2024
End‐of‐life emergency department use and healthcare expenditures among older adults: A nationally representative study
Gettel C, Kitchen C, Rothenberg C, Song Y, Hastings S, Kennedy M, Ouchi K, Haimovich A, Hwang U, Venkatesh A. End‐of‐life emergency department use and healthcare expenditures among older adults: A nationally representative study. Journal Of The American Geriatrics Society 2024 PMID: 39311623, DOI: 10.1111/jgs.19199.Peer-Reviewed Original ResearchEnd-of-lifeOut-of-pocket spendingED visitsTotal healthcare spendingMedicare beneficiariesHealthcare spendingEmergency departmentOlder adultsMedicare Current Beneficiary Survey dataAnalysis of Medicare beneficiariesPooled cross-sectional analysisEmergency department usePrimary outcomeDecreased likelihoodDiagnosis of dementiaOut-of-pocket costsNationally representative studyNationally representative sampleAdult decedentsHospice statusDepartment useED useED servicesHealth careHealthcare expendituresCalculation of Overall Hospital Quality Star Ratings With and Without Inclusion of the Peer Grouping Step
Gettel C, Bagshaw K, Qin L, Lin Z, Rothenberg E, Omotosho P, Goutos D, Herrin J, Suter L, Schreiber M, Fleisher L, Myers R, Spivack S, Venkatesh A. Calculation of Overall Hospital Quality Star Ratings With and Without Inclusion of the Peer Grouping Step. JAMA Network Open 2024, 7: e2411933. PMID: 38753326, PMCID: PMC11099678, DOI: 10.1001/jamanetworkopen.2024.11933.Peer-Reviewed Original ResearchConceptsCenters for Medicare & Medicaid ServicesCross-sectional studyHospital characteristicsHigher star ratingsStar ratingsOverall hospital qualityLowest-performing hospitalsOverall star ratingQuality star ratingsHospital star ratingsStar Ratings scoresHospital qualityHospital performanceStratified hospitalsMedicaid ServicesMain OutcomesFace validityPeer groupPeer group approachPrimary outcomePeer comparisonHospitalRating scoresPeerMeasurement group
2023
Inequities among patient placement in emergency department hallway treatment spaces
Tuffuor K, Su H, Meng L, Pinker E, Tarabar A, Van Tonder R, Chmura C, Parwani V, Venkatesh A, Sangal R. Inequities among patient placement in emergency department hallway treatment spaces. The American Journal Of Emergency Medicine 2023, 76: 70-74. PMID: 38006634, DOI: 10.1016/j.ajem.2023.11.013.Peer-Reviewed Original ResearchEscalation of careAdjusted odds ratioED revisitsHallway bedsEmergency departmentHigher oddsPatient placementPatient insurance coverageSocial risk factorsPatient social factorsDischarge AMAED visitsSecondary outcomesPatient agePatient demographicsPrimary outcomeMale sexPatient sexTreatment spaceED censusFemale sexRisk factorsOdds ratioED staffingObservational studyUnfilled in emergency medicine: An analysis of the 2022 and 2023 Match by program accreditation, ownership, and geography
Gettel C, Bennett C, Rothenberg C, Smith J, Goldflam K, Sun W, Venkatesh A. Unfilled in emergency medicine: An analysis of the 2022 and 2023 Match by program accreditation, ownership, and geography. AEM Education And Training 2023, 7: e10902. PMID: 37600854, PMCID: PMC10436034, DOI: 10.1002/aet2.10902.Peer-Reviewed Original ResearchEM residency programsClinical sitesResidency programsGreater riskCross-sectional observational studyPrimary outcomeObservational studyProfit ownershipResidency program characteristicsMedicaid ServicesEmergency medicineCore-based statistical areasGraduate Medical EducationHigher numberRiskAccreditation CouncilDurationMatch cycleProgram characteristicsYearsStatusAvailable dataResidency positionsSociodemographic Disparities in Queue Jumping for Emergency Department Care
