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Chary AN, Suh M, Ordoñez E, Cameron-Comasco L, Ahmad S, Zirulnik A, Hardi A, Landry A, Ramont V, Obi T, Weaver EH, Carpenter CR. A scoping review of geriatric emergency medicine research transparency in diversity, equity, and inclusion reporting. J Am Geriatr Soc 2024. [PMID: 38994587 DOI: 10.1111/jgs.19052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 06/09/2024] [Indexed: 07/13/2024]
Abstract
INTRODUCTION The intersection of ageism and racism is underexplored in geriatric emergency medicine (GEM) research. METHODS We performed a scoping review of research published between January 2016 and December 2021. We included original emergency department-based research focused on falls, delirium/dementia, medication safety, and elder abuse. We excluded manuscripts that did not include (1) original research data pertaining to the four core topics, (2) older adults, (3) subjects from the United States, and (4) for which full text publication could not be obtained. The primary objective was to qualitatively describe reporting about older adults' social identities in GEM research. Secondary objectives were to describe (1) the extent of inclusion of minoritized older adults in GEM research, (2) GEM research about health equity, and (3) feasible approaches to improve the status quo of GEM research reporting. RESULTS After duplicates were removed, 3277 citations remained and 883 full-text articles were reviewed, of which 222 met inclusion criteria. Four findings emerged. First, race and ethnicity reporting was inconsistent. Second, research rarely provided a rationale for an age threshold used to define geriatric patients. Third, GEM research more commonly reported sex than gender. Fourth, research commonly excluded older adults with cognitive impairment and speakers of non-English primary languages. CONCLUSION Meaningful assessment of GEM research inclusivity is limited by inconsistent reporting of sociodemographic characteristics, specifically race and ethnicity. Reporting of sociodemographic characteristics should be standardized across different study designs. Strategies are needed to include in GEM research older adults with cognitive impairment and non-English primary languages.
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Affiliation(s)
- Anita N Chary
- Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Michelle Suh
- Section of Emergency Medicine, University of Chicago, Chicago, Illinois, USA
| | - Edgardo Ordoñez
- Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Lauren Cameron-Comasco
- Department of Emergency Medicine, Corewell Health William Beaumont University Hospital, Royal Oaks, Michigan, USA
| | - Surriya Ahmad
- Department of Emergency Medicine, Kings County Hospital Center, Brooklyn, New York, USA
| | - Alexander Zirulnik
- Department of Emergency Medicine, Massachusetts General Brigham, Boston, Massachusetts, USA
| | - Angela Hardi
- Olin Medical Library, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Alden Landry
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Vivian Ramont
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Tracey Obi
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
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Chary AN, Hernandez N, Rivera AP, Santangelo I, Ritchie C, Ouchi K, Liu SW, Naik AD, Kennedy M. Emergency department communication with diverse caregivers and persons living with dementia: A qualitative study. J Am Geriatr Soc 2024; 72:1687-1696. [PMID: 38553011 DOI: 10.1111/jgs.18897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/24/2024] [Accepted: 03/07/2024] [Indexed: 06/19/2024]
Abstract
BACKGROUND Research to date has detailed numerous challenges in emergency department (ED) communication with persons living with dementia (PLWD) and their caregivers. However, little is known about communication experiences of individuals belonging to minoritized racial and ethnic groups, who are disproportionately impacted by dementia and less likely to be included in dementia research. METHODS We conducted semi-structured interviews with 29 caregivers of PLWD from two urban academic hospital EDs with distinct patient populations. The first site is an ED in the Northeast serving a majority White, English-speaking, and insured population. The second site is an ED in the South serving a majority Black and/or Hispanic, Spanish-speaking, and underinsured population. Interviews lasted an average of 25 min and were digitally recorded and transcribed. We used an inductive approach to analyze interview transcripts for dominant themes and compared themes between sites. RESULTS Our sample included caregivers of diverse racial and ethnic backgrounds. Caregivers cared for PLWD who spoke English, Spanish, Arabic, Chinese, and Vietnamese. We identified three themes. First, caregiver advocacy was central to experiences of ED communication, particularly when PLWD primarily spoke a non-English language. Second, routine care plans did not address what mattered most to participants and PLWD. Participants felt that care arose from protocols and did not address what mattered most to them. Third, White English-speaking caregivers in Site 1 more commonly expected ED staff to engage them in care decision-making than Black, Hispanic, Asian, and Middle Eastern caregivers in Site 2. CONCLUSION Language barriers amplify the higher intensity care needed by PLWD in the ED. Strategies should be developed for communicating with PLWD and caregivers about what matters most in their ED care.
