MEMC-GREAT 2015

Western Journal of Emergency Medicine

Volume XVII, May 2016

PRESENTS

Supplement to

West

Open Access at www.westjem.com

ISSN 1936-900X

Western Journal of Emergency Medicine:

SEPTEMBER 20TH HYATT REGENCY ORANGE COUNTY, CA

MEMC-GREAT Abstracts Special Issue VOLUME XVII, March 2016 Supplement

2016

Integrating Emergency Care with Population Health

MEMC-GREAT 2015

Jointly Organized by the American Academy of Emergency Medicine (AAEM), the Global Research on Acute Conditions Team Italy (GREAT Italy) Network, and the Mediterranean Academy of Emergency Medicine (MAEM)

PAGES 1-12

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Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health Indexed in MEDLINE Mark I. Langdorf, MD, MHPE, Editor-in-Chief University of California, Irvine School of Medicine Niels K. Rathlev, MD, Associate Editor Tufts University Medical School and Baystate Medical Center

Shahram Lotfipour, MD, MPH, Managing Associate Editor University of California, Irvine School of Medicine Rick A. McPheeters, DO, Associate Editor Kern Medical Center

Joel M. Schofer, MD, MBA, Associate Editor Naval Medical Center Portsmouth

Edward Michelson, MD, Associate Editor Texas Tech University

Thomas Terndrup, MD, Associate Editor Ohio State University

Section Editors AAEM/RSA

ED Administration

Behavioral Emergencies

James Langabeer II, MBA, EMT, PhD Rolando Valenzuela, MD University of Texas Medical School University of Southern California

Andrew W. Phillips, MD, MEd Stanford/Kaiser Emergency Medicine Michael P. Wilson, MD, PhD University of California, San Diego

Gary Johnson, MD Upstate Medical University

International Medicine

Emergency Cardiac Care

Legal Medicine

Michael Abraham, MD University of Maryland

Amal Mattu, MD University of Maryland

Methodology and Biostatistics

Eric Snoey, MD Alameda County Medical Center

Emergency Medical Services

Elizabeth Burner, MD, MPH University of Southern California

Leslie Zun, MD, MBA Chicago Medical School

Clinical Practice

Michael Kurz, MD University of Alabama at Birmingham

Christopher Kahn, MD, MPH University of California, San Diego

David Thompson, MD University of California, San Francisco Derek Cooney, MD State University of New York Upstate Medical University, New York Kenneth S. Whitlow, DO Kaweah Delta Medical Center Joshua B. Gaither, MD Critical Care University of Arizona, Tuscon Joseph Shiber, MD University of Florida - College of Medicine Shira A. Schlesinger, MD, MPH University of California, Irvine Todd Slesinger, MD Aventura Hospital and Medical Center Geriatrics Teresita M. Hogan, MD Christopher “Kit� Tainter, MD University of Chicago University of California, San Diego Kathleen Walsh, DO, MS Disaster Medicine University of Wisconsin Christopher Kang, MD Madigan Army Medical Center Infectious Disease Robert Derlet, MD Gentry Wilkerson, MD University of California, Davis University of Maryland

Education

Douglas Ander, MD Emory University Jeffrey Druck, MD University of Colorado Michael Epter, DO Maricopa Medical Center

Sukhjit S. Takhar, MD Harvard Medical School

Resident/Student/Fellow Forum

Chris Mills, MD, MPH Santa Clara Valley Medical Center

John Ashurst, DO Lehigh Valley Health Network Cecylia Kelley, DO Inspira Health Network

Statistics

Greg P. Moore, MD, JD Madigan Army Medical Center

Shu B. Chan MD, MS, FACEP Resurrection Medical Center Stormy M. Morales Monks, PhD, MPH Texas Tech Health Science University

Craig Anderson, MPH, PhD University of California, Irvine

Technology in Emergency Medicine Sanjay Arora, MD University of Southern California

Christian McClung, MD MPhil University of Southern California

Robert L. Rogers, MD University of Kentuky

Musculoskeletal

Trauma

Juan F. Acosta DO, MS Pacific Northwest University

William Paolo, MD SUNY Upstate

Neurosciences

Edward P. Sloan, MD, MPH University of Illinois at Chicago William D. Whetstone, MD University of California, San Francisco

Pediatric Emergency Medicine

Judith Klein, MD University of California, San Francisco Paul Walsh, MD, MSc University of California, Davis

David Peak, MD Massachusetts General Hospital/Havard Medical School

Toxicology

Jeffrey R. Suchard, MD University of California, Irvine Brandon Wills, DO, MS Virginia Commonwealth University

Ultrasound

Muhammad Waseem, MD Gavin Budhram, MD Lincoln Medical & Mental Health Center Tufts University

Public Health

Injury Prevention

Jeremy Hess, MD, MPH Emory University

Laleh Gharahbaghian, MD Stanford University

Bharath Chakravarthy, MD, MPH University of California, Irvine

Chadd Kraus, DO, DrPH, MPH University of Missouri - Columbia

Shane Summers, MD Brooke Army Medical Center

Wirachin Hoonpongsimanont, MD University of California, Irvine

Trevor Mills, MD, MPH Northern California VA Health Care

J. Matthew Fields, MD Thomas Jefferson University

Michael Gottlieb, MD Rush Medical Center

Official Journal of the California Chapter of the American College of Emergency Physicians, the America College of Osteopathic Emergency Physicians, and the California Chapter of the American Academy of Emergency Medicine

Available in MEDLINE, PubMed, PubMed Central, CINAHL, SCOPUS, Google Scholar, eScholarship, Melvyl, DOAJ, EBSCO, EMBASE, Medscape, HINARI, and MDLinx Emergency Med. Members of OASPA. Editorial and Publishing Office: WestJEM/Depatment of Emergency Medicine, UC Irvine Health, 333 City Blvd, West, Rt 128-01, Orange, CA 92868, USA Office: 1-714-456-6389; Email: Editor@westjem.org

Western Journal of Emergency Medicine

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Volume XVII, Supplement : August 2016

Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health Indexed in MEDLINE

Editorial Board Erik D. Barton, MD, MBA University of California, Irvine

Edward Panacek, MD, MPH University of South Alabama

Peter A. Bell, DO, MBA Ohio University, Heritage College of Osteopathic Medicine

Niels K. Rathlev, MD Tufts University Medical School and Baystate Medical Center

Barry E. Brenner, MD, MPH Case Western Reserve University

Robert M. Rodriguez, MD University of California, San Francisco

David F.M. Brown, MD Massachusetts General Hospital/ Harvard Medical School Francis Counselman, MD Eastern Virginia Medical School

Advisory Board Peter A. Bell, DO, MBA American College of Osteopathic Emergency Physicians Ohio University, Heritage College of Osteopathic Medicine John B. Christensen, MD California Chapter Division of AAEM

Mark I. Langdorf, MD, MHPE UC Irvine Health SOM

Peter Sokolove, MD University of California, San Francisco Samuel J. Stratton, MD, MPH Orange County, CA, EMS Agency Robert Suter, DO, MHA UT Southwestern Medical Center

Shahram Lotfipour, MD, MPH UC Irvine Health SOM

Steven Gabaeff, MD Clinical Forensic Medicine

Thomas Terndrup, MD Ohio State University

Brent King, MD, MMM University of Texas, Houston

Scott Zeller, MD Alameda County Medical Center

William Mallon, MD California ACEP American College of Emergency Physicians University of Southern California Keck School of Medicine

Edward Michelson, MD Texas Tech University

Leslie Zun, MD, MBA Chicago Medical School

Daniel J. Dire, MD University of Texas Health Sciences Center San Antonio

Trevor Mills, MD, MPH California Chapter Division of AAEM LSU Medical Center

Linda S. Murphy, MLIS University of California, Irvine School of Medicine Librarian

Aimee Moulin, MD California ACEP American College of Emergency Physicians University of California, Davis

Jonathan Olshaker, MD Boston University

Editorial Staff

International Editorial Board Arif A. Cevik, MD Eskişehir Osmangazi University Medical Center, Eskişehir, Turkey

Amin A. Kazzi, MD The American University of Beirut, Lebanon

Francesco D. Corte, MD Azienda Ospedaliera Universitaria “Maggiore della Carità”, Novara, Italy

Steven H. Lim, MD Changi General Hospital, Singapore

Vijay Gautam, MBBS University of London, United Kingdom Wirachin Hoonpongsimanont, MD University of California, Irvine

Jan Wachtler American College of Osteopathic Emergency Physicians

Amal Khalil, MBA UC Irvine Health SOM

Scott Rudkin, MD, MBA University of California, Irvine

Elena Lopez-Gusman California ACEP American College of Emergency Physicians

Robert W. Derlet, MD University of California, Davis

Robert Suter, DO, MHA American College of Osteopathic Emergency Physicians UT Southwestern Medical Center

Kobi Peleg, PhD, MPH Tel-Aviv University, Israel Rapeepron Rojsaengroeng, MD Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

Usman Alum, BS Marketing Director

Nancy Hernandez, BS Associate Publishing Director

June Casey, BA Copy Editor

Joyce Y. Kim, BS Editorial Director

Maryam Farooqui, BS Associate Editorial Director

Vincent Lam, BS Publishing Director

Alissa Fiorentino WestJEM Staff Liaison

Samantha Shwe, BS Publishing Director

Official Journal of the California Chapter of the American College of Emergency Physicians, the America College of Osteopathic Emergency Physicians, and the California Chapter of the American Academy of Emergency Medicine

Available in MEDLINE, PubMed, PubMed Central, CINAHL, SCOPUS, Google Scholar, eScholarship, Melvyl, DOAJ, EBSCO, EMBASE, Medscape, HINARI, and MDLinx Emergency Med. Members of OASPA. Editorial and Publishing Office: WestJEM/Depatment of Emergency Medicine, UC Irvine Health, 333 City Blvd, West, Rt 128-01, Orange, CA 92866, USA Office: 1-714-456-6389; Email: Editor@westjem.org

Volume XVII, Supplement : August 2016

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Western Journal of Emergency Medicine

Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health Indexed in MEDLINE

This open access publication would not be possible without the generous and continual financial support of our society sponsors, department and chapter subscribers.

