of ED services. How this might change clinical practice: This study provides a background for further research into whether providing preliminary drug counseling and referral has the potential to decrease excess ED visits and health care costs for patients with chronic substance abuse. 128 The Effect of In-Room Registration on Emergency Department Length of Stay (Original Research) MH Gorelick, K Yen, HJ Yun What is already known on this topic: Length of emergency department (ED) stay is often a source of patient discontent and frequently the target of interventions, but little data on efficacy of those interventions exist. What question this study addressed: Examining 4 years of ED data, the authors first analyzed factors that affected patient length of stay and then measured length of stay after implementing an in-room registration process. What this study adds to our knowledge: The average daily ED census, hospital census, and hospital occupancy all correlated with a longer ED patient length of stay, whereas emergency physician staffing levels did not. After implementing an in-room registration process, the length of stay decreased a mean of 15 minutes (9.3% of previous length of stay), although still showing variations similar to those of the before-intervention phase. How this might change clinical practice: This methodology could identify local ED length of stay variations and correlates and suggest process changes, including (but not limited to) registration changes to shorten this interval. 134 Comparison of Nasal Tampons for the Treatment of Epistaxis in the Emergency Department: A Randomized Controlled Trial (Original Research) AJ Singer, M Blanda, K Cronin, M LoGiudice-Khwaja, J Gulla, J Bradshaw, A Katz
e designates free full-text access for nonsubscribers at www.mosby.com/AnnEmergMed.
Volume , . : February
Annals of Emergency Medicine 9A
CONTENTS (continued)
What is already known on this topic: Nasal packing is the primary treatment for persistent or severe anterior epistaxis; however, little is known about whether different materials or techniques can affect the discomfort or ease of nasal packing insertion or removal. What question this study addressed: Is a moistened, gel-coated, balloon-inflated nasal tampon less painful on insertion and removal than a dry hydrophilic nasal tampon? What this study adds to our knowledge: In 40 patients, the moistened, gelcoated, balloon-inflated nasal tampon was more comfortable on insertion and removal, and physicians reported greater ease in both insertion and removal compared with the dry hydrophilic tampon. Both devices were effective at initial hemorrhage control, but use of the moistened, gel-coated tampon was associated with less recurrent bleeding after removal. How this might change clinical practice: This study did not address the relative safety and cost of the 2 devices. If these are comparable, this study supports the preferential use of the moistened, gel-coated nasal tampon.
INJURY PREVENTION 140 Student Drivers: A Study of Fatal Motor Vehicle Crashes Involving 16-Year-Old Drivers (Original Research) MM Gonzales, LM Dickinson, C DiGuiseppi, SR Lowenstein What is already known on this topic: Motor vehicle crashes are the leading cause of death for US teenagers. Studies in a variety of locales have shown that fatal crashes involving novice drivers involve circumstances and behaviors different than those among more experienced drivers. What question this study addressed: This study sought to confirm the findings of other studies and better characterize the circumstances in which novice drivers have fatal accidents. What this study adds to our knowledge: In this cross-sectional study of the Colorado Fatality Analysis Reporting System database, 158 fatal accidents involved 16-year-old drivers and 2,262 fatal accidents had drivers aged between 25 and 49 years. Novice drivers were more likely to be speeding or driving recklessly; more likely to be in a rollover, run-off-road, and/or a single-vehicle crash; and more likely to have 2 or more passengers in their vehicle than experienced drivers. However, 16-year-old drivers were less likely to be involved in a fatal crash caused by alcohol or adverse weather. Nonuse of safety belts was high in both groups. How this might change clinical practice: The study will not change clinical practice, but it has important policy implications, including the need for educational programs and laws for novice drivers that are informed by the findings of this and related studies. 147 Graduated Driver Licensing in Utah: Is It Effective? (Original Research) LK Hyde, LJ Cook, S Knight, LM Olson What is already known on this topic: Motor vehicle crashes are the most common cause of injury and death in US teenagers. In some states, graduated driver license restrictions have successfully decreased the number and severity of novice driver accidents. What question this study addressed: Did enactment of a graduated driver licensing system in Utah lead to a decrease in the number and severity of crashes involving 16-year-old drivers? What this study adds to our knowledge: The study examined 2 years of data after enactment of minimum driving practice requirements and nighttime restrictions, and shorter periods after enactment of primary enforcement of seat belt use and passenger limitations. During this time, the overall crash rate per 1,000 licensed 16-year-old drivers decreased by 5%, a reduction smaller than that reported in other states that invoked similar programs. How this might change clinical practice: The study will not change clinical practice, but may inform implementation of programs to reduce vehicular accidents in novice drivers. 155 Teen Crash Victims: Who Are These People and Why Are They Here? (Editorial) R Martinez 157 Not Enough Children Ages Four Through Eight Using Booster Seats (NHTSA Notes) 157 Commentary: Child Occupant Safety in Vehicles: A Great Story That Needs a Boost (NHTSA Notes) HG Garrison
10A Annals of Emergency Medicine
Volume , . : February