Leon Haley | University of Florida (original) (raw)

Papers by Leon Haley

Research paper thumbnail of A Conceptual Model for Navigating a Career Path in Medical School Leadership

AEM Education and Training

There is a paucity of literature providing guidance to physicians hoping to attain a position as ... more There is a paucity of literature providing guidance to physicians hoping to attain a position as a medical school dean. Realizing this gap, the Society for Academic Emergency Medicine (SAEM) Faculty Development Committee organized an educational session focused on offering faculty guidance for obtaining a position in medical school leadership. The session involved panelists who are nationally known leaders in medical school administration and was successfully presented at the SAEM 2018 annual meeting in Indianapolis, Indiana. Knowledge and perspective gained both during this session and through literature review was analyzed using a conceptual thinking skills framework. This process offered insights that promoted the development of a conceptual model informed by current evidence and expert insight and rooted in educational, economic, and cognitive theory. This model provides a step-by-step guide detailing a process that physicians can use to create a plan for professional development that is informed, thoughtful, and individualized to their own needs to optimize their future chances of advancing to a career in medical school leadership.

Research paper thumbnail of Emergency Medicine and the Public's Health EM Clinics of North America Racial/Ethnic Disparities

This chapter will discuss these disparities from a public health perspective; specifically why ra... more This chapter will discuss these disparities from a public health perspective; specifically why racial and ethnic disparities threaten to impede the efforts to improve the nation's health.13 We will 1) provide background information, including a review of the Institute Of Medicine (IOM) report on healthcare disparities; 2) describe the racial and ethnic compositions of individuals in the ED setting from

Research paper thumbnail of When Patients Are Impatient: The Communication Strategies Utilized by Emergency Department Employees to Manage Patients Frustrated by Wait Times

Http Dx Doi Org 10 1080 10410236 2012 680948, Apr 11, 2013

Studies have documented the frustrations patients experience during long wait times in emergency ... more Studies have documented the frustrations patients experience during long wait times in emergency departments (EDs), but considerably less research has sought to understand ED staff responses to these frustrations. In-depth interviews were conducted with 18 ED social workers, patient navigators, and medical staff members at a large urban hospital regarding their experiences and interpersonal strategies for dealing with frustrated patients. Staff indicated that patients often attribute delays to neglect and do not understand why their health problem is not prioritized. They voiced several strategies for addressing wait time frustrations, including expressing empathy for patients, making patients feel occupied and wait times seem more productive, and educating patients about when health issues should be treated through primary care. All staff members recognized the need for engaging in empathic communication with frustrated patients, but social workers and patient navigators were able to dedicate more time to these types of interactions.

Research paper thumbnail of Disparities in Emergency Department Health Care: Systems and Administration

Academic Emergency Medicine, Nov 1, 2003

Disparities are likely to present both in the emergency department and within the larger health c... more Disparities are likely to present both in the emergency department and within the larger health care system; however, disparities must be recognized to be addressed. This article summarizes the proceedings from the AEM Consensus Conference 2003: Disparities in Emergency Health Care. The goals of the conference were to examine the presence, causes, and outcomes related to disparities of health care as they occur in emergency departments, and determine the degree to which external forces have an impact on our patients. Participants were asked to describe the means of defining, assessing, measuring, and investigating disparities that may occur in emergency care. The committee members who wrote this report were asked to examine the influence of health care systems and administration on disparities in health care, using the following series of questions to frame the discussion. 1) Are all disparities bad? 2) Are only the vulnerable served inadequately by our current health care system? 3) Are what appear to be inequities really systems incompetence? 4) We assume there should be no inequality in health care: does society also assume this? 5) What would be the systems costs of equality in health care?

