Acad Emerg Med
· 2026 Mar · PMID 41872631
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Emergency physicians evaluate the full spectrum of traumatic brain injury (TBI) and generate the initial clinical descriptions that influence downstream care, follow-up, and patient expectations. Despite advances in neur...Emergency physicians evaluate the full spectrum of traumatic brain injury (TBI) and generate the initial clinical descriptions that influence downstream care, follow-up, and patient expectations. Despite advances in neuroimaging, biomarker science, and systems of care, acute TBI is still commonly summarized using categorical labels: mild, moderate, and severe, derived from the Glasgow Coma Scale (GCS). In 2025, the National Institutes of Health-National Institute of Neurological Disorders and Stroke (NIH-NINDS) Traumatic Brain Injury Classification and Nomenclature Initiative proposed a multidimensional framework for acute TBI characterization incorporating Clinical, Biomarker, Imaging, and Modifier elements (CBI-M). The framework is intended to improve characterization and research rigor, and has generated broad interest and discussion across clinical disciplines. This special contribution introduced the CBI-M framework to the emergency medicine community and provides an interpretive, clinically grounded commentary on its relevance to emergency practice. The rationale for the framework is described, its core components are summarized, and its relevance to emergency department (ED) practice is discussed. Areas where CBI-M aligns with current emergency care, where important implementation questions remain, and how emergency physicians might engage with the framework as a shared language for describing injury rather than as a prescriptive management tool are highlighted. By situating CBI-M within the realities of emergency care and existing ED decision frameworks, this article aims to inform, contextualize, and encourage discussion within the emergency medicine community as this new approach to TBI characterization continues to evolve.
Acad Emerg Med
· 2026 Mar · PMID 41866862
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BACKGROUND: Older adults are frequent users of the Emergency Department (ED), with a significant proportion presenting with pre-existing or acute cognitive impairment. While negative post-ED outcomes associated with cogn...BACKGROUND: Older adults are frequent users of the Emergency Department (ED), with a significant proportion presenting with pre-existing or acute cognitive impairment. While negative post-ED outcomes associated with cognitive status are well documented, their direct impact on care processes and resource allocation within the hospital remains poorly understood. This study aims to quantify how different cognitive profiles affect costs and care needs for acutely ill older adults. METHODS: We conducted a secondary analysis of a prospective cohort study at a single, tertiary care hospital. We included patients aged ≥ 65 years admitted to the hospital through the ED. They were stratified into three groups based on the brief Confusion Assessment Method (bCAM) and the 10-Point Cognitive Screener (10-CS): normal cognition, cognitive impairment without delirium, and delirium. Primary outcome was cost of care. Resource utilization, characterized by the number of medical specialties involved, geriatric consultation, type of inpatient bed allocated from the ED, time to hospitalization, and patient satisfaction, were explored as secondary outcomes. Multiple regression models were used to assess associations, adjusting for sociodemographic factors, clinical severity, and geriatric vulnerability. RESULTS: The sample comprised 824 patients: 429 (52.1%) with normal cognition, 165 (20.0%) with delirium, and 230 (27.9%) with cognitive impairment without delirium. Clinical severity, but not cognitive status, was independently associated with costs (B = 0.18; 95% CI: 0.08, 0.27). Delirium was independently associated with allocation to high-complexity bed and receiving a geriatric consultation. Cognitive impairment was independently associated with a greater number of specialties involved. CONCLUSIONS: Clinical severity showed the strongest association with costs. In contrast, cognitive profiles were independently associated with the care pathway and complexity, with delirium linked to higher-acuity allocation and preexisting cognitive impairment without delirium to broader multidisciplinary involvement. Recognizing these distinct cognitive profiles is fundamental for anticipating care demands and optimizing resource allocation for this vulnerable population.
