Jill Baren - Academia.edu (original) (raw)
Papers by Jill Baren
Adolescent medicine: state of the art reviews
It is well known that adolescents delay and avoid sexual health care and fail to disclose necessa... more It is well known that adolescents delay and avoid sexual health care and fail to disclose necessary information to providers when their confidentiality is not ensured. However, it is not always clear if adolescents are psychosocially, affectively, or cognitively ready for independent decision-making. Whether confidentiality can and should be maintained necessitates that parents and providers have an understanding of adolescents' need for confidentiality. This article explores the concepts of confidentiality and consent in the context of teenage development and behaviors and addresses the complexity of the decision-making triad in adolescent sexual health care.
Emergency medicine clinics of North America, 2002
Asthma continues to be an enormous health problem and economic burden in US society. EDs probably... more Asthma continues to be an enormous health problem and economic burden in US society. EDs probably will continue to provide a substantial amount of care for those affected by the disease. Pediatric asthma patients frequently are encountered in EDs. Emergency physicians must remain current in their approach to providing expert care while the management of acute asthma exacerbations continues to evolve, older therapies are challenged and new therapies are developed, tested, and implemented.
and the Mayo Clinic, Saint Marys Hospital, Rochester, MN (Schears).
Objective: To identify factors associated with admis- sion among children. Methods: We performed ... more Objective: To identify factors associated with admis- sion among children. Methods: We performed a prospective cohort study as part of the Multicenter Airway Research Collaboration. Patients aged 2 to 17 years who presented to the emer- gency department (ED) with acute asthma underwent a structured interview in the ED and another by tele- phone 2 weeks later. The study was
The American Journal of Surgery, 2013
Progesterone (PRO) may confer a survival advantage in traumatic brain injury (TBI) by reducing ce... more Progesterone (PRO) may confer a survival advantage in traumatic brain injury (TBI) by reducing cerebral edema. We hypothesized that PRO reduces edema by blocking polymorphonuclear (PMN) interactions with endothelium (EC) in the blood-brain barrier (BBB). CD1 mice received repeated PRO (16 mg/kg intraperitoneally) or vehicle (cyclodextrin) for 36 hours after TBI. Sham animals underwent craniotomy without TBI. The modified Neurological Severity Score graded neurologic recovery. A second craniotomy allowed in vivo observation of pial EC/PMN interactions and vascular macromolecule leakage. Wet/dry ratios assessed cerebral edema. Compared with the vehicle, PRO reduced subjective cerebral swelling (2.9 ± .1 vs 1.2 ± .1, P < .001), PMN rolling (95 ± 1.8 vs 57 ± 2.0 cells/100 μm/min, P < .001), total EC/PMN adhesion (2.0 ± .4 vs .8 ± .1 PMN/100 μm, P < .01), and vascular permeability (51.8% ± 4.9% vs 27.1% ± 4.6%, P < .01). TBI groups had similar a Neurological Severity Score and cerebral wet/dry ratios (P > .05). PRO reduces live pericontusional EC/PMN and BBB macromolecular leakage after TBI. Direct PRO effects on the microcirculation warrant further investigation.
Pediatric Emergency Care, 2008
At a time when there has been a reduction in mental health resources nationwide, the incidence of... more At a time when there has been a reduction in mental health resources nationwide, the incidence of mental health disorders in children has seen a dramatic increase for many reasons. A review of the literature was done to identify the epidemiology, barriers to care, useful emergency department (ED) screening methods, and resources regarding pediatric mental health disorders in the ED. Although there are many challenges to the provision of care for children with mental health emergencies, some resources are available. Furthermore, ED screening and intervention may be effective in improving patient outcomes. Collaborative efforts with multidisciplinary services can create a continuum of care, promote better identification of children and adolescents with mental health disorders, and promote early recognition and intervention, which are key to effective referral and treatment.
