Paris Datillo - Academia.edu (original) (raw)

Papers by Paris Datillo

Western Journal of Emergency Medicine, 2010

Background: The objective of this study was to evaluate those factors, both intrinsic and extrins... more Background: The objective of this study was to evaluate those factors, both intrinsic and extrinsic to the emergency department (ED) that influence two specific components of throughput: “door-to-doctor” time and dwell time. Methods: We used a prospective observational study design to determine the variables that played a significant role in determining ED flow. All adult patients seen or waiting to be seen in the ED were observed at 8pm (Monday-Friday) during a three-month period. Variables measured included daily ED volume, patient acuity, staffing, ED occupancy, daily admissions, ED boarder volume, hospital volume, and intensive care unit volume. Both log-rank tests and time-to-wait (survival) proportional-hazard regression models were fitted to determine which variables were most significant in predicting “door-to-doctor” and dwell times, with full account of the censoring for some patients. Results: We captured 1,543 patients during our study period, representing 27% of total d...

Western Journal of Emergency Medicine, 2015

Guidelines are designed to encompass the needs of the majority of patients with a particular cond... more Guidelines are designed to encompass the needs of the majority of patients with a particular condition. The American Heart Association (AHA) in conjunction with the American College of Cardiology (ACC) and the American College of Emergency Physicians (ACEP) developed risk stratification guidelines to aid physicians with accurate and efficient diagnosis and management of patients with acute coronary syndrome (ACS). While useful in a primary care setting, in the unique environment of an emergency department (ED), the feasibility of incorporating guidelines into clinical workflow remains in question. We aim to compare emergency physicians&amp;amp;amp;amp;amp;#39; (EP) clinical risk stratification ability to AHA/ACC/ACEP guidelines for ACS, and assessed each for accuracy in predicting ACS. We conducted a prospective observational cohort study in an urban teaching hospital ED. All patients presenting to the ED with chest pain who were evaluated for ACS had two risk stratification scores assigned: one by the treating physician based on clinical evaluation and the other by the AHA/ACC/ACEP guideline aforementioned. The patient&amp;amp;amp;amp;amp;#39;s ACS risk stratification classified by the EP was compared to AHA/ACC/ACEP guidelines. Patients were contacted at 30 days following the index ED visit to determine all cause mortality, unscheduled hospital/ED revisits, and objective cardiac testing performed. We enrolled 641 patients presenting for evaluation by 21 different EPs. There was a difference between the physician&amp;amp;amp;amp;amp;#39;s clinical assessment used in the ED, and the AHA/ACC/ACEP task force guidelines. EPs were more likely to assess patients as low risk (40%), while AHA/ACC/ACEP guidelines were more likely to classify patients as intermediate (45%) or high (45%) risk. Of the 119 (19%) patients deemed high risk by EP evaluation, 38 (32%) were diagnosed with ACS. AHA/ACC/ACEP guidelines classified only 57 (9%) patients low risk with 56 (98%) of those patients diagnosed with no ACS. In the ED, physicians are more efficient at correctly placing patients with underlying ACS into a high-risk category. A small percentage of patients were considered low risk when applying AHA/ACC/ACEP guidelines, which demonstrates how clinical insight is often required to make an efficient assessment of cardiac risk and established criteria may be overly conservative when applied to an acute care population.

The western journal of emergency medicine, 2010

THE OBJECTIVE OF THIS STUDY WAS TO EVALUATE THOSE FACTORS, BOTH INTRINSIC AND EXTRINSIC TO THE EM... more THE OBJECTIVE OF THIS STUDY WAS TO EVALUATE THOSE FACTORS, BOTH INTRINSIC AND EXTRINSIC TO THE EMERGENCY DEPARTMENT (ED) THAT INFLUENCE TWO SPECIFIC COMPONENTS OF THROUGHPUT: "door-to-doctor" time and dwell time. We used a prospective observational study design to determine the variables that played a significant role in determining ED flow. All adult patients seen or waiting to be seen in the ED were observed at 8pm (Monday-Friday) during a three-month period. Variables measured included daily ED volume, patient acuity, staffing, ED occupancy, daily admissions, ED boarder volume, hospital volume, and intensive care unit volume. Both log-rank tests and time-to-wait (survival) proportional-hazard regression models were fitted to determine which variables were most significant in predicting "door-to-doctor" and dwell times, with full account of the censoring for some patients. We captured 1,543 patients during our study period, representing 27% of total daily volum...