Acad Emerg Med
· 2026 Mar · PMID 41854499
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BACKGROUND: Status epilepticus (SE) is a medical emergency requiring rapid intervention. Despite treatment guidelines, delays in real-world SE management persist, potentially worsening outcomes. The Established Status Ep...BACKGROUND: Status epilepticus (SE) is a medical emergency requiring rapid intervention. Despite treatment guidelines, delays in real-world SE management persist, potentially worsening outcomes. The Established Status Epilepticus Treatment Trial (ESETT), while comparing second-line antiseizure medications, also enabled analysis of treatment timelines in emergency settings. OBJECTIVES: This study evaluates the timing of SE treatment steps in ESETT to assess adherence to guideline-recommended timeframes and identify factors contributing to delays. METHODS: This secondary analysis of ESETT included patients aged ≥ 2 years with generalized convulsive SE unresponsive to benzodiazepines, randomized to receive fosphenytoin, levetiracetam, or valproic acid. Key intervals analyzed included time from emergency department (ED) arrival to first benzodiazepine, initiation of second-line therapy, and other interventions (e.g., intubation, rescue meds). We used descriptive statistics and the Van Elteren test to compare timelines between those who achieved treatment success, defined as seizure cessation and improved mental status at 60 min, and those who did not. RESULTS: Among 487 patients (53% adults, 47% children; 57% male), 46% achieved treatment success. Nearly half did not receive any prehospital benzodiazepines. Median time from ED arrival to first benzodiazepine was 11 min (IQR 5-41), and to second-line antiseizure medications was 26 min (IQR 18-43), both generally aligning with guidelines. Earlier administration of second-line therapy was significantly associated with treatment success (p = 0.03). CONCLUSIONS: Although many treatment steps occurred within recommended windows, considerable variability exists. Prehospital benzodiazepine use was often absent, and in-hospital treatment timing was inconsistent. Earlier delivery of second-line therapy correlated with improved outcomes. These real-world data provide a lens through which to better understand the causes and impact of practice variability in time to treatment and assess the extent to which current guidelines on timing may be important, but also how they may be ambiguous or unrealistic.
Beachy S, McCarthy DM, Lenoir J
… +8 more, Gentsch A, Hass R, Witmer M, Ostroff P, Tupas M, Shughart L, Shughart H, Rising KL
Acad Emerg Med
· 2026 Mar · PMID 41841766
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BACKGROUND: Transitions of care are high-risk periods for patient safety in the emergency department (ED), particularly for patients who are still in the diagnostic process and are discharged with diagnostic uncertainty....BACKGROUND: Transitions of care are high-risk periods for patient safety in the emergency department (ED), particularly for patients who are still in the diagnostic process and are discharged with diagnostic uncertainty. Care transitions must be improved for these patients, as one third of discharged ED patients have diagnostic uncertainty. Yet there are no validated measures that assess the quality of care transitions from the ED, limiting the ability to assess the impact of interventions. Thus, we developed and validated the ED Transitions (EDT) measure. METHODS: This mixed methods study was conducted across a large healthcare system in three phases: item generation, cognitive interviewing, and large-scale validation. Scale items were generated by experts and then iteratively refined using feedback from cognitive interviews (n = 11). The measure was then validated on a large sample of patients (n = 301) recently discharged from the ED. Exploratory structural equation modeling (ESEM) was employed to assess factor structure. Bivariate correlations were used to assess discriminant and convergent validity using the Care Transition Measure (CTM-3) and the Communication Assessment Tool-Teams (CAT-T). RESULTS: The measure was iteratively refined by way of an expert panel and cognitive interviews which resulted in a 15-item measure to be used for validation. The validation sample (n = 301) was 62% women, 49% White, and the majority having Medicare and/or Medicaid (68%). Sequential comparisons between confirmatory factor analyses and ESEM resulted in a final 10-item two-factor structure. Reliability was excellent (0.93), and bivariate correlations indicated positive correlations between the EDT, CTM-3, and CAT-T. CONCLUSION: The EDT measure demonstrates content validity, structural validity, convergent validity, discriminant validity, and high internal consistency (i.e., reliability). This newly developed patient reported outcome measure can be used in future clinical and research work to better understand the impact of ED interventions on quality-of-care transitions for patients with diagnostic uncertainty.
