Oskvarek JJ, Zocchi MS, Jouriles N
… +3 more, Seaberg D, Bedolla J, Pines JM
Ann Emerg Med
· 2026 May · PMID 42080778
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STUDY OBJECTIVE: We evaluate a program designed to safely reduce avoidable emergency department (ED) admissions for chest pain using peer feedback. METHODS: We analyzed data from August 1, 2020, to December 31, 2022, com...STUDY OBJECTIVE: We evaluate a program designed to safely reduce avoidable emergency department (ED) admissions for chest pain using peer feedback. METHODS: We analyzed data from August 1, 2020, to December 31, 2022, comparing clinical protocols, education, and feedback starting in July 2021 at 16 EDs in a Mountain-region state (state A) and 22 in a Southwestern state (state B), compared with 70 controls with protocols and education alone. Difference-in-difference analyses compared temporal changes in admission rates in intervention versus control EDs. RESULTS: The study included 368,730 visits for chest pain. After implementation, feedback was not associated with a significant overall relative improvement in ED admission rates for chest pain. However, among baseline high-admitting clinicians, chest pain admissions declined in state A by 14.3% (95% confidence interval -21.7% to -6.9%) and in state B by 5.6% (95% confidence interval -10.5% to -0.8%), relative to high-admitting clinicians in control states. We estimate that 4 admissions in every 100 chest pain visits could have been avoided if feedback had the same effect in control EDs as it did in state A. CONCLUSION: Adding peer feedback to clinical protocols and education was associated with reduced admissions for chest pain among baseline high-admitting clinicians.
Ishimine P, Atigapramoj NS, Yen K
… +8 more, Ugalde IT, Badawy M, Chaudhari PP, McCarten-Gibbs KA, Upperman JS, Tancredi DJ, Kuppermann N, Holmes JF
Ann Emerg Med
· 2026 Apr · PMID 41989358
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STUDY OBJECTIVE: We evaluated the association of observation with computed tomography (CT) use in children with blunt abdominal trauma. METHODS: We performed a secondary analysis of a prospective multicenter cohort study...STUDY OBJECTIVE: We evaluated the association of observation with computed tomography (CT) use in children with blunt abdominal trauma. METHODS: We performed a secondary analysis of a prospective multicenter cohort study of children with blunt abdominal trauma. Clinicians documented Pediatric Emergency Care Applied Research Network abdominal trauma rule variables and whether a period of observation with deferred CT decisionmaking was performed. Intra-abdominal injury undergoing acute intervention was defined as intra-abdominal injury resulting in surgery, angiography, blood transfusion, or death. We used multivariable logistic regression to examine the association between observation status and CT use, adjusting for age, study site, clinician suspicion of intra-abdominal injury, and Pediatric Emergency Care Applied Research Network predicition rule variables. RESULTS: Among 7,442 children with documented observation status, 2,024 (27.2%, 95% confidence interval [CI] 26.2%, 28.2%) underwent observation. CT use was less frequent among observed patients (414/2,024 [20.5%]) than those not observed (2,011/5,418 [37.1%; difference 16.7%, 95% CI 14.5%, 18.8%]). Intra-abdominal injury undergoing acute intervention occurred in 8/2,024 (0.4%) of observed versus 137/5,418 (2.5%) of not observed patients (difference 2.1%, 95% CI 1.6%, 2.6%). Observation was associated with lower CT use when clinician suspicion of intra-abdominal injury was 1% to 5% (odds ratio [OR] = 0.31, 95% CI 0.25, 0.39), 6% to 10% (OR = 0.15, 95% CI 0.10, 0.23), and 11% to 50% (OR = 0.18, 95% CI 0.08%, 0.39%). A total of 1,610 (79.5%) observed patients were discharged without CT, and none (0%, 95% CI 0%, 0.3%) had intra-abdominal injury undergoing acute intervention. CONCLUSION: Observation with deferred CT decisionmaking was associated with less frequent CT use, particularly in patients with intermediate clinician suspicion, without an increase in missed injuries.
