Increased emergency department use by adolescents and young adults with eating disorders

Objective: This study describes patterns of emergency department (ED) utilization by patients who screen positive for eating disorders. Method: ED patients aged 14–20 years ( n = 1,920) completed a computerized questionnaire. The analyses compared the rates of ED use between patients who screened positive for an eating disorder and those who did not and examined the reasons for ED use amongst patients with eating disorders. Results: ED patients who screened positive for eating disorders were significantly more likely to have previously visited the ED and, on average, utilized the ED at a rate 1.6 times higher than patients who screen negative for eating disorders. The most common chief complaints among patients who screen positive for eating disorders were abdominal pain and other gastrointestinal‐related problems. Discussion: Patients with eating disorders utilize the ED more frequently than those without and commonly present for complaints seemingly unrelated to their eating disorder. © 2012 by Wiley Periodicals, Inc. (Int J Eat Disord 2013)Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/97531/1/22070_ftp.pd

The prevalence and correlates of eating disorders in adult emergency department patients

ObjectiveThis study describes the prevalence of eating disorders among adult patients who present to the emergency department for medical care and examines the relationship between eating disorders, depression, and substance use disorders.MethodEmergency department patients aged 21-65-years (n = 1,795) completed a computerized questionnaire that included validated screening tools for eating disorders, risky drinking behavior, other substance use, and depression. Analyses were conducted comparing individuals who screened positive for an eating disorder with those who did not based on demographics (gender, age, race, income, education), body mass index (BMI), risky drinking behavior, other substance use, and depression.ResultsNearly 16% (15.9%) of all patients screened positive for an eating disorder regardless of their reason for presenting to the emergency department. Patients who screened positive for an eating disorder were significantly more likely to have a BMI->-30 (odds ratio [OR] = 2.68, confidence interval [CI] = 1.98, 3.62, p-<-.001), to also screen positive for depression (OR = 3.19, CI = 2.28, 4.47, p-<-.001) and to be female (OR = 2.37, CI = 1.76, 3.19, p-<-.001). No differences in the prevalence of positive screens for eating disorders were seen across age or racial groups, level of education or income, or for any of the included substance use variables.DiscussionEating disorders are common among adult emergency department patients and are associated with high rates of comorbid depression and higher BMI. Given the significant morbidity and mortality associated with eating disorders, targeted screening may be warranted in the emergency department setting.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152020/1/eat23140_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/152020/2/eat23140.pd

Alternative Markers of Performance in Simulation: Where We Are and Where We Need To Go

This article on alternative markers of performance in simulation is the product of a session held during the 2017 Academic Emergency Medicine Consensus Conference â Catalyzing System Change Through Health Care Simulation: Systems, Competency, and Outcomes.â There is a dearth of research on the use of performance markers other than checklists, holistic ratings, and behaviorally anchored rating scales in the simulation environment. Through literature review, group discussion, and consultation with experts prior to the conference, the working group defined five topics for discussion: 1) establishing a working definition for alternative markers of performance, 2) defining goals for using alternative performance markers, 3) implications for measurement when using alternative markers, identifying practical concerns related to the use of alternative performance markers, and 5) identifying potential for alternative markers of performance to validate simulation scenarios. Five research propositions also emerged and are summarized.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142535/1/acem13321_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142535/2/acem13321.pd

Developing Technical Expertise in Emergency Medicine—The Role of Simulation in Procedural Skill Acquisition

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72919/1/j.1553-2712.2008.00218.x.pd

Treatment of Nausea and Vomiting in Pregnancy: Factors Associated with ED Revisits

Introduction: Nausea and vomiting in pregnancy (NVP) is a condition that commonly affects women in the first trimester of pregnancy. Despite frequently leading to emergency department (ED) visits, little evidence exists to characterize the nature of ED visits or to guide its treatment in the ED. Our objectives were to evaluate the treatment of NVP in the ED and to identify factors that predict return visits to the ED for NVP. Methods: We conducted a retrospective database analysis using the electronic medical record from a single, large academic hospital. Demographic and treatment variables were collected using a chart review of 113 ED patient visits with a billing diagnosis of “nausea and vomiting in pregnancy” or “hyperemesis gravidarum.” Logistic regression analysis was used with a primary outcome of return visit to the ED for the same diagnoses. Results: There was wide treatment variability of nausea and vomiting in pregnancy patients in the ED. Of the 113 patient visits, 38 (33.6%) had a return ED visit for NVP. High gravidity (OR 1.31, 95% CI [1.06-1.61]), high parity (OR 1.50 95% CI [1.12-2.00]), and early gestational age (OR 0.74 95% CI [0.60-0.90]) were associated with an increase in return ED visits in univariate logistic regression models, while only early gestational age (OR 0.74 95% CI [0.59-0.91]) was associated with increased return ED visits in a multiple regression model. Admission to the hospital was found to decrease the likelihood of return ED visits (p=0.002). Conclusion: NVP can be difficult to manage and has a high ED return visit rate. Optimizing care with aggressive, standardized treatment in the ED and upon discharge, particularly if factors predictive of return ED visits are present, may improve quality of care and reduce ED utilization for this condition

Treatment of Nausea and Vomiting in Pregnancy: Factors Associated with ED Revisits