Pediatric Emergency Care, 2007
We hypothesize that nonpediatric and pediatric residents are exposed to a very low percentage of ... more We hypothesize that nonpediatric and pediatric residents are exposed to a very low percentage of critically ill patients in a high-volume children's hospital emergency department (ED). Retrospective chart review of resident-patient encounters during a 1-year period using a patient tracking system. Critically ill patients included those who were triaged as "critical," died in the ED, or admitted to the intensive care unit. Descriptive data are presented as means +/- SD, frequencies, and percentages. Analysis of variance was used for continuous data and the chi test for categorical data. A total of 3048 (4.2% of the total ED volume) critically ill patients with a mean age of 6 (+/- 5.6) years were evaluated. One hundred four emergency medicine (EM) residents were involved in the care of 903 (30%), 136 pediatric residents managed 2003 (65%), and 36 family medicine residents managed 142 (5%) critically ill patients. There was no significant difference in the mean age of evaluated patients compared by type of training program. On average, EM residents evaluated 5 patients per 10 shifts compared with pediatric residents ([9 patients per 10 shifts] P < 0.0001). Unlike pediatric residents, the number of patients cared for by EM or family medicine residents did not increase with the level of resident training. Sixty-seven life-saving procedures were performed, of which 32 (48%) were cardiopulmonary resuscitations and 35 (52%) were intubations. Pediatric and nonpediatric residents who rotate through a high-volume children's hospital ED are exposed to a very low number of critically ill children. Other educational formats, such as mock resuscitations or standardized patient encounters, may be required to correct this deficit.
Neurology, 2009
Background: Despite the high incidence of acute stroke, only a minority of patients are enrolled ... more Background: Despite the high incidence of acute stroke, only a minority of patients are enrolled in acute stroke treatment trials. We aimed to identify factors associated with participation in clinical trials of novel therapeutic agents for acute stroke.
The Journal of Emergency Medicine, 2006
Background: Emergency department evaluation of young febrile children often includes a white bloo... more Background: Emergency department evaluation of young febrile children often includes a white blood cell count. Although a high white blood cell count is associated with an increased likelihood of infection, the clinical significance of extreme leukocytosis (EL), defined as a white blood cell count of Ն25,000/mm 3 , has not been well-studied. Objective: To determine diagnoses associated with EL in febrile children evaluated in a pediatric emergency department and to compare rates of serious bacterial infection in those with EL and in those with more modest leukocytosis (LK) (15,000 -24,999/mm 3 ). Methods: A retrospective case-control study of children 2-24 months of age was performed. Those with EL were frequency ageand gender-matched to controls with LK. Results: Sixty-nine patients with EL and 94 patients with LK were included. The mean age was 9.9 months, and 91 (56%) patients were male. The diagnoses were similar between the 2 groups, with otitis media, viral syndrome and pneumonia being the most common. The rates of proven serious bacterial infection were similar between EL (25%; 95% confidence interval, 15-36%) and LK (17%; 95% confidence interval, 10 -26%) patients. Using different white blood cell cutoff points did not distinguish between patients with and without serious bacterial infection. Conclusion: Young febrile children whose emergency department evaluation revealed EL had diagnoses and rates of serious bacterial infection similar to those of children with LK.
European Journal of Emergency Medicine, 2004
Universal screening for interpersonal violence is recommended despite a lack of confirmed efficac... more Universal screening for interpersonal violence is recommended despite a lack of confirmed efficacy. We hypothesized that the detection of violence via universal screening would result in high intervention rates for victims. Women aged 18-65 years presenting to an emergency department were screened using a standard protocol. Medical and social work records were reviewed for positively screened patients. Outcomes included whether victims received counseling/referral services. Secondary outcomes were the documentation of services offered and safety assessment performed. A total of 1732 patients were evaluated; 615 (35.5%) responded positively to at least one query. Patients had a mean age of 34.7+/-12 years, 79% were non-white, 19% were married, and 76% had completed high school. Twenty-five out of 606 victims (4%) had documentation of violence. Residents were more likely than faculty or nurses to document domestic violence [3.3% (95% confidence interval 1.8-4.8%) versus 2.1 (0.9-3.4) versus 0.7 (0.0-1.4)]. The documentation of police contact, suicide/homicide risk, weapon presence, safety assessment and outside resource referrals occurred in less than 2% of charts. Only two victims were referred to social work (0.3%; 0-0.9%). Even in an institution with a heavy emphasis and training on interpersonal violence and alternative mechanisms for universal screening we could not prove that the identification of victims resulted in counseling/referral being offered in the emergency department.