Mundo W, Clark M, Picazo JG
… +2 more, Portz JD, Goldberg EM
Acad Emerg Med
· 2026 Mar · PMID 41839810
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BACKGROUND: Falls are a leading cause of morbidity among older adults. Although emergency departments (EDs) routinely screen for fall risk, few patients are connected to prevention programs after discharge. Digital tools...BACKGROUND: Falls are a leading cause of morbidity among older adults. Although emergency departments (EDs) routinely screen for fall risk, few patients are connected to prevention programs after discharge. Digital tools could automate notification and referral, yet few have been developed or tested in acute care settings with ED end-users in mind. OBJECTIVE: To assess the feasibility, acceptability, and usability of ALERT-ED, a novel digital intervention designed to automate fall risk notification and referral. METHODS: We conducted semi-structured interviews with English- and Spanish-speaking ED patients aged ≥ 65, caregivers, and nurses across multiple hospitals within a large integrated healthcare system. ALERT-ED automatically embeds a QR code in the After Visit Summary of high fall risk ED patients, linking to a chatbot (Livi) that supports self-screening, fall education, and referral to community programs. Thematic analysis of interview transcripts informed optimization of the intervention ahead of a planned clinical trial. RESULTS: Interviews of 6 nurses, 12 patients, and 4 caregivers revealed seven themes: (1) feasibility depends on dissemination strategies and workflow alignment; (2) barriers include limited awareness and nursing time constraints; (3) acceptability improves trust, readability, and personalization; (4) expanding scope to enhance engagement; (5) privacy and artificial intelligence skepticism persist; (6) usability is high due to the QR interface; and (7) accessibility gaps remain for users with impairments. CONCLUSION: ALERT-ED demonstrates strong feasibility, acceptability, and usability among older adults, caregivers, and ED nurses. By automating fall risk notification and referral, ALERT-ED offers a pathway for integrating public health interventions into emergency care.
Liu SW, Horeczko T, Jordan J
… +3 more, Clarke SO, Runde DP, Coates WC
Acad Emerg Med
· 2026 Mar · PMID 41839801
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IMPORTANCE: Unsolicited peer review requests have increased with the expansion of academic publishing, raising concerns about reviewer fatigue. Peer review is a critical component in disseminating scientific discovery re...IMPORTANCE: Unsolicited peer review requests have increased with the expansion of academic publishing, raising concerns about reviewer fatigue. Peer review is a critical component in disseminating scientific discovery requiring time and expertise, often uncompensated. OBJECTIVE: We sought to quantify and analyze characteristics of the review solicitation burden on a group of senior faculty. METHODS: We conducted a prospective mixed-methods study of 6 senior academic physicians who are peer reviewers and editors. Each participant monitored their email inboxes (9/1-12/13, 2024) for peer review requests. We collected solicitation date, journal name, discipline, reviewer's existing relationship to journal, content relevance, response to request, immediate Plutchik Basic Emotions reaction, narrative comments, using hermeneutic phenomenology. We calculated descriptive statistics and performed a thematic analysis with a constructivist paradigm of narrative comments. RESULTS: Participants (5 institutions, 3 males) received 139 solicitations. Over half (52.5%, 73) were requests from a journal with whom the physician had no or unknown previous contact. Less than 1/3 of solicitations were directly relevant (28.1%, 39); 43.2% (60) partially relevant; 28.8% (40) irrelevant. Only 2.3% (3) of requests were accepted; 55.4% (77) were declined and 42.4% (59) were ignored. Of the Plutchik Basic Emotions, most were surprised (36%, 48) or disgusted (31%, 41). Qualitative analysis identified four themes: (1) issues with review process/journal quality, (2) time/effort demands, (3) relevancy to expertise, (4) technology/administrative barriers. CONCLUSIONS: Academic faculty received copious peer review requests and declined or ignored many, citing frustration, surprise or disgust. Editors should optimize the review request process to avoid reviewer burnout.