Research paper thumbnail of Reasons for Using the Emergency Department: Results of the EMPATH Study

Academic Emergency Medicine Official Journal of the Society For Academic Emergency Medicine, Dec 1, 2005

Objectives: Emergency Medicine Patients' Access To Healthcare (EMPATH) was a cross-sectional, obs... more Objectives: Emergency Medicine Patients' Access To Healthcare (EMPATH) was a cross-sectional, observational study conducted to identify the principal reasons why patients seek care in hospital emergency departments (EDs) in the United States. Methods: Twenty-eight U.S. hospitals, stratified by geographic region and hospital characteristics, participated in this study. Demographic, clinical, and insurance data were collected for a 24-hour period at each site, using chart reviews and a structured interview administered to all consenting adult patients seeking treatment during that period. Patients' reasons for presenting to the ED were assessed by their level of agreement (on a threepoint Likert scale) with 21 carefully worded statements designed to capture a range of possible reasons for seeking care in the ED. Factor analysis was used to consolidate highly correlated responses and to identify the principal factors explaining patients' reasons for coming to the ED. Results: A total of 1,579 patient interviews and 2,004 chart reviews were obtained from a diverse sample that was 55.4% female, 58.3% white, 28.3% African American, 7.0% Hispanic, and 6.0% other ethnic groups. This exploratory analysis yielded five factors characterizing patients' principal reasons for seeking ED care, with medical necessity the most frequent, followed by ED preference, convenience, affordability, and limitations of insurance. Conclusions: Use of the ED is, for most people, an affirmative choice over other providers rather than a last resort; it is often a choice driven by lack of access to or dissatisfaction with other sources of care.

Research paper thumbnail of Transforming Hospital Emergency Department Workflow and Patient Care

Research paper thumbnail of Benefit of a Tiered-Trauma Activation System for Triaging Dead-on-Arrival Patients

Western Journal of Emergency Medicine, 2012

Research paper thumbnail of Care Management Unit, Cost Analysis, and Outcome With Heart Failure

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine, 2005

Research paper thumbnail of Kiosk versus In-person Screening for Alcohol and Drug Use in the Emergency Department: Patient Preferences and Disclosure

The western journal of emergency medicine, 2015

Annually eight million emergency department (ED) visits are attributable to alcohol use. Screenin... more Annually eight million emergency department (ED) visits are attributable to alcohol use. Screening ED patients for at-risk alcohol and substance use is an integral component of screening, brief intervention, and referral to treatment programs, shown to be effective at reducing substance use. The objective is to evaluate ED patients' acceptance of and willingness to disclose alcohol/substance use via a computer kiosk versus an in-person interview. This was a cross-sectional, survey-based study. Eligible participants included those who presented to walk-in triage, were English-speaking, ≥18 years, were clinically stable and able to consent. Patients had the opportunity to access the kiosk in the ED waiting room, and were approached for an in-person survey by a research assistant (9am-5pm weekdays). Both surveys used validated assessment tools to assess drug and alcohol use. Disclosure statistics and preferences were calculated using chi-square tests and McNemar's test. A total...

Research paper thumbnail of Restructuring chronic care delivery in a public hospital asthma clinic

Research paper thumbnail of Transforming Hospital Emergency Department Workflow and Patient Care

Research paper thumbnail of Hospital Emergency Departments

Medical Care, 2003

... E-mail: Akell01@emory.edu. ... the authors approached the problem from the perspective of eme... more ... E-mail: Akell01@emory.edu. ... the authors approached the problem from the perspective of emergency departments, where three quarters of these admissions occur ... are told to seek care in an emergency department, and those who are sent from their doctor's office for stabilization ...

Research paper thumbnail of How community members and health professionals conceptualize medical emergencies: implications for primary care promotion

Health Education Research, 2012

Access to continuous care through a primary care provider is associated with improved health outc... more Access to continuous care through a primary care provider is associated with improved health outcomes, but many communities rely on emergency departments (EDs) for both emergent and non-emergent health problems. This article describes one portion of a community-based participatory research project and investigates the type of education that might be needed as part of a larger intervention to encourage use of a local primary care clinic. In this article we examine how people who live in a low-income urban community and the healthcare workers who serve them conceptualize 'emergency medical condition'. We conducted forum and focus group discussions with 52 community members and individual interviews with 32 healthcare workers. Our findings indicate that while community members share a common general definition of what constitutes a medical emergency, they also desire better guidelines for how to assess health problems as requiring emergency versus primary care. Pain, uncertainty and anxiety tend to influence their choice to use EDs rather than availability of primary care. Implications for increasing primary care use are discussed.