Professional Society Sponsors American College of Osteopathic Emergency Physicians California Chapter Division of American Academy of Emergency Medicine

California ACEP

Academic Department of Emergency Medicine Subscriber Allegheny Health Network Pittsburgh, PA American University of Beirut Beirut, Lebanon Arrowhead Regional Medical Center Colton, CA Baylor College of Medicine Houston, TX Baystate Medical Center/Tufts University Springfield, MA Boston Medical Center Boston, MA Brigham and Women’s Hospital Department of Emergency Medicine Boston, MA Brown University Providence, RI California State University Fresno Fresno, CA Carl R. Darnall Army Medical Center Fort Hood, TX Conemaugh Memorial Medical Center Johnstown, PA Eastern Virginia Medical School Norfolk, VA Emory University Atlanta, GA Florida Hospital Medical Center Orlando, FL Georgia Regents University Emergency Medicine Residency and Fellowship Augusta, GA Good Samaritan Hospital Medical Center West Islip, NY Henry Ford Medical Center Detroit, MI Highland Hospital Oakland, CA

INTEGRIS Health Oklahoma City, OK Kaweah Delta Health Care District Visalia, CA Kennedy University Hospitals Turnersville, NJ Kern Medical Center Bakersfield, CA Lakeland HealthCare St. Joseph, MI Lehigh Valley Hospital and Health Network Allentown, PA Louisiana State University Health Sciences Center New Orleans, LA Madigan Army Medical Center Tacoma, WA Maimonides Medical Center Brooklyn, NY Maricopa Medical Center Phoenix, AZ Massachusetts General Hospital Boston, MA Mayo Clinic College of Medicine Rochester, MN Medical College of Wisconsin Milwaukee, WI Mt. Sinai Medical Center Miami Beach, FL National University Hospital Singapore, Singapore New York Methodist Hospital Brooklyn, NY North Shore University Hospital Manhasset, NY Northwestern Medical Group Chicago, IL Ohio State University Medical Center Columbus, OH Oklahoma University Norman, OK

Penn State Milton S. Hershey Medical Center Hershey, PA Presence Resurrection Medical Center Chicago, IL Regions Hospital/ Health Partners Institute for Education and Research St. Paul, MN Robert Wood Johnson Hospital New Brunswick, NJ Southern Illinois University Carbondale, IL Stanford University Palo Alto, CA SUNY Upstate Medical Center Syracuse, NY Temple University Philadelphia, PA University Hospitals Case Medical Center Cleveland, OH University of Alabama, Birmingham Birmingham, AL University of Arizona Tucson, AZ University of California, Davis Medical Center Sacramento, CA University of California, San Francisco San Francisco, CA University of California, San Francisco, Fresno Fresno, CA University of California Irvine Orange, CA University of California, Los Angeles Los Angeles, CA University of California San Diego La Jolla, CA University of Colorado & Denver Health Denver, CO University of Florida Jacksonville, FL

State Chapter Subscriber

Arizona Chapter Division of the American Academy of Emergency Medicine California Chapter Division of the American Academy of Emergency Medicine Florida Chapter Division of the American Academy of Emergency Medicine Great Lakes Chapter Division of the American Academy of Emergency Medicine

University of Illinois at Chicago Chicago, IL University of Iowa Iowa City, IA University of Kansas Hospital Kansas City, KS University of Louisville Louisville, KY University of Maryland Baltimore, MD University of Michigan Ann Arbor, MI University of Missouri Columbia, MO University of Nebraska Medical Center Omaha, NE University of Nevada Las Vegas, NV University of Oklahoma Norman, OK University of Southern California/Keck School of Medicine Los Angeles, CA University of Tennessee, Memphis Memphis, TN University of Texas Houston, TX University of Washington Seattle, WA University of Wisconsin Hospitals and Clinics Madison, WI Virginia Commonwealth University Medical Center Richmond, VA York Hospital York, ME Wake Forest University Winston-Salem, NC Wright State University Dayton, OH

Tennessee Chapter Division of the American Academy of Emergency Medicine Uniformed Services Chapter Division of the American Academy of Emergency Medicine Virginia Chapter Division of the American Academy of Emergency Medicine

International Society Partners

Sociedad Argentina de Emergencias Thai Association for Emergency Medicine Sociedad Chileno Medicina Urgencia Emergency Medicine Association of Turkey To become a WestJEM departmental sponsor, waive article processing fee, receive print and copies for all faculty and electronic for faculty/residents, and free CME and faculty/fellow position advertisement space, please go to http://westjem.com/subscribe or contact: Alissa Fiorentino WestJEM Staff Liaison Phone: 1-800-884-2236 Email: sales@westjem.org

Western Journal of Emergency Medicine

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Volume XVII, Supplement : August 2016

MEMC-GREAT 2015 - Jointly Organized by the American Academy of Emergency Medicine (AAEM), the Global Research on Acute Conditions Team Italy (GREAT Italy) Network, and the Mediterranean Academy of Emergency Medicine (MAEM)

Western Journal Emergency Medicine: Integrating Emergency Care with Population Health is pleased to publish some of the best abstracts from the 8th Mediterranean EM Congress/Italian GREAT Network Congress, held September 5-9, 2015 in Rome, Italy. These abstracts largely focus on population health and systems of medicine, which is reflected in the journal’s subtitle.

Special thanks to Dr. Amin Kazzi, American University of Beirut, Dr. Lisa Moreno-Walton, Louisiana State University, Dr. Gary Gaddis, University of Missouri, Kansas City and Professor Salvatore D. Somma, University La Sapienza Rome, for offering us the privilege to publish these worldwide advances in emergency medicine science.

I look forward to seeing you and our international EM colleagues at the next congress in 2017. Until then, Arrivederci!

Professor Mark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMS Editor-in-Chief, Western Journal of Emergency Medicine

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Table of Contents Author Index Abstracts

Western Journal of Emergency Medicine

The Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health would like to thank the Mediterranean Academy of Emergency Medicine and the Academic Research and Educational Organization for helping to make this collaborative special issue possible.

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Volume XVII, Supplement : May 2016

Editorial

Greetings from MEMC-GREAT 2015 and AAEM! Lisa Moreno-Walton, MD, MS, MSCR, FAAEM

Secretary-Treasurer, AAEM Board of Directors Executive Chair, MEMC-GREAT 2017

Going forward, you will see AAEM’s presence increasingly in the Mediterranean area. AAEM Board members and general members are hard at work in productive collaborations with emergency physicians in countries such as Lebanon, Iraq, Italy, Oman, Qatar, Turkey, Poland, the Republic of Georgia, Saudi Arabia, the United Arab Emirates, and many more. And we are hard at work preparing the 9th MEMC. As executive chair of that Congress, I hope that I will be welcoming you, not only as an attendee, but as an abstract presenter and even as a speaker. Read the 2015 Congress abstracts, and be inspired to do some research of your own in time for the 9th MEMC in Lisbon, Portugal in September, 2017! I’m looking forward to hearing from you when you are ready to submit your abstract and your presentation ideas! Become a partner with AAEM and with our partners, GREAT and MAEM, to advance research, education and board certification in the Mediterranean and throughout the world.

The 8th Annual Mediterranean Emergency Medicine Congress (MEMC) and the American Academy of Emergency Medicine (AAEM) are grateful to the Western Journal of Emergency Medicine for kindly offering to publish some of the top abstracts from MEMC-GREAT 2015, held in Rome in September 2015. As chair of the Abstract Committee, it was my great pleasure to review the over 600 abstracts from over 61 countries that were submitted for the Congress. While you may say that this was an onerous task, what made it a pleasure was the wonderfully high quality of the research submitted for review. Did you know that 80% of the published scientific research comes from only 20 countries? As physicians, you know that genetics and culture have a significant impact on the way patients respond to treatment, education or public health interventions, and so you understand why it is essential that both the benefits and the burden of research be equally distributed. AAEM has a strong commitment to eliminating health disparities, and we work collaboratively to increase residency training, board certification and quality research and health care throughout the globe. In 2015, for the first time, MEMC was a collaboration between AAEM, GREAT (Global Research on Acute Conditions Team), headed up

by Professor Salvatore Di Somma in Rome, and one of AAEM’s newest chapters, the Mediterranean Academy of Emergency Medicine (MAEM) headed up by former AAEM President, Professor Antoine Kazzi. Along with the AAEM team (Drs. Terry Mulligan, William Durkin, Bob Suter, Gary Gaddis and me), GREAT and MAEM put on an amazingly successful Congress, attended by almost 1,200 attendees.

Volume XVII, Supplement : May 2016

Address for Correspondence: Lisa Moreno-Walton, MD, MS, MSCR, FAAEM. Secretary-Treasurer, AAEM Board of Directors, Executive Chair, MEMC-GREAT 2017.

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.

Copyright: © 2016 Moreno-Walton. This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/ licenses/by/4.0/

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Western Journal of Emergency Medicine

MEMC-GREAT Abstracts - Table of Contents 1.

Post-Graduate Training of Faculty at National Emergency Medicine-Critical Care Medicine Conferences Shiber J, Fontane E

2.

Assessment of an Emergency Department Chest Pain Patient Cohort at Low Risk for Significant Adverse Events During Admission for Acute Coronary Syndrome Perkins J, Voore N, Patel J, Sanna S, Mann E, Gozu A

3.

Emergency Medicine and Active Labor Act Violations 2002-15: Review of Office of Inspector General Patient Dumping Settlements Langdorf M, Zuabi N

4.

