2023
Severe acute respiratory coronavirus virus 2 (SARS-CoV-2) RNA and viable virus contamination of hospital emergency department surfaces and association with patient coronavirus disease 2019 (COVID-19) status and aerosol-generating procedures
Roberts S, Barbell E, Barber D, Dahlberg S, Heimer R, Jubanyik K, Parwani V, Pettigrew M, Tanner J, Ulrich A, Wade M, Wyllie A, Yolda-Carr D, Martinello R, Tanner W. Severe acute respiratory coronavirus virus 2 (SARS-CoV-2) RNA and viable virus contamination of hospital emergency department surfaces and association with patient coronavirus disease 2019 (COVID-19) status and aerosol-generating procedures. Infection Control And Hospital Epidemiology 2023, 45: 244-246. PMID: 37767709, PMCID: PMC10877528, DOI: 10.1017/ice.2023.183.Peer-Reviewed Original Research
2022
Patient cost consciousness in the emergency department
Gaylor JM, Chan E, Parwani V, Ulrich A, Rothenberg C, Venkatesh A. Patient cost consciousness in the emergency department. The American Journal Of Emergency Medicine 2022, 61: 61-63. PMID: 36054987, DOI: 10.1016/j.ajem.2022.08.039.Peer-Reviewed Original ResearchConceptsEmergency departmentPocket costsED patientsLarge academic hospital systemAcademic hospital systemCertain patient demographicsEmergency department settingPerceptions of patientsCost of careMedicare/MedicaidPatient demographicsED careUnscheduled careUninsured patientsDepartment settingPatients' estimatesPatient's abilityEmergency careHigh school educationPatientsPrivate insuranceFinal analysisHospital systemCareConvenience sampleEMS Non-Transport of Low-Risk COVID-19 Patients
Couturier K, Nelson AR, Burns K, Cone DC, Rollins M, Venkatesh AK, Ulrich A, Shapiro M, Joseph D. EMS Non-Transport of Low-Risk COVID-19 Patients. Prehospital Emergency Care 2022, 27: 310-314. PMID: 35639643, DOI: 10.1080/10903127.2022.2083278.Peer-Reviewed Original ResearchConceptsEMS cliniciansLow-risk COVID-19 patientsSuburban EMS systemLow-risk patientsED visit ratesEMS systemCOVID-19 patientsCOVID-19 infectionCOVID-19ED visitsRetrospective reviewEmergency departmentCOVID-19 casesProtocol violationsCommon reasonConnecticut OfficeHospital resourcesPatientsSmall studyVisit ratesVital signsHealth systemSymptomsReasonable adherenceClinicians
2021
Design and Implementation of an Agitation Code Response Team in the Emergency Department
Wong AH, Ray JM, Cramer LD, Brashear TK, Eixenberger C, McVaney C, Haggan J, Sevilla M, Costa DS, Parwani V, Ulrich A, Dziura JD, Bernstein SL, Venkatesh AK. Design and Implementation of an Agitation Code Response Team in the Emergency Department. Annals Of Emergency Medicine 2021, 79: 453-464. PMID: 34863528, PMCID: PMC9038629, DOI: 10.1016/j.annemergmed.2021.10.013.Peer-Reviewed Original ResearchConceptsResponse team interventionPhysical restraint useInterrupted time series analysisRestraint useEmergency departmentTeam interventionRates of physical restraint useTeam-based interventionAdministrative supportQuality improvement studyResponse teamBehavioral health systemManagement of agitated patientsInterprofessional collaborationRestraint ordersExcessive psychomotor activityRestraint ratesHealth systemED visitsImprovement studyPhysical restraintCompare trendsPrimary outcomeTime series analysisAgitated patientsSimulating approaches to emergency department pandemic physician staffing during COVID-19.