The Journal of Emergency Medicine, 2012

Background: The current paradigm for the evaluation of patients with suspected acute coronary syn... more Background: The current paradigm for the evaluation of patients with suspected acute coronary syndromes (ACS) in the emergency department (ED) is focused on the identification of patients with active underlying coronary disease. The majority of patients evaluated in the ED setting do not have active underlying cardiac disease. Objective: To measure the effect of bedside point-of-care (POC) cardiac biomarker testing on telemetry unit admissions from the ED. Furthermore, to evaluate the effect telemetry admissions have on ED length of stay (LOS) and overall hospital LOS. Methods: Primary data were collected over two 6-month periods in an urban teaching hospital ED. This was an observational cohort study conducted pre-and post-availability of a POC testing platform for cardiac biomarkers. Major measures included number of overall telemetry admissions, ED LOS, hospital LOS, and disposition. Patients were followed at 30 days for significant cardiac events, repeat ED visit or admission, and death. Results: In the post-implementation period there was a 30% (95% confidence interval [CI] 36-44%) reduction in admissions to telemetry with a 33% (95% CI 26-39%) reduction in ED LOS and a 20% (95% CI 7-34%) reduction in hospital LOS. There was a 62% reduction in overall mortality between the pre-implementation period and the postimplementation period (p = 0.001). Conclusion: The focused use of a rapid cardiac disposition protocol can dramatically impact resource utilization, expedite patient flow, and improve short-term outcomes for patients with suspected ACS. Ó 2012 Elsevier Inc.

Academic Emergency Medicine, 2006

Objectives: To update the profile of author-reported funding of reports of original research publ... more Objectives: To update the profile of author-reported funding of reports of original research published since 1994 in the four U.S. peer-reviewed general emergency medicine (EM) journals.

The American Journal of Emergency Medicine, 2008

Objectives: The objectives of the study were to examine the last decade of general emergency medi... more Objectives: The objectives of the study were to examine the last decade of general emergency medicine (EM) literature published in the United States for trends with regard to authorship and multidisciplinary collaboration and to estimate the effect on extramural funding. Methods: Print articles published in the Academic Emergency Medicine, Annals of Emergency Medicine, Journal of Emergency Medicine, and American Journal of Emergency Medicine between 1994 and 2003 were reviewed. Original research, case reports/series, and others (consensus/educational) were considered; abstracts, book reviews, and editorials were not. The author byline was reviewed for number, specialty, nationality, collaboration, and presence of extramural funding. Multidisciplinary collaboration was defined as authors from 2 or more specialties, whereas multi-institutional collaboration was defined as EM authors from more than one institution. Logistic regression was used to identify predictors of extramural funding from the variables collected. Results: Of 5728 articles identified, there were 3278 (57%) original research, 1437 (25%) case reports/ series, and 975 (17%) classified as others. The percentage funded was 22% for all articles (32% for original research). The literature had at least one EM investigator as coauthor 84% of the time. Article location of origin was the United States (63%), foreign (15%), and combined (22%). Multidisciplinary collaboration increased overall from 33% in 1994 to a high of 43% in 2003. Multi-institutional collaboration also increased from 16% in 1994 to 26% in 2003. The percentage of articles having 6 or more authors increased from 12% to 18% over the decade. Of all variables studied, only article type (original research: odds ratio, 4.8; 95% confidence interval, 4.0-5.6) and foreign source (non-United States: odds ratio, 1.3; 95% confidence interval, 1.1-1.5) predicted extramural funding. Conclusions: The number of authors per article in the EM literature has steadily increased over the last decade, as has evidence of collaboration with other specialties. This increase in collaboration and author number has not been associated with increased extramural funding in the general EM literature published in the United States. D

The American Journal of Emergency Medicine, 2011

Annals of Emergency Medicine, 2004

accuracy 97% (95% CI 92% to 100%), sensitivity 94% (95% CI 89% to 99%), and specificity 98% (95% ... more accuracy 97% (95% CI 92% to 100%), sensitivity 94% (95% CI 89% to 99%), and specificity 98% (95% CI 93% to 100%).