First Pass Success of the Glidescope Titanium Mac Video Laryngoscope is Higher When Used as a Video Laryngoscope Than When as a Direct Laryngoscope for Emergency Intubation Sakles J, Arcaris B, Patanwala A, Mosier J, Dicken J Does Emergency Department Triage Pain Score Predict Disposition?

Riordan J, Wakim M, Patrie J, Dell W

5.

13.

Utilizing Simulations to Develop and Assess SocioBehavioral Competency in an Emergency Medicine Residency Program: A Pilot Project Rega P

14.

Using Patient Voice to Construct an Emergency Medicine Clerkship Curriculum Peterson C

15.

Feasibility of ALS at Scene Assisted by Video Call with Physician in Republic of Korea Park S, Oh Y

16.

How Countertransference Affects Medical DecisionMaking: Comparing Emergency Medicine Versus Psychiatry Residents-in-Training Moukaddam N, Shah A, Laufman L, Tucci V

17.

SEWS Reliability to Pick up the Acutely Ill Patients in a Busy Emergency Department Majeed MA, Naveed A, Imam S, Giovannetti G

18.

A Critical Analysis of Factors that Influence Emergency Medicine Consultants in Their Careers: Why Have Consultants Chosen Emergency Medicine, Why Do They Stay and Why Might They Go? James F, Gerrard F

19.

Hospital Performance Based on PabĂłn Lasso Model Hosseini Kasnavieh S, Basirghafouri H, Masumi G, Chardoli M, Yasinzadeh M, Tavakoli N, Amiri H

20.

Bedside Ultrasonography of Optic Nerve Versus Ophthalmoscopy for Predicting Elevated Intracranial Pressure Golshani K, Ebrahim Zadeh M, Masoumi B, Azizkhani R

21.

A Flow-Processing Manager Nurse in the Emergency Department to Improve Safety, Optimize Throughput and Increase Performances Lanzarini C, Ferrari R, Canovi S, Vitale G, Cavazza M

22.

Utilizing Physician and Patient Complaints as a Quality Assurance Marker in Emergency Medicine Gurley K, Wolfe R, Grossman S, Edlow J, Burstein J

Utility of Ultrasonography as Adjuncts in Risk Stratification for Pediatric Septic Arthritis Cochon L, Shashikant Patel P, Baez A

23.

X-Ray Ordering Among Emergency Department Physicians As a Function of the Patient’s Primary Language Bilal S, Kuo DC, Peacock WF, Pillow MT

Palliative Care Screening in the Emergency Department: A Quality Improvement Initiative Christos S

24.

Clinical Decision Rule to Prevent Unnecessary Chest X-Ray in Patients with Blunt Multiple Traumas Forouzanfar MM, Safari S, Mahdavi NS, Hashemi B, Baratloo A, Rahmati F

25.

Satisfaction of Emergency Medicine Residents with a Web-Based Communication Group for Education Alfaraj D, Alshahrani M

6.

The Effects of Screening for Ebola on Emergency Department Throughput Mwangi W, Nagurka R, Steenberg M, Sugalski G, Murano T, Lamba S, Keller S

7.

The Role of Emergency Ultrasound in Cardiopulmonary Resuscitation Matsuoka Y, Hata N, Hayashi T, Ariyoshi K

8.

Effectiveness of Focused Cardiac Ultrasound by the Emergency Physician in the Diagnosis Treatment and Referral of Patients in the Emergency Department Lassoued M Ben, Jebri R, Hammami R, Arafa M, Andolsi O, Khila O, Lamine K

9.

10.

11.

12.

Vulnerability Study of Healthcare Human Resources in the Iranian Ministry of Health and Medical Education Hosseini Kasnavieh S, Basirghafouri H, Masumi G, Chardoli M, Yasinzadeh M, Tavakoli N, Amiri H

Effect of a Novel Engagement Strategy Using Twitter on Test Performance Adkins B, Barnett K, Patel N, Doty C, Silverberg M, Morehead S, Stearley S

Western Journal of Emergency Medicine

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Volume XVII, Supplement : May 2016

MEMC-GREAT Abstracts Author Index Adkins, B, 6 Alfaraj, D, 12 Alshahrani, M, 12 Amiri, H, 4, 9 Andolsi, O, 4 Arafa, M, 4 Arcaris, B, 2 Ariyoshi, K, 4 Azizkhani, R, 9 Baez, A, 10 Barnett, K, 6 Baratloo, A, 11 Basirghafouri, H, 4,9 Bilal, S, 5 Burstein, J, 5 Canovi, S, 10 Cavazza, M, 10 Chardoli, M, 4, 9 Christos,S, 11 Cochon, L, 10 Dell, W, 3 Dicken, J, 2 Doty, C, 6 Ebrahim, M, 9 Edlow, J, 5 Ferrari, R, 10 Fontane, E, 1 Forouzanfar, MM, 11 Gerrard, F, 9 Giovannetti, G, 8 Golshani, K, 9 Gozu, A, 1 Grossman, S, 5 Gurley, K, 5 Hammami, R, 4 Hashemi, B, 11 Hata, N, 4 Hayashi, T, 4 Hosseini, S, 4, 9 Imam, S, 8 James, F, 9 Jebri, R, 4 Keller, S, 3 Khila, O, 4 Kuo, DC, 5 Lamba, S, 3 Lamine, K, 4 Langdorf, M, 2 Lanzarini, C, 10

Volume XVII, Supplement : May 2016

Lassoued, B, 4 Laufman, L, 8 Mahdavi, NS, 11 Majeed, MA, 8 Mann, E, 1 Masoumi, B, 9 Masumi, G, 4, 9 Matsuoka, Y, 4 Morehead, S, 6 Mosier, J, 2 Moukaddam, N, 8 Murano, T, 3 Mwangi, W, 3 Nagurka, R, 3 Naveed, A, 8 Oh, Y, 7 Park, S, 7 Patanwala, A, 2 Patel, N, 6 Patel, J, 1 Patrie, J, 3 Peacock, WF, 5 Perkins, J, 1 Peterson, C, 7 Pillow, MT, 5 Rahmati, F, 11 Rega, P, 6 Riordan, J, 3 Safari, S, 11 Sakles J, 2 Sanna, S, 1 Shah, A, 8 Shashikant, P, 10 Shiber, J, 1 Silverberg, M, 6 Stearley, S, 6 Steenberg, M, 3 Sugalski, G, 3 Tavakoli, N, 4, 9 Tucci, V, 8 Vitale, G, 10 Voore, N, 1 Wakim, M, 3 Wolfe, R, 5 Yasinzadeh, M, 4, 9 Zuabi, N, 2

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Western Journal of Emergency Medicine

MEMC-GREAT Abstracts 2016

1

Post-Graduate Training of Faculty at National Emergency Medicine-Critical Care Medicine Conferences

Shiber J, Fontane E / University of Florida, College of Medicine, Jacksonville, FL Introduction: There are numerous conferences advertised as some combination of Emergency Medicine and Critical Care Medicine (EM-CCM) but the background and qualifications of the speakers at these conferences is not well known.

Methods: Review of the course programs for the training and background of the faculty speakers at seven prominent national EM-CCM conferences from 20092012: American College of Emergency Physicians (ACEP) Scientific Assembly – CCM Tract, Critical Points: Emergency Critical Care, The Weil Symposium on Critical Care and Emergency Medicine, Emergency and Critical Care Medicine -The Cutting Edge, Florida Emergency Physicians Symposium on Critical Care in the Emergency Department, U. MD – The Crashing Patient, and Resuscitation.

Confirmation of post-graduate training was performed by on-line research. We compared the percentage of speakers trained in both emergency medicine (EM) and CCM with the post-graduate training of the speakers at the ACEP Pediatric Emergency Medicine Assembly who have training in both Pediatrics and Emergency Medicine as compared to Emergency Medicine or Pediatrics alone.

Results: There were a total of 221 speakers at the seven studied EM-CCM conferences from 2009-2012: faculty trained in EM-CCM 42 (19.1%) and trained in EM alone 179 (80.9%). There were 58 speakers at the ACEP Pediatric Emergency Medicine Assembly from 2010-2012: faculty trained in Peds-EM 29 (50.0%), Pediatrics plus subspecialty [critical care, cardiology, dermatology, etc.] 23 (39.6%), EM plus subspecialty [ultrasound, toxicology, etc.] 4 (6.9%), Pediatrics alone 1 (1.7%), and EM alone 1 (1.7%).

Conclusions: In the included EM-CCM conferences, less than 1/5 of speakers were trained in both EM and CCM with the overwhelming majority trained in only EM. Using the ACEP Pediatric EM Assembly as a comparison model, there were a much larger percentage of dually trained speakers in either PedsEM or Peds Subspecialty, with only a very small percentage of speakers trained in EM alone or Peds alone. We believe that conference directors should be encouraged to invite speakers who have the appropriate training (additional residency or fellowship) in the area of the specific conference so that the audience can benefit from those presenters with the most formal education and expertise in their respective specialty.

Western Journal of Emergency Medicine

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Assessment of an Emergency Department Chest Pain Patient Cohort at Low Risk for Significant Adverse Events During Admission for Acute Coronary Syndrome

Perkins J, Voore N, Patel J, Sanna S, Mann E, Gozu A / Virginia Tech Carilion School of Medicine, Roanoke, VA, Medstar Franklin Square Hospital Center, Baltimore, MD, Virginia Commonwealth University School Of Medicine, Richmond, VA, University of Maryland School of Medicine, Baltimore, MD Introduction: The American College of Cardiology (ACC) and the American Heart Association (AHA) have recommended telemetry monitoring for all admitted patients that will be evaluated for an acute coronary syndrome (ACS).

This recommendation is not evidence based and leads to broad utilization of a costly resource. Our purpose was to evaluate a cohort of chest pain patients felt to be at very low risk for significant adverse events (e.g. ventricular fibrillation (VF), ventricular tachycardia (VT), sudden cardiac death (SCD)) during inpatient admission. We hypothesized that this cohort would have few, if any; adverse events and the characteristics of this cohort could be used for future prospective studies.