Introduction: Nausea and vomiting in pregnancy (NVP) is a condition that commonly affects women in thefirst trimester of pregnancy. Despite frequently leading to emergency department (ED) visits, little evidenceexists to characterize the nature of ED visits or to guide its treatment in the ED. Our objectives were toevaluate the treatment of NVP in the ED and to identify factors that predict return visits to the ED for NVP.Methods: We conducted a retrospective database analysis using the electronic medical record from asingle, large academic hospital. Demographic and treatment variables were collected using a chart reviewof 113 ED patient visits with a billing diagnosis of “nausea and vomiting in pregnancy” or “hyperemesisgravidarum.” Logistic regression analysis was used with a primary outcome of return visit to the ED for thesame diagnoses.Results: There was wide treatment variability of nausea and vomiting in pregnancy patients in the ED.Of the 113 patient visits, 38 (33.6%) had a return ED visit for NVP. High gravidity (OR 1.31, 95% CI [1.06-1.61]), high parity (OR 1.50 95% CI [1.12-2.00]), and early gestational age (OR 0.74 95% CI [0.60-0.90])were associated with an increase in return ED visits in univariate logistic regression models, while onlyearly gestational age (OR 0.74 95% CI [0.59-0.91]) was associated with increased return ED visits in amultiple regression model. Admission to the hospital was found to decrease the likelihood of return ED visits(p=0.002).Conclusion: NVP can be difficult to manage and has a high ED return visit rate. Optimizing care with aggressive,standardized treatment in the ED and upon discharge, particularly if factors predictive of return EDvisits are present, may improve quality of care and reduce ED utilization for this condition. [West J EmergMed. 2016;17(5)585-590.]

Alternative Markers of Performance in Simulation: Where We Are and Where We Need To Go.

This article on alternative markers of performance in simulation is the product of a session held during the 2017 Academic Emergency Medicine Consensus Conference Catalyzing System Change Through Health Care Simulation: Systems, Competency, and Outcomes. There is a dearth of research on the use of performance markers other than checklists, holistic ratings, and behaviorally anchored rating scales in the simulation environment. Through literature review, group discussion, and consultation with experts prior to the conference, the working group defined five topics for discussion: 1) establishing a working definition for alternative markers of performance, 2) defining goals for using alternative performance markers, 3) implications for measurement when using alternative markers, identifying practical concerns related to the use of alternative performance markers, and 5) identifying potential for alternative markers of performance to validate simulation scenarios. Five research propositions also emerged and are summarized

Attitudes towards eating disorders clinicians with personal experience of an eating disorder

Purpose: This study explores the perspectives and opinions towards ED clinicians with lived experience of ED. Methods: Three hundred and eighty-five ED clinicians and 124 non-clinicians from 13 countries, between 18 and 76 years of age completed an online survey about attitudes towards ED clinicians with a personal ED history. Almost half the respondents (n = 242, 47.5%) reported a lifetime ED diagnosis. Survey items included ten multiple-choice and three open questions about clinician disclosure, employer hiring practices, and perceived advantages and disadvantages of clinicians with a personal ED history practicing in the ED field. Multiple-choice responses from clinicians with and without a personal ED history were compared with responses from non-clinicians with and without a personal ED history. Open questions were examined using thematic analysis. Results: Clinicians with no ED history, whose responses often differed from both ED-history groups (clinicians and non-clinicians), were more likely to indicate that clinicians with an ED should not generally treat ED patients, and that clinicians should self-disclose their ED history to employers but not to their patients. Thematic analysis of the open-ended questions revealed that advantages of having clinicians with an ED history include a deep experiential understanding and the ability to be empathic and non-judgmental, whereas disadvantages include the lack of objectivity and the risk of clinicians being triggered. Conclusion: Further research informing guidelines for ED clinicians with a personal ED history, their colleagues and employers are needed to protect and empower the significant minority of ED professionals with “lived experience” of EDs. Level of evidence: Level III, case-control analytic study

Reporting achievement of medical student milestones to residency program directors: An educational handover

Copyright © by the Association of American Medical Colleges. Problem Competency-based education, including assessment of specialty-specific milestones, has become the dominant medical education paradigm; however, how to determine baseline competency of entering interns is unclear - as is to whom this responsibility falls. Medical schools should take responsibility for providing residency programs with accurate, competency-based assessments of their graduates. Approach A University of Michigan ad hoc committee developed (spring 2013) a post-Match, milestone-based medical student performance evaluation for seven students matched into emergency medicine (EM) residencies. The committee determined EM milestone levels for each student based on assessments from the EM clerkship, end-of-third-year multistation standardized patient exam, EM boot camp elective, and other medical school data. Outcomes In this feasibility study, the committee assessed nearly all 23 EM milestones for all seven graduates, shared these performance evaluations with the program director (PD) where each student matched, and subsequently surveyed the PDs regarding this pilot. Of the five responding PDs, none reported using the traditional medical student performance evaluation to customize training, four (80%) indicated that the proposed assessment provided novel information, and 100% answered that the assessment would be useful for all incoming trainees. Next Steps An EM milestone-based, post-Match assessment that uses existing assessment data is feasible and may be effective for communicating competency-based information about medical school graduates to receiving residency programs. Next steps include further aligning assessments with competencies, determining the benefit of such an assessment for other specialties, and articulating the national need for an effective educational handover tool between undergraduate and graduate medical education institutions