The Dangerous Practice of Boarding Admitted Patients in the ER and Proposed Solutions Are the Focus as Emergency Physicians Meet in Las Vegas

Sep 13, 2010, 12:35 ET from American College of Emergency Physicians

Latest Emergency Medicine Research Highlights Pediatric Care, Patient Safety, Workforce Issues, Who Visits the ER and When, and Alcohol Use

WASHINGTON, Sept. 13 /PRNewswire-USNewswire/ -- The risks associated with boarding admitted patients in the emergency department – including patient mortality – as well as proposed solutions will be key themes of Scientific Assembly, the annual meeting of the American College of Emergency Physicians.  In addition, emergency physicians will present more than 450 research studies during 2010 Research Forum, the premier, annual scientific research event focused on the latest advances in the practice of emergency medicine.  The Research Forum will take place on September 28th and 29th during Scientific Assembly (September 28October 1, 2010) in The Mandalay Bay Resort and Convention Center, 43950 Las Vegas Boulevard South in Las Vegas.  

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Researcher physicians will present their latest findings in emergency medicine research, focusing on topics including the following: pediatrics, public health, neurology, cardiology, pain management, trauma, infectious diseases, psychiatry, imaging, EMS, geriatrics, toxicology and disaster preparedness. More than 450 posters will be presented in The Mandalay Bay Ballroom L, Mandalay Bay Convention Center South. For more information, visit: http://bit.ly/c1OL8q.  To search by title, presenter, topic and time, visit the Research Forum Planner at:  http://bit.ly/bKk99a.

Each day of the Research Forum will feature a special presentation in The Mandalay Bay Convention Center in the Tradewinds AB Room.

At 1 p.m. on Tuesday, September 28, 2010, Brian O'Neil, MD, FACEP, will offer a state-of-the-art presentation on resuscitation followed by oral presentations on four papers from 1:30 p.m. to 2:30 p.m.:

  • Emergent brain imaging prior to stroke center transfer delays care and worsens outcomes in patients with stroke, Presenter: S.S. Ali, Penn State Hershey Medical Center, Hershey, Pa.
  • Implementation of early goal-directed therapy and the Surviving Sepsis Campaign resuscitation bundle in Asia is associated with decreased mortality: analysis of a team versus non-team model of care for the ATLAS investigation, Presenter: H. Nguyen, Loma Linda University, Loma Linda, Calif.
  • Out-of-hospital initiation of therapeutic hypothermia with cold saline improves survival in patients with return of spontaneous circulation in the field, Presenter: J.G. Cabanas, Wake County Emergency Medical Services, Raleigh, N.C.
  • Human recombinant low molecular weight fibroblast growth factor 2 (FGF2) protects the heart from reperfusion injury through activation of FGF receptors and nitric oxide signaling, Presenter:  S.L. House, Washington University, St. Louis, Mo.

At 8 a.m. on Wednesday, September 29, 2010, Brent Asplin, MD, MPH, FACEP, will offer a state-of-the-art presentation on health policy followed by oral presentations on four papers from 8:30 a.m. to 9:30 a.m.:

  • Impact of daily pollen levels on emergency department visits for asthma, Presenter: J. Hess, Emory University, Atlanta, Ga.
  • National trends in emergency department testing and treatment and its impact on length of stay: 1998-2007, Presenter: K.E. Kocher, University of Michigan, Ann Arbor, Mich.
  • The impact of specific surveillance system methodology on influenza-like illness prevalence rates, Presenter: D.P. Rumoro, Rush University Medical Center, Chicago, Ill.
  • Impact of an urban screening, brief intervention and referral to treatment program, Presenter: K.B. Broderick, Denver Health Medical Center, Denver, Colo.