Methods: All patients in an electronic medical record system aged 18-49 admitted from a community emergency department (ED) with a primary diagnosis of chest pain from January 1, 2009 through June 30, 2010 were retrospectively analyzed. Patients were excluded if they had an abnormal initial troponin-I level, a history of coronary artery disease (CAD), an initial electrocardiogram (ECG) suggestive or diagnostic

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Volume XVII, Supplement : May 2016

MEMC-GREAT Abstracts 2016 of ischemia or dysrhythmia, or had no discharge summary available for review. All subjects were reviewed for occurrence of primary endpoints (VF, VT, SCD) and secondary endpoints (STEMI, NSTEMI or upgrade to a higher level of care). The data was analyzed using STATA 10.

Results: There were 1519 patients admitted for chest pain and 814 met the study inclusion criteria. None of the study patients suffered VF, VT, or SCD. Four patients were subsequently diagnosed with an NSTEMI while no patients had a STEMI or required upgrade to a higher level of care.

Conclusions: We conclude that our study cohort is a patient population at very low risk for ACS and may be suited for non-telemetry admission when admitted for chest pain. Using Medicare cost estimates for a 24-hour charge of telemetry (i.e. cost above med/surg bed) of $300 per patient per day; we calculate $244,200 could have been saved by admitting this patient cohort to a non-telemetry bed. Future prospective studies of patients at low risk for ACS may help stimulate ACC/ AHA policy change.

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from hospitals for insurance/financial status in 30/192 (15.6%) of cases. There were 13/192 (6.8%) violations for patients in active labor. In 12/192 (6.3%) cases, the on-call physician refused to see the patient and in 28/192 (14.6%) cases, the patient was inappropriately discharged. Other settlements included hospital not accepting a referral 3/192 (1.6%), no accepting physician available 4/192 (2.1%), emergency department on diversion status 3/192 (1.6%), and hospital had capacity but still refused 4/192 (2.1%). Although loss of Medicare/Medicaid federal funding is an additional possible penalty for EMTALA violation, there were no disclosures of any revocation of federal reimbursement for hospitals. There was no information on EMTALA investigations that were not subject to settlement.

Conclusions: Most hospitals and physicians settled allegations of failing to provide screening and stabilization to patients with emergency medical conditions. The reason for patient “dumping” was due to insurance or financial status in 15.6% of settlements.

Emergency Medicine and Active Labor Act Violations 2002-15: Review of Office of Inspector General Patient Dumping Settlements

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First Pass Success of the Glidescope Titanium Mac Video Laryngoscope is Higher When Used as a Video Laryngoscope Than When as a Direct Laryngoscope for Emergency Intubation

Langdorf M, Zuabi N / University of California, Irvine, Department of Emergency Medicine, Orange, CA

Sakles J, Arcaris B, Patanwala A, Mosier J, Dicken J / University of Arizona College of Medicine, Tucson, AZ

Introduction: The Emergency Medicine and Active Labor Act (EMTALA) of 1986 was passed to prevent hospitals from “dumping” or refusing service to patients for financial reasons.

The Office of the Inspector General (OIG) of the Department of Health and Human Services enforces the statute. Our objective was to determine the scope, cost and most common allegations leading to settlement of the OIG against hospitals and physicians for patient dumping.

Methods: Review of OIG patient dumping archive on May 2015, which includes cases of EMTALA allegations settled from 2002-2015 (https://oig.hhs.gov/fraud/enforcement/cmp/ patient_dumping.asp).

Results: There were 192 settlement agreements (14 per year average for 4000+ hospitals in the USA). Fines against both hospitals and physicians totaled $6,357,000 (hospital and physician average $33,435 and $25,625 respectively). There were 184/192 (95.8%, $6,152,000) settlements involving hospitals and eight against physicians ($205,000). The most common settlements were for failing to screen 144/192 (75%) and stabilize 82/192 (42.7%) for emergency medical conditions. There were 22/192 (11.5%) cases where the hospital inappropriately transferred the patient and 22/192 (11.5%) cases where the hospital failed to transfer the patient. Hospitals failed to accept an appropriate transfer in 25/192 (13.0%) of cases. Patients were turned away

Introduction: The GlideScope Titanium Mac Video Laryngoscope is a new video airway device with standard Macintosh blade geometry. It can be used as a primary video laryngoscope (VL) or as a traditional direct laryngoscope (DL).

The objective of this study was to compare the first pass success (FPS) when it was used as a VL compared to when it was used as a DL. Methods: The GlideScope Titanium Mac VL was introduced into our Emergency Department (ED) on July 1, 2014. After each intubation in the ED the operator filled out a CQI data form that included multiple patient, operator, and intubation characteristics.

First pass success was defined as successful intubation with a single laryngoscope insertion. Ultimate success was defined as successful intubation with the initial device used, regardless of the number of attempts. Adult patients were included in the analysis that underwent rapid sequence intubation (RSI) in the ED with a GlideScope Mac Titanium VL from July 1, 2014 to April 30, 2015. The primary outcome was the first pass success and the secondary outcome was ultimate success.

Results: Over the 10-month study period 352 adult patients underwent RSI in the ED. Of these the GlideScope Titanium Mac VL was used as the initial device in 148 (42%) patients.

When used primarily as a VL the FPS was 74/79 (93.7%; 95% CI: 85.8%-97.9%). When used primarily as a DL the FPS was

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29/69 (42.0%; 95% CI [30.2%-54.5%]). When the initial attempt as a DL device failed, operators switched to the video screen and were able to increase their FPS to 59/69 (85.5%; 95% CI [75.0%-92.8%]). The ultimate success was 78/79 (98.7%; 95% CI [93.2%-100%]) in the VL only group and 67/69 (97.1%; 95% CI [89.9%-99.7%]) in the DL to VL switch group.

Conclusions: The GlideScope Titanium Mac VL has a much higher first pass success when it is used as a VL device compared to when it was used as a DL device for emergency intubation.

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Mwangi W, Nagurka R, Steenberg M, Sugalski G, Murano T, Lamba S, Keller S / Rutgers New Jersey Medical School, Newark, NJ Introduction: Emergency department (ED) crowding and boarding are ongoing healthcare issues that are compounded by unexpected events. With the connected global community, hospitals are susceptible to international epidemics like the recent Ebola virus disease outbreak in West Africa. University Hospital in Newark, New Jersey, is a designated United States Centers for Disease Control and Prevention Ebola Assessment Hospital and is a receiving hospital of Newark Liberty International Airport. Initially, patients suspicious for being infected with Ebola were evaluated in isolation rooms within the ED. Due to Ebola’s highly infectious nature and recognizing that these patients require isolation and a high level of individualized care, an extended treatment area physically outside of the ED was established. Resources such as physicians, nursing staff and some medications were provided by the ED. It was hypothesized that the complex work up for suspected Ebola patients might impact ED functioning and throughput processes. The purpose of this study was to determine the effect screening suspected Ebola patients in the extended treatment area had on the length of stay for patients in the ED. Methods: We retrospectively obtained patient data for the months when patients with suspected Ebola presented to the ED. Arrival, disposition and discharge times, and hourly volume were analyzed using two-tailed T-tests. We compared monthly average time to disposition to the average time to disposition of each day when there were patients evaluated for Ebola.

Results: Eleven patients were evaluated for Ebola over a three-month period. There was a significant increase (p<0.001) in the ED length of stay regardless of where the suspected Ebola patient was evaluated. Probability 5/5 times for getting a longer length of stay with suspected Ebola patients is p<0.03.

Conclusion: There was an increased average length of stay of other ED patients on days when there was a patient being evaluated for Ebola regardless of where the potential Ebola patient was evaluated. This may be because these patients utilize manpower and resources for the ED.

Does Emergency Department Triage Pain Score Predict Disposition?

Riordan J, Wakim M, Patrie J, Dell W / University of Virginia, Charlottesville, VA Introduction: Emergency Severity Index considers severe pain as one component in assigning a five-level triage scale. We know that higher acuity patients tend to be admitted. According to the index, severe pain/distress is determined by clinical observation and/or patient rating of greater than or equal to 7 on 0-10 pain scale. Is Pain Score a marker of critical illness, or is pain, more appropriately used as an early identifier of patients requiring early analgesia? This study seeks to determine if pain score is associated with emergency department disposition.

Methods: This was a retrospective, observational, cohort study of all visits to an academic emergency department from 4/1/13-3/31/14. Data was collected from the electronic medical record (EPIC) into EXCEL. Pain scores were extracted along with: disposition, age, ESI acuity and gender. Statistical analysis created two regression models.

Results: 50,939 patient encounters had complete variables for analysis. The first analysis compared a priori variables ability to predict discharge. The multivariate model yielded a C-statistic=0.79. Acuity level, age, pain score and sex all predicted discharge. The second analysis compared a priori variables ability to predict severe pain. This model yielded a C-statistic=0.68. Age, sex, acuity level and disposition all predicted severe pain. Patients without severe pain were 1.6 times (1.51, 1.70) more likely to be assigned an ESI 2 than those with severe pain.

Conclusions: Acuity was the strongest predictor for discharge followed by age. Pain also predicted discharge with moderate pain (4-6) being the most likely to be discharged followed by severe pain (7-10). Patients without pain were least likely to be discharged followed by mild pain (1-3). Age was the strongest predictor for ESI pain score. Middle age patients were the most likely to report severe pain. Women were more likely to report severe pain than men. Discharged patients were more likely to report severe pain. Acuity did predict severe pain. However, it was acuity level 4 which demonstrated the highest probability of severe pain. Acuity level 2 had the lowest probability of severe pain.