Morrison CN, Bushover BR, Crowe RP
… +3 more, Mills CW, Lo AX, Rundle AG
Ann Emerg Med
· 2026 Mar · PMID 41920120
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STUDY OBJECTIVE: The National Emergency Medical Services Information System public release data set is an important tool for researching emergency medical services (EMS) responses. However, multiple EMS units might atten...STUDY OBJECTIVE: The National Emergency Medical Services Information System public release data set is an important tool for researching emergency medical services (EMS) responses. However, multiple EMS units might attend to a single patient and the data are organized by EMS response, presenting challenges to inferences about patient-level events. We test whether data on time of the 911 call and patient characteristics can be used to screen for multiple EMS records that reflect a single patient encounter. METHODS: In this cross-sectional study, we used data on EMS responses to assaults in New York City in 2024 to identify EMS responses that had identical data for 911 call time, patient age, sex, race/ethnicity, and longitude-latitude where the patient was encountered. EMS responses with identical data for all of these variables were assumed to have attended to a single patient. We assessed the validity of matching on 911 call time, patient age, sex, and race/ethnicity to identify instances where separate EMS responses matched for these variables plus location. RESULTS: Of 32,202 EMS responses, 5,143 responses matched other responses for all variables, suggesting that there were 26,451 patients encounters. Matching on permutations of variables for time of 911 call, patient age, sex, race, and ethnicity had 100% sensitivity and a high specificity (range 91.3% to 98.6%) for identifying responses that matched on all of these variables plus longitude-latitude. CONCLUSION: Data available in the National Emergency Medical Services Information System public release data set may potentially be used to screen for duplicate EMS responses improving inferences about patient-level events.
Ann Emerg Med
· 2026 Mar · PMID 41874493
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STUDY OBJECTIVE: Health care researchers, policymakers, and managers have long been concerned with heavy emergency department (ED) use for low-acuity conditions that can be addressed in office-based settings. Clinically,...STUDY OBJECTIVE: Health care researchers, policymakers, and managers have long been concerned with heavy emergency department (ED) use for low-acuity conditions that can be addressed in office-based settings. Clinically, urgent care clinics are a viable substitute. Yet, we know little about how ED use and urgent care use interact, and how their combined or separate use varies across population groups. People may cluster in groups with distinct patterns of combined health care utilization, which we consider a meaningful way to study health care use. We aimed to identify latent classes of adult health care utilization based on observed characteristics. METHODS: We conducted a latent class analysis to identify distinct classes of health care utilization among adults (18+ years old) using publicly available, de-identified data from the 2022-2023 National Health Interview Survey (N=56,181). The latent class model included 4 indicators and 2 ordinal variables: having the last visit being a wellness visit, having a usual place of care, delaying or foregoing care due to cost, having a hospitalization, urgent care use (0, 1-2 visits, and 3+ visits), and ED use (0, 1, and 2+ visits) in the past year. We compared the fit of 2, 3, and 4-class models using Akaike's Information Criterion and Bayesian Information Criterion statistics. We then estimated regression models of class probabilities on sociodemographic and health-related characteristics. RESULTS: A 4-class model had the best model fit. Two classes were distinguished by low health care use: one with barriers to care ("nonusers with access barriers," the smallest class, 6.8%) and one without ("nonusers without access barriers"; the largest class, 59.7%). The class of "heavy health care users" (15.7%) is characterized by the highest probability of ED use (mean probability of having 1 visit 0.471 and 2+ visits 0.351) and the highest probability of hospitalization (0.515) of all classes, alongside moderate urgent care use (probability of 1+ visits 0.430). The class of "urgent care users" (17.7%) is marked by the highest probability of urgent care use (zero probability of no visit, 0.786 of 1-2 visits and 0.214 of 3+ visits), alongside low probability of ED use and the lowest probability of hospitalizations (<0.01). In adjusted regression analyses, the probability of being in the "nonusers with access barriers" class was substantially higher for the uninsured and the probability of being in the "heavy health care users" class was substantially higher for Medicaid enrollees. The probability of being an "urgent care user" was higher for those with higher educational attainment and private insurance. CONCLUSION: Our findings suggest that urgent care is either complementary to the ED (in the "heavy health care users" class) or is used alongside low to no use hospital-based care and low to no barriers to care ("urgent care users" class). At the same time, our analysis did not identify a distinct class of ED users, with low to no urgent care use. Our findings can inform health system decisionmaking, especially in areas of health care delivery and improving access.