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 ResearchVirtual Scribes and Physician Time Spent on Electronic Health Records
Rotenstein L, Melnick E, Iannaccone C, Zhang J, Mugal A, Lipsitz S, Healey M, Holland C, Snyder R, Sinsky C, Ting D, Bates D. Virtual Scribes and Physician Time Spent on Electronic Health Records. JAMA Network Open 2024, 7: e2413140. PMID: 38787556, PMCID: PMC11127114, DOI: 10.1001/jamanetworkopen.2024.13140.Peer-Reviewed Original ResearchConceptsEHR timeElectronic health recordsHealth recordsPhysician timePre-post quality improvement studyPrimary care specialtiesQuality improvement studyFactors associated with changesAssociated with significant decreasesAssociated with burnoutMultivariate linear regression modelAcademic medical centerCare specialtiesImprovement studyLinear regression modelsMedical specialistsMedical specialtiesOutpatient settingStudy sampleSignificant decreasePhysiciansMedical CenterParticipation episodesAppointmentWomen's HospitalFormative 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
2022
User 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 patients
2021
Emergency 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
The Association Between Perceived Electronic Health Record Usability and Professional Burnout Among US Physicians
Melnick ER, Dyrbye LN, Sinsky CA, Trockel M, West CP, Nedelec L, Tutty MA, Shanafelt T. The Association Between Perceived Electronic Health Record Usability and Professional Burnout Among US Physicians. Mayo Clinic Proceedings 2019, 95: 476-487. PMID: 31735343, DOI: 10.1016/j.mayocp.2019.09.024.Peer-Reviewed Original ResearchConceptsElectronic health record usabilityOdds of burnoutUS physiciansStrong dose-response relationshipAmerican Medical Association Physician MasterfileEHR usabilityDose-response relationshipCross-sectional surveyLower oddsPhysician MasterfileMultivariate analysisPractice settingsCurrent EHR systemsMaslach Burnout InventoryPhysiciansSUS scoreProfessional burnoutMedical specialtiesNumber of nightsPrevious studiesOddsScoresPhysician usersTechnology usabilityBurnout InventoryUser-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
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
2007
Clinicopathological conference: 29-year-old with visual loss, hypertension, and a seizure.
Suchard J, Melnick E. Clinicopathological conference: 29-year-old with visual loss, hypertension, and a seizure. Academic Emergency Medicine 2007, 14: 819-24. PMID: 17726128, DOI: 10.1197/j.aem.2007.06.019.Peer-Reviewed Original Research