Mentorship and how to conduct research: A research primer for low- and middle-income countries
Emergency medicine; Research; Mentorship; Low income countries
Development of a successful research program can seem daunting when looked at from the starting line. It will take years if not decades to succeed and become sustainable. It requires local partnerships and mentoring; it mandates the establishment of review boards; it requires national health policies to allow for protected time for research in salaries and for fund granting agencies to be set up; it requires training of researchers and support staff as well as a change in the mindset of clinical staff on the floor. It will almost inevitably require international support of some kind for low- and middle-income country researchers, be it university programs or other academic or private institutions. Success can occur; most likely it will occur by partnering with local research experts outside of emergency medicine in some combination with international networks and mentoring. Perhaps the most critical elements to success are intellectual curiosity and a burning flame of passion - and neither of those carry a financial cost.
Ducharme J; Simon EL; Jouriles N; Kole T; Maharjan RK
African Journal Of Emergency Medicine
2020
1905-7
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.afjem.2020.09.005" target="_blank" rel="noreferrer noopener">10.1016/j.afjem.2020.09.005</a>
Estimates of throughput and utilization at freestanding compared to low-volume hospital-based emergency departments.
OBJECTIVE: Our investigation compared throughput metrics and utilization measures for freestanding emergency departments (FSEDs) versus hospital-based emergency departments (HBEDs) of similar volumes in the United States. METHODS: This study is a cross sectional survey of 183 FSEDs and 317 HBEDs located across the United States using the Emergency Department Benchmarking Alliance (EDBA) Database. We measured common emergency department (ED) throughput metrics. Primary outcomes included overall length of stay, length of stay for admitted, and length of stay for treated and released patients. Outcomes were weighted based on the proportion of ED volume per facility as per a prior pilot study. Multiple linear regression analysis was used to adjust for measured differences between FSEDs and HBEDs. The variables that were controlled for in regression analysis included geographic location of the ED (urban, suburban, and rural), percent of high acuity capacity, ED volume, percentage of patients arriving via emergency medical services (EMS), and percentage of pediatric patients. RESULTS: Nationally, the median length of stay in minutes (104.2 vs 140.0), length of stay for treated and released patients (98.6 vs 122.9), door-to-bed (4.0 vs 8.0), door-to-doctor (11.0 vs 16.0), percentage of patients admitted through the ED (4.0 vs 11.0), and percentage of patients leaving the ED without being seen (LWBS) (0.9 vs 1.5), were significantly lower at FSEDs compared to HBEDs (P < 0.0001 for all comparisons). Length of stay for admitted patients (265.9 vs 241.8) and median boarding time (96.8 vs. 71.3) were significantly lower in HBEDs compared to FSEDs. X-ray, computed tomography, and ECG utilization per 100 patients was significantly lower at the FSEDs compared to HBEDs. Multiple linear regression analysis demonstrated that the length of stay for treated and released patients was 8.67 minutes shorter for FSEDs as compared to HBEDs (95% confidence interval [CI] = -1.4 to -16.0). The length of stay for admitted patients was 44 minutes longer for FSEDs as compared to HBEDs (95% CI = 25.5 to 63.0). CONCLUSIONS: In this study of similarly sized EDs in the United States, throughput metrics for FSEDs tended to be significantly shorter from the arrival of the patient until their departure, except for patients requiring hospital admission. For measures favoring FSEDs, throughput times range from 20%-50% shorter than HBEDs.
Dark C;Canellas M; Mangira C; Jouriles N; Simon EL
Journal of the American College of Emergency Physicians Open
2020
2020-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1002/emp2.12318" target="_blank" rel="noreferrer noopener">10.1002/emp2.12318</a>
Regionalization Of Emergency Care Future Directions And Research: Workforce Issues
departments; Emergency Medicine; impact; management; medicine residency; nurse-practitioners; on-call coverage; physicians; quality; shortage; surgeon
Ginde A A; Rao M; Simon E L; Edwards J M; Gardner A; Rogers J; Lopez E; Camargo C A; Piazza G; Rosenau A; Schneider S; Jouriles N
Academic Emergency Medicine
2010
2010-12
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1111/j.1553-2712.2010.00938.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2010.00938.x</a>
Emergency Department Performance Measures Updates: Proceedings of the 2014 Emergency Department Benchmarking Alliance Consensus Summit
care; costs; Emergency Medicine; operations; outcomes; patient satisfaction; project; publication guidelines; quality improvement; risk; stay
ObjectivesThe objective was to review and update key definitions and metrics for emergency department (ED) performance and operations. MethodsForty-five emergency medicine leaders convened for the Third Performance Measures and Benchmarking Summit held in Las Vegas, February 21-22, 2014. Prior to arrival, attendees were assigned to workgroups to review, revise, and update the definitions and vocabulary being used to communicate about ED performance and operations. They were provided with the prior definitions of those consensus summits that were published in 2006 and 2010. Other published definitions from key stakeholders in emergency medicine and health care were also reviewed and circulated. At the summit, key terminology and metrics were discussed and debated. Workgroups communicated online, via teleconference, and finally in a face-to-face meeting to reach consensus regarding their recommendations. Recommendations were then posted and open to a 30-day comment period. Participants then reanalyzed the recommendations, and modifications were made based on consensus. ResultsA comprehensive dictionary of ED terminology related to ED performance and operation was developed. This article includes definitions of operating characteristics and internal and external factors relevant to the stratification and categorization of EDs. Time stamps, time intervals, and measures of utilization were defined. Definitions of processes and staffing measures are also presented. Definitions were harmonized with performance measures put forth by the Centers for Medicare and Medicaid Services (CMS) for consistency. ConclusionsStandardized definitions are necessary to improve the comparability of EDs nationally for operations research and practice. More importantly, clear precise definitions describing ED operations are needed for incentive-based pay-for-performance models like those developed by CMS. This document provides a common language for front-line practitioners, managers, health policymakers, and researchers. (C) 2015 by the Society for Academic Emergency Medicine
Wiler J L; Welch S; Pines J; Schuur J; Jouriles N; Stone-Griffith S
Academic Emergency Medicine
2015
2015-05
Journal Article
<a href="http://doi.org/10.1111/acem.12654" target="_blank" rel="noreferrer noopener">10.1111/acem.12654</a>