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The Role of Emergency Ultrasound in Cardiopulmonary Resuscitation

Lassoued M Ben, Jebri R, Hammami R, Arafa M, Andolsi O, Khila O, Lamine K / Military Hospital of Tunis, Tunis, Tunisia

Matsuoka Y, Hata N, Hayashi T, Ariyoshi K / Kobe City Medical Center General Hospital, Department of Emergency Medicine, Kobe, Japan

Introduction: The objectives of the focused cardiac ultrasound (FOCUS) specific to emergency medicine were approved by the 2010 consensus of the American Society of Echocardiography and the American College of Emergency Physicians. The objective of our study was to evaluate the contribution of FOCUS directed by the emergency physician (EP) as part of the diagnostic management, therapeutic and targeted referral of patients admitted in the emergency department (ED).

Methods: We conducted a prospective observational study in the ED over a six-month period, including patients with acute chest pain, dyspnea or acute traumatic shock. The patients underwent FOCUS examination conducted by an EP who had a master’s degree in echocardiography and Doppler.

FOCUS was performed before any therapeutic management.

The main evaluation criteria were the following: diagnostic, therapeutic and orientation changes after realization of FOCUS and the secondary endpoint was the concordance between the diagnosis of EP and final diagnosis of a specialist.

Results: Eighty-two patients were included in the study, mean age was 62±13 years, the sex ratio: 2. Fifty-five patients (59.7%) had cardiovascular co-morbidities: 25 ischemic heart disease, 18 arrhythmias, 12 valvular heart disease, 28 high blood pressure and 9 arthritis. Ninety FOCUS exams were performed. We found as follows: - A change of diagnosis in 38% of cases - A change in the therapeutic management in 43% of cases -And a change in the patient’s orientation in 26% of cases.

A concordance between the diagnosis of the EP and final diagnosis of a specialist was observed in 94% of patients.

Sensitivity was 89%, specificity 94%, positive predictive value of 95% and a negative predictive value of 85% of FOCUS to the selected initial diagnosis.

Conclusion: FOCUS directed by the emergency physician is a rapid, reliable and useful examination. This imaging tool allows quick, noninvasive access and valuable information that can improve the diagnostic management, treatment and orientation of patients in the emergency department.

Introduction: Emergency ultrasound is a useful diagnostic tool for identifying reversible causes of cardiopulmonary arrests, at bedside, without interrupting standard resuscitation. However, there are no clear guideline recommendations for its use during cardiopulmonary resuscitation (CPR). The aim of our study was to determine the effectiveness of emergency ultrasound for diagnosing the etiology of cardiopulmonary arrests.

Methods: We conducted a retrospective analysis of adult patients with non-traumatic out-of-hospital cardiac arrests who were brought to an urban emergency department between April 2010 and March 2014 in Japan. To evaluate the diagnostic value of emergency ultrasound, we compared the results of emergency ultrasound performed by emergency physicians with autopsy-proven diagnoses. Data were abstracted from records at Kobe City Medical Center General Hospital and the Medical Examiner’s Office of Hyogo Prefecture. Only patients who underwent autopsy and who were examined with emergency ultrasound during CPR were enrolled. The exclusion criteria were as follows: age <18 years, traumatic injuries, known terminal illness, and prior completion of a “do not resuscitate” form.

Results: A total of 268 patients with non-traumatic out-ofhospital cardiac arrests underwent autopsy (168 men [62.7%], 100 women [37.3%]; mean age, 71.3±15 years). Of them, 202 patients (75.3%) were examined by emergency physicians using emergency ultrasound. The most common cause of cardiac arrest was acute coronary syndrome (72 cases, 36%), followed by aortic pathology (21, 10%), arrhythmia (20, 10%), and pulmonary embolism (9, 4.6%). The following causes of out-of-hospital cardiac arrests were detected by emergency ultrasound in 19 patients: cardiac tamponade (14 cases), rupture of abdominal/thoracic aortic aneurysm (3), and pulmonary embolism (2). Emergency ultrasound identified causes of cardiopulmonary arrests with a sensitivity of 54.3% (95% confidence interval, 44.1–58.4), specificity of 98.8% (96.7–99.7), and overall accuracy of 91.1% (87.6–92.5).

Conclusion: Emergency ultrasound identified potentially reversible causes of cardiopulmonary arrests with a high accuracy. Advanced life support with emergency ultrasound would improve the quality of cardiopulmonary resuscitation compared with standard protocols.

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Hosseini Kasnavieh S, Basirghafouri H, Masumi G, Chardoli M, Yasinzadeh M, Tavakoli N, Amiri H / Iran University Of Medical Sciences, Tehran, Iran

Effectiveness of Focused Cardiac Ultrasound by the Emergency Physician in the Diagnosis Treatment and Referral of Patients in the Emergency Department

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Vulnerability Study of Healthcare Human Resources in the Iranian Ministry of Health and Medical Education

Introduction: Healthcare personnel are the major asset of the healthcare system. How they perceive their status within the system can exert high impact on the effectiveness of health 4

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MEMC-GREAT Abstracts 2016 policies and the overall performance of the healthcare system.

This study, hence, was designed to explore possible areas of human resource damage to the employees of the Iranian Ministry of Health and Medical Education (MOHME).

Methods: We surveyed 316 MOHME staff, using. a 36item questionnaire designed to examine three dimensions of the healthcare system – behavioral, structural, and contextual – and the potential negative impact of human resources policies on personnel.. The content validity of the questionnaire was ensured by applying the opinions of experts in this domain.

The reliability of the instrument was ensured by obtaining a Cronbach’s alpha of 0.93. We used T-test and Friedman test for inferential analysis of the data.

Results: The behavioral dimension was perceived to represent the most vulnerable area of human resources damage, followed by structural and contextual dimensions. In regard to the behavioral dimension, ”motivational factors” were perceived to be the most important area of damage, followed by “job satisfaction” and “job security.” Regarding the structural dimension, “appointment and job promotion” received the highest perceived significance, followed by “payment system” and “recruitment.”

Conclusion: This study ranks the areas of potential career damage to healthcare personnel in MOHME. Our results support previous studies highlighting the role of behavioral factors in causing dissatisfaction among these employees. Our findings, therefore, could be applied to the development of supportive human resources policies aimed at improving the performance of developing governmental health organizations. Specifically, providing motivating incentives and implementing strategies supporting job satisfaction and job security would bring significant protection to personnel within the healthcare system.

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ED physicians and nurses who made a final determination as to whether or not an error and/or adverse event occurred.

Results: We identified 570 complaints within a database of 383,419 cases, of which 33 were patient-generated and 537 were physician-generated. Physician errors that led to a preventable adverse event were detected in 2.9% (95% CI 1.38 range 1.52% to 4.28%); 9.1% of patient complaints correlated to preventable errors leading to an adverse event (95% CI 9.81 range -0.71% to 18.91%). Of the complaints made by a physician alone, 2.6% were preventable physician errors leading to an adverse event (95% CI 1.35 range 1.25% to 3.95%). Near-miss events were more accurately reported by physicians, with physician error found in 12.1% of reported cases (95% CI 2.76 range 9.34% to 14.86%) and in 9.1% of those reported by patients (95% CI 9.81 range -0.71% to 18.91%). Adverse events in general were found in 12.1% of patient complaints (95% CI 11.13 range 0.97% to 23.23%) and in 5.8% of physician complaints (95% CI 1.98 range 3.82% to 7.78%) Conclusion: Screening and systemized evaluation of ED patient and physician complaints may be an underutilized and efficient QA tool. Patient complaints may more accurately identify physician errors that result in preventable adverse events, while physician complaints may be more likely to uncover a near-miss that did not lead to an adverse event.

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Bilal S, Kuo DC, Peacock WF, Pillow MT / Baylor College of Medicine - Section of Emergency Medicine, Houston, TX Introduction: Our goal was to evaluate the effects of a patient’s primary language on x-ray ordering by emergency department (ED) physicians.

Methods: This is a 15-month retrospective case-control study conducted at a Level I trauma center in Houston, Texas, U.S., with an annual census >100,000. We abstracted from the electronic medical record a convenience sample of patients presenting to the ED. Patients were stratified based on triage level (1=highest, 5=lowest acuity) and language group divided into local (English) and non-local language speakers. Race and primary language was self-identified. Patients were included if their age was >18, and had both their triage level and primary language recorded. We defined X-ray ordering as obtaining ultrasound (US) and/or computed tomography (CT) imaging of any type while in the ED. Univariate analysis was performed, with results presented as proportions and 95% confidence intervals. We excluded data from triage levels 1 and 5 as in these cohorts X-ray ordering practices were either performed by protocol (level 1), or was very rare (level 5).

Results: Overall, 1,692 patients met the entry criteria and 659 were male. The primary language was 382 English, 674 Spanish, and 636 neither. Race was reported as 50.6% Latino,

Utilizing Physician and Patient Complaints as a Quality Assurance Marker in Emergency Medicine

Gurley K, Wolfe R, Grossman S, Edlow J, Burstein J / Beth Israel Deaconess Medical Center Department of Emergency Medicine at Harvard University, Boston, MA Introduction: The value of systematic evaluation of both patient and physician complaints in emergency medicine remains poorly characterized as a marker for emergency department (ED) quality assurance (QA).

Methods: We conducted a prospective, observational cohort study of consecutive patients presenting to an academic ED with 57,000 annual visits from January 2008 to December 2014.

Randomly assigned, trained reviewers not involved in the patients’ care used a structured tool to determine the presence of error and adverse events using an eight-point Likert scale. If a reviewer felt that the case had a possible error or adverse event that resulted in the need for intervention, additional treatment, or caused patient harm, it was referred to a 20-member quality QA committee of

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MEMC-GREAT Abstracts 2016 35% Asian/Pacific Islanders, 5.9% African-American, 2.4% Caucasian, and 6.1% other. X-ray ordering practices were similar in the higher acuity triage category (level 2) among local (n=20, [26.3%], 95% CI [16.9-37.7]) vs. non-local language speakers (35, [24.6%], 95% CI [17.6-31.7]). However, among the low acuity cohort (triage 4), two local language speakers (2.9%; 95% CI [0.34-10.1]) vs. 14 non-local language speakers (18.2%; 95% CI [10.3-28.6]) received imaging. Low acuity non-local language speaking patients were 500 times more likely to receive imaging than local language speakers.