Sangal R, Su H, Khidir H, Parwani V, Liebhardt B, Pinker E, Meng L, Venkatesh A, Ulrich A. Sociodemographic Disparities in Queue Jumping for Emergency Department Care. JAMA Network Open 2023, 6: e2326338. PMID: 37505495, PMCID: PMC10383013, DOI: 10.1001/jamanetworkopen.2023.26338.Peer-Reviewed Original ResearchConceptsCross-sectional studyHigh acuityPatient demographicsSame acuityLatino ethnicityNon-Hispanic raceEmergency department careBed placementTime of triageNon-Hispanic blacksNon-Hispanic whitesED visitsPrimary outcomeED arrivalED patientsMedicaid insuranceMean ageTriage acuityStudy visitAcuity patientsSociodemographic disparitiesED outcomesHigher oddsMAIN OUTCOMECare accessEmergency medicine physician workforce attrition differences by age and gender
Gettel C, Courtney D, Agrawal P, Madsen T, Rothenberg C, Mills A, Lall M, Keim S, Kraus C, Ranney M, Venkatesh A. Emergency medicine physician workforce attrition differences by age and gender. Academic Emergency Medicine 2023, 30: 1092-1100. PMID: 37313983, PMCID: PMC10973949, DOI: 10.1111/acem.14764.Peer-Reviewed Original ResearchConceptsFemale emergency physiciansEmergency physiciansMedian ageMultivariate logistic regression modelMale emergency physiciansResidency graduationRepeated cross-sectional analysisCharacteristics of physiciansWorkforce attritionCross-sectional analysisLogistic regression modelsStudy time frameDate of birthPrimary outcomeFemale genderMale physiciansClinical practiceFemale physiciansClinical servicesPhysiciansEmergency medicineAgeNumber of yearsRecent dataWorkforce concernsReal-World Observational Evaluation of Common Interventions to Reduce Emergency Department Prescribing of Opioid Medications
Sangal R, Rothenberg C, Hawk K, D'Onofrio G, Hsiao A, Solad Y, Venkatesh A. Real-World Observational Evaluation of Common Interventions to Reduce Emergency Department Prescribing of Opioid Medications. The Joint Commission Journal On Quality And Patient Safety 2023, 49: 239-246. PMID: 36914528, DOI: 10.1016/j.jcjq.2023.01.013.Peer-Reviewed Original ResearchConceptsOpioid prescribingED visitsElectronic health recordsOpioid prescriptionsEmergency department opioid prescriptionsAnalgesia prescriptionOpioid stewardshipOpioid medicationsSecondary outcomesPrimary outcomePreintervention periodInterruptive alertsCommon interventionPrescribingAlert fatigueElectronic prescribingPrevious interventionsHospital systemObservational evaluationHealth recordsVisitsStewardship policiesInterventionOutcomesPrescriptionChoice Architecture to Assist Clinicians with Appropriate COVID-19 Test Ordering
Sangal R, Venkatesh A, Cahill J, Pettker C, Peaper D. Choice Architecture to Assist Clinicians with Appropriate COVID-19 Test Ordering. The Journal Of Applied Laboratory Medicine 2023, 8: 98-105. PMID: 36610419, DOI: 10.1093/jalm/jfac104.Peer-Reviewed Original ResearchConceptsRSV testingSymptomatic visitsED visitsSARS-CoV-2 nucleic acid amplification testsCOVID-19Respiratory syncytial virus testingNucleic acid amplification testsElectronic health record ordersSystems-based interventionsSARS-CoV-2Symptomatic patientsPrimary outcomeInfluenza testingClinical guidelinesClinician educationClinician practiceVirus testingAmplification testsPatientsTest orderingInstitutional guidelinesClinical needHospital systemVisitsTesting patterns
2022
Establishment of SEP-1 national practice guidelines does not impact fluid administration for septic shock patients
Boccio E, Haimovich A, Jacob V, Zhao X, Wira CR, Venkatesh A, Belsky J. Establishment of SEP-1 national practice guidelines does not impact fluid administration for septic shock patients. The American Journal Of Emergency Medicine 2022, 62: 19-24. PMID: 36209655, DOI: 10.1016/j.ajem.2022.09.038.Peer-Reviewed Original ResearchConceptsSeptic shock patientsShock patientsFluid administrationFluid managementSevere sepsis/septic shockSepsis/septic shockEarly Management BundleRetrospective observational analysisDate of presentationNational practice guidelinesUrban academic centerNational quality measuresLogistic regression analysisOdds of complianceHigh-quality careSepsis severityPrimary outcomeSeptic shockED settingResuscitation strategiesBlood culturesPractice patternsOdds ratioPractice guidelinesProvider practicesImplementation of an Electronic Health Record Integrated Clinical Pathway Improves Adherence to COVID-19 Hospital Care Guidelines