Schoenfeld EM, Soares WE, Girardin AL
… +6 more, Simon C, Strokes N, Lauren N, Santana CS, Beck SA, Westafer LM
Acad Emerg Med
· 2026 Mar · PMID 41811078
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OBJECTIVES: Although robust evidence exists supporting opioid agonist treatment (OAT) as the best currently available treatment for opioid use disorder (OUD), many barriers prevent widespread access to the two most effic...OBJECTIVES: Although robust evidence exists supporting opioid agonist treatment (OAT) as the best currently available treatment for opioid use disorder (OUD), many barriers prevent widespread access to the two most efficacious forms of OAT, buprenorphine and methadone. We sought to address interpersonal and knowledge-related barriers to OAT implementation by facilitating shared decision-making in the context of ED care. The objective of this study was to refine and evaluate an OUD treatment conversation aid in partnership with people with lived experience (PWLE). METHODS: We combined community-based participatory research principles, decision aid development guidelines, and qualitative methods. Via the longitudinal involvement of a multi-stakeholder Steering Committee (SC), interviews, and focus groups, we iteratively refined and evaluated a conversation aid, Talk About It (TAI). We performed beta-testing with ED patients with untreated OUD and clinicians and evaluated the aid via validated implementation measures of acceptability, appropriateness, and feasibility (3 scales, 4 questions each, range 1-5). Finally, TAI was translated into Spanish and Spanish-speaking patients and clinicians gave feedback. RESULTS: Over 100 people engaged in the refinement and evaluation of TAI. Of the 75 patient and community member participants, about half (34) reported using opioids within the past week. Refinements to TAI included changing content, simplifying language, and adding quotes, faces, and local resources. Validated acceptability, appropriateness, and feasibility measures demonstrated increasing scores. ED patients with untreated OUD gave the final version mean scores of 4.72, 4.70, and 4.67, respectively (range 1-5), indicating high agreement with implementation potential. CONCLUSION: TAI's content and style were designed, refined, and approved by PWLE, ED clinicians, and addiction experts. Further testing will be needed to measure effectiveness.
Schowe J, North AM, Schuchter K
… +2 more, Hunold KM, Rozycki E
Acad Emerg Med
· 2026 Mar · PMID 41803059
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BACKGROUND: Older adults are susceptible to adverse drug effects due to age-related changes, a higher prevalence of comorbidities, and complexities in medication management. Nearly half of geriatric patients are prescrib...BACKGROUND: Older adults are susceptible to adverse drug effects due to age-related changes, a higher prevalence of comorbidities, and complexities in medication management. Nearly half of geriatric patients are prescribed at least one new medication at ED discharge. This study evaluated potential pharmacist interventions on ED discharge prescriptions for older adults using the Geriatric Emergency Medicine Safety Recommendations (GEMS-Rx) list. METHODS: This single-center, IRB-approved, retrospective review analyzed ED discharge prescriptions for potentially inappropriate medications based on GEMS-Rx criteria from October 2021 to September 2024 for patients ≥ 65 years who were discharged from the ED. Prescriptions were reviewed by a trained pharmacist for medication-related problems (MRPs). Outcomes included: rate of potential pharmacist intervention, number of prescriptions with at least one MRP, MRP types, missing risk vs. benefit documentation, rates of current practice pharmacist review, two or more GEMS-Rx prescriptions at discharge, and polypharmacy. All prescriptions during the study period were reviewed to determine medication sub-class distribution, with a random sample of 250 patients, ensuring at least 10 prescriptions per sub-class, if available. Descriptive statistics were utilized. RESULTS: During the study period, 1458 prescriptions were written for included sub-classes. Of 284 prescriptions screened, 265 (for 250 patients) were included. The median (IQR) age was 69.5 (67-75) years with patients on a median (IQR) of 5 (3-8) scheduled home medications and discharged with a median (IQR) of 2 (1-3) new medications. Skeletal muscle relaxants (37.0%) and first-generation antihistamines (28.7%) were most frequent. Pharmacist intervention was potentially needed in 204 patients (81.6.%) with a median (IQR) of 2 (1, 2) MRPs per patient. Common MRPs included dose adjustment (53.2%), indication mismatch (41.1%), and frequency (38.1%). CONCLUSIONS: Most GEMS-Rx prescriptions had at least one MRP, indicating an opportunity for enhanced prescribing. Future research should target strategies to optimize medications at ED discharge for older adults.