Bioethics, 2010
Bioethics would also like to thank the following individuals who most generously agreed to refere... more Bioethics would also like to thank the following individuals who most generously agreed to referee manuscripts for us between June 2003 and May 2004. Whilst every effort has been made to include everyone, we apologise for any oversights–please do let us know if we have missed you so that we can update our records.
Annals of Emergency Medicine, 2001
We determined whether a simple emergency department intervention improves the likelihood of prima... more We determined whether a simple emergency department intervention improves the likelihood of primary care provider (PCP) follow-up after ED discharge for an acute asthma exacerbation. This randomized, controlled clinical trial was conducted in an urban university-based ED. Participants were patients with asthma between the ages of 16 and 45 years who were treated and discharged from the ED. The study intervention was usual care or an intervention that consisted of a free 5-day course of prednisone, vouchers for transportation to and from their PCP, and a 48-hour telephone reminder to make an appointment with their PCP. The main outcome was whether the patient received follow-up care as determined by PCP contact at 4 weeks. One hundred ninety-two patients with asthma were enrolled over 8 months; 178 (93%) had complete follow-up. The intervention and control groups were similar with regard to age, sex, ethnicity, or years of education. The 2 groups were also comparable with respect to multiple measures of baseline access/barriers to care and severity of ED exacerbation. Patients receiving the intervention were significantly more likely to follow up with their PCP than control patients (relative risk 1.6; 95% confidence interval [CI] 1.1, 2.4). When adjusted for other factors influencing PCP follow-up care (ethnicity, prior PCP relationship, insurance status, regular car access), intervention patients were more likely to follow up with their PCP (odds ratio 3.1; 95% CI 1.5, 6.3). Providing medication, transportation vouchers, and a telephone reminder to make an appointment increased the likelihood that discharged patients with asthma obtained PCP follow-up.
Annals of Emergency Medicine, 2009
Study objective: We determine the incidence of serious bacterial infection in infants presenting ... more Study objective: We determine the incidence of serious bacterial infection in infants presenting to the emergency department (ED) with an apparent life-threatening event.
Annals of Emergency Medicine, 2008
DC (Shesser).
Annals of Emergency Medicine, 2004
Annals of Emergency Medicine, 1995
The National Highway Traffic Safety Administration developed the EMS (emergency medical services)... more The National Highway Traffic Safety Administration developed the EMS (emergency medical services) Technical Assessment Program to assist states in developing and improving their EMS systems. The main goals of this evaluation were to document the level of improvement in EMS system development following completion of the Technical Assessment Program and to identify necessary program improvements at the National Highway Traffic Safety Administration. Independent investigators retrospectively reviewed the information in Technical Assessment Program reports from 35 states that participated in the program during a 5-year period. Training and certification programs for prehospital personnel were the most well-developed elements of EMS systems. Conversely, comprehensive quality management and EMS system evaluation programs were almost uniformly absent (89% of states). Areas of need targeted for improvement included enabling legislation for EMS (60%) or trauma system development (69%), an improved mechanism to assess system resources (71%), an established or updated state EMS plan (80%), aging and unreliable communications equipment (89%), fully operational prehospital data collection systems (89%), and consistent medical oversight for all prehospital providers (92%). Program evaluation revealed that significant recommendation-based changes occurred in all components of EMS systems. The Technical Assessment Program is one tool that states can use to promote EMS system improvements.