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Affiliation(s)
- Anita N Chary
- Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Norvin Hernandez
- School of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | | | - Ilianna Santangelo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christine Ritchie
- Division of Palliative Care and Geriatric Medicine, Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kei Ouchi
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Shan W Liu
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Aanand D Naik
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Consortium on Aging, University of Texas Health Science Center, Houston, Texas, USA
| | - Maura Kennedy
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Carpenter CR, Lee S, Kennedy M, Arendts G, Schnitker L, Eagles D, Mooijaart S, Fowler S, Doering M, LaMantia MA, Han JH, Liu SW. Delirium detection in the emergency department: A diagnostic accuracy meta-analysis of history, physical examination, laboratory tests, and screening instruments. Acad Emerg Med 2024. [PMID: 38757369 DOI: 10.1111/acem.14935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/13/2024] [Accepted: 04/15/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION Geriatric emergency department (ED) guidelines emphasize timely identification of delirium. This article updates previous diagnostic accuracy systematic reviews of history, physical examination, laboratory testing, and ED screening instruments for the diagnosis of delirium as well as test-treatment thresholds for ED delirium screening. METHODS We conducted a systematic review to quantify the diagnostic accuracy of approaches to identify delirium. Studies were included if they described adults aged 60 or older evaluated in the ED setting with an index test for delirium compared with an acceptable criterion standard for delirium. Data were extracted and studies were reviewed for risk of bias. When appropriate, we conducted a meta-analysis and estimated delirium screening thresholds. RESULTS Full-text review was performed on 55 studies and 27 were included in the current analysis. No studies were identified exploring the accuracy of findings on history or laboratory analysis. While two studies reported clinicians accurately rule in delirium, clinician gestalt is inadequate to rule out delirium. We report meta-analysis on three studies that quantified the accuracy of the 4 A's Test (4AT) to rule in (pooled positive likelihood ratio [LR+] 7.5, 95% confidence interval [CI] 2.7-20.7) and rule out (pooled negative likelihood ratio [LR-] 0.18, 95% CI 0.09-0.34) delirium. We also conducted meta-analysis of two studies that quantified the accuracy of the Abbreviated Mental Test-4 (AMT-4) and found that the pooled LR+ (4.3, 95% CI 2.4-7.8) was lower than that observed for the 4AT, but the pooled LR- (0.22, 95% CI 0.05-1) was similar. Based on one study the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) is the superior instrument to rule in delirium. The calculated test threshold is 2% and the treatment threshold is 11%. CONCLUSIONS The quantitative accuracy of history and physical examination to identify ED delirium is virtually unexplored. The 4AT has the largest quantity of ED-based research. Other screening instruments may more accurately rule in or rule out delirium. If the goal is to rule in delirium then the CAM-ICU or brief CAM or modified CAM for the ED are superior instruments, although the accuracy of these screening tools are based on single-center studies. To rule out delirium, the Delirium Triage Screen is superior based on one single-center study.
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Affiliation(s)
| | - Sangil Lee
- University of Iowa, Iowa City, Iowa, USA
| | - Maura Kennedy
- Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Glenn Arendts
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Linda Schnitker
- Bolton Clarke Research Institute, Bolton Clarke School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | | | - Simon Mooijaart
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
- LUMC Center for Medicine for Older People, Leiden University Medical Center, Leiden, The Netherlands
| | - Susan Fowler
- University of Connecticut Health Sciences, Farmington, Connecticut, USA
| | - Michelle Doering
- Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | | | - Jin H Han
- Geriatric Research Education and Clinical Center (GRECC), Tennessee Valley Healthcare Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shan W Liu
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Penfold RS, Squires C, Angus A, Shenkin SD, Ibitoye T, Tieges Z, Neufeld KJ, Avelino-Silva TJ, Davis D, Anand A, Duckworth AD, Guthrie B, MacLullich AMJ. Delirium detection tools show varying completion rates and positive score rates when used at scale in routine practice in general hospital settings: A systematic review. J Am Geriatr Soc 2024; 72:1508-1524. [PMID: 38241503 DOI: 10.1111/jgs.18751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/11/2023] [Accepted: 12/16/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Multiple short delirium detection tools have been validated in research studies and implemented in routine care, but there has been little study of these tools in real-world conditions. This systematic review synthesized literature reporting completion rates and/or delirium positive score rates of detection tools in large clinical populations in general hospital settings. METHODS PROSPERO (CRD42022385166). Medline, Embase, PsycINFO, CINAHL, and gray literature were searched from 1980 to