Lebin JA, Hensen C, Lun Z
… +3 more, Goldberg EM, Lum HD, Hoppe JA
Acad Emerg Med
· 2026 Mar · PMID 41803048
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BACKGROUND: Alcohol misuse among midlife and older adults is increasing, and age-related physiological vulnerability heightens the risk for adverse outcomes. Emergency departments (EDs) are key health system touchpoints...BACKGROUND: Alcohol misuse among midlife and older adults is increasing, and age-related physiological vulnerability heightens the risk for adverse outcomes. Emergency departments (EDs) are key health system touchpoints for identifying alcohol misuse, yet the delivery of evidence-based interventions following screening in this population remains poorly described. METHODS: We conducted a retrospective cohort study of ED encounters from January 1, 2019-December 31, 2023, across 11 hospital-based EDs in a large integrated health system. We included patients aged ≥ 55 years old who screened positive for alcohol misuse using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C; ≥ 4 for men, ≥ 3 for women). Primary outcomes were delivery of evidence-based interventions, including brief intervention and referral to treatment and provision of medication for alcohol use disorder (MAUD). Secondary measures included demographics, co-occurring substance use, clinical presentation, and health care utilization. Age-adjusted logistic regression evaluated associations between AUDIT-C score and outcomes. RESULTS: Of 698,308 ED encounters among adults aged ≥ 55 years old, 39,912 (5.7%) screened positive for alcohol misuse. Men accounted for 58% of encounters, with gender differences narrowing with age. Co-use of substances was common: 21% reported illicit drug use, 27% cannabis use, and 23% tobacco use, with higher prevalence in younger age groups. Recent opioid and benzodiazepine prescriptions were documented in 12% and 6% of encounters, respectively. Brief intervention and referral to treatment occurred in 30% of encounters overall and in 46% among those with severe misuse. Despite guideline support for pharmacotherapy, MAUD was prescribed in only 3% of encounters. CONCLUSIONS: Among midlife and older ED patients who screen positive for alcohol misuse, delivery of evidence-based interventions, particularly pharmacotherapy, is uncommon despite substantial healthcare utilization and co-occurring risk factors. These findings highlight a gap between identification and treatment and underscore the ED's potential role in initiating evidence-based interventions for alcohol misuse.
Suffoletto B, Ashenburg N, Losak M
… +1 more, Kim D
Acad Emerg Med
· 2026 Mar · PMID 41803038
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BACKGROUND: Emergency department (ED) fall-risk screening often relies on measures that incompletely capture body movement signals relevant to future falls. OBJECTIVE: Test whether inertial measurement unit (IMU) feature...BACKGROUND: Emergency department (ED) fall-risk screening often relies on measures that incompletely capture body movement signals relevant to future falls. OBJECTIVE: Test whether inertial measurement unit (IMU) features from a brief, modified, instrumented Timed Up and Go (miTUG) provide incremental prognostic value for 6-month falls after ED discharge beyond a clinical screening tool. METHODS: We conducted a prospective cohort study of community-dwelling adults ≥ 60 years discharged from an urban academic ED (September 2023-May 2024). Before discharge, participants completed a miTUG; four IMU features (sit-to-stand dominant frequency and duration; turn-to-sit spectral power and dominant frequency) were added to nine clinical predictors. The primary outcome was any fall within 180 days (6 months). Model performance was assessed using discrimination (AUC/C-index) and operating characteristics at ED-relevant thresholds. Secondary analyses examined models predicting time to first fall. Exploratory analyses examined patient sub-groups that may benefit from additional testing. RESULTS: Among 360 participants, 94 (26.1%) fell within 180 days. The combined clinical+IMU model demonstrated modestly improved discrimination compared with the clinical-only model (AUC 0.72 vs. 0.67; Wilcoxon p = 0.19). At a prespecified 30% fall risk threshold, addition of IMU features improved sensitivity (0.57 vs. 0.45), specificity (0.80 vs. 0.76) and positive predictive value (0.50 vs. 0.39). In time-to-event analyses, the combined clinical+IMU model showed higher concordance (C-index 0.73 vs. 0.69) and better fit (likelihood-ratio p = 0.0006). Incremental gains were largest among adults ≥ 70 years, those with a recent prior fall, and those classified as lower risk by the clinical screen. CONCLUSIONS: In older adults discharged from the ED, IMU features from a brief, mobility assessment added modest improvements in fall risk stratification beyond a clinical screen. These findings are hypothesis-generating and support the need for external validation and implementation studies before clinical adoption.