Sangal RB, Venkatesh AK, Kinsman J, Dashevsky M, Scofi JE, Ulrich A. Simulating approaches to emergency department pandemic physician staffing during COVID-19. American Journal Of Disaster Medicine 2021, 16: 85-93. PMID: 34392521, DOI: 10.5055/ajdm.2021.0391.Peer-Reviewed Original ResearchConceptsEmergency departmentInfection rateStaffing modelsPercent infection rateCohort modelHigher infection rateInfectious disease outbreaksEmergency physiciansED staffAvailable physiciansThree-teamWeek 5Health systemEM physiciansPhysiciansAdequate staffingImmunityPhysician attritionCOVID-19CohortDisease outbreaksPandemicPandemic disasterWeeksDisparities in Accessing and Reading Open Notes in the Emergency Department Upon Implementation of the 21st Century CURES Act
Sangal RB, Powers E, Rothenberg C, Ndumele C, Ulrich A, Hsiao A, Venkatesh AK. Disparities in Accessing and Reading Open Notes in the Emergency Department Upon Implementation of the 21st Century CURES Act. Annals Of Emergency Medicine 2021, 78: 593-598. PMID: 34353651, DOI: 10.1016/j.annemergmed.2021.06.014.Peer-Reviewed Original ResearchConceptsProportion of patientsPatient portal accessEmergency departmentOpen notesClinical notesPortal accessPublic insuranceUrgent care centersCentury Cures ActDifferent patient demographicsSingle health systemPatient demographicsPrimary outcomeCures ActPatient utilizationPatient visitsCare centerObservational studyPatientsDigital health toolsAge 18Health systemHealth toolsUnique barriersNon-English speakers
2020
Work team identification associated with less stress and burnout among front-line emergency department staff amid the COVID-19 pandemic
Sangal R, Wrzesniewski A, DiBenigno J, Reid E, Ulrich A, Liebhardt B, Bray A, Yang E, Eun E, Venkatesh A, King M. Work team identification associated with less stress and burnout among front-line emergency department staff amid the COVID-19 pandemic. BMJ Leader 2020, 5: 51-54. DOI: 10.1136/leader-2020-000331.Peer-Reviewed Original ResearchFront-line healthcare workersHealthcare workersCOVID-19 pandemicEmergency department staffQuality improvement initiativesCOVID-19Cross-sectional surveyCross-sectional analysisEmergency departmentProtective effectOngoing COVID-19Mental healthWork stressImprovement initiativesDepartment staffProlonged stressFeelings of stressReduced reportsLess work stressFurther evidenceLongitudinal evidencePandemicFirst waveFront-line workersWorkersAssociation between patient-physician gender concordance and patient experience scores. Is there gender bias?
Chekijian S, Kinsman J, Taylor RA, Ravi S, Parwani V, Ulrich A, Venkatesh A, Agrawal P. Association between patient-physician gender concordance and patient experience scores. Is there gender bias? The American Journal Of Emergency Medicine 2020, 45: 476-482. PMID: 33069544, DOI: 10.1016/j.ajem.2020.09.090.Peer-Reviewed Original ResearchConceptsPatient satisfaction surveyFemale patientsProvider scoresOverall assessment scoreEmergency departmentPatient satisfactionPhysician genderPatient-physician gender concordanceFemale physiciansAssessment scoresGender concordancePatient satisfaction survey dataSatisfaction surveyEffect of patientFemale emergency physiciansPatient experience scoresLogistic regression modelsCross-sectional analysisElectronic health recordsPatients' oddsAdult patientsPatient genderEmergency physiciansLower oddsEmergency careClinical impact of rapid influenza PCR in the adult emergency department on patient management, ED length of stay, and nosocomial infection rate
Peaper DR, Branson B, Parwani V, Ulrich A, Shapiro MJ, Clemons C, Campbell M, Owen M, Martinello RA, Landry ML. Clinical impact of rapid influenza PCR in the adult emergency department on patient management, ED length of stay, and nosocomial infection rate. Influenza And Other Respiratory Viruses 2020, 15: 254-261. PMID: 32851793, PMCID: PMC7902247, DOI: 10.1111/irv.12800.Peer-Reviewed Original ResearchConceptsEmergency departmentInfluenza PCRPatient managementClinical redesignED lengthInfluenza seasonED workflowPCR testingBed transfersAnti-influenza medicationsDiverse emergency departmentsHospital-acquired influenzaInfluenza-positive patientsHA influenzaNosocomial infection ratesDiagnosis of influenzaAdult emergency departmentAnti-viral therapyCommon presenting concernPost-intervention periodPre-post studyED LOSED patientsSignificant morbidityTherapeutic guidelinesStudy protocol for the ACT response pilot intervention: development, implementation and evaluation of a systems-based Agitation Code Team (ACT) in the emergency department
