PCOM Library / Hot Topics in Research / Archive for "Emergency Medicine"

Category: Emergency Medicine

Hot Topics: Online Ratings Highlight Patient Opinions

Jackie Werner Emergency Medicine, Hot Topics in Research

Online ratings of the patient experience: Emergency departments versus urgent care centers

Agarwal AK, Mahoney K, Lanza AL, et al. Online ratings of the patient experience: Emergency departments versus urgent care centers. Annals of Emergency Medicine. 2018. http://www.sciencedirect.com/science/article/pii/S0196064418313222.

Study objective

Individuals increasingly use online rating platforms to rate and review hospitals. We seek to describe and compare publicly available online review content and ratings of emergency departments (EDs) and urgent care centers.

Methods

We analyzed Yelp reviews of EDs and urgent care centers to identify topics most correlated with 1- and 5-star ratings. Latent Dirichlet Allocation, a method of identifying groups of co-occurring words in narrative text, was used to identify and label 25 topics across 1- and 5-star reviews of urgent care centers and EDs. Differential Language Analysis was then used to measure the correlation of these topics with 1- and 5-star reviews for urgent care centers and EDs.

Results

We analyzed 100,949 Yelp reviews, 16,447 from 1,566 EDs and 84,502 from 5,601 urgent care centers. There were significantly more 5-star urgent care center reviews (n=43,487; 51%) than 5-star ED reviews (n=4,437; 27%). Themes associated with 5-star reviews among EDs and urgent care centers were similar for comfort, professionalism, facilities, pediatric care, and staff interactions. Themes associated with 1-star reviews among EDs and urgent care centers were similar for communication, telephone experience, waiting, billing, pain management, and diagnostic testing. Themes unique to 5-star ED reviews included bedside manner, care for family members, and access. Themes unique to 5-star urgent care center reviews were based on recommendation and prescription refills. Themes unique to 1-star ED reviews were service and speed of care. Themes unique to 1-star urgent care center reviews were lack of confidence and reception experience.

Conclusion

Understanding drivers for high and low online ratings and what patients value in their ED and urgent care center experiences offers insights for health systems and providers to improve acute care delivery. Patients’ perspectives may become increasingly important as they seek care in the expanding urgent care markets.

Hot Topics: Ketamine Could Be Alternative to Opioids in ER

Jackie Werner Emergency Medicine, Hot Topics in Research

A Systematic Review and Meta‐analysis of Ketamine as an Alternative to Opioids for Acute Pain in the Emergency Department

Nicholas K, Schlaepfer CH, Stoll CR, et al. A systematic review and meta-analysis of ketamine as an alternative to opioids for acute pain in the emergency department. Academic Emergency Medicine. 2018. https://doi.org/10.1111/acem.13502.

Background
Opioids are commonly prescribed in the emergency department (ED) for the treatment of acute pain. Analgesic alternatives are being explored in response to an epidemic of opioid misuse. Low‐dose ketamine (LDK) is one opioid alternative for the treatment of acute pain in the ED.

Objectives
This systematic review and meta‐analysis sought to quantify whether LDK is an effective and safe opioid alternative for acute pain reduction in adults in the ED setting. (PROSPERO Registration Number CRD42017065303).

Methods
This was a systematic review of randomized controlled trials comparing intravenous opioids to LDK for relief of acute pain in the ED. Studies where the control group initially received opioids prior to ketamine were excluded. A research librarian designed the electronic search strategy. Changes in visual analog scale or numeric rating scale pain scales were analyzed to determine the relative effects of LDK and opioids in the treatment of acute pain.

Results
Three studies met the criteria for inclusion in this meta‐analysis. Compared to pain scale reduction with morphine, ketamine was not inferior (relative reduction = 0.42, 95% confidence interval = –0.70 to 1.54). No severe adverse events were reported in any study, but higher rates of nonsevere adverse events were observed with ketamine.

Conclusions
Ketamine is noninferior to morphine for the control of acute pain, indicating that ketamine can be considered as an alternative to opioids for ED short‐term pain control.

Hot Topics: Stress of Healthcare Staff Can Affect Service During Disasters

Jackie Werner Emergency Medicine, Hot Topics in Research

Staff Stress: The Sleeping Cell of Healthcare Failure

Achour N, Munokaran S, Barker F, Soetanto R. Staff stress: The sleeping cell of healthcare failure. Procedia Engineering. 2018;212:459-466. doi: 10.1016/j.proeng.2018.01.059.

Much research has been conducted to increase the resilience of healthcare service to major hazards; however, every time a major hazard takes place we discover that this critical service is yet to reach the anticipated resilient state. This paper reports an ongoing research work that looked at: the resilience of the structure of healthcare facilities, equipment stability, lifeline (utility) supplies, the interaction between hospitals and emergency agencies and the support the latter can provide during major emergencies. This paper presents findings on the ability of human resources to deal with the stress associated with major hazards. A mixed research method was adopted, including a systematic literature review followed by a survey to gather evidence about the stress level amongst healthcare staff in hospitals and their motivation. The literature review was conducted to find information about the level of stress healthcare staff experience with during major emergencies. Findings suggest that healthcare staff remain at high risk of stress and thus represent a major weakness of healthcare service resilience. The research concludes with a set of recommendations to address this issue.