The Research Forum will close with a panel session highlighting some of the most significant research, Cutting Edge: Highlights of Emergency Medicine Research, moderated by Brian J. O'Neil, MD, FACEP, from 4 p.m. to 5:30 p.m. on Wednesday, September 29, 2010, in Breakers L, Mandalay Bay Convention Center South. Panelists for this event include: Debra E. Houry, MD, MPH, FACEP; William K. Mallon, MD, FACEP; Ian G. Stiell, MD, and Donald M. Yealy, MD, FACEP.

Members of the news media may register on-site. Credentialed members of the news media are invited to attend all Scientific Assembly sessions and courses, including the Research Forum. Registration fees are waived for media.  News media may also register onsite for free in Reef D of the Mandalay Bay Convention Center.

The following are the hours of operation of the News Media Workroom, in Reef F, which has phones and workspace for the news media.  

Monday, September 27:1:30 p.m.5:30 p.m.

Tuesday, September 28: 7:30 a.m.6:00 p.m.

Wednesday, September 29: 7:30 a.m.6:00 p.m.

Thursday, September 30: 7:30 a.m.6:00 p.m.

Friday, October 1: 7:30 a.m.11:30 a.m.

HIGHLIGHTS FROM 2010 RESEARCH FORUM ABSTRACTS

SEPTEMBER 28-29, 2010

AMERICAN COLLEGE OF EMERGENCY PHYSICIANS

MANDALAY BAY CONVENTION CENTER, TRADEWINDS AB ROOM

TUESDAY, SEPTEMBER 28

7:30 a.m.8:45 a.m.

Ultrasound evaluation for appendicitis in children: can we safely reduce CT scan utilization? (#1)

Presenter: S. Bentley, Mount Sinai School of Medicine, New York, N.Y.

A protocol to increase the use of ultrasonography for diagnosing pediatric appendicitis reduced the number of CT scans, and therefore radiation exposure, without increasing the rate of false positives or false negatives.

Liquid pediatric medication dosing cups are inaccurate (#2)

Presenter: A. Tadros, West Virginia University, Morgantown, W.Va.

Over-the-counter pediatric liquid medication measuring cups may provide a larger dose of medication than intended.

8:00 a.m.9:00 a.m.

Inpatient mortality for sepsis patients from the emergency department versus direct admissions: a nationwide cross-sectional study (#29)

Presenter: E.S. Powell, Northwestern University, Chicago, Ill.

Patients who were admitted to the hospital from the emergency department with the principal diagnosis of sepsis had 11 percent lower odds of dying as an inpatient than patients who were directly admitted to the hospital with sepsis.

Uninsured adult trauma patients: less OR, more transfers and higher mortality (#90)

Presenter: C.M. Schroder, Wayne State University School of Medicine, Detroit, Mich.

Uninsured trauma patients were less likely to receive surgical care, and uninsured ICU patients had substantially higher mortality.

10:45 a.m.11:45 a.m.

Visits by pediatric passengers due to motorcycle crashes in United States emergency departments (#137)

Presenter: A. Tadros, West Virginia University, Morgantown, W.Va.

More than 1,400 children visited emergency departments in 2006 for injuries related to motorcycle crashes, for a total cost of $8.3 million.

Epidemiology of assault-related hospitalizations in the United States, 2006 (#434)

Presenter: S. Muazzam, West Virginia University Injury Control Research Center, Morgantown, W.Va.

Younger adults, males and patients with lower socio-economic status accounted for most assault-related hospitalizations in the United States during 2006.

A prospective open label trial of low dose ketamine for acute suicidal states in the emergency department (#157)

Presenter: R.R. Turelli, Yale University School of Medicine, New Haven, Conn.

This is the first emergency department trial to suggest that low-dose ketamine is a feasible and safe drug that rapidly alleviates both depression and suicidal thinking.

Emergency department utilization by individuals with a mental health diagnosis as compared to the overall emergency department population (#159)

Presenter: J. Riley, George Washington University, Washington D.C.

People with mental illness and substance abuse disorders visited the emergency department more than the general population.

