2024
Abbreviated MRI in the evaluation of dizziness: report turnaround times and impact on length of stay compared to CT, CTA, and conventional MRI
Tu L, Tegtmeyer K, de Oliveira Santo I, Venkatesh A, Forman H, Mahajan A, Melnick E. Abbreviated MRI in the evaluation of dizziness: report turnaround times and impact on length of stay compared to CT, CTA, and conventional MRI. Emergency Radiology 2024, 31: 705-711. PMID: 39034381, DOI: 10.1007/s10140-024-02273-7.Peer-Reviewed Original ResearchLength of stayEvaluation of dizzinessAbbreviated MRIConventional MRIMRI protocolEmergency departmentNon-contrast CT headConventional MRI protocolHead and neckPosterior circulation strokeAnalysis of length of stayTurnaround timeED length of stayCT headNo significant differenceAcute dizzinessCirculation strokeRetrospective analysisDizzinessAcute settingAssociated with greater impactMRI studiesImaging modalitiesMRIPatientsFormative evaluation of an emergency department clinical decision support system for agitation symptoms: a study protocol
Wong A, Nath B, Shah D, Kumar A, Brinker M, Faustino I, Boyce M, Dziura J, Heckmann R, Yonkers K, Bernstein S, Adapa K, Taylor R, Ovchinnikova P, McCall T, Melnick E. Formative evaluation of an emergency department clinical decision support system for agitation symptoms: a study protocol. BMJ Open 2024, 14: e082834. PMID: 38373857, PMCID: PMC10882402, DOI: 10.1136/bmjopen-2023-082834.Peer-Reviewed Original ResearchConceptsComputerised clinical decision supportED treatRestraint useExperiences of restraint useMental health-related visitsEmergency departmentPrevent agitationSystems-related factorsImprove patient experienceClinical decision support systemsRegional health systemClinical decision supportDe-escalation techniquesRandomised controlled trialsFormative evaluationPeer-reviewed journalsBest-practice guidanceAt-risk populationsCDS toolsThematic saturationED cliniciansPatient experienceED sitesHealth systemED physicians
2023
Cost-Effectiveness of CT, CTA, MRI, and Specialized MRI for Evaluation of Patients Presenting to the Emergency Department With Dizziness.
Tu L, Melnick E, Venkatesh A, Sheth K, Navaratnam D, Yaesoubi R, Forman H, Mahajan A. Cost-Effectiveness of CT, CTA, MRI, and Specialized MRI for Evaluation of Patients Presenting to the Emergency Department With Dizziness. American Journal Of Roentgenology 2023, 222: e2330060. PMID: 37937837, DOI: 10.2214/ajr.23.30060.Peer-Reviewed Original ResearchQuality-adjusted life yearsEvaluation of patientsSecondary prevention measuresEmergency departmentProbabilistic sensitivity analysesConventional MRICumulative quality-adjusted life yearsCost-effective strategyIncremental costNoncontrast CT headAcute stroke treatmentSpecialized MRISelection of patientsHigher quality-adjusted life yearsConventional brain MRIMarkov decision-analytic modelNon-contrast CTNoncontrast head CTHealthcare system perspectiveUse of MRIBase-case analysisPrevention measuresDecision analytic modelGreater quality-adjusted life yearsDeterministic sensitivity analysesCT With CTA Versus MRI in Patients Presenting to the Emergency Department With Dizziness: Analysis Using Propensity Score Matching.