Research paper thumbnail of When Patients Are Impatient: The Communication Strategies Utilized by Emergency Department Employees to Manage Patients Frustrated by Wait Times

Health Communication, 2013

Studies have documented the frustrations patients experience during long wait times in emergency ... more Studies have documented the frustrations patients experience during long wait times in emergency departments (EDs), but considerably less research has sought to understand ED staff responses to these frustrations. In-depth interviews were conducted with 18 ED social workers, patient navigators, and medical staff members at a large urban hospital regarding their experiences and interpersonal strategies for dealing with frustrated patients. Staff indicated that patients often attribute delays to neglect and do not understand why their health problem is not prioritized. They voiced several strategies for addressing wait time frustrations, including expressing empathy for patients, making patients feel occupied and wait times seem more productive, and educating patients about when health issues should be treated through primary care. All staff members recognized the need for engaging in empathic communication with frustrated patients, but social workers and patient navigators were able to dedicate more time to these types of interactions.

Research paper thumbnail of The Emergency Department as a prevention site: A demographic analysis of substance use among ED patients

Drug and Alcohol Dependence, 2013

To identify rates of alcohol and drug use among patients presenting to an inner-city Emergency De... more To identify rates of alcohol and drug use among patients presenting to an inner-city Emergency Department (ED) and to describe demographic and health characteristics of patients with high-risk use. A cross-sectional study of patients presenting to the ED for any complaint. Patients were administered a brief screening about past 12-months alcohol and drug use. Patients who answered "yes" to any question were approached for a longer survey, the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Based on ASSIST scores patients received a brief intervention, and, when appropriate, a referral for brief outpatient therapy or specialized substance abuse treatment. Patients whose score indicated high-risk or dependent use were also asked demographic and health questions. Over a 20-month period, 19,055 patients were pre-screened. 87.1% of patients were black, 57% were male, with average age 44.8 years. 27.6% of patients pre-screened positive for drug or alcohol use; among these patients 44.2% scored in the low-risk range on the ASSIST, 35.8% moderate risk, 10% high risk and 10% probable dependence. Among patients with high-risk or dependent use, 70% rated their current health as fair/poor, with a mean of 1.7 ED visits in the prior 30 days. 40.7% reported "extreme" stress due to their use. 34.6% reported that they had stable housing and 13.6% were fully employed. Among all patients seen in the ED for any complaint, a significant proportion is engaged in alcohol and drug use that increases their risk of health and social consequences.

Research paper thumbnail of Emergency Department Design: A Practical Guide to Planning for the Future

Annals of Emergency Medicine, 2003

Research paper thumbnail of 184: Opening the Back Door of Emergency Department Improves Flow to Inpatient Setting but May Not Help With Overall Length of Stay

Annals of Emergency Medicine, 2010

Study Objective: To compare emergency department (ED) admission percentage, mean ED length of sta... more Study Objective: To compare emergency department (ED) admission percentage, mean ED length of stay (LOS), and percentage of patients who leave before treatment is complete (LBTC) among various volume EDs using data from the Emergency Department Benchmarking Alliance (EDBA) database.

Research paper thumbnail of Hematuria in the evaluation of renal colic: Is it helpful?

Annals of Emergency Medicine, 1999

Study objective: To determine the likelihood ratio (LR) for hematuria in the evaluation of patien... more Study objective: To determine the likelihood ratio (LR) for hematuria in the evaluation of patients with a suspected renal calculi.

Research paper thumbnail of Adapt and Survive

Academic Emergency Medicine, 2009

Research paper thumbnail of Diversity in Emergency Medicine—A Model Program

Academic Emergency Medicine, 2001

Emergency medicine's (EM's) development as a specialty has spanned the last 25 ye... more Emergency medicine's (EM's) development as a specialty has spanned the last 25 years, with the first certifying examination administered by the American Board of Emergency Medicine in 1980. National census data project that the new millennium will bring a U.S. population that will be 40% minority. In the year 2000, the U.S. population had a projected minority population of 28%. The diversity of the patients we treat demonstrates the need for EM programs to diversify their faculty and residency staff. Strategies include expanding recruitment and supporting retention of underrepresented students, faculty, and trainees, addressing barriers that may exist for promotion of underrepresented women and minorities, mentoring underrepresented minority (URM) faculty in research and education, providing opportunities for URMs to advance in the field, and mentoring URMs at the junior high and high school levels in the sciences to expand the applicant pool in the field. The authors describe an academic EM program that is a model program for diversity within our specialty.