Sangal RB, Liu RB, Cole KO, Rothenberg C, Ulrich A, Rhodes D, Venkatesh AK. Implementation of an Electronic Health Record Integrated Clinical Pathway Improves Adherence to COVID-19 Hospital Care Guidelines. American Journal Of Medical Quality 2022, 37: 335-341. PMID: 35026785, PMCID: PMC9241559, DOI: 10.1097/jmq.0000000000000036.Peer-Reviewed Original ResearchConceptsClinical pathwaySecondary outcomesCOVID-19 treatment guidelinesEmergency department cliniciansIntegrated clinical pathwayCOVID-19Electronic health recordsPrimary outcomeTreatment guidelinesClinician adherenceED cliniciansED patientsCare guidelinesTreatment recommendationsMedication administrationPatient outcomesPatient carePatientsCliniciansHealth systemHealth recordsOutcomesAdherenceAspirinCOVID-19 pandemicIdentifying high-value care for Medicare beneficiaries: a cross-sectional study of acute care hospitals in the USA
Herrin J, Yu H, Venkatesh AK, Desai SM, Thiel CL, Lin Z, Bernheim SM, Horwitz LI. Identifying high-value care for Medicare beneficiaries: a cross-sectional study of acute care hospitals in the USA. BMJ Open 2022, 12: e053629. PMID: 35361641, PMCID: PMC8971780, DOI: 10.1136/bmjopen-2021-053629.Peer-Reviewed Original ResearchConceptsAcute care hospitalsHigh-value careStar hospitalsCare hospitalMedicare spendingEligible Medicare patientsRetrospective observational studyCross-sectional studyNon-teaching statusHigh-quality careHigh-quality hospitalsLow-cost hospitalsHigh-cost hospitalsCharacteristics of hospitalsValue of careSecondary outcomesPrimary outcomeMedicare patientsObservational studyMedicare beneficiariesHospitalQuality careOverall star ratingHospital ValuePrehospital emergency department care activations during the initial COVID-19 pandemic surge.
Leff R, Fleming-Nouri A, Venkatesh AK, Parwani V, Rothenberg C, Sangal RB, Flood CT, Goldenberg M, Wira C. Prehospital emergency department care activations during the initial COVID-19 pandemic surge. American Journal Of Disaster Medicine 2022, 17: 23-39. PMID: 35913181, DOI: 10.5055/ajdm.2022.0417.Peer-Reviewed Original ResearchConceptsCOVID-19 hospital admissionsCOVID-19 pandemic surgeTotal ED volumeNumber of patientsCOVID-19 hospitalizationScatterplot smoothing curvesPublic health measuresCritical medical conditionPublic health emergencyPrehospital presentationStroke activationHospital admissionPrimary outcomeTrauma activationsUrban EDAcademic EDCOVID-19 casesPrehospital settingClinical indicationsType of presentationMedical conditionsED volumePandemic surgeAbsolute decreaseHealth measures
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 patientsDisparities 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 speakersNational trends in emergency department closures, mergers, and utilization, 2005-2015
Venkatesh AK, Janke A, Rothenberg C, Chan E, Becher RD. National trends in emergency department closures, mergers, and utilization, 2005-2015. PLOS ONE 2021, 16: e0251729. PMID: 34015007, PMCID: PMC8136839, DOI: 10.1371/journal.pone.0251729.Peer-Reviewed Original ResearchConceptsHospital-based EDsEmergency department closureED visitsHospital admissionHospital bedsED closureYearly ED visitsLarge health systemAmerican Hospital Association Annual SurveyInpatient bed capacityPrimary outcomeSecondary outcomesMore patientsEmergency departmentRelative increaseInpatient bedsPatient volumeRural areasHealth systemAdmissionVisitsNational trendsBed capacityEDObservational analysisA Cross-Sectional Analysis of High-Acuity Professional Services Performed by Urban and Rural Emergency Care Physicians Across the United States