Academic Emergency Medicine, 2004
Objectives: To characterize emergency medicine (EM) residents' clinical experience during a pedia... more Objectives: To characterize emergency medicine (EM) residents' clinical experience during a pediatric emergency medicine (PEM) rotation. Methods: Prospective observational study of EM resident-patient encounters in a children's hospital emergency department (ED). Results: Fifty-six residents participated in the study. The mean (6SD) patient age was 6.3 (65.6) years. Ambulatory infectious disease, respiratory illness, and wound management represented almost 50% of final diagnoses. Six and a half procedures/resident were performed per rotation, mainly nonemergent procedures, whereas resuscitations and child abuse evaluations were rare. A minority of patients required data interpretation: 34.4% had laboratory testing, 24.6% had radiographic studies, and 2.3% had electrocardiograms. Conclusions: Analysis of patient encounters during a PEM rotation showed deficiencies in critical care procedures, resuscitations, child abuse evaluations, and neonatal evaluations. Quantitative data of skills utilized during rotations can be used by residency programs to identify and correct deficiencies in their residents' PEM education.
Academic Emergency Medicine, 2005
Objectives: Nested pediatric emergency departments (nPEDs) are defined as dedicated treatment are... more Objectives: Nested pediatric emergency departments (nPEDs) are defined as dedicated treatment areas operating during peak pediatric hours within general emergency departments (EDs). This study examined three staffing models for nPEDs and their impact on pediatric encounters. Methods: Three models were applied to children younger than 37 months presenting to the ED of an urban community hospital over one year. In the nPED, physicians cared only for nPED patients. In the restricted (rPED) model, physicians cared only for pediatric patients presenting outside nPED hours. In the total ED (tED) model, physicians treated all pediatric patients regardless of time. Full-time equivalent pediatric encounters, potential neonatal lumbar punctures, and illness severity were determined for all models. Statistical analysis was performed by analysis of variance and chisquare test. Results: For the 3,389 eligible ED visits, the number of annual patient encounters per full-time equivalent was 1,236 for the nPED, 805 for the tED, and 336 for
Academic Emergency Medicine, 2010
Adolescent medicine: state of the art reviews
It is well known that adolescents delay and avoid sexual health care and fail to disclose necessa... more It is well known that adolescents delay and avoid sexual health care and fail to disclose necessary information to providers when their confidentiality is not ensured. However, it is not always clear if adolescents are psychosocially, affectively, or cognitively ready for independent decision-making. Whether confidentiality can and should be maintained necessitates that parents and providers have an understanding of adolescents' need for confidentiality. This article explores the concepts of confidentiality and consent in the context of teenage development and behaviors and addresses the complexity of the decision-making triad in adolescent sexual health care.
Emergency medicine clinics of North America, 2002
Asthma continues to be an enormous health problem and economic burden in US society. EDs probably... more Asthma continues to be an enormous health problem and economic burden in US society. EDs probably will continue to provide a substantial amount of care for those affected by the disease. Pediatric asthma patients frequently are encountered in EDs. Emergency physicians must remain current in their approach to providing expert care while the management of acute asthma exacerbations continues to evolve, older therapies are challenged and new therapies are developed, tested, and implemented.
and the Mayo Clinic, Saint Marys Hospital, Rochester, MN (Schears).