Tu L, Navaratnam D, Melnick E, Forman H, Venkatesh A, Malhotra A, Yaesoubi R, Sureshanand S, Sheth K, Mahajan A. CT With CTA Versus MRI in Patients Presenting to the Emergency Department With Dizziness: Analysis Using Propensity Score Matching. American Journal Of Roentgenology 2023, 221: 836-845. PMID: 37404082, DOI: 10.2214/ajr.23.29617.Peer-Reviewed Original ResearchConceptsSecondary stroke prevention medicationsStroke prevention medicationsEmergency departmentPrevention medicationsEchocardiography evaluationPosterior circulation strokeProportion of patientsGroup of patientsPhysical examination findingsNeuroimaging resultsUse of MRIReview of systemsGreater frequencyPropensity-score matchingExamination findingsRetrospective studyED readmissionMedical historyHead CTClinical impactMRI examinationsBrain MRINeck CTADizzinessPatientsImplementation strategies to address the determinants of adoption, implementation, and maintenance of a clinical decision support tool for emergency department buprenorphine initiation: a qualitative study
Simpson M, Ritger C, Hoppe J, Holland W, Morris M, Nath B, Melnick E, Tietbohl C. Implementation strategies to address the determinants of adoption, implementation, and maintenance of a clinical decision support tool for emergency department buprenorphine initiation: a qualitative study. Implementation Science Communications 2023, 4: 41. PMID: 37081581, PMCID: PMC10117277, DOI: 10.1186/s43058-023-00421-7.Peer-Reviewed Original ResearchOpioid use disorderBuprenorphine initiationClinical decision support toolEmergency departmentED cliniciansSignificant public health problemCDS interventionsIntervention EDsUsual care armPragmatic clinical trialsPublic health problemEvidence-based treatmentsCare armED initiationBuprenorphine treatmentED settingIntervention armOngoing treatmentClinical trialsClinician experienceClinician trainingUse disordersBuprenorphineHealth problemsSecondary aimRacial and ethnic disparities in emergency department–initiated buprenorphine across five health care systems
Holland W, Li F, Nath B, Jeffery M, Stevens M, Melnick E, Dziura J, Khidir H, Skains R, D'Onofrio G, Soares W. Racial and ethnic disparities in emergency department–initiated buprenorphine across five health care systems. Academic Emergency Medicine 2023, 30: 709-720. PMID: 36660800, PMCID: PMC10467357, DOI: 10.1111/acem.14668.Peer-Reviewed Original ResearchConceptsOpioid use disorderCommunity emergency departmentsEmergency departmentDischarge diagnosisHealth care systemHispanic patientsBlack patientsHospital typeCare systemNon-Hispanic patientsOpioid overdose deathsClinical decision support systemOpioid withdrawalPrimary outcomeMedication treatmentBuprenorphine accessED treatmentTreatment accessOverdose deathsX-waiverBuprenorphinePatientsUse disordersEthnic disparitiesSecondary analysisImplementation of Eye-Tracking Technology to Monitor Clinician Fatigue in Routine Clinical Care: A Feasibility Study
Kadhim B, Khairat S, Li F, Gross I, Nath B, Hauser R, Melnick E. Implementation of Eye-Tracking Technology to Monitor Clinician Fatigue in Routine Clinical Care: A Feasibility Study. ACI Open 2023, 07: e1-e7. DOI: 10.1055/s-0042-1760267.Peer-Reviewed Original ResearchRoutine clinical careFatigue scoresClinical careClinician fatigueReal-world clinical settingMixed methods feasibility studyAcademic emergency departmentSelf-reported fatigueRoutine careEmergency departmentPhysician fatigueConfounding factorsClinical settingStudy designConvenience sampleCareMedical errorsFeasibility studyCliniciansScoresPhysiological fatigueEye-tracking technologyFatigue
2022
Monthly Rates of Patients Who Left Before Accessing Care in US Emergency Departments, 2017-2021
Janke AT, Melnick ER, Venkatesh AK. Monthly Rates of Patients Who Left Before Accessing Care in US Emergency Departments, 2017-2021. JAMA Network Open 2022, 5: e2233708. PMID: 36178693, PMCID: PMC9526078, DOI: 10.1001/jamanetworkopen.2022.33708.Peer-Reviewed Original ResearchUser centered clinical decision support to implement initiation of buprenorphine for opioid use disorder in the emergency department: EMBED pragmatic cluster randomized controlled trial