Wong AH, Ray JM, Auerbach MA, Venkatesh AK, McVaney C, Burness D, Chmura C, Saxa T, Sevilla M, Flood CT, Patel A, Whitfill T, Dziura JD, Yonkers KA, Ulrich A, Bernstein SL. Study protocol for the ACT response pilot intervention: development, implementation and evaluation of a systems-based Agitation Code Team (ACT) in the emergency department. BMJ Open 2020, 10: e036982. PMID: 32606062, PMCID: PMC7328814, DOI: 10.1136/bmjopen-2020-036982.Peer-Reviewed Original ResearchConceptsEmergency departmentRestraint useCode teamControlled interrupted time series designResponse interventionsRate of restraint useInterrupted time series designAcute care settingDe-escalation techniquesTime series designPeer-reviewed publicationsED staffIdentified teamworkPilot interventionCare settingsHealth systemPatient encountersAgitation managementHuman Investigation CommitteeWorkplace violenceEthical approvalStaff safetyPatient agitationReduce harmSeries designLess social emergency departments: implementation of workplace contact reduction during COVID-19
Sangal RB, Scofi JE, Parwani V, Pickens AT, Ulrich A, Venkatesh AK. Less social emergency departments: implementation of workplace contact reduction during COVID-19. Emergency Medicine Journal 2020, 37: 463-466. PMID: 32581052, PMCID: PMC7418594, DOI: 10.1136/emermed-2020-209826.Peer-Reviewed Original ResearchMeSH KeywordsBetacoronavirusCoronavirus InfectionsCOVID-19Delivery of Health CareDisease Transmission, InfectiousEmergency Service, HospitalHumansInfection ControlInterdisciplinary CommunicationInterpersonal RelationsOrganizational InnovationPandemicsPneumonia, ViralPolicy MakingSARS-CoV-2United StatesWorkplaceConceptsHealthcare worker transmissionDirect patient carePublic health measuresCOVID-19 Task ForceNon-pharmaceutical interventionsEmergency departmentMultidisciplinary recommendationsHealthcare workersPatient careHealth measuresPatient arrivalED patient arrivalsTransmission riskPatientsPerson contactPandemic response effortsCOVID-19COVID-19 pandemicContact reductionClose personTask ForceSocial distancingUnique challengesStaffCare
2019
Electronic Health Record–Assisted Reflex Urine Culture Testing Improves Emergency Department Diagnostic Efficiency
Coughlin RF, Peaper D, Rothenberg C, Golden M, Landry ML, Cotton J, Parwani V, Shapiro M, Ulrich A, Venkatesh AK. Electronic Health Record–Assisted Reflex Urine Culture Testing Improves Emergency Department Diagnostic Efficiency. American Journal Of Medical Quality 2019, 35: 252-257. PMID: 31296024, DOI: 10.1177/1062860619861947.Peer-Reviewed Original ResearchConceptsUrine culture ordersUrine culture testingED visitsUrine cultureEmergency departmentDiagnostic yieldCulture ordersCulture testingUrine culture utilizationClinical decision support toolElectronic health recordsSecondary outcomesPrimary outcomeTest utilizationHealth recordsSignificant decreaseDiagnostic efficiencyMean numberVisitsCulture utilizationOutcomesTesting algorithmEffects of Real-time EMS Direction on Optimizing EMS Turnaround and Load-balancing Between Neighboring Hospital Campuses
Felice J, Coughlin RF, Burns K, Chmura C, Bogucki S, Cone DC, Joseph D, Parwani V, Li F, Saxa T, Ulrich A. Effects of Real-time EMS Direction on Optimizing EMS Turnaround and Load-balancing Between Neighboring Hospital Campuses. Prehospital Emergency Care 2019, 23: 788-794. PMID: 30798628, DOI: 10.1080/10903127.2019.1587123.Peer-Reviewed Original ResearchConceptsNurse navigator programSingle healthcare systemNavigator programHealthcare systemEmergency medical services (EMS) providersHealth system capacityNurse navigatorChief complaintEmergency departmentMedical service providersED volumeInpatient facilitiesTurnaround timeNeighboring hospitalRegistered NursesHospitalHospital campusSignificant decreaseED capacityIncidenceReal-time assessmentProgram implementationPrimary objectiveSignificant improvementPatients