Gettel CJ, Canavan ME, Greenwood-Ericksen MB, Parwani VL, Ulrich AS, Pilgrim RL, Venkatesh AK. A Cross-Sectional Analysis of High-Acuity Professional Services Performed by Urban and Rural Emergency Care Physicians Across the United States. Annals Of Emergency Medicine 2021, 78: 140-149. PMID: 33771412, PMCID: PMC8238845, DOI: 10.1016/j.annemergmed.2020.11.019.Peer-Reviewed Original ResearchConceptsCross-sectional analysisCare EvaluationRural physiciansMedicare feeEmergency careUrban physiciansMedicare Public Use FilesManagement service codesEmergency care physiciansLogistic regression analysisPrimary outcomeCare physiciansPhysician levelService beneficiariesPublic Use FilePhysiciansIndividual physiciansUse FileRegression analysisQuintileCareProportion of servicesReimbursementPart B.Urban settings
2020
Who provides what care? An analysis of clinical focus among the national emergency care workforce
Gettel CJ, Canavan ME, D'Onofrio G, Carr BG, Venkatesh AK. Who provides what care? An analysis of clinical focus among the national emergency care workforce. The American Journal Of Emergency Medicine 2020, 42: 228-232. PMID: 33298349, PMCID: PMC8005412, DOI: 10.1016/j.ajem.2020.11.069.Peer-Reviewed Original ResearchConceptsAdvanced practice providersEmergency care workforceMedicare feeClinical focusEM physiciansED cliniciansED settingPublic Use FileService beneficiariesMedicare Public Use FilesCare workforceImproved patient outcomesCross-sectional analysisUnique cliniciansPrimary outcomePatient outcomesCare EvaluationClinician expertisePractice providersEmergency careIndividual cliniciansClinical settingPractice settingsCliniciansPhysicians
2018
An appraisal of emergency medicine clinical practice guidelines: Do we agree?
Zupon A, Rothenberg C, Couturier K, Tan T, Siddiqui G, James M, Savage D, Melnick ER, Venkatesh AK. An appraisal of emergency medicine clinical practice guidelines: Do we agree? International Journal Of Clinical Practice 2018, 73: e13289. PMID: 30372798, PMCID: PMC6351191, DOI: 10.1111/ijcp.13289.Peer-Reviewed Original ResearchConceptsACEP clinical policyClinical practice guidelinesStrength of recommendationsClinical policyPractice guidelinesEvidence-based emergency careAGREE II instrumentAppraisal of GuidelinesRigor of developmentAGREE II criteriaOverall qualityPrimary outcomeOverall assessmentEmergency physiciansAmerican CollegeEmergency carePublication dateClarity of presentationSecondary analysisAppraisal instrumentsMean scorePositive associationGuidelinesAppraisal itemsScoresOpening of Psychiatric Observation Unit Eases Boarding Crisis
Parwani V, Tinloy B, Ulrich A, D'Onofrio G, Goldenberg M, Rothenberg C, Patel A, Venkatesh A. Opening of Psychiatric Observation Unit Eases Boarding Crisis. Academic Emergency Medicine 2018, 25: 456-460. PMID: 29266537, DOI: 10.1111/acem.13369.Peer-Reviewed Original ResearchConceptsED LOSLength of stayMedian ED LOSTotal LOSPsychiatric admission ratesCrisis intervention unitSecondary outcomesPrimary outcomeObservation unitAdmission ratesPrimary analysisTertiary care academic medical centerPsychiatric chief complaintsBehavioral health staffInpatient psychiatric bedsAcute psychiatric careAcademic medical centerHours of careEmergency department boardingAdult EDAdult patientsPreintervention periodChief complaintPediatric hospitalInpatient admissions
2013
Time to antibiotics for septic shock: evaluating a proposed performance measure
Venkatesh AK, Avula U, Bartimus H, Reif J, Schmidt MJ, Powell ES. Time to antibiotics for septic shock: evaluating a proposed performance measure. The American Journal Of Emergency Medicine 2013, 31: 680-683. PMID: 23380106, DOI: 10.1016/j.ajem.2012.12.008.Peer-Reviewed Original ResearchConceptsHours of arrivalSeptic shockED arrivalAntibiotic administrationConsecutive ED patientsSeptic shock definitionSeptic shock recognitionEmergency department arrivalCross-sectional studyClinical coursePrimary outcomeAcademic EDED patientsMedian timeShock recognitionVariable progressionPatientsInternational guidelinesShock definitionAntibioticsTime courseAdministrationHours