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In the complex world of modern medicine, it often requires purposeful thought and action to place our patients at the center of the care process. This study serves to remind us how to employ evidence-based patient-centered care during the course of emergency medicine (EM) practice. 

Source
Recommendations for patient-centered emergency care. CJEM. 2024 Aug;26(8):513-519. doi: 10.1007/s43678-024-00706-3. Epub 2024 Jun 21. PMID: 38904747.

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The MISSION Act Scribes Trial evaluated the implementation of medical scribes in Veterans Health Administration (VHA) EDs. Contrary to expectations, scribes decreased provider productivity and increased patient throughput times.

Source
Effect of the Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act Scribes Trial on Emergency Department Provider Productivity and Patient Throughput Times. J Emerg Med. 2024 Jul;67(1):e89-e98. doi: 10.1016/j.jemermed.2024.03.036. Epub 2024 Mar 30.

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There are significant administrative burdens faced by hospitalists and administrative leaders, which negatively impact efficiency, well-being, and job satisfaction. The findings highlight the importance of systematically identifying and measuring administrative burdens as a critical step towards creating healthier work environments, thereby optimizing healthcare delivery.

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The first direct comparison of the Clinical Institute Withdrawal Assessment-Alcohol Revised (CIWA-Ar) scale to a slightly modified Richmond Agitation and Sedation Scale (mRASS-AW) in a pre-post quality assurance study found mRASS-AW to not compromise length of stay or safety for the evaluation of alcohol withdrawal syndrome (AWS), while we already know it to be faster and more intuitive.

Source
Replacing the Clinical Institute Withdrawal Assessment-Alcohol revised with the modified Richmond Agitation and Sedation Scale for alcohol withdrawal to support management of alcohol withdrawal symptoms: potential impact on length of stay and complications. CJEM. 2024;26(6):431-435. doi:10.1007/s43678-024-00710-7

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Patients are increasingly accessing electronic health portals during ED encounters, but disparities in portal access exist – male, Black, and non-commercially insured patients show lower rates of usage.

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In underserved populations, where the Emergency Department may be patients' greatest contact with the healthcare system, simply asking may increase seasonal influenza vaccination.

Source
Promotion of Influenza Vaccination in the Emergency Department. NEJM Evid 2024;3(4) DOI: 10.1056/EVIDoa2300197

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In a large multicenter observational cohort of patients with sepsis, the strongest mortality benefit was seen for early antibiotic administration (within 3 hours of arrival to the emergency department) in patients with metastatic cancer and with shock.

Source
Heterogeneity of Benefit from Earlier Time-to-Antibiotics for Sepsis. Am J Respir Crit Care Med. 2024 Apr 1;209(7):852-860. doi: 10.1164/rccm.202310-1800OC. PMID: 38261986; PMCID: PMC10995570.

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This retrospective study found that of the 4,446 patients transferred over a 4.5-year period, 1,509 (34%) transfers could have possibly been avoided by utilizing telehealth/teleconsultation, with the most common transfer complaints being abdominal pain, asthma, and cough. 

Source
Pediatric Patients Discharged After Transfer to a Pediatric Emergency Department: Opportunities for Telehealth?. Ann Emerg Med. 2024;83(3):208-213. doi:10.1016/j.annemergmed.2023.08.489

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In this retrospective study of ED physicians in one state, researchers found statistically significant differences in admission rates among clinicians but little consistency in admission tendencies across multiple conditions. Clinicians with greater tolerance to risk (as a general attitude) had associated lower rates of admission when compared to projections.

Source
Clinician Risk Tolerance and Rates of Admission From the Emergency Department. JAMA Netw Open. 2024 Feb 5;7(2):e2356189. doi: 10.1001/jamanetworkopen.2023.56189.

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In the absence of a standardized approach, patients placed in hallway beds were more likely to be male, have Medicaid/self-pay payer status, and elope in this single health system study.

Source
Inequities among patient placement in emergency department hallway treatment spaces. Am J Emerg Med. 2024 Feb;76:70-74. doi: 10.1016/j.ajem.2023.11.013. Epub 2023 Nov 11.