Objective: To identify factors associated with admis- sion among children. Methods: We performed ... more Objective: To identify factors associated with admis- sion among children. Methods: We performed a prospective cohort study as part of the Multicenter Airway Research Collaboration. Patients aged 2 to 17 years who presented to the emer- gency department (ED) with acute asthma underwent a structured interview in the ED and another by tele- phone 2 weeks later. The study was
The American Journal of Surgery, 2013
Progesterone (PRO) may confer a survival advantage in traumatic brain injury (TBI) by reducing ce... more Progesterone (PRO) may confer a survival advantage in traumatic brain injury (TBI) by reducing cerebral edema. We hypothesized that PRO reduces edema by blocking polymorphonuclear (PMN) interactions with endothelium (EC) in the blood-brain barrier (BBB). CD1 mice received repeated PRO (16 mg/kg intraperitoneally) or vehicle (cyclodextrin) for 36 hours after TBI. Sham animals underwent craniotomy without TBI. The modified Neurological Severity Score graded neurologic recovery. A second craniotomy allowed in vivo observation of pial EC/PMN interactions and vascular macromolecule leakage. Wet/dry ratios assessed cerebral edema. Compared with the vehicle, PRO reduced subjective cerebral swelling (2.9 ± .1 vs 1.2 ± .1, P < .001), PMN rolling (95 ± 1.8 vs 57 ± 2.0 cells/100 μm/min, P < .001), total EC/PMN adhesion (2.0 ± .4 vs .8 ± .1 PMN/100 μm, P < .01), and vascular permeability (51.8% ± 4.9% vs 27.1% ± 4.6%, P < .01). TBI groups had similar a Neurological Severity Score and cerebral wet/dry ratios (P > .05). PRO reduces live pericontusional EC/PMN and BBB macromolecular leakage after TBI. Direct PRO effects on the microcirculation warrant further investigation.
Pediatric Emergency Care, 2008
At a time when there has been a reduction in mental health resources nationwide, the incidence of... more At a time when there has been a reduction in mental health resources nationwide, the incidence of mental health disorders in children has seen a dramatic increase for many reasons. A review of the literature was done to identify the epidemiology, barriers to care, useful emergency department (ED) screening methods, and resources regarding pediatric mental health disorders in the ED. Although there are many challenges to the provision of care for children with mental health emergencies, some resources are available. Furthermore, ED screening and intervention may be effective in improving patient outcomes. Collaborative efforts with multidisciplinary services can create a continuum of care, promote better identification of children and adolescents with mental health disorders, and promote early recognition and intervention, which are key to effective referral and treatment.
Pediatric Emergency Care, 2007
We hypothesize that nonpediatric and pediatric residents are exposed to a very low percentage of ... more We hypothesize that nonpediatric and pediatric residents are exposed to a very low percentage of critically ill patients in a high-volume children's hospital emergency department (ED). Retrospective chart review of resident-patient encounters during a 1-year period using a patient tracking system. Critically ill patients included those who were triaged as "critical," died in the ED, or admitted to the intensive care unit. Descriptive data are presented as means +/- SD, frequencies, and percentages. Analysis of variance was used for continuous data and the chi test for categorical data. A total of 3048 (4.2% of the total ED volume) critically ill patients with a mean age of 6 (+/- 5.6) years were evaluated. One hundred four emergency medicine (EM) residents were involved in the care of 903 (30%), 136 pediatric residents managed 2003 (65%), and 36 family medicine residents managed 142 (5%) critically ill patients. There was no significant difference in the mean age of evaluated patients compared by type of training program. On average, EM residents evaluated 5 patients per 10 shifts compared with pediatric residents ([9 patients per 10 shifts] P < 0.0001). Unlike pediatric residents, the number of patients cared for by EM or family medicine residents did not increase with the level of resident training. Sixty-seven life-saving procedures were performed, of which 32 (48%) were cardiopulmonary resuscitations and 35 (52%) were intubations. Pediatric and nonpediatric residents who rotate through a high-volume children's hospital ED are exposed to a very low number of critically ill children. Other educational formats, such as mock resuscitations or standardized patient encounters, may be required to correct this deficit.
Neurology, 2009
Background: Despite the high incidence of acute stroke, only a minority of patients are enrolled ... more Background: Despite the high incidence of acute stroke, only a minority of patients are enrolled in acute stroke treatment trials. We aimed to identify factors associated with participation in clinical trials of novel therapeutic agents for acute stroke.