Melnick ER, Nath B, Dziura JD, Casey MF, Jeffery MM, Paek H, Soares WE, Hoppe JA, Rajeevan H, Li F, Skains RM, Walter LA, Patel MD, Chari SV, Platts-Mills TF, Hess EP, D'Onofrio G. User centered clinical decision support to implement initiation of buprenorphine for opioid use disorder in the emergency department: EMBED pragmatic cluster randomized controlled trial. The BMJ 2022, 377: e069271. PMID: 35760423, PMCID: PMC9231533, DOI: 10.1136/bmj-2021-069271.Peer-Reviewed Original ResearchConceptsOpioid use disorderUsual care armEmergency departmentUse disordersCare armPragmatic clusterClinical decision supportIntervention armRoutine emergency careSecondary implementation outcomesSeverity of withdrawalTertiary care centerClinical decision support toolInitiation of buprenorphineElectronic health record tasksElectronic health record workflowsRE-AIM frameworkElectronic health record platformsHealth record platformsClinical decision support systemElectronic health recordsVisit documentationTreatment of addictionUsual careAdult patientsPragmatic clinical trial design in emergency medicine: Study considerations and design types
Gettel CJ, Yiadom MYAB, Bernstein SL, Grudzen CR, Nath B, Li F, Hwang U, Hess EP, Melnick ER. Pragmatic clinical trial design in emergency medicine: Study considerations and design types. Academic Emergency Medicine 2022, 29: 1247-1257. PMID: 35475533, PMCID: PMC9790188, DOI: 10.1111/acem.14513.Peer-Reviewed Original ResearchConceptsPragmatic clinical trialsClinical trial designTrial designReal-world clinical practicePragmatic clinical trial designElectronic health recordsEmergency departmentClinical trialsStudy design typeClinical practiceStudy typeTrial componentsHealth recordsEmergency medicineEmergency medicine investigatorsHuman subjects concernsInvestigatorsStudy findingsStudy considerationsTrialistsTrials
2019
Identifying Opioid Use Disorder in the Emergency Department: Multi-System Electronic Health Record–Based Computable Phenotype Derivation and Validation Study
Chartash D, Paek H, Dziura JD, Ross BK, Nogee DP, Boccio E, Hines C, Schott AM, Jeffery MM, Patel MD, Platts-Mills TF, Ahmed O, Brandt C, Couturier K, Melnick E. Identifying Opioid Use Disorder in the Emergency Department: Multi-System Electronic Health Record–Based Computable Phenotype Derivation and Validation Study. JMIR Medical Informatics 2019, 7: e15794. PMID: 31674913, PMCID: PMC6913746, DOI: 10.2196/15794.Peer-Reviewed Original ResearchOpioid use disorderNegative predictive valuePositive predictive valueEmergency department patientsEmergency departmentUse disordersHealth care systemPredictive valueComputable phenotypeExternal validation phasesDepartment patientsCare systemPhysician chart reviewLarge health care systemExternal validation cohortEmergency medicine physiciansHigh predictive valueElectronic health recordsChart reviewChief complaintValidation cohortPragmatic trialClinical dataBilling codesMedicine physiciansUser-centred clinical decision support to implement emergency department-initiated buprenorphine for opioid use disorder: protocol for the pragmatic group randomised EMBED trial
Melnick ER, Jeffery MM, Dziura JD, Mao JA, Hess EP, Platts-Mills TF, Solad Y, Paek H, Martel S, Patel MD, Bankowski L, Lu C, Brandt C, D’Onofrio G. User-centred clinical decision support to implement emergency department-initiated buprenorphine for opioid use disorder: protocol for the pragmatic group randomised EMBED trial. BMJ Open 2019, 9: e028488. PMID: 31152039, PMCID: PMC6550013, DOI: 10.1136/bmjopen-2018-028488.Peer-Reviewed Original ResearchMeSH KeywordsAdultBuprenorphineCluster AnalysisDecision Support Systems, ClinicalEmergency Service, HospitalFemaleHumansMaleMiddle AgedMulticenter Studies as TopicNarcotic AntagonistsOpiate Substitution TreatmentOpioid-Related DisordersPragmatic Clinical Trials as TopicRandomized Controlled Trials as TopicUnited StatesYoung AdultConceptsOpioid use disorderEmergency departmentSecondary outcomesUse disordersEmergency department-initiated buprenorphineWestern Institutional Review BoardData Safety Monitoring BoardIndependent study monitorsRates of cliniciansRoutine emergency careSafety monitoring boardInstitutional review boardClinical decision support systemClinician prescribingPragmatic clusterPatient characteristicsPeer-reviewed journalsClinical decision supportPrimary outcomeED cliniciansWithdrawal symptomsOngoing treatmentPatients' willingnessMonitoring boardBuprenorphine
2018
ADHERENCE TO THE PECARN PEDIATRIC HEAD INJURY RULE IN TWO CANADIAN EMERGENCY SETTINGS