Research paper thumbnail of A Conceptual Model for Navigating a Career Path in Medical School Leadership

AEM Education and Training

There is a paucity of literature providing guidance to physicians hoping to attain a position as ... more There is a paucity of literature providing guidance to physicians hoping to attain a position as a medical school dean. Realizing this gap, the Society for Academic Emergency Medicine (SAEM) Faculty Development Committee organized an educational session focused on offering faculty guidance for obtaining a position in medical school leadership. The session involved panelists who are nationally known leaders in medical school administration and was successfully presented at the SAEM 2018 annual meeting in Indianapolis, Indiana. Knowledge and perspective gained both during this session and through literature review was analyzed using a conceptual thinking skills framework. This process offered insights that promoted the development of a conceptual model informed by current evidence and expert insight and rooted in educational, economic, and cognitive theory. This model provides a step-by-step guide detailing a process that physicians can use to create a plan for professional development that is informed, thoughtful, and individualized to their own needs to optimize their future chances of advancing to a career in medical school leadership.

Research paper thumbnail of Emergency Medicine and the Public's Health EM Clinics of North America Racial/Ethnic Disparities

This chapter will discuss these disparities from a public health perspective; specifically why ra... more This chapter will discuss these disparities from a public health perspective; specifically why racial and ethnic disparities threaten to impede the efforts to improve the nation's health.13 We will 1) provide background information, including a review of the Institute Of Medicine (IOM) report on healthcare disparities; 2) describe the racial and ethnic compositions of individuals in the ED setting from

Research paper thumbnail of When Patients Are Impatient: The Communication Strategies Utilized by Emergency Department Employees to Manage Patients Frustrated by Wait Times

Http Dx Doi Org 10 1080 10410236 2012 680948, Apr 11, 2013

Studies have documented the frustrations patients experience during long wait times in emergency ... more Studies have documented the frustrations patients experience during long wait times in emergency departments (EDs), but considerably less research has sought to understand ED staff responses to these frustrations. In-depth interviews were conducted with 18 ED social workers, patient navigators, and medical staff members at a large urban hospital regarding their experiences and interpersonal strategies for dealing with frustrated patients. Staff indicated that patients often attribute delays to neglect and do not understand why their health problem is not prioritized. They voiced several strategies for addressing wait time frustrations, including expressing empathy for patients, making patients feel occupied and wait times seem more productive, and educating patients about when health issues should be treated through primary care. All staff members recognized the need for engaging in empathic communication with frustrated patients, but social workers and patient navigators were able to dedicate more time to these types of interactions.

Research paper thumbnail of Disparities in Emergency Department Health Care: Systems and Administration

Academic Emergency Medicine, Nov 1, 2003

Disparities are likely to present both in the emergency department and within the larger health c... more Disparities are likely to present both in the emergency department and within the larger health care system; however, disparities must be recognized to be addressed. This article summarizes the proceedings from the AEM Consensus Conference 2003: Disparities in Emergency Health Care. The goals of the conference were to examine the presence, causes, and outcomes related to disparities of health care as they occur in emergency departments, and determine the degree to which external forces have an impact on our patients. Participants were asked to describe the means of defining, assessing, measuring, and investigating disparities that may occur in emergency care. The committee members who wrote this report were asked to examine the influence of health care systems and administration on disparities in health care, using the following series of questions to frame the discussion. 1) Are all disparities bad? 2) Are only the vulnerable served inadequately by our current health care system? 3) Are what appear to be inequities really systems incompetence? 4) We assume there should be no inequality in health care: does society also assume this? 5) What would be the systems costs of equality in health care?