December 31, 2022. Included studies or audit reports used a validated delirium detection tool performed directly with the patient as part of routine care in large clinical populations (n ≥ 1000) within a general acute hospital setting. Narrative synthesis was performed. RESULTS Twenty-two research studies and four audit reports were included. Tools used alone or in combination were the Confusion Assessment Method (CAM), 4 'A's Test (4AT), Delirium Observation Screening Scale (DOSS), Brief CAM (bCAM), Nursing Delirium Screening Scale (NuDESC), and Intensive Care Delirium Screening Checklist (ICDSC). Populations and settings varied and tools were used at different stages and frequencies in the patient journey, including on admission only; inpatient, daily or more frequently; on admission and as inpatient; inpatient post-operatively. Tool completion rates ranged from 19% to 100%. Admission positive score rates ranged from: CAM 8%-51%; 4AT 13%-20%. Inpatient positive score rates ranged from: CAM 2%-20%, DOSS 6%-42%, and NuDESC 5-13%. Postoperative positive score rates were 21% and 28% (4AT). All but two studies had moderate-high risk of bias. CONCLUSIONS This systematic review of delirium detection tool implementation in large acute patient populations found clinically important variability in tool completion rates, and in delirium positive score rates relative to expected delirium prevalence. This study highlights a need for greater reporting and analysis of relevant healthcare systems data. This is vital to advance understanding of effective delirium detection in routine care.
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Affiliation(s)
- Rose S Penfold
- Edinburgh Delirium Research Group, Ageing and Health and Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | | | - Susan D Shenkin
- Edinburgh Delirium Research Group, Ageing and Health and Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Temi Ibitoye
- Edinburgh Delirium Research Group, Ageing and Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Zoë Tieges
- School of Computing, Engineering and Built Environment, Glasgow Caledonian University, Glasgow, UK
| | - Karin J Neufeld
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Daniel Davis
- MRC Unit for Lifelong Health and Ageing, UCL, London, UK
| | - Atul Anand
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | | | - Bruce Guthrie
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Alasdair M J MacLullich
- Edinburgh Delirium Research Group, Ageing and Health, Usher Institute, University of Edinburgh, Edinburgh, UK
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Brune C, Liljas A. "You treat what you have to treat, and you don't care as much if they understand or if they feel good about it": Communication barriers and perceptions of moral distress among doctors in emergency departments. Medicine (Baltimore) 2023; 102:e36610. [PMID: 38115277 PMCID: PMC10727579 DOI: 10.1097/md.0000000000036610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/16/2023] [Accepted: 11/21/2023] [Indexed: 12/21/2023] Open
Abstract
Doctors facing communication barriers when assessing patients in emergency departments (ED) is a frequent phenomenon, as the global prevalence of dementia and migration have increased. This study aims to explore how communication barriers influence moral distress as perceived by medical doctors working at emergency departments. Twelve doctors at 2 different EDs in Stockholm, Sweden, participated. Answers on communication barriers were collected from an interview guide on moral distress. Informants' responses were analyzed using qualitative thematic analysis. The results suggest that doctors experience moral distress when assessing patients with communication barriers due to an inability to mediate calm and safety and understand their patients, and due an increased need of resources and difficulties in obtaining consent before conducting examinations or interventions. In conclusion, communication barriers can be a cause of moral distress, which should be considered when developing tools and methods to mitigate and manage moral distress.
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Affiliation(s)
- Clara Brune
- Karolinska Institutet, Department of Global Public Health, Stockholm, Sweden
| | - Ann Liljas
- Karolinska Institutet, Department of Global Public Health, Stockholm, Sweden
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Dresden SM. Optimizing the Care of Persons Living with Dementia in the Emergency Department. Clin Geriatr Med 2023; 39:599-617. [PMID: 37798067 DOI: 10.1016/j.cger.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Emergency department (ED) care for persons living with dementia (PLWD) involves the identification of dementia or cognitive impairment, ED care which is sensitive to the specific needs of PLWD, effective communication with PLWD, their care partners, and outpatient clinicians who the patient and care-partner know and trust, and care-transitions from the emergency department to other health care settings. The recommendations in this article made based on wide-ranging heterogeneous studies of various interventions which have been studied primarily in single-site studies. Future research should work to incorporate promising findings from interventions such as hospital at home, or ED to home Care Transitions Intervention.
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Affiliation(s)
- Scott M Dresden
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Center for Healthcare Studies and Outcomes Research, 211 East Ontario Street, Suite 200, Chicago, IL 60611, USA.
