Key Insights from Emergency Medicine Journals

Emergency Medicine Practice of Medicine

Trypanophobes Rejoice! Big IVs Hurt No More Than Little Ones
April 2, 2024October 15, 2024

Spoon Feed —
This single centre RCT investigated the link between IV cannula diameter and how painful it will be to insert. 18G cannulas were not more painful nor more difficult to place than 20G cannulas across the spectrum of experience levels. Pain and insertion success rates being equal, patients are better off with cannulas that can accommodate higher flow rates.

Source
Spiced RCT: Success and Pain Associated with Intravenous Cannulation in the Emergency Department Randomized Controlled Trial. J Emerg Med. 2024;66(2):57-63. doi:10.1016/j.jemermed.2023.10.008.

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Emergency Medicine Ethics Health Policy Practice of Medicine

Private Equity Acquisition May Be Dangerous for Patients
March 1, 2024October 15, 2024

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In a self-described “quasi-experimental” analysis of Medicare claims data, private equity owned hospitals were associated with a 25% increase in hospitalization-acquired adverse events when compared with non-private equity hospitals. Notably, there was a 27% increase in falls, a 38% increase in the volume of central line-associated infections, despite the placement of 16% fewer central lines, and a doubling of surgical site infections despite 8% fewer surgical procedures being performed (underpowered assertion).

Source
Changes in Hospital Adverse Events and Patient Outcomes Associated With Private Equity Acquisition. JAMA. 2023 Dec 26;330(24):2365-2375. doi: 10.1001/jama.2023.23147.

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ED-Hospital-Clinic Operations Emergency Medicine Practice of Medicine

Simplest Way to Boost Patient Satisfaction? You Might Want to Sit Down for This…
January 22, 2024October 15, 2024

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Chair placement near the bedside is a simple intervention that increased the likelihood of physician sitting during patient encounters and yielded higher patient scores in satisfaction and communication.

Source
Effect of chair placement on physicians’ behavior and patients’ satisfaction: randomized deception trial. BMJ. 2023;383:e076309. Published 2023 Dec 15. doi:10.1136/bmj-2023-076309.

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Critical Care Emergency Medicine Landmark Pediatric Emergency Practice of Medicine

Best Articles of 2023
January 1, 2024October 15, 2024

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These are the top articles from 2023. Enjoy!

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Education Emergency Medicine Ethics Practice of Medicine

Snarky Sign-outs – How to Avoid Bias During Handoff
November 9, 2023October 15, 2024

Spoon Feed —
Our words during handoff can bias our colleagues against our patients. Here’s how it happens and what we can do to improve.

Source
Patient Factors Associated With Biased Language in Nightly Resident Verbal Handoff. JAMA Pediatr. 2023 Oct 1;177(10):1098-1100. doi: 10.1001/jamapediatrics.2023.2581.

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Emergency Medicine Internal Medicine Landmark Practice of Medicine

Is 98.6F (37C) Wrong?
November 1, 2023October 25, 2024

Spoon Feed —
Normal oral temperature is hard to define, but this large cross-sectional study suggests that the average is not 37^oC (98.6^oF).

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ED-Hospital-Clinic Operations Education Emergency Medicine Health Policy Practice of Medicine

Experienced or Rusty? Physician Age and Patient Mortality
October 23, 2023October 15, 2024

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Emergency physician (EP) advancing age was associated with higher 7-day patient mortality. This is a call to keep current with literature, clinical skills, and best practices.

Source
Association Between Emergency Physician’s Age and Mortality of Medicare Patients Aged 65 to 89 Years After Emergency Department Visit. Ann Emerg Med. 2023 Sep;82(3):301-312. doi: 10.1016/j.annemergmed.2023.02.010. Epub 2023 Mar 23.

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ED-Hospital-Clinic Operations Education Emergency Medicine Practice of Medicine

How to Identify Errors – “Would You Have Done Something Differently?”
October 9, 2023October 15, 2024

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Asking EPs the question – “Would you have done something differently? (WYHDSD)” – was found to have high sensitivity (97.4%) and NPV (99.8%) in predicting medical error. Specificity was lower at 92.9%.

Source
Can Asking Emergency Physicians Whether or Not They Would Have Done Something Differently (WYHDSD) be a Useful Screening Tool to Identify Emergency Department Error? J Emerg Med. 2023 Sep;65(3):e250-e255. doi: 10.1016/j.jemermed.2023.05.005. Epub 2023 Jun 10.

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Education Emergency Medicine Practice of Medicine Venous Thromboembolism

Anchoring – Does Information from Triage Bias Our Workup?
September 29, 2023October 15, 2024

Spoon Feed —
Veterans Affairs (VA) patients with known congestive heart failure (CHF) presenting for shortness of breath as a chief complaint were less likely to receive testing for venous thromboembolism (VTE) when triage reported CHF.

Source
Evidence for Anchoring Bias During Physician Decision-Making. JAMA Intern Med. 2023 Aug 1;183(8):818-823. doi: 10.1001/jamainternmed.2023.2366.

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Critical Care Emergency Medicine Ethics Practice of Medicine

Do We Need to Reconsider the Word… Need?
September 4, 2023October 15, 2024

Spoon Feed —
Need in medicine describes what is missing and the necessary corrective action (i.e. you need a transfusion), but this wording allows little latitude for discussion with patients and families. However, saying, “Can we talk about what this means and what to do next?” allows for dialogue without presuming the desired course of action.

Source
Reconsidering the Language of Serious Illness. JAMA. 2023 Aug 15;330(7):587-588. doi: 10.1001/jama.2023.11409.

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