Conclusion: Physicians ordered more imaging studies for non-local language speaking lower triage acuity patients.

Mitigating the consequences of a lack of local language fluency could potentially have beneficial consequences for radiation exposure, cost, and ED operational throughput.

that using Twitter assisted the students in image recognition even if they did not participate in Twitter all the time. This finding did reach statistical significance. The statistically significant effect present in the combined image questions (classroom and Twitter images) might be due to the fact that Twitter users scores are better on the Twitter exclusive images. While limited, our study shows that social media content delivery might serve as a novel engagement tool for tech-savvy learners.

of a Novel Engagement Strategy Using 12 Effect Twitter on Test Performance Adkins B, Barnett K, Patel N, Doty C, Silverberg M, Morehead S, Stearley S / University of Kentucky College of Medicine, Lexington, KY, SUNY-Downstate, New York City, NY

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Introduction: Medical educators in recent years have been using social media for more penetrance to technologicallysavvy learners. Medical students use social media platforms for discussion, learning, and collaboration in medical learning. The utility of using Twitter for curriculum content delivery has not been studied. We attempted to test if participation in a didactic program of quizzing identification of visual pathologies via Twitter would improve student performance on a test of clinical images at the end of the semester.

Methods: 116 second-year medical students were enrolled in the Introduction to Clinical Medicine II course. In the testable course content, several clinical images of physical examination findings were presented as part of the lecture series. An optional weekly assessment was also performed using Twitter. Each week, a photograph of a physical examination finding not covered in the course lectures was distributed from the class Twitter account. Over 80 students participated to some extent in this social media assessment of ungraded material. At semester end, 116 students were tested over their recognition of 24 clinical images revealed for 30 seconds each in a slideshow.

Twelve images were from the course lecture content and 12 images were from the Twitter quizzes.

Results: Students active on the Twitter feed scored significantly higher on the overall and Twitter portions of the quiz (Doty Figures 1 and 2). There was no significant difference in the classroom portion of the quiz between the students who were active on the Twitter feed and those who were not (p=0.124).

Conclusion: Medical students are using social media more often in professional learning environments. Our data support Volume XVII, Supplement : May 2016

Utilizing Simulations to Develop and Assess Socio-Behavioral Competency in an Emergency Medicine Residency Program: A Pilot Project

Rega P / University of Toledo College of Medicine, Toledo, OH Introduction: Emergency medicine (EM) residency programs have a responsibility to ensure that its residents not only have the requisite clinical skills but also the necessary socio-behavioral skills that will ensure a successful and long career in EM. A well-planned simulation medical program can properly teach and assess clinical skills, but oftentimes the socio-behavioral talents assume secondary importance. This lack of prioritization may lead to worsening communication skills, improper interdisciplinary behavior, malignant patient encounters, and, ultimately, a threat to patient care and job security. We created an intense socio-behavioral simulation functional exercise to explore its limits and to define the required logistical issues.

Methods: We created a series of eight scenarios emphasizing the socio-behavioral challenges of EM: 1) the derisive consultant; 2) the verbally abusive patient; 3) the sarcastic and demeaning nurse; 4) the drug-seeker and the medically inappropriate senior medical colleague; 5) the medically dangerous consultant; 6) ED command and control pending arrival of three motor vehicle victims; 7) a consultantâ&#x20AC;&#x2122;s inappropriate imaging demands for a pediatric patient; and 8) notification of parents following the death of their baby. The 6

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MEMC-GREAT Abstracts 2016 scenarios and logistics were discussed with the technical staff and volunteer actors. The resident-subject was unaware of the specific cases other than the general objectives.

Results: The preparatory phase required eight hours (4 hours: scenario development; 2 hours: meetings; 2 hours: human patient simulator prep). The execution phase lasted 2.5 hours as the resident managed each scenario consecutively (0.5 hours briefing, 1.5 hours of consecutive or simultaneous scenarios, and 0.5 hours de-briefing). The number of faculty and staff personnel involved: three staff, three actors, two faculty. The entire exercise was recorded. The project was assessed from the viewpoints of the subject, the residency director, and the simulation technicians.

Conclusion: The general consensus was that the project required a significant amount of time and resources. However, given the importance of the objectives, it was a successful enterprise and worthy of consideration as part of the overall residency program, in terms of education, assessment, and remediation.

of learning and professional growth in a way that ensures a theorypractice dynamic, affords the opportunity to acquire essential skills such as empathic communication, negotiation, conflict resolution and collaborative problem solving.

Conclusion: EM educators are in a unique position to question whether current trends best serve patient interests and to move the system to a patient-centered focus where delivery of emergency care is attuned to patient voice and issues of empowerment, autonomy, access are integral to the delivery of care, and to design a curriculum that accentuates the dynamic interaction between patient and provider, as well as acknowledges the tension between academic study and the actual practice of emergency medicine.

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Park S, Oh Y / Hallym University Medical Center Hallym University Sacred Heart Hospital, Anyang-Si, South Korea

of ALS at Scene Assisted by Video 15 Feasibility Call with Physician in Republic of Korea

Using Patient Voice to Construct an Emergency Medicine Clerkship Curriculum

Introduction: In the Republic of Korea, on average the emergency medical service (EMS) team arrives on the scene in seven minutes. In another study, the patient survival rate was shown to be 7.5%, but only 4.8% of cardiac arrest victims survive in Korea. In the United States, EMS teams perform advanced life support (ALS) for longer than 20 minutes. In contrast, Korean EMS teams perform basic life support (BLS) for only five minutes and transport to the nearest hospital. We hypothesized that ALS longer than 20 minutes at the scene would decrease mortality and neurological morbidity. Thus, we conducted a study in which ALS was performed by the EMS team at the scene for longer than 20 minutes while being advised by an emergency physician via video call .

Methods: This was a prospective cohort study conducted between July 1, 2014, and December 31, 2014. We conducted the study in an urban city with a population of one million, 13 ambulances, and 75 paramedics; a 3.7% return of spontaneous circulation (ROSC) was recorded in the same period of previous year. In Korea, the EMS is organized by province with a single call center that answers all patientsâ&#x20AC;&#x2122; phone calls to 119.

Once a bystander activates the EMS system, two ambulance and six paramedics rush to the scene; a first-class paramedic partners with an emergency medical technician who video calls a physician board-certified in emergency medicine and certified in EMS supervision. ALS was performed in real time by paramedics following the physicianâ&#x20AC;&#x2122;s orders. We enrolled all cardiac arrest patients. We excluded trauma, pediatrics, refusal of cardiopulmonary resuscitation, missing data and a clear sign of death. We evaluated prehospital return of spontaneous circulation (ROSC) data, survival rate at discharge, favorable neurological outcome (cerebral performance category 1-2) at discharge, and then compared these outcomes with the same period of the

Peterson C / New York Presbyterian Hospital, New York City, NY, Weill Cornell Medical Center, New York, NY Introduction: Past decades brought significant advances in emergency medicine (EM); these advances occurred within a healthcare system comprised of complex bureaucracies organized more for the benefit of service providers than healthcare consumers. Economic incentives and legal considerations have assumed tremendous importance in the delivery of emergency care in the United States.

Methods: The EM clerkship curriculum we developed is distinguished by an attentiveness to patient voice, designed to integrate varied aspects of emergency care delivery and to explore and analyze the dynamics of illness from multiple perspectives. Participation in multi-disciplinary collaborative partnerships with patients and clinicians realistically illustrates the complex skills required to identify and overcome barriers and create micro-systems of care functioning with integrated attention to the macro-systems in which they operate.

Using techniques of ethnographic research with focus on areas of communication, patient rights, power dynamics, cultural sensitivity and case-based, problem-solving tutorials sensitizes students to the ethical and legal dilemmas encountered in the emergency setting. Didactic sessions expand the scope and diversity of knowledge by exploring the historical evolution and the broad social and cultural forces that shape patterns of health, medicine, disease and illness. Examining the social implications of power inequities, technology and scientific research, and understanding legislative and regulatory systems relevant to EM illustrate how systems affect the healthcare of individuals and drive institutional change.

Results: Subjective evaluation has shown effective facilitation Western Journal of Emergency Medicine

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Results: Of the total 251 cardiac arrests thatoccurred, we excluded 124 patients and included 127. We found statistical significance in prehospital ROSC (4.3% vs 24.4%), survival rate at discharge (2.6% vs 11.8%), and favorable neurological outcome (0.9% vs 8.7%).

Conclusion: In the prehospital setting, video call-assisted ALS for longer than 20 minutes showed more favorable survival rates and neurological outcomes at discharge.

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linking countertransference to how resident providers made medical decisions. There are specialty-specific differences.

CT affects adherence to recommended algorithms. The effect is most prominent when the criticized/mistreated, helpless/ inadequate dimensions are activated. These findings offer an opportunity for intervention and training.

Reliability to Pick up the Acutely Ill 17 SEWS Patients in a Busy Emergency Department

How Countertransference Affects Medical Decision-Making: Comparing Emergency Medicine Versus Psychiatry Residents-inTraining

Majeed MA, Naveed A, Imam S, Giovannetti G / University Hospital Birmingham, Birmingham, United Kingdom Introduction: Early warning systems (EWS) are bedside tools used to assess basic physiological parameters to identify patients with potential or established critical illness. Current evidence suggests that they may predict risk of intensive care admission, death and length of hospital stay. Our objective was to establish whether a “SEWS” scoring of >=4 on patient’s arrival to Accident and Emergency (A&E) is useful in predicting critically ill status, likelihood of patient deterioration and need for direct intensive therapy unit (ITU) admission.

