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Assessing adequacy of emergency provider documentation among interhospital transferred patients with acute aortic dissection

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World Journal of Emergency Medicine 2019年第2期10卷 94-100页

作者： Mark Rose Carina Newton Benchaa Boualam Nancy Bogne Adam Ketchum Umang Shah Jordan Mitchell Safura Tanveer tucker lurie Walesia Robinson Rebecca Duncan Stephen Thom Quincy Khoi Tran Department of Emergency Medicine University of Maryland School of Medicine University of Maryland at College Park University of Maryland School of Medicine Program of Trauma The R Adams Cowley Shock Trauma Center University of Maryland School of Medicine

BACKGROUND: Acute aortic dissection(AoD) is a hypertensive emergency often requiring the transfer of patients to higher care hospitals; thus, clinical care documentation and compliance with the Emergency Medical Treatment and Active Labor Act(EMTALA) is crucial. The study assessed emergency providers(EP) documentation of clinical care and EMTALA compliance among interhospital transferred AoD ***: This retrospective study examined adult patients transferred directly from a referring emergency department(ED) to a quaternary academic center between January 1, 2011 and September 30, 2015. The primary outcome was the percentage of records with adequate documentation of clinical care(ADoCC). The secondary outcome was the percentage of records with adequate documentation of EMTALA compliance(ADoEMTALA). RESULTS: There were 563 electronically identified patients with 287 included in the final analysis. One hundred and five(36.6%) patients had ADoCC while 166(57.8%) patients had ADoEMTALA. Patients with inadequate documentation of EMTALA(IDoEMTALA) were associated with a higher likelihood of not meeting the American Heart Association(AHA) ED Departure SBP guideline(OR 1.8, 95% CI 1.03–3.2, P=0.04). Male gender, handwritten type of documentation, and transport by air were associated with an increased risk of inadequate documentation of clinical care(IDoCC), while receiving continuous infusion was associated with higher risk of ***: Documentation of clinical care and EMTALA compliance by Emergency Providers is poor. Inadequate EMTALA documentation was associated with a higher likelihood of patients not meeting the AHA ED Departure SBP guideline. Therefore, Emergency Providers should thoroughly document clinical care and EMTALA compliance among this critically ill group before transfer.

关键词： Acute aortic dissection EMTALA Interhospital transfer Documentation Compliance

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Predictors associated with inappropriate transport of near shore spinal injuries

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Chinese Journal of Traumatology 2021年第5期24卷 286-290页

作者： tucker lurie Timothy Traynor Maira Sher Bano Quincy K.Tran University of Maryland School of Medicine BaltimoreMD21201USA Research Associate Program in Emergency Medicine&Critical Care University of Maryland School of MedicineBaltimoreMD21201USA Department of Emergency Medicine University of Maryland Schoo of MedicineBatimoreMD21201USA Program in Trauma The R Adams Cowley Shock Trauma CenterUniversity of Maryland School of MedicineBaltimoreMD21201USA

Purpose:Spinal injuries resulting in neurological damage cause significant *** neurosurgical intervention can mitigate negative ***,variable mechanisms of injury may be associated with inappropriate transport(IAT),which may delay necessary surgical *** with near shore spinal injuries(NSSI)presented with unique mechanisms,so we investigated factors associated with IAT in patients with ***:We performed a multicenter retrospective study of all adult patients transported from a beach resort to 3 hospitals for suspected NSSI between *** excluded patients transferred to other facilities,and those not injured in the *** outcome was IAT,defined as patients with NSSI requiring transfer to another trauma *** avoid heterogeneity in our analysis,we further excluded patients without NSSI who were inappropriately transported to a level I trauma *** used multivariable logistic regression to assess association of independent variables(such as demographic,environmental,and clinical factors)with ***:We analyzed 278 patients with suspected NSSI,and found 14(5.0%)had *** to appropriately transported patients,diving was associated with higher percentages of IAT(28.6%vs.3.9%,p=0.014)and more were transported by air(50.0%vs.20.6%,p=0.01).In multivariable regression,patients'oxygenation saturation(odds ratio[OR]=0.8,95%confidence intervals[Cl]:077-0.98)and diving(OR=7.5,95%Cl:1.2-46)were significantly associated with ***:Rate of IAT for patients with NSSI was ***,first responders and emergency medicine providers should be aware that diving is associated with a higher likelihood of IAT.

关键词： Transport Spinal injury Near shore spinal injury Wave riding Shallow water diving

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