2018
Real-Time Surveys Reveal Important Safety Risks During Interhospital Care Transitions for Neurologic Emergencies
Sather J, Rothenberg C, Finn EB, Sheth KN, Matouk C, Pham L, Parwani V, Ulrich A, Venkatesh AK. Real-Time Surveys Reveal Important Safety Risks During Interhospital Care Transitions for Neurologic Emergencies. American Journal Of Medical Quality 2018, 34: 53-58. PMID: 29987938, DOI: 10.1177/1062860618785248.Peer-Reviewed Original ResearchConceptsEmergency departmentMultidisciplinary quality improvement effortNeuroscience intensive care unitTertiary health care systemIll neurologic patientsIntensive care unitAdvanced practice providersHealth care systemQuality improvement effortsClinician typeIll patientsNeurologic emergencyCare unitCare transitionsClinical surveyNeurologic patientsPractice providersPatient transferCare systemImportant safety risksPatientsRiskReal-time surveySafety risksImprovement effortsEmergency department boarding and adverse hospitalization outcomes among patients admitted to a general medical service
Lord K, Parwani V, Ulrich A, Finn EB, Rothenberg C, Emerson B, Rosenberg A, Venkatesh AK. Emergency department boarding and adverse hospitalization outcomes among patients admitted to a general medical service. The American Journal Of Emergency Medicine 2018, 36: 1246-1248. PMID: 29605480, DOI: 10.1016/j.ajem.2018.03.043.Peer-Reviewed Original ResearchConceptsAdverse hospitalization outcomesRapid response team activationGeneral medical servicesHospitalization outcomesEmergency departmentED boardingComposite outcomeCare escalationPrimary outcomeAdverse outcomesRRT activationPatient encountersConsecutive patient encountersGeneral medicine serviceInpatient hospital stayMedical servicesEmergency department boardingED departureHospital mortalityHospital deathHospital stayED admissionPatient demographicsHospital admissionIntensive care
2017
Multiple Fentanyl Overdoses — New Haven, Connecticut, June 23, 2016
Tomassoni AJ, Hawk KF, Jubanyik K, Nogee DP, Durant T, Lynch KL, Patel R, Dinh D, Ulrich A, D’Onofrio G. Multiple Fentanyl Overdoses — New Haven, Connecticut, June 23, 2016. MMWR Morbidity And Mortality Weekly Report 2017, 66: 107-111. PMID: 28151928, PMCID: PMC5657834, DOI: 10.15585/mm6604a4.Peer-Reviewed Case Reports and Technical NotesConceptsIntensive care unitEmergency departmentYale-New Haven HospitalEmergency medical services (EMS) crewsInterviews of patientsContinuous naloxone infusionNew Haven HospitalPublic health alertsRespiratory failureCare unitNaloxone infusionEndotracheal intubationOpioid overdoseNaloxone distributionPatientsRoute of intoxicationSubsequent episodesHealth alertsOpioid antidoteFentanylHospitalPublic healthFamily membersCocaineRapid notification
2011
Impact of an Emergency Department Closure on the Local Emergency Medical Services System
Sayed M, Mitchell PM, White LF, Rubin-Smith JE, Maciejko TM, Obendorfer DT, Ulrich AS, Dyer S, Olshaker JS. Impact of an Emergency Department Closure on the Local Emergency Medical Services System. Prehospital Emergency Care 2011, 16: 198-203. PMID: 22191683, DOI: 10.3109/10903127.2011.640418.Peer-Reviewed Original ResearchMeSH KeywordsAcademic Medical CentersAmbulancesBostonConfidence IntervalsEmergency Medical ServicesEmergency Service, HospitalEmergency TreatmentFemaleHumansMaleMassachusettsNeeds AssessmentOutcome Assessment, Health CareProspective StudiesRisk AssessmentTime FactorsTransportation of PatientsTrauma CentersUrban PopulationConceptsBoston Medical CenterEmergency departmentED volumeUrban EMS systemED closureAmbulance diversionLocal emergency medical services systemAdult patient visitsEmergency department closureMean emergency departmentTotal ED volumeRatio of patientsEmergency medical services (EMS) providersBusy emergency departmentEmergency medical services systemSignificant increaseEmergency medical servicesEMS systemMedical services systemPatient visitsMedical CenterMedical service providersHospital destinationMultivariate analysisSignificant decrease
2009
Abdominal 64-MDCT for suspected appendicitis: the use of oral and IV contrast material versus IV contrast material only.