Methods: We performed a retrospective single-center cohort study including 500 patients seen at the emergency department of University Hospital Birmingham during December-November 2013. It was decided from previous experience to define a SEWS of 4 or more as a “critical score.”

Primary endpoints were ITU/HDU (high dependency unit) admissions, admission to a non-critical ward, discharged, selfdischarged, transfer to another hospital and death within one month of the admission.

Inclusion criteria: Adult patients were included.

Exclusion criteria: Under 16 years old.

Results: We went through the notes of 500 patients.

Overall, 49.4% (247) of patients were male, and 46.6% (233) were female. The mean age of patients was of 54 years.

A total of 21.2% of patients were admitted to ITU/CCU (critical care unit); of these only 43% had a SEWS of 4 or more on arrival. Meanwhile, this was true for 8.6% of the 39.4% ward admissions, and 2.2% of the 36.2% patients who were discharged home from A&E. Discussion: Currently, there are several hundred unique yet similar EWS systems in use worldwide. Our results indicate that SEWS variables in isolation may have little or no practical usefulness in detecting the critically ill patient, patient deterioration or intensive care unit admission.

Conclusions: A patient with a SEWS of <4 still has got more than 50% chance of being admitted to an intensive care unit.

The results show that SEWS is a rather sensitive tool but less specific in picking up acutely ill patients. It might be useful supporting the more inexperienced doctors and nurses in assessing the risk of deterioration for their patients, initiating early and focused investigations and treatment.

Moukaddam N, Shah A, Laufman L, Tucci V / Baylor College of Medicine, Houston, TX Introduction: Medical decision-making is not an objective process, despite the presence of medical algorithms for work up and diagnosis. The reason for difficult patient-provider interactions can be due to the patient or the provider. Bias in medical decision-making can cause costly mistakes in treatment, and has been linked to race, gender, and socio-economic status; but it does not fully explain fluctuations in how providers make decisions. Countertransference (CT), the psychodynamic concept representing feelings of providers towards patients, has been reported anecdotally to affect decision-making.

Modern countertransference is operationalized into eight dimensions: overwhelmed/disorganized, helpless/inadequate, positive, special/overinvolved, sexualized, disengaged, parental/ protective, and criticized/mistreated. In this study, we explore how CT affects medical decision-making and compare emergency medicine (EM) vs psychiatry residents in that respect.

Methods: Psychiatry and EM residents were asked to view five (standardized) patient encounters: 1) a likeable nurse presenting with chest pain; 2) a young man with drug addiction and chest pain, inability to walk more than a few steps, marginally cooperative; 3) a young woman with borderline, histrionic personality complaining of chest pain and palpitations (has pulmonary embolism); 4) an entitled patient with acute cholecystitis who is insulting to house staff; and 5. a young man presenting with sleepiness, has an overbearing, overly controlling mother; patient has a knife in his belt buckle and presents very differently when interviewed alone. Residents were shown the vignettes, asked what work up they would order for the patient, their top three differential diagnoses, and were then asked to fill out a countertransference questionnaire.

Results: CT influenced medical decision-making. CT elicited by patient vignettes were consistent with projected hypotheses, and varied with training levels. There were differences between psychiatry and EM in CT scores and in tests ordered.

Conclusion: To our knowledge, this is the first study Volume XVII, Supplement : May 2016

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A Critical Analysis of Factors that Influence Emergency Medicine Consultants in Their Careers: Why Have Consultants Chosen Emergency Medicine, Why Do They Stay and Why Might They Go?

Hosseini Kasnavieh S, Basirghafouri H, Masumi G, Chardoli M, Yasinzadeh M, Tavakoli N, Amiri H / Iran University of Medical Sciences, Tehran, Iran Introduction: The hospital is the largest and most costly operating unit within the healthcare system. Provision of optimal care requires that hospital administrators identify hospital performance based on relevant indicators. This study used the Pabón Lasso analysis to assess the performance of hospitals and identify strategies towards an improved hospital performance.

Methods: This cross-sectional descriptive study involved all eight general hospitals affiliated with Tehran University of Medical Sciences. We collected data on average length of stay, bed occupation and bed turnover rates using questionnaires.

Results: The overall average length of stay, bed occupation and bed turnover rates were 4.78 days, 79.95% and 28.36, respectively.

One hospital demonstrated inefficiency and under-utilization of resources by falling into Zone I, two hospitals were placed in Zone II, and five hospitals in Zone IV. None of the hospitals were located in Zone III, which represents a satisfactory level of efficiency.

Conclusion: This study showed that the studied hospitals have generally low performance as indicated by Pabón Lasso analysis. The administrators should therefore seek a strategy for balancing average length of stay, bed occupation and bed turnover rates for an improved hospital performance.

James F, Gerrard F / Cardiff University, Cardiff, United Kingdom Introduction: Emergency departments (ED) in the United Kingdom are currently facing intense pressures, which are resulting in many senior doctors leaving and decreasing the attractiveness of emergency medicine (EM) for junior doctors.

The reduced workforce is seeing increased patient numbers resulting in over-stretched EM trainees, leading to further attrition. This research aims to understand why current EM consultants in Welsh EDs pursued a career and remain in EM amidst this negativity. This information will be used to identify methods of increasing the popularity of EM to medical students and junior doctors, most of whom have very limited exposure to EM. Methods: We conducted narrative semi-structured interviews with 10 EM consultants, focusing on how and why they began their careers in EM, why they choose to remain in EM and factors that might influence them to leave the specialty. Interviews were audio recorded and transcribed verbatim. We identified common themes and used thematic analysis for data analysis.

Results: The challenge of the undifferentiated patient and the generalist nature of EM was a motivating factor for the majority of consultants. Another strong motivating factor was having a positive effect on patients’ lives, which maintains their enthusiasm for EM. EM is well suited to flexible training and participants were strong advocates for this. Consultants’ inability to perform their job effectively due to exit block is a significant barrier to job satisfaction.

The majority of consultants’ enthusiasm stemmed from passionate role models on EM placements as undergraduates or junior doctors. Inability to provide patients with the best possible standard of care created a sense of failure amongst participants. Increased awareness of the suitability of EM for family life is required to increase the attractiveness of EM. Conclusion: This study reinforces the need for dedicated undergraduate EM placements, thus enabling the development of positive EM role models to stimulate interest and encourage EM aspirations. Improving the physical work environment for current EM staff would improve their ability to do their job effectively and increase retention of current staff. Further research is required to determine if these viewpoints are universal amongst UK EM consultants.

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Golshani K, Ebrahim Zadeh M, Masoumi B, Azizkhani R / Isfahan University Of Medical Sciences, Isfahan, Iran Introduction: Increased intracranial pressure (ICP) is a challenging diagnosis. Measuring cerebrospinal fluid pressure is an important tool for making the correct diagnosis, but its use is not practical for all patients with possible increased ICP) In this study we compared two commonly used noninvasive methods (ophthalmoscopy and bedside ultrasonography) in the diagnosis of elevated ICP with non-contrast brain computed tomography (CT) as a frequent and available method in many emergency departments.

Methods: We enrolled 131 patients with possible clinical diagnosis of elevated ICP in the study. We excluded the following: age less than 18 years old, direct blunt or penetrating trauma to the eyes, or other ophthalmic diseases that limit effective ophthalmoscopy. A minimum sample size of 117 was calculated with a sensitivity of 0.9, a prevalence of 30%, alpha=0.05 and d=0.1. Within 30 minutes of admission, ophthalmoscopy, ophthalmic bedside ultrasonography and brain CT were obtained and the results were recorded. Optic nerve disk widening, ocular venous engorgement, blurring or hemorrhage over optic nerve disk, elevation of optic disk, and

Performance Based on Pabón Lasso 19 Hospital Model Western Journal of Emergency Medicine

Bedside Ultrasonography of Optic Nerve Versus Ophthalmoscopy for Predicting Elevated Intracranial Pressure

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MEMC-GREAT Abstracts 2016 retinal venous tortuosity are considered signs of raised ICP in ophthalmoscopy. Optic nerve diameter 3 mm beneath the retina was calculated three times ultrasonographically by a linear probe, and mean measures more than 5 mm were considered as increased ICP. CT findings in favor of elevated ICP consist of cerebral edema, midline shift, cistern compression, ventricular collapse and its enlargement.

Results: The mean age of participants was 46.29±10 years (77% male). The number of diagnosed elevated ICPs with ophthalmoscopy and ultrasound were 98 (74.8%) and 102 (77.9%) cases, respectively. The calculated sensitivity and specificity of ophthalmoscopy and ultrasonography in detection of elevated ICP were 100.0% (95% CI [88.6, 100.0]) and 35.4% (95% CI [26.0, 46.2]), 100.0% (95% CI [84.0, 100.0]) and 31.9% (95% CI [23.0, 41.7]), respectively.

Conclusion: The study revealed that in contrast to their specificity, optic nerve bedside ultrasonography and ophthalmoscopy are useful screening tools for discovering elevated ICP.

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A Flow-Processing Manager Nurse in the Emergency Department to Improve Safety, Optimize Throughput and Increase Performances

Lanzarini C, Ferrari R, Canovi S, Vitale G, Cavazza M / Emergency Department, Policlinico Sant’orsola - Malpighi, Bologna, Italy Introduction: In an era of emergency department (ED) crowding, an efficient triage system is essential to allow the emergency team to treat patients according to the urgency of their conditions.

The increase in wait times is related to lower safety for both critical and subcritical cases, and decreased patient and healthcare-worker satisfaction.

The widespread four-level triage system has been shown to be inefficient “per se” in managing the growing complexity of the incoming phase.

Methods: A senior experienced nurse, with both technical and non-technical skills, was added in the ED, acting after the usual nurse triage protocol, and before the emergency physician taking charge of the patient.