Schedule of classes and alcohol-related emergencies (#165)

Presenter: M.E. Takacs, University of Iowa, Iowa City, Iowa

After the University of Iowa increased the number of classes held on Friday, alcohol-related emergency department visits among its students dropped significantly.

1:30 p.m.2:30 p.m.

Out-of-hospital initiation of therapeutic hypothermia with cold saline improves survival in patients with return of spontaneous circulation in the field (#13)

Presenter: J.G. Cabanas, Wake County Emergency Medical Services, Raleigh, N.C.

For patients who had a return of spontaneous circulation in the field, the addition of out-of-hospital induced hypothermia had a significant contribution to patient survival.

2:30 p.m.4:00 p.m.

Boarding times and patient safety: a generalizable quantitative model (#183)

Presenter: J. Wilson, University of South Florida, Tampa, Fla.

There is a point at which the hours patients are "boarded," or held in the emergency department while waiting for an in-patient bed, directly leads to patients in the waiting room leaving without treatment.

A profile of emergency medicine board-certified physicians: 2001 – 2007 (#215)

Presenter: A.F. Sullivan, Massachusetts General Hospital, Boston, Mass.

The number of emergency physicians continues to rise, but not to the level needed to care for the growing numbers of emergency patients.

Factors in recruiting and retaining emergency physicians to rural emergency departments (#219)

Presenter: A.P. Steptoe, Massachusetts General Hospital, Boston, Mass.

Increasing access to specialists may attract more emergency physicians to rural areas, while higher salaries may encourage them to stay.

Significant regional variations exist in emergency department charges for uninsured care (#222)

Presenter: B.S. Heavrin, Vanderbilt University Medical Center, Nashville, Tenn.

Emergency patients in the western part of the United States are charged the most for emergency care while emergency patients in the northeast are charged the least.

Impact of insurance status on frequent users of the emergency department (#223)

Presenter: E. Brauer, Henry Ford Hospital, Detroit, Mich.

Frequent users of the emergency department who have inadequate health insurance report that the cost of clinics and prescription medications prevents them from seeking primary care.

The average age of CVA emergency department patients is decreasing in the United States but not in Italy (#239)

Presenter: S. Van Pelt, Morristown Memorial Hospital, Morristown, N.J.

The average age of stroke patients decreased significantly between 2004 and 2009 in the United States, but did not change significantly in Italy, perhaps due to the increasing rate of obesity in the U.S.

WEDNESDAY, SEPTEMBER 29

9:30 a.m.11:30 a.m.

The effect of a hospital policy of rapid bed assignment and patient transfer on emergency department patient length of stay (#254)

Presenter: D.K. Pauze, Albany Medical College, Albany, N.Y.

A hospital that implemented a policy requiring that patients admitted to the hospital from the emergency department be moved to an in-patient bed within 30 minutes reduced the time spent waiting for an in-patient bed by more than 50 percent.

Analysis of the association between day of the week and daily patient influx into the emergency department (#256)

Presenter: N. Menke, Lincoln Medical and Mental Health Center, Bronx, N.Y.

Mondays are the busiest day of the week in emergency departments, and Tuesdays, Wednesdays and Thursdays are busier than weekend days.

Emergency department visits by older adults for motor vehicle crashes (#276)

Presenter: J.A. Vogel, Denver Health Emergency Medicine Residency, Denver, Colo.

Although fewer older adults visited the emergency department for injuries sustained in motor vehicle crashes, their injuries were more severe and they were more likely to be admitted to the hospital.

The association between length of emergency department boarding and mortality: a multicenter study (#277)

Presenter: A.J. Singer, Stony Brook University, Stony Brook, N.Y.

The association between length of boarding in emergency departments and mortality varied from hospital to hospital, but patients who boarded longer than 24 hours had significantly higher mortality rates than those who boarded for less than two hours.