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Chary AN, Cameron-Comasco L, Shankar KN, Samuels-Kalow ME. Diversity, Equity, and Inclusion: Considerations in the Geriatric Emergency Department Patient. Clin Geriatr Med 2023; 39:673-686. [PMID: 37798072 PMCID: PMC10775156 DOI: 10.1016/j.cger.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
This article introduces core topics in health equity scholarship and provides examples of how diversity, equity, and inclusion impact the aging population and emergency care of older adults. It offers strategies for promoting diversity, equity, and inclusion to both strengthen the patient-clinician therapeutic relationship and to address operations and systems that impact care of the geriatric emergency department patient.
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Affiliation(s)
- Anita N Chary
- Department of Emergency Medicine, Baylor College of Medicine, 2450 Holcombe Boulevard, Suite 01Y, Houston, TX 77021, USA; Department of Medicine, Section of Health Services Research, Baylor College of Medicine, 2450 Holcombe Boulevard, Suite 01Y, Houston, TX 77021, USA.
| | - Lauren Cameron-Comasco
- Department of Emergency Medicine, Beaumont Hospital, 3601 West 13 Mile Road, Royal Oak, MI 48073, USA
| | - Kalpana N Shankar
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Neville House, Boston, MA 02115, USA
| | - Margaret E Samuels-Kalow
- Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua Street, Suite 9206, Boston, MA 02114, USA
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Chary AN, Brickhouse E, Torres B, Santangelo I, Carpenter CR, Liu SW, Godwin KM, Naik AD, Singh H, Kennedy M. Leveraging the Electronic Health Record to Implement Emergency Department Delirium Screening. Appl Clin Inform 2023; 14:478-486. [PMID: 37054983 PMCID: PMC10284630 DOI: 10.1055/a-2073-3736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 04/06/2023] [Indexed: 04/15/2023] Open
Abstract
OBJECTIVE The aim of this study is to understand how emergency departments (EDs) use health information technology (HIT), and specifically the electronic health record (EHR), to support implementation of delirium screening. METHODS We conducted semi-structured interviews with 23 ED clinician-administrators, representing 20 EDs, about how they used HIT resources to implement delirium screening. Interviews focused on challenges participants experienced when implementing ED delirium screening and EHR-based strategies they used to overcome them. We coded interview transcripts using dimensions from the Singh and Sittig sociotechnical model, which addresses use of HIT in complex adaptive health care systems. Subsequently, we analyzed data for common themes across dimensions of the sociotechnical model. RESULTS Three themes emerged about how the EHR could be used to address challenges in implementation of delirium screening: (1) staff adherence to screening, (2) communication among ED team members about a positive screen, and (3) linking positive screening to delirium management. Participants described several HIT-based strategies including visual nudges, icons, hard stop alerts, order sets, and automated communications that facilitated implementation of delirium screening. An additional theme emerged about challenges related to the availability of HIT resources. CONCLUSION Our findings provide practical HIT-based strategies for health care institutions planning to adopt geriatric screenings. Building delirium screening tools and reminders to perform screening into the EHR may prompt adherence to screening. Automating related workflows, team communication, and management of patients who screen positive for delirium may help save staff members' time. Staff education, engagement, and access to HIT resources may support successful screening implementation.
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Affiliation(s)
- Anita N. Chary
- Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, United States
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, United States
| | - Elise Brickhouse
- School of Medicine, Baylor College of Medicine, Houston, Texas, United States
| | - Beatrice Torres
- University of Texas School of Public Health, UT Health Science Center, Houston, Texas, United States
| | - Ilianna Santangelo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Christopher R. Carpenter
- Department of Emergency Medicine, Barnes Jewish Hospital, Washington University School of Medicine, Emergency Care Research Core, St. Louis, Missouri, United States
| | - Shan W. Liu
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
| | - Kyler M. Godwin
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, United States
| | - Aanand D. Naik
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, United States
- University of Texas School of Public Health, UT Health Science Center, Houston, Texas, United States
- University of Texas Health Consortium on Aging, Houston, Texas, United States
| | - Hardeep Singh
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, United States
| | - Maura Kennedy
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
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Chary AN, Naik AD, Kennedy M. Reply to: Expanding options to include language barriers for predicting postoperative delirium in geriatric patients. J Am Geriatr Soc 2023; 71:294-295. [PMID: 36254368 DOI: 10.1111/jgs.18083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/18/2022] [Indexed: 01/25/2023]
Abstract
This letter comments on the letter by Streetman et al.