The Journal of Emergency Medicine, 2006
Background: Emergency department evaluation of young febrile children often includes a white bloo... more Background: Emergency department evaluation of young febrile children often includes a white blood cell count. Although a high white blood cell count is associated with an increased likelihood of infection, the clinical significance of extreme leukocytosis (EL), defined as a white blood cell count of Ն25,000/mm 3 , has not been well-studied. Objective: To determine diagnoses associated with EL in febrile children evaluated in a pediatric emergency department and to compare rates of serious bacterial infection in those with EL and in those with more modest leukocytosis (LK) (15,000 -24,999/mm 3 ). Methods: A retrospective case-control study of children 2-24 months of age was performed. Those with EL were frequency ageand gender-matched to controls with LK. Results: Sixty-nine patients with EL and 94 patients with LK were included. The mean age was 9.9 months, and 91 (56%) patients were male. The diagnoses were similar between the 2 groups, with otitis media, viral syndrome and pneumonia being the most common. The rates of proven serious bacterial infection were similar between EL (25%; 95% confidence interval, 15-36%) and LK (17%; 95% confidence interval, 10 -26%) patients. Using different white blood cell cutoff points did not distinguish between patients with and without serious bacterial infection. Conclusion: Young febrile children whose emergency department evaluation revealed EL had diagnoses and rates of serious bacterial infection similar to those of children with LK.
European Journal of Emergency Medicine, 2004
Universal screening for interpersonal violence is recommended despite a lack of confirmed efficac... more Universal screening for interpersonal violence is recommended despite a lack of confirmed efficacy. We hypothesized that the detection of violence via universal screening would result in high intervention rates for victims. Women aged 18-65 years presenting to an emergency department were screened using a standard protocol. Medical and social work records were reviewed for positively screened patients. Outcomes included whether victims received counseling/referral services. Secondary outcomes were the documentation of services offered and safety assessment performed. A total of 1732 patients were evaluated; 615 (35.5%) responded positively to at least one query. Patients had a mean age of 34.7+/-12 years, 79% were non-white, 19% were married, and 76% had completed high school. Twenty-five out of 606 victims (4%) had documentation of violence. Residents were more likely than faculty or nurses to document domestic violence [3.3% (95% confidence interval 1.8-4.8%) versus 2.1 (0.9-3.4) versus 0.7 (0.0-1.4)]. The documentation of police contact, suicide/homicide risk, weapon presence, safety assessment and outside resource referrals occurred in less than 2% of charts. Only two victims were referred to social work (0.3%; 0-0.9%). Even in an institution with a heavy emphasis and training on interpersonal violence and alternative mechanisms for universal screening we could not prove that the identification of victims resulted in counseling/referral being offered in the emergency department.
Bioethics, 2010
Bioethics would also like to thank the following individuals who most generously agreed to refere... more Bioethics would also like to thank the following individuals who most generously agreed to referee manuscripts for us between June 2003 and May 2004. Whilst every effort has been made to include everyone, we apologise for any oversights–please do let us know if we have missed you so that we can update our records.
Annals of Emergency Medicine, 2001
We determined whether a simple emergency department intervention improves the likelihood of prima... more We determined whether a simple emergency department intervention improves the likelihood of primary care provider (PCP) follow-up after ED discharge for an acute asthma exacerbation. This randomized, controlled clinical trial was conducted in an urban university-based ED. Participants were patients with asthma between the ages of 16 and 45 years who were treated and discharged from the ED. The study intervention was usual care or an intervention that consisted of a free 5-day course of prednisone, vouchers for transportation to and from their PCP, and a 48-hour telephone reminder to make an appointment with their PCP. The main outcome was whether the patient received follow-up care as determined by PCP contact at 4 weeks. One hundred ninety-two patients with asthma were enrolled over 8 months; 178 (93%) had complete follow-up. The intervention and control groups were similar with regard to age, sex, ethnicity, or years of education. The 2 groups were also comparable with respect to multiple measures of baseline access/barriers to care and severity of ED exacerbation. Patients receiving the intervention were significantly more likely to follow up with their PCP than control patients (relative risk 1.6; 95% confidence interval [CI] 1.1, 2.4). When adjusted for other factors influencing PCP follow-up care (ethnicity, prior PCP relationship, insurance status, regular car access), intervention patients were more likely to follow up with their PCP (odds ratio 3.1; 95% CI 1.5, 6.3). Providing medication, transportation vouchers, and a telephone reminder to make an appointment increased the likelihood that discharged patients with asthma obtained PCP follow-up.