Research paper thumbnail of Reasons for Using the Emergency Department: Results of the EMPATH Study

Academic Emergency Medicine Official Journal of the Society For Academic Emergency Medicine, Dec 1, 2005

Objectives: Emergency Medicine Patients' Access To Healthcare (EMPATH) was a cross-sectional, obs... more Objectives: Emergency Medicine Patients' Access To Healthcare (EMPATH) was a cross-sectional, observational study conducted to identify the principal reasons why patients seek care in hospital emergency departments (EDs) in the United States. Methods: Twenty-eight U.S. hospitals, stratified by geographic region and hospital characteristics, participated in this study. Demographic, clinical, and insurance data were collected for a 24-hour period at each site, using chart reviews and a structured interview administered to all consenting adult patients seeking treatment during that period. Patients' reasons for presenting to the ED were assessed by their level of agreement (on a threepoint Likert scale) with 21 carefully worded statements designed to capture a range of possible reasons for seeking care in the ED. Factor analysis was used to consolidate highly correlated responses and to identify the principal factors explaining patients' reasons for coming to the ED. Results: A total of 1,579 patient interviews and 2,004 chart reviews were obtained from a diverse sample that was 55.4% female, 58.3% white, 28.3% African American, 7.0% Hispanic, and 6.0% other ethnic groups. This exploratory analysis yielded five factors characterizing patients' principal reasons for seeking ED care, with medical necessity the most frequent, followed by ED preference, convenience, affordability, and limitations of insurance. Conclusions: Use of the ED is, for most people, an affirmative choice over other providers rather than a last resort; it is often a choice driven by lack of access to or dissatisfaction with other sources of care.

Research paper thumbnail of Transforming Hospital Emergency Department Workflow and Patient Care

Research paper thumbnail of Benefit of a Tiered-Trauma Activation System for Triaging Dead-on-Arrival Patients

Western Journal of Emergency Medicine, 2012

Research paper thumbnail of Care Management Unit, Cost Analysis, and Outcome With Heart Failure

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine, 2005

Research paper thumbnail of Kiosk versus In-person Screening for Alcohol and Drug Use in the Emergency Department: Patient Preferences and Disclosure

The western journal of emergency medicine, 2015

Annually eight million emergency department (ED) visits are attributable to alcohol use. Screenin... more Annually eight million emergency department (ED) visits are attributable to alcohol use. Screening ED patients for at-risk alcohol and substance use is an integral component of screening, brief intervention, and referral to treatment programs, shown to be effective at reducing substance use. The objective is to evaluate ED patients' acceptance of and willingness to disclose alcohol/substance use via a computer kiosk versus an in-person interview. This was a cross-sectional, survey-based study. Eligible participants included those who presented to walk-in triage, were English-speaking, ≥18 years, were clinically stable and able to consent. Patients had the opportunity to access the kiosk in the ED waiting room, and were approached for an in-person survey by a research assistant (9am-5pm weekdays). Both surveys used validated assessment tools to assess drug and alcohol use. Disclosure statistics and preferences were calculated using chi-square tests and McNemar's test. A total...

Research paper thumbnail of Restructuring chronic care delivery in a public hospital asthma clinic

Research paper thumbnail of Transforming Hospital Emergency Department Workflow and Patient Care

Research paper thumbnail of Hospital Emergency Departments

Medical Care, 2003

... E-mail: Akell01@emory.edu. ... the authors approached the problem from the perspective of eme... more ... E-mail: Akell01@emory.edu. ... the authors approached the problem from the perspective of emergency departments, where three quarters of these admissions occur ... are told to seek care in an emergency department, and those who are sent from their doctor's office for stabilization ...

Research paper thumbnail of How community members and health professionals conceptualize medical emergencies: implications for primary care promotion

Health Education Research, 2012

Access to continuous care through a primary care provider is associated with improved health outc... more Access to continuous care through a primary care provider is associated with improved health outcomes, but many communities rely on emergency departments (EDs) for both emergent and non-emergent health problems. This article describes one portion of a community-based participatory research project and investigates the type of education that might be needed as part of a larger intervention to encourage use of a local primary care clinic. In this article we examine how people who live in a low-income urban community and the healthcare workers who serve them conceptualize 'emergency medical condition'. We conducted forum and focus group discussions with 52 community members and individual interviews with 32 healthcare workers. Our findings indicate that while community members share a common general definition of what constitutes a medical emergency, they also desire better guidelines for how to assess health problems as requiring emergency versus primary care. Pain, uncertainty and anxiety tend to influence their choice to use EDs rather than availability of primary care. Implications for increasing primary care use are discussed.