Gariepy M, Gravel J, Turcotte S, Légaré F, Melnick E, Hess E, Witteman H, Lelaidier-Hould L, Truchon C, Sauvé L, Plante P, Lesage N, Archambault P. ADHERENCE TO THE PECARN PEDIATRIC HEAD INJURY RULE IN TWO CANADIAN EMERGENCY SETTINGS. Paediatrics & Child Health 2018, 23: e9-e10. PMCID: PMC5961350, DOI: 10.1093/pch/pxy054.024.Peer-Reviewed Original ResearchTraumatic brain injuryLevel II trauma centerEmergency departmentHead CTPECARN rulesHead traumaTrauma centerImportant traumatic brain injuryMinor traumatic brain injuryMandatory inclusion criteriaRetrospective chart reviewPediatric level ICanadian emergency departmentsRisk of cancerYears of ageCT overuseEligible patientsChart reviewPediatric patientsRelated complicationsHead injuryMedical recordsBrain injuryInclusion criteriaLevel I
2017
Patient-Centered Decision Support: Formative Usability Evaluation of Integrated Clinical Decision Support With a Patient Decision Aid for Minor Head Injury in the Emergency Department
Melnick ER, Hess EP, Guo G, Breslin M, Lopez K, Pavlo AJ, Abujarad F, Powsner SM, Post LA. Patient-Centered Decision Support: Formative Usability Evaluation of Integrated Clinical Decision Support With a Patient Decision Aid for Minor Head Injury in the Emergency Department. Journal Of Medical Internet Research 2017, 19: e174. PMID: 28526667, PMCID: PMC5457532, DOI: 10.2196/jmir.7846.Peer-Reviewed Original ResearchConceptsMinor head injuryCanadian CT Head RuleClinician-patient relationshipPatient-specific riskHead injuryPatient decision aidClinical decision supportDecision supportCT useEmergency departmentPatient concernsCanadian Computed Tomography Head RuleUser interface developmentMinor head injury patientsFormative usability evaluationPatient-centered decision supportEmergency care cliniciansUser-centered designHead injury patientsClinical decision rulePatients' specific concernsIntegrated clinical decision supportTomography Head RuleInitial prototype developmentHealth information technology
2016
Development and Testing of Shared Decision Making Interventions for Use in Emergency Care: A Research Agenda
Melnick ER, Probst MA, Schoenfeld E, Collins SP, Breslin M, Walsh C, Kuppermann N, Dunn P, Abella BS, Boatright D, Hess EP. Development and Testing of Shared Decision Making Interventions for Use in Emergency Care: A Research Agenda. Academic Emergency Medicine 2016, 23: 1346-1353. PMID: 27457137, PMCID: PMC5145730, DOI: 10.1111/acem.13045.Peer-Reviewed Original ResearchConceptsEmergency carePractice Work GroupLevel of evidenceEvidence-based toolsED settingSDM interventionsEmergency departmentPatient understandingMedical optionsDecision aidPatient engagementNominal group techniquePatientsInterventionCliniciansCareOutcomesKey domainsFacilitate conversationsGroupRisk communicationGroup techniqueCaregivers
2015
Understanding Overuse of Computed Tomography for Minor Head Injury in the Emergency Department: A Triangulated Qualitative Study
Melnick ER, Shafer K, Rodulfo N, Shi J, Hess EP, Wears RL, Qureshi RA, Post LA. Understanding Overuse of Computed Tomography for Minor Head Injury in the Emergency Department: A Triangulated Qualitative Study. Academic Emergency Medicine 2015, 22: 1474-1483. PMID: 26568523, DOI: 10.1111/acem.12824.Peer-Reviewed Original ResearchConceptsMinor head injuryCanadian CT Head RuleEmergency departmentHead injuryComputed tomographyPatient expectationsUrban academic emergency departmentUse of CTCommunity emergency departmentsClinical decision ruleHigh-quality evidenceAcademic emergency departmentHealth care providersFocus groupsPatient anxietyCT useED practiceCT scanCare providersProvider confidenceED contextPatient engagementQualitative studyTriangulated qualitative studyMultidisciplinary team
2012
CT Overuse for Mild Traumatic Brain Injury
Melnick ER, Szlezak CM, Bentley SK, Dziura JD, Kotlyar S, Post LA. CT Overuse for Mild Traumatic Brain Injury. The Joint Commission Journal On Quality And Patient Safety 2012, 38: 483-489. PMID: 23173394, DOI: 10.1016/s1553-7250(12)38064-1.Peer-Reviewed Original ResearchConceptsMild traumatic brain injuryCanadian CT Head RuleNew Orleans CriteriaTraumatic brain injuryProportion of casesComputed tomographyEmergency departmentBrain injuryCT useEmergency Physicians Clinical PolicyLevel I emergency departmentImportant brain injuryClinical Excellence (NICE) guidelinesMinor head injuryProspective observational studyCurrent guideline recommendationsHead CT findingsEvidence-based guidelinesHealth care costsRadiation-induced cancerCT overuseAdult patientsExcellence guidelinesCT findingsGuideline recommendations