Anderson SW, Soto JA, Lucey BC, Ozonoff A, Jordan JD, Ratevosian J, Ulrich AS, Rathlev NK, Mitchell PM, Rebholz C, Feldman JA, Rhea JT. Abdominal 64-MDCT for suspected appendicitis: the use of oral and IV contrast material versus IV contrast material only. American Journal Of Roentgenology 2009, 193: 1282-8. PMID: 19843742, DOI: 10.2214/ajr.09.2336.Peer-Reviewed Original ResearchMeSH KeywordsAbdominal PainAcute DiseaseAdministration, OralAdultAgedAged, 80 and overAppendicitisArea Under CurveContrast MediaDiagnosis, DifferentialFemaleHumansInjections, IntravenousMaleMiddle AgedRadiographic Image Interpretation, Computer-AssistedRadiography, AbdominalReference StandardsROC CurveSensitivity and SpecificityTomography, X-Ray ComputedTriiodobenzoic AcidsConceptsNontraumatic abdominal painDiagnosis of appendicitisAbdominal painContrast materialGroup 2Group 1Contrast mediumAcute nontraumatic abdominal painUrban academic emergency departmentDiagnostic accuracyPresence of appendicitisSmall bowel obstructionOral contrast materialGroup 2 subjectsAcademic emergency departmentGroup 1 subjectsAdult patientsClinical suspicionClinical outcomesEmergency departmentCT examinationsRadiologic diagnosisAppendicitisPatientsCases of disagreementHigh-Risk Chief Complaints II: Disorders of the Head and Neck
Nentwich L, Ulrich AS. High-Risk Chief Complaints II: Disorders of the Head and Neck. Emergency Medicine Clinics Of North America 2009, 27: 713-746. PMID: 19932402, DOI: 10.1016/j.emc.2009.08.002.Peer-Reviewed Original ResearchConceptsHigh-risk chief complaintsAcute focal neurologic deficitsFocal neurologic deficitsDiagnosis of conditionsNeck painNeurologic deficitsOcular emergenciesChief complaintDifficult airwayEmergency departmentDifferent complaintsDiagnosisNeckComplaintsDisordersHeadPainAirwayPatientsSeizuresPathology
2000
Clinical Characteristics as Predictors of Recurrent Alcohol‐related Seizures
Rathlev N, Ulrich A, Fish S, D'Onofrio G. Clinical Characteristics as Predictors of Recurrent Alcohol‐related Seizures. Academic Emergency Medicine 2000, 7: 886-891. PMID: 10958128, DOI: 10.1111/j.1553-2712.2000.tb02066.x.Peer-Reviewed Original ResearchConceptsAlcohol-related seizuresClinical characteristicsBlood pressureEthanol levelsRecurrent seizuresLower riskLower-risk clinical characteristicsPlacebo-treated patientsDiastolic blood pressureSubset of patientsSystolic blood pressureRetrospective secondary analysisDaily ethanol consumptionRecurrent alcoholPlacebo armRandomized trialsPrevious seizuresEmergency departmentEthanol abuseClinical dataDrug treatmentHeart rateEthanol consumptionSeizuresRespiratory rate