Research paper thumbnail of When Patients Are Impatient: The Communication Strategies Utilized by Emergency Department Employees to Manage Patients Frustrated by Wait Times

Health Communication, 2013

Studies have documented the frustrations patients experience during long wait times in emergency ... more Studies have documented the frustrations patients experience during long wait times in emergency departments (EDs), but considerably less research has sought to understand ED staff responses to these frustrations. In-depth interviews were conducted with 18 ED social workers, patient navigators, and medical staff members at a large urban hospital regarding their experiences and interpersonal strategies for dealing with frustrated patients. Staff indicated that patients often attribute delays to neglect and do not understand why their health problem is not prioritized. They voiced several strategies for addressing wait time frustrations, including expressing empathy for patients, making patients feel occupied and wait times seem more productive, and educating patients about when health issues should be treated through primary care. All staff members recognized the need for engaging in empathic communication with frustrated patients, but social workers and patient navigators were able to dedicate more time to these types of interactions.

Research paper thumbnail of The Emergency Department as a prevention site: A demographic analysis of substance use among ED patients

Drug and Alcohol Dependence, 2013

To identify rates of alcohol and drug use among patients presenting to an inner-city Emergency De... more To identify rates of alcohol and drug use among patients presenting to an inner-city Emergency Department (ED) and to describe demographic and health characteristics of patients with high-risk use. A cross-sectional study of patients presenting to the ED for any complaint. Patients were administered a brief screening about past 12-months alcohol and drug use. Patients who answered "yes" to any question were approached for a longer survey, the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Based on ASSIST scores patients received a brief intervention, and, when appropriate, a referral for brief outpatient therapy or specialized substance abuse treatment. Patients whose score indicated high-risk or dependent use were also asked demographic and health questions. Over a 20-month period, 19,055 patients were pre-screened. 87.1% of patients were black, 57% were male, with average age 44.8 years. 27.6% of patients pre-screened positive for drug or alcohol use; among these patients 44.2% scored in the low-risk range on the ASSIST, 35.8% moderate risk, 10% high risk and 10% probable dependence. Among patients with high-risk or dependent use, 70% rated their current health as fair/poor, with a mean of 1.7 ED visits in the prior 30 days. 40.7% reported "extreme" stress due to their use. 34.6% reported that they had stable housing and 13.6% were fully employed. Among all patients seen in the ED for any complaint, a significant proportion is engaged in alcohol and drug use that increases their risk of health and social consequences.

Research paper thumbnail of Emergency Department Design: A Practical Guide to Planning for the Future

Annals of Emergency Medicine, 2003

Research paper thumbnail of 184: Opening the Back Door of Emergency Department Improves Flow to Inpatient Setting but May Not Help With Overall Length of Stay

Annals of Emergency Medicine, 2010

Study Objective: To compare emergency department (ED) admission percentage, mean ED length of sta... more Study Objective: To compare emergency department (ED) admission percentage, mean ED length of stay (LOS), and percentage of patients who leave before treatment is complete (LBTC) among various volume EDs using data from the Emergency Department Benchmarking Alliance (EDBA) database.

Research paper thumbnail of Hematuria in the evaluation of renal colic: Is it helpful?

Annals of Emergency Medicine, 1999

Study objective: To determine the likelihood ratio (LR) for hematuria in the evaluation of patien... more Study objective: To determine the likelihood ratio (LR) for hematuria in the evaluation of patients with a suspected renal calculi.

Research paper thumbnail of Adapt and Survive

Academic Emergency Medicine, 2009

Research paper thumbnail of Diversity in Emergency Medicine—A Model Program

Academic Emergency Medicine, 2001

Emergency medicine's (EM's) development as a specialty has spanned the last 25 ye... more Emergency medicine's (EM's) development as a specialty has spanned the last 25 years, with the first certifying examination administered by the American Board of Emergency Medicine in 1980. National census data project that the new millennium will bring a U.S. population that will be 40% minority. In the year 2000, the U.S. population had a projected minority population of 28%. The diversity of the patients we treat demonstrates the need for EM programs to diversify their faculty and residency staff. Strategies include expanding recruitment and supporting retention of underrepresented students, faculty, and trainees, addressing barriers that may exist for promotion of underrepresented women and minorities, mentoring underrepresented minority (URM) faculty in research and education, providing opportunities for URMs to advance in the field, and mentoring URMs at the junior high and high school levels in the sciences to expand the applicant pool in the field. The authors describe an academic EM program that is a model program for diversity within our specialty.