2024
Benchmarking Emergency Physician EHR Time per Encounter Based on Patient and Clinical Factors
Iscoe M, Venkatesh A, Holland M, Krumholz H, Sheares K, Melnick E. Benchmarking Emergency Physician EHR Time per Encounter Based on Patient and Clinical Factors. JAMA Network Open 2024, 7: e2427389. PMID: 39136949, PMCID: PMC11322841, DOI: 10.1001/jamanetworkopen.2024.27389.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedBenchmarkingElectronic Health RecordsEmergency MedicineEmergency Service, HospitalFemaleHumansMaleMiddle AgedPhysiciansTime FactorsFormative 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 ResearchMeSH KeywordsAdultDecision Support Systems, ClinicalEmergency Service, HospitalHumansInformed ConsentRandomized Controlled Trials as TopicResearch DesignConceptsComputerised 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
Adoption of Emergency Department–Initiated Buprenorphine for Patients With Opioid Use Disorder
Gao E, Melnick E, Paek H, Nath B, Taylor R, Loza A. Adoption of Emergency Department–Initiated Buprenorphine for Patients With Opioid Use Disorder. JAMA Network Open 2023, 6: e2342786. PMID: 37948075, PMCID: PMC10638655, DOI: 10.1001/jamanetworkopen.2023.42786.Peer-Reviewed Original ResearchMeSH KeywordsBuprenorphineEmergency Service, HospitalHumansNarcotic AntagonistsOpiate Substitution TreatmentOpioid-Related DisordersConceptsHealth care systemED initiationOpioid use disorderBuprenorphine initiationCare systemUse disordersEmergency Department-Initiated BuprenorphineSecondary analysisClinician's roleEmergency department initiationClinical decision support interventionClinical decision support toolProportional hazard modelingCare of patientsNetwork of cliniciansDecision support interventionsAdvanced practice practitionersDose-dependent mannerUnique cliniciansTime-dependent covariatesTrial interventionNonintervention groupED clustersMore effective interventionsNumber of exposuresCT 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 ResearchMeSH KeywordsDizzinessEmergency Service, HospitalFemaleHumansMagnetic Resonance ImagingMaleMiddle AgedPropensity ScoreRetrospective StudiesStrokeTomography, X-Ray ComputedConceptsSecondary 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 CTADizzinessPatientsRacial 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 ResearchMeSH KeywordsBuprenorphineDelivery of Health CareEmergency Service, HospitalHumansOpiate Substitution TreatmentOpioid-Related DisordersConceptsOpioid 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 analysis
2022
Hospital Occupancy and Emergency Department Boarding During the COVID-19 Pandemic
Janke AT, Melnick ER, Venkatesh AK. Hospital Occupancy and Emergency Department Boarding During the COVID-19 Pandemic. JAMA Network Open 2022, 5: e2233964. PMID: 36178691, PMCID: PMC9526134, DOI: 10.1001/jamanetworkopen.2022.33964.Peer-Reviewed Original ResearchMonthly 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 ResearchMeSH KeywordsAdultBuprenorphineDecision Support Systems, ClinicalEmergency Service, HospitalHumansNarcotic AntagonistsOpiate Substitution TreatmentOpioid-Related DisordersConceptsOpioid 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 patientsTrends and Disparities in Access to Buprenorphine Treatment Following an Opioid-Related Emergency Department Visit Among an Insured Cohort, 2014-2020
Stevens MA, Tsai J, Savitz ST, Nath B, Melnick ER, D’Onofrio G, Jeffery MM. Trends and Disparities in Access to Buprenorphine Treatment Following an Opioid-Related Emergency Department Visit Among an Insured Cohort, 2014-2020. JAMA Network Open 2022, 5: e2215287. PMID: 35657629, PMCID: PMC9166266, DOI: 10.1001/jamanetworkopen.2022.15287.Peer-Reviewed Original Research
2021
Pilot MRI-based strategies to improve the detection of stroke in patients with dizziness/vertigo