The nurse’s tasks, as flow-processing manager, were the following: to upgrade the triage evaluation process and improve throughput efficiency in a timely manner; to early identify timedependent situations and outliers; and to redirect and address the specific patient to a specific route and specific physician.

We performed a prospective “before and after” cohort study, from 08/4/2012 to 07/4/2013, and from 08/4/2013 to 7/4/2014, to assess the impact of using a flow-processing manager.

Results: The number of triaged patients increased (67,400 “before” versus 70,922 “after”). Wait times (media, in minutes) Volume XVII, Supplement : May 2016

slightly changed depending on “triage code” (red 7.04 versus 7.02; yellow 15.32 vs 21.25, green 84.10 vs 88.07, white 88.55 vs 78.04). Total time spent in the ED (media) dramatically changed depending on “triage code” (red 221 versus 940; yellow 988 vs 1,159, green 218 vs 699, white 161 vs 177). The number of patients admitted slightly increased (24,687 versus 24,759), and the left-without-being-seen rate decreased (1,135 versus 741).

Conclusion: In the ED the introduction of an additional experienced nurse provider as flow-processing manager showed the ability to ameliorate patient throughput, wait times and leftwithout-being-seen rates, improving both safety and quality of care, even coping with the dramatic increase in length of staying due to crowding and shortage of beds.

ED waiting rooms are high-liability areas for hospitals: the addition of a flow-processing manager can actually reduce risks in individual patients.

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Utility of Ultrasonography as Adjuncts in Risk Stratification for Pediatric Septic Arthritis

Cochon L, Shashikant Patel P, Baez A / Universitat De Barcelona, Barcelona, Spain, Jackson Memorial Hospital, Miami, FL, University of Florida Gainesville, Gainesville, FL Introduction: Differentiation between septic arthritis and transient synovitis of the hip in children can be difficult given their similar, non-traumatic presentations. Because of the high morbidity associated with septic arthritis, it is important to make this diagnosis in a timely manner. The Kocher criteria were derived to identify factors important in distinguishing septic arthritis and transient synovitis. The objective was to determine whether the imaging modalities of ultrasonography, plain film radiography and magnetic resonance imaging (MRI) can improve the pre-test probability of the Kocher criteria.

Methods: The Kocher criteria consist of four clinical yes/ no questions: 1) ability to weight bear, 2) fever, 3) ESR >40mm/ hr, and 4) WBC >12,000 cell/mm3. The pre-test probability of having septic arthritis ranges from 3% for 1 point to 99% for 4 points. Using these pre-test probabilities, we constructed a Bayesian nomogram using pooled sensitivity and specificity estimates for plain radiography, ultrasonography, and MRI, in order to derive post-test probabilities for each imaging modality.

Results: The pooled sensitivity, specificity, positive and negative likelihood ratios for plain radiography were 59%, 79%, 2.81 and 0.52. For ultrasonography, they were 86.4%, 89.7%, 8.30, and 0.15. For MRI, they were 79%, 100%, 790, and 0.21. Each of the imaging studies helped to improve the pre-test probability, and the most incremental gain was seen in the moderate risk category (2 points on Kocher criteria), which clinically is most helpful. Of the three imaging modalities, ultrasonography provided the best relative gain using the negative likelihood ratio. Specifically, ultrasonography decreased the pretest probability from 40% to 7%, representing 10

Western Journal of Emergency Medicine

MEMC-GREAT Abstracts 2016 a relative gain of 77%.

Conclusion: Patients with a moderate Kocher score present the biggest diagnostic dilemma. In this group, performing an ultrasound of the hip significantly improved the ability to rule out septic arthritis.

Care Screening in the Emergency 23 Palliative Department: A Quality Improvement Initiative Christos S / Presence Resurrection Medical Center, Department Of Emergency Medicine, Chicago, IL Introduction: Between 2009–2010, 19.6 million emergency department (ED) visits in the United States were made by persons aged 65 and over; and with the aging population this number will increase. Many of these patients will present with advanced and end-stage diseases in need of symptom management, pain relief and referral for long-term care. Emergency physicians (EP) have the opportunity to support early front-loaded palliative care (PC) interventions that will promote quality of life with improved outcomes, provide support for families and caregivers and reduce costs by reducing length of stay and utilization of intensive care and other resources.

Methods: A brief validated PC screening tool was implemented in the ED over two months. Patients 65 years old and over were screened. Patients were scored on their present health status, functional status and other criteria, including need for complex care, unacceptable level of pain or other symptoms of distress >24 hours. A score of >5 would prompt the EP to ask the patient’s primary medical doctor for a palliative care consult. We collected data regarding age, gender, length of stay (LOS), and disposition and hospital costs by retrospective chart review. We analyzed the data for comparison of patients receiving palliative care consultation versus patients without consultation.

Results: Patient’s LOS was shorter in the PC consult vs no-consult group (LOS >2day 59% vs 82%, LOS >3 days 41% vs 65% and LOS >4 days (37% vs 53%). Fewer patients were transferred to a skilled nursing facility in the PC consult vs noconsult group (33% vs 65%); more patients were discharge home (15% vs 6%) or to hospice (30% vs 6%) in the PC group.

Finally, total costs (median) were less in the PC consult vs noconsult group ($5,280 vs $8,465).

Conclusion: These results suggest that patients receiving early palliative care consultation from the ED will have decreased

Western Journal of Emergency Medicine

length of stay, will more likely be discharged home or to hospice, and there will be a total median hospital cost reduction.

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Clinical Decision Rule to Prevent Unnecessary Chest X-Ray in Patients with Blunt Multiple Traumas

Forouzanfar MM, Safari S, Mahdavi NS, Hashemi B, Baratloo A, Rahmati F / Emergency Department, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Anesthesiologist and Intensive Care Specialist, Shahid Beheshti University of Medical Sciences, Tehran, Iran Introduction: Given that the diagnostic yield of chest X-ray (CXR) is not high enough when ordered for patients with multiple blunt traumas, we undertook this study to evaluate the relationship between clinical and CXR findings in order to formulate a clinical decision rule to prevent unnecessary CXR in these patients.

Methods: Stable multiple-blunt trauma patients seen in the emergency department were included in this study.

We collected the clinical and radiographic findings of these patients and analyzed the relationships between these variables. Finally, based on the regression coefficients (ß) of the variables, we designed the Thoracic Injury Rule-out Criteria (TIRC).

Results: Of the 2,607 patients included in the study, 78.9% were males and mean age was 34.1±15.0 years. We found the following to be independent factors predicting thoracic injury: age over 60 (beta=0.8; 95% CI [0.27–1.34]; P=0.003), crepitation (beta=4.33; 95% CI [1.65–7.0]; P<0.001); loss of consciousness (beta=3.16; 95% CI [2.44–3.88]; P<0.001); decrease in pulmonary sounds (beta=2.67; 95% CI [1.73–3.6]; P<0.001), chest wall pain (beta=2.12; 95% CI [1.63–2.61]; P<0.001) and tenderness (beta=1.78; 95% CI [1.26–2.27]; P<0.001); dyspnea (beta=1.3; 95% CI [0.41–2.18]; P=0.004) and abrasion (beta=0.5; 95% CI [0.22–0.83]; P=0.03). CXR in stable conscious patients with multiple blunt trauma who were under the age of 60 and without chest wall pain and tenderness, decrease in pulmonary sounds, crepitation, skin abrasion, or dyspnea did not provide any additional findings.

Conclusion: Based on TIRC, it seems that CXR in stable multiple blunt trauma patients who are conscious and under 60 and have no decrease in pulmonary sounds, no dyspnea, no thoracic skin abrasion, and no crepitation can be ignored.

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MEMC-GREAT Abstracts 2016

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Satisfaction of Emergency Medicine Residents with a Web-Based Communication Group for Education

Alfaraj D, Alshahrani M / University of Dammam, Khobar, Saudi Arabia Introduction: Because of the busy shift environment of the emergency department, the teaching opportunities for residents are sometimes reduced. As the use of smartphones and social media is widespread, in this study we use a chat group application to enable greater communication between residents and senior doctors to better allow the exchange of knowledge and experience. In this study we aimed to measure the satisfaction of emergency medicine (EM) residents regarding their involvement with this new tool in the residency training program.

Methods: We chose a chat application available on

Volume XVII, Supplement : May 2016

smartphones. We then invited all EM residents and consultants to participate, with residents discussing one to two cases per day with consultants for training and teaching purposes. We sent questionnaires to the group participants via a link using SurveyMonkey® to measure the satisfaction of EM residents.

This study will also serve as a pilot study.

Results: The data were analyzed using SurveyMonkey®.

We used a ranking scale (1–5) to measure residents’ satisfaction regarding the organization of the group discussions (3.24), supervision by consultants (3.32), new medical information (4.2), and the application as a useful learning tool (4.04).

Overall, the residents were satisfied with their experience in the group (3.72).

Conclusion: The use of smartphone group chat applications is a useful method to overcome the busy environment of emergency departments and the lack of teaching opportunities during shifts. Regarding EM residents’ satisfaction levels, larger prospective studies are required to confirm this observation.

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Western Journal of Emergency Medicine

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COMMONSENSE

JULY/AUGUST 2016

MEMC-GREAT 2017 Joint Congresses 6-10 SEPTEMBER 2017 – LISBON, PORTUGAL

Learn more at emcongress.org

The IXth MEMC is jointly organized by the American Academy of Emergency Medicine (AAEM), the Global Research on Acute Conditions Team (GREAT), and the Mediterranean Academy of Emergency Medicine (MAEM).

Topics: Cutting Edge Tracks, Clinical Updates, Reviews, Research, ED Management, and more Speakers include the Who’s Who in EM and an exceptional selection from EM departments and societies from all over the world.

GREAT NETWORK CONGRESS FOCUS ON INNOVATIONS AND TRANSLATIONAL RESEARCH IN EMERGENCY MEDICINE

AAEM-0816-104