McQuown CM, Snell K, Song S
… +4 more, Koepf B, Ragsdale LC, Abbate LM, Arora K
Acad Emerg Med
· 2026 Mar · PMID 41796395
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BACKGROUND: Ensuring follow up care can be a barrier to emergency department (ED) discharge for high-risk older adults. The US Dept of Veterans Affairs (VA) sought to address this challenge by creating an ED-based care t...BACKGROUND: Ensuring follow up care can be a barrier to emergency department (ED) discharge for high-risk older adults. The US Dept of Veterans Affairs (VA) sought to address this challenge by creating an ED-based care transition program, SCOUTS (Supporting Community, Outpatient, Urgent care, and Telehealth Services). SCOUTS combines post ED care coordination and a home visit to assess home safety, geriatric syndromes, and unmet social needs and to provide a video visit with an ED provider. The purpose of this study is to evaluate the effects of the program on health care utilization. METHODS: Patients (aged ≥ 65 years) identified as high risk through geriatric emergency medicine care processes were offered a home visit with the program. SCOUTS patients were compared to a 1:1 propensity matched group of older ED patients. Primary outcomes for health care utilization included hospital admissions (from ED and 30- and 90-days after ED visit) and ED revisits (3 days and 30 days). RESULTS: During the first year of the program, there were 684 SCOUTS patients matched to 684 ED patients. SCOUTS patients were less likely to be admitted to the hospital from the ED (OR 0.12 (95% CI 0.07-0.02)) and had lower 30- and 90-day inpatient admissions (OR 0.33 (CI 0.24-0.45), OR 0.48 (CI 0.37-0.63)). Secondary matching of only discharged patients showed a decrease in 72-h ED revisit (OR 0.29 (CI 0.15, 0.6)), while maintaining an equivalent 30-day ED revisit rate and 30- and 90-day admissions as matched control. SCOUTS patients were significantly more likely to receive durable medical equipment orders (OR 1.94 (CI 1.54, 2.45)) and follow up with VA social work (OR 1.41 (CI 1.02, 1.95)). CONCLUSIONS: An ED-based care transition program using home visits decreases admissions and ED revisits while increasing orders for durable medical equipment and referrals to follow up services.
Coupet E, Chawarski MC, Hercules K
… +7 more, Williams JL, Ward AM, Owens PH, Fiellin DA, Hawk KF, Martel SH, D'Onofrio G
Acad Emerg Med
· 2026 Feb · PMID 41735229
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OBJECTIVE: Significant racial and ethnic disparities exist in treatment referral engagement for opioid use disorder (OUD) after an emergency department (ED) visit. Little is known about how contextual factors influence p...OBJECTIVE: Significant racial and ethnic disparities exist in treatment referral engagement for opioid use disorder (OUD) after an emergency department (ED) visit. Little is known about how contextual factors influence preferences for ED OUD treatment coordination and how these preferences vary by race and ethnicity. This study seeks to evaluate and compare structural and support-related factors by eliciting ED OUD treatment coordination preferences among Black, Hispanic, and White individuals with OUD. METHODS: Two trained qualitative investigators conducted semi-structured telephone individual interviews with 57 participants (20 non-Hispanic Black, 20 non-Hispanic White, 17 Hispanic) formerly enrolled in Project ED-Innovation. We used the National Institute on Minority Health and Health Disparities Research Framework to explore preferences in ED OUD treatment coordination and how they may be shaped by structural and support-related factors. Participants were recruited using purposeful sampling from eight ED sites: Cooper (NJ), Grady Memorial (GA), Henry Ford (MI), Maine (ME), University of New Mexico (NM), University of Utah, and the Alameda Health System (CA). Transcript were categorized and analyzed by race and ethnicity. RESULTS: Black participants emphasized relational encouragement as a facilitator of treatment engagement. Hispanic and White participants described difficulty navigating a two-tiered racialized treatment system: methadone and buprenorphine. Participants from all three groups emphasized: (1) recognition and appreciation of hospitals' efforts in providing ED-initiated buprenorphine; (2) the importance of ED addiction care efficiency; (3) value of demonstrating compassion during conversations about OUD; (4) enhancing accessibility of OUD treatment post-ED visit. CONCLUSIONS: Black participants underscored relational encouragement as a facilitator of engagement, while Hispanic and White participants described difficulty navigating a two-tiered OUD treatment system. All groups supported ED-initiated buprenorphine; however, they noted a need to improve accessibility post-ED visit. Future ED-based studies should integrate these contextual factors to develop models that improve OUD treatment engagement among all populations post-ED visit.