Tu LH, Mahajan A, Minja FJ, Navaratnam D, Melnick ER. Pilot MRI-based strategies to improve the detection of stroke in patients with dizziness/vertigo. Clinical Imaging 2021, 82: 234-236. PMID: 34902799, DOI: 10.1016/j.clinimag.2021.12.001.Peer-Reviewed Original ResearchConceptsDizziness/vertigoCT/CTAPosterior strokeNon-specific complaintsEmergency department practiceSuch patientsPosterior circulationStroke evaluationDetection of strokeFalse reassuranceConventional MRIStrokePatientsMRIVertigoDepartment practiceHigh rateSpecialized MRICTALow sensitivityDizzinessComplaintsCTImprove Access to Care for Opioid Use Disorder: A Call to Eliminate the X-Waiver Requirement Now
D'Onofrio G, Melnick ER, Hawk KF. Improve Access to Care for Opioid Use Disorder: A Call to Eliminate the X-Waiver Requirement Now. Annals Of Emergency Medicine 2021, 78: 220-222. PMID: 33966933, PMCID: PMC8324519, DOI: 10.1016/j.annemergmed.2021.03.023.Peer-Reviewed Original ResearchEmergency Department Visits for Nonfatal Opioid Overdose During the COVID-19 Pandemic Across Six US Health Care Systems
Soares WE, Melnick ER, Nath B, D'Onofrio G, Paek H, Skains RM, Walter LA, Casey MF, Napoli A, Hoppe JA, Jeffery MM. Emergency Department Visits for Nonfatal Opioid Overdose During the COVID-19 Pandemic Across Six US Health Care Systems. Annals Of Emergency Medicine 2021, 79: 158-167. PMID: 34119326, PMCID: PMC8449788, DOI: 10.1016/j.annemergmed.2021.03.013.Peer-Reviewed Original ResearchConceptsHealth care systemCause ED visitsNonfatal opioid overdoseED visitsOpioid use disorderCare systemOpioid overdoseUse disordersCOVID-19 pandemicOpioid-related complicationsEmergency department visitsHospital-based interventionsED visit ratesEmergency department utilizationVisit countsUS health care systemOpioid overdose ratesDepartment visitsHistorical controlsAdult visitsOpioid overdosesOverdose ratesMedical emergencyVisit ratesMore weeks
2020
Trends in Emergency Department Visits and Hospital Admissions in Health Care Systems in 5 States in the First Months of the COVID-19 Pandemic in the US
Jeffery MM, D’Onofrio G, Paek H, Platts-Mills TF, Soares WE, Hoppe JA, Genes N, Nath B, Melnick ER. Trends in Emergency Department Visits and Hospital Admissions in Health Care Systems in 5 States in the First Months of the COVID-19 Pandemic in the US. JAMA Internal Medicine 2020, 180: 1328-1333. PMID: 32744612, PMCID: PMC7400214, DOI: 10.1001/jamainternmed.2020.3288.Peer-Reviewed Original ResearchConceptsHospital admission ratesEmergency department visitsED visitsHealth care systemAdmission ratesDepartment visitsHospital admissionCare systemCOVID-19 pandemicLarge health care systemAcute care deliveryCross-sectional studyAnnual ED volumeCoronavirus disease 2019Daily ED visitsInflux of patientsPublic health officialsCOVID-19 case ratesCOVID-19 casesNational public healthDisease 2019MAIN OUTCOMEED volumeSerious symptomsContagious infection
2019
User-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
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 ResearchMeSH KeywordsCraniocerebral TraumaDecision Support Systems, ClinicalDecision Support TechniquesEmergency Service, HospitalFemaleHumansMaleConceptsMinor 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 ResearchMeSH KeywordsCommunicationDecision MakingDecision Support TechniquesEmergency MedicineEmergency Service, HospitalHumansPatient ParticipationPatient-Centered CareRiskConceptsEmergency 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 teamRedefining Overuse to Include Costs: A Decision Analysis for Computed Tomography in Minor Head Injury
Melnick ER, Keegan J, Taylor RA. Redefining Overuse to Include Costs: A Decision Analysis for Computed Tomography in Minor Head Injury. The Joint Commission Journal On Quality And Patient Safety 2015, 41: 313-ap2. PMID: 26108124, DOI: 10.1016/s1553-7250(15)41041-4.Peer-Reviewed Original ResearchConceptsNet monetary benefitCurrent clinical decision rulesMonetary benefitsInclusion of costsCosts outweigh benefitsDecision analysisDecision analytic modelTwo-way sensitivity analysesDecision rulesProbability of lesionCanadian CT Head RuleMain driversOnly effectivenessCostSignificant impactSensitivity analysisCost of CT
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