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Affiliation(s)
- Anita N Chary
- Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Aanand D Naik
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- University of Texas School of Public Health, UT Health Science Center, Houston, Texas, USA
- University of Texas Health Consortium on Aging, Houston, Texas, USA
| | - Maura Kennedy
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Streetman D, Hagley A, Shalom M, Gendreau JL. Expanding options to include language barriers for predicting postoperative delirium in geriatric patients. J Am Geriatr Soc 2023; 71:292-293. [PMID: 36254361 DOI: 10.1111/jgs.18082] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/16/2022] [Accepted: 08/21/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Daniel Streetman
- Department of General Surgery, Mercer University School of Medicine, Savannah, Georgia, USA
| | - Alana Hagley
- Department of General Surgery, Mercer University School of Medicine, Savannah, Georgia, USA
| | - Moshe Shalom
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Julian L Gendreau
- Department of Biomedical Engineering, Johns Hopkins Whiting School of Engineering, Baltimore, Maryland, USA
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Sampson C, Liang SY. The Tip of the Spear: Emergency Medicine and Missouri's Response to the COVID-19 Pandemic. MISSOURI MEDICINE 2022; 119:432-436. [PMID: 36337989 PMCID: PMC9616458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The COVID-19 pandemic provided the specialty of emergency medicine the opportunity to showcase what many knew all along: emergency physicians (EP) are well suited to deal with the unknown and can quickly adapt even with incomplete or limited information and resources. Emergency physicians in Missouri served in integral positions locally, nationally and internationally. Missouri EPs published numerous manuscripts on topics from basic science to clinical care. Device innovation also occurred with the development of protective devices for health care workers. As we approach the three-year mark of the COVID-19 pandemic, the burden of clinical care still weighs heavily on EPs. Each wave of the pandemic has brought challenges and spurred EPs to innovate in new ways. As Michigan EP Brian Zink, MD once said "Anyone, Anything, Anytime". These words correctly sum up emergency medicine. When others hesitated to care for COVID-19 patients, EPs stepped up despite uncertainty and risks to their own health. Emergency medicine has led the way and continues to innovate and push the envelope of emergency care.
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Affiliation(s)
- Christopher Sampson
- Department of Emergency Medicine, University of Missouri - Columbia School of Medicine, Columbia, Missouri
| | - Stephen Y Liang
- Department of Emergency Medicine and the Division of Infectious Diseases, Department of Medicine at Washington University School of Medicine, St. Louis, Missouri
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Carpenter CR, Dresden SM, Shah MN, Hwang U. Adapting Emergency Care for Persons Living With Dementia: Results of the Geriatric Emergency Care Applied Research Network Scoping Review and Consensus Conference. J Am Med Dir Assoc 2022; 23:1286-1287. [PMID: 35940679 DOI: 10.1016/j.jamda.2022.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 05/14/2022] [Indexed: 12/16/2022]
Affiliation(s)
- Christopher R Carpenter
- Department of Emergency Medicine, Washington University in St Louis School of Medicine, Emergency Care Research Core, St Louis, MO, USA.
| | - Scott M Dresden
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Manish N Shah
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Ula Hwang
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
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Chary A, Liu SW, Southerland L, Cameron-Comasco L, Ouchi K, Carpenter CR, Boyer EW, Naik AD, Kennedy M. Emergency Department Policies to Improve Care Experiences for Older Adults During the COVID-19 Pandemic. JOURNAL OF GERIATRIC EMERGENCY MEDICINE 2022; 3:10.17294/2694-4715.1031. [PMID: 36111131 PMCID: PMC9473422 DOI: 10.17294/2694-4715.1031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Anita Chary
- Section of Health Services Research, Dept. of Medicine; Dept. of Emergency Medicine; Center for Innovations in Quality, Effectiveness and Safety; Baylor College of Medicine
| | - Shan W Liu
- Dept. of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School
| | | | - Lauren Cameron-Comasco
- Dept. of Emergency Medicine, Beaumont Hospital-Royal Oak, Oakland University William Beaumont School of Medicine
| | - Kei Ouchi
- Department of Emergency Medicine, Brigham and Women's Hospital, Dana Farber Cancer Institute
| | - Christopher R Carpenter
- Department of Emergency Medicine, Barnes Jewish Hospital, Washington University School of Medicine
| | - Edward W Boyer
- Department of Emergency Medicine, Ohio State University, Harvard Medical School
| | - Aanand D Naik
- Department of Management, Policy, and Community Health, UT School of Public Health and UT Health Consortium on Aging
| | - Maura Kennedy
- Dept. of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School
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