Baptista P, Gaines C, Jones CW
… +8 more, Remboski L, Marks CM, Nyce A, Scudder AM, Haimovich AD, Shapiro NI, Trzeciak S, Roberts BW
Acad Emerg Med
· 2026 Feb · PMID 41738159
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BACKGROUND: Healthcare system distrust-patients' belief that the healthcare system may not act in their best interests-is a recognized social determinant of health and is associated with poor health outcomes, decreased a...BACKGROUND: Healthcare system distrust-patients' belief that the healthcare system may not act in their best interests-is a recognized social determinant of health and is associated with poor health outcomes, decreased adherence to treatment, and heightened health disparities, especially among marginalized populations. Compassion from clinicians may be a modifiable factor that can foster trust in healthcare systems, but its association with system-level distrust, particularly in emergency department (ED) settings, remains underexplored. METHODS: We conducted a nested cross-sectional study enrolling adult patients treated at two urban academic EDs in the United States between September 2023 to May 2024. We separately measured patient experience of physician and nursing staff compassion using the validated 5-item compassion measure, and patient healthcare system distrust using the Healthcare System Distrust Scale. Multivariable linear regression models, adjusted for demographics and study site, tested associations between perceived compassion and distrust, including subgroup analyses by race, gender, and other sociodemographic factors. RESULTS: The primary analysis included 779 patients. Both physician (median score 20 [IQR 17-20]) and nursing staff compassion (median score 20 [IQR 17-20]) were highly rated. Higher compassion scores for both physicians (β = -0.62, 95% CI 0.80 to -0.44) and nursing staff (β = -0.24, 95% CI 0.38 to -0.09) were independently associated with lower healthcare system distrust. Compared to non-Hispanic White patients, Black patients reported higher healthcare system distrust, driven by values (i.e., honesty, motives, and equity)-based distrust rather than competency-based distrust, but did not report lower compassion scores. The association between compassion and reduced distrust was consistent across demographic subgroups. CONCLUSION: Greater experience of compassion from ED physicians and nursing staff is independently associated with lower healthcare system distrust. Interventions to enhance clinician compassion have the potential to foster trust and may reduce health disparities in emergency care settings.
Gartner HT, Simmons RE, Wan HZ
… +5 more, Moran B, Ali US, Rashid SS, Sollee DR, Sheikh S
Acad Emerg Med
· 2026 Feb · PMID 41731318
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BACKGROUND: Iatrogenic medication errors are a preventable source of harm in older adults. Yet their prevalence, types, and outcomes remain poorly characterized. This study aims to describe healthcare-associated iatrogen...BACKGROUND: Iatrogenic medication errors are a preventable source of harm in older adults. Yet their prevalence, types, and outcomes remain poorly characterized. This study aims to describe healthcare-associated iatrogenic medication errors in older adults, including those occurring in the emergency department (ED) and prehospital settings. METHODS: An Institutional Review Board-approved retrospective cohort study was conducted among patients aged 65 years and older who had an iatrogenic medication exposure reported to a regional poison center network between January 1, 2020, and May 23, 2025. Cases were extracted from the poison center network's electronic health record and manually reviewed for inclusion as healthcare-associated medication errors. Error severity was assessed using the National Poison Data System (NPDS) medical outcome scale and the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) index. Clinical effects, implicated medications, and treatment data were collected and analyzed using descriptive statistics. RESULTS: Out of 192 potential cases, 182 met inclusion criteria. Most errors occurred in a healthcare setting (nursing facility 32%, non-critical care unit 14%, or ED 12%) and were managed in an ED (60%, 110). Cardiovascular (32%, 129) agents were most often implicated. Most errors occurred during the administration phase (77%, 138), primarily due to medication given to the wrong patient (24%, 43) or at the wrong dose (20%, 36). More than half of cases were classified as NCC MERP Category E or higher, indicating patient harm. CONCLUSIONS: Iatrogenic medication errors in older adults occur across care settings and are most often managed in the ED. While many cause minor harm, a subset results in serious outcomes, with ED-based errors posing higher risk. These findings underscore the need for targeted interventions, particularly during administration and for cardiovascular agents, and provide data to guide strategies and future research to protect this vulnerable population.