Annals of Emergency Medicine, 2009
Study objective: We determine the incidence of serious bacterial infection in infants presenting ... more Study objective: We determine the incidence of serious bacterial infection in infants presenting to the emergency department (ED) with an apparent life-threatening event.
Annals of Emergency Medicine, 2008
DC (Shesser).
Annals of Emergency Medicine, 2004
Annals of Emergency Medicine, 1995
The National Highway Traffic Safety Administration developed the EMS (emergency medical services)... more The National Highway Traffic Safety Administration developed the EMS (emergency medical services) Technical Assessment Program to assist states in developing and improving their EMS systems. The main goals of this evaluation were to document the level of improvement in EMS system development following completion of the Technical Assessment Program and to identify necessary program improvements at the National Highway Traffic Safety Administration. Independent investigators retrospectively reviewed the information in Technical Assessment Program reports from 35 states that participated in the program during a 5-year period. Training and certification programs for prehospital personnel were the most well-developed elements of EMS systems. Conversely, comprehensive quality management and EMS system evaluation programs were almost uniformly absent (89% of states). Areas of need targeted for improvement included enabling legislation for EMS (60%) or trauma system development (69%), an improved mechanism to assess system resources (71%), an established or updated state EMS plan (80%), aging and unreliable communications equipment (89%), fully operational prehospital data collection systems (89%), and consistent medical oversight for all prehospital providers (92%). Program evaluation revealed that significant recommendation-based changes occurred in all components of EMS systems. The Technical Assessment Program is one tool that states can use to promote EMS system improvements.
Academic Emergency Medicine, 2004
Objectives: To characterize emergency medicine (EM) residents' clinical experience during a pedia... more Objectives: To characterize emergency medicine (EM) residents' clinical experience during a pediatric emergency medicine (PEM) rotation. Methods: Prospective observational study of EM resident-patient encounters in a children's hospital emergency department (ED). Results: Fifty-six residents participated in the study. The mean (6SD) patient age was 6.3 (65.6) years. Ambulatory infectious disease, respiratory illness, and wound management represented almost 50% of final diagnoses. Six and a half procedures/resident were performed per rotation, mainly nonemergent procedures, whereas resuscitations and child abuse evaluations were rare. A minority of patients required data interpretation: 34.4% had laboratory testing, 24.6% had radiographic studies, and 2.3% had electrocardiograms. Conclusions: Analysis of patient encounters during a PEM rotation showed deficiencies in critical care procedures, resuscitations, child abuse evaluations, and neonatal evaluations. Quantitative data of skills utilized during rotations can be used by residency programs to identify and correct deficiencies in their residents' PEM education.
Academic Emergency Medicine, 2005
Objectives: Nested pediatric emergency departments (nPEDs) are defined as dedicated treatment are... more Objectives: Nested pediatric emergency departments (nPEDs) are defined as dedicated treatment areas operating during peak pediatric hours within general emergency departments (EDs). This study examined three staffing models for nPEDs and their impact on pediatric encounters. Methods: Three models were applied to children younger than 37 months presenting to the ED of an urban community hospital over one year. In the nPED, physicians cared only for nPED patients. In the restricted (rPED) model, physicians cared only for pediatric patients presenting outside nPED hours. In the total ED (tED) model, physicians treated all pediatric patients regardless of time. Full-time equivalent pediatric encounters, potential neonatal lumbar punctures, and illness severity were determined for all models. Statistical analysis was performed by analysis of variance and chisquare test. Results: For the 3,389 eligible ED visits, the number of annual patient encounters per full-time equivalent was 1,236 for the nPED, 805 for the tED, and 336 for
Academic Emergency Medicine, 2010