Reporting patient flow measures to the hospital board and performance on percutaneous intervention for acute myocardial infarction: Is there an association? (#279)

Presenter: M. McHugh, Health Research & Educational Trust, Chicago, Ill.

When emergency patient waiting and boarding times were reported to hospitals' governing boards, door-to-balloon times improved for heart attack patients.

Do parents in the emergency department understand the Food and Drug Administration's recommendation on cough and cold medication use in children under two years of age? A survey (#301)

Presenter: S.M. Varney, Wilford Hall Medical Center, Lackland Air Force Base, Texas

The majority of parents surveyed in the emergency department did not know about the FDA's 2007 public health advisory recommending that over-the-counter cough and cold medications not be used in infants and children under the age of two.

How big is the weekend surge of infant visits to the emergency department? (#305)

Presenter: B.S. Heavrin, Vanderbilt University Medical Center, Nashville, Tenn.

Parents bring infants to the emergency department substantially more often on weekends than weekdays, regardless of region or season.

Adult sexual assault is rarely reported to the police (#324)

Presenter: S. Securro, St. Luke's Roosevelt Hospital Center, New York, N.Y.

Sexual assault was rarely reported to the police, though sexual assault victims were more likely to report the crime if the assailant was a stranger.

1:30 p.m.2:30 p.m.

Professional fee revenue characteristics of frequent users of the emergency department (#393)

Presenter: J. Peterson, Henry Ford Wyandotte Hospital, Wyandotte, Mich.

Physicians are reimbursed less by frequent users of the emergency department (defined as 10 or more visits per calendar year) than by non-frequent users, possibly because they are more likely to be insured by Medicaid.

Effects of holidays on the patient severity and census in the emergency department (#396)

Presenter: M. Leming, Christiana Care Health System, Newark, Del.

Significantly more patients visited emergency departments on the day after holidays (such as New Year's Day, Easter, Labor Day, etc.) than on non-holidays.

2:30 p.m.3:30 p.m.

Survival of apneic patients: better than you might expect (#418)

Presenter: C.B. Irvin, St. John Hospital and Medical Center, New Baltimore, Mich.

Nearly half of blunt trauma patients who are not breathing actually survive; when other signs of life are present – such as a palpable pulse – survival rates climb to 80 percent in adults and almost 90 percent in children.

Successes and challenges of trauma care during the Haitian earthquake (#419)

Presenter: S. Shah, Rhode Island Hospital, Providence, R.I.

Emergency physicians responding to the disaster in Haiti provided numerous medical services, including amputations, but were limited by shortages of essential medicines, a lack of coordination among the multiple medical volunteers and cultural challenges.

Pandemic influenza and major disease outbreak preparedness in U.S. emergency departments: an assessment of disaster medicine experts (#423)

Presenter: M.J. Morton, Johns Hopkins University School of Medicine, Baltimore, Md.

Significant deficits in pandemic influenza and other infections disease outbreak preparedness were attributed to a lack of hospital administration support, funding shortages, staffing shortages and inadequate communication among disaster response agencies.

Presentation characteristics and the impact on emergency department resources related to college-age drinking (#455)

Presenter: D.P. Betten, Sparrow Hospital, Lansing, Mich.

Alcohol consumption among college students appeared to be responsible for a large number of emergency department visits.

Prevalence and severity of depression in emergency department patients with diabetes: what is the association with glycemic control? (#457)

Presenter: M.D. Menchine, University of Southern California, Los Angeles, Calif.

More than one-third of emergency patients with diabetes also suffered from depression, and those patients with depression had poorer glycemic control overall than the diabetes patients who were not depressed.

Increasing incidence of induced loss of consciousness in sexual assault victims in the New York area (#460)

Presenter: I. Llovera, North Shore University Hospital, Manhasset, N.Y.

An increase in loss of consciousness among sexual assault victims suggests a possible increase in the use of date rape drugs in the New York metropolitan area.

ACEP is a national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.

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