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 adherenceCliniciansImplementation 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 pandemic
2021
Improving Emergency Department Throughput Using Audit-and-Feedback With Peer Comparison Among Emergency Department Physicians
Scofi J, Parwani V, Rothenberg C, Patel A, Ravi S, Sevilla M, D'Onofrio G, Ulrich A, Venkatesh AK. Improving Emergency Department Throughput Using Audit-and-Feedback With Peer Comparison Among Emergency Department Physicians. Journal For Healthcare Quality 2021, 44: 69-77. PMID: 34570029, DOI: 10.1097/jhq.0000000000000329.Peer-Reviewed Original ResearchConceptsAdmission ratesEmergency department throughputEmergency physiciansMean timeUrban academic EDEmergency department physiciansMean admission rateLower admission ratesFirst study periodED physiciansAcademic EDDepartment physiciansPatient visitsPractice variationAdmissionPeer comparisonPhysiciansPhysician performanceStudy periodPatientsAcademic emergency physiciansReportAuditMinutesHoursUniversal SARS-CoV-2 Testing of Emergency Department Admissions Increases Emergency Department Length of Stay
Sangal RB, Peaper DR, Rothenberg C, Landry ML, Sussman LS, Martinello RA, Ulrich A, Venkatesh AK. Universal SARS-CoV-2 Testing of Emergency Department Admissions Increases Emergency Department Length of Stay. Annals Of Emergency Medicine 2021, 79: 182-186. PMID: 34756452, PMCID: PMC8424016, DOI: 10.1016/j.annemergmed.2021.09.005.Peer-Reviewed Original ResearchConceptsSARS-CoV-2 testingUniversal SARS-CoV-2 testingEmergency department lengthAdmission lengthED admissionPositivity rateSARS-CoV-2 testAcademic health systemCOVID-19 prevalenceSecondary outcomesED lengthPrevention needsED boardingPatientsStayPositive casesClinical costsHealth systemAdmissionTesting policiesContainment effortsTestingPrevalenceTesting changesPositivityDisparities 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 speakersFailure Mode and Effect Analysis: Engineering Safer Neurocritical Care Transitions
Chilakamarri P, Finn EB, Sather J, Sheth KN, Matouk C, Parwani V, Ulrich A, Davis M, Pham L, Chaudhry SI, Venkatesh AK. Failure Mode and Effect Analysis: Engineering Safer Neurocritical Care Transitions. Neurocritical Care 2021, 35: 232-240. PMID: 33403581, PMCID: PMC8255326, DOI: 10.1007/s12028-020-01160-6.Peer-Reviewed Original ResearchConceptsPatient safetyInter-hospital transferEmergency department throughputIntracerebral hemorrhageAcute careSubarachnoid hemorrhageNeurocritical careCare transitionsMulti-disciplinary teamPatient transferHemorrhageSignificant reductionInterventionCareHazard analysisOutcomesRiskSafetyMultiple providersSpecific use-case examplesEvidence of successPatientsStrokeMethodsWe
2020
The cost of waiting: Association of ED boarding with hospitalization costs
Baloescu C, Kinsman J, Ravi S, Parwani V, Sangal RB, Ulrich A, Venkatesh AK. The cost of waiting: Association of ED boarding with hospitalization costs. The American Journal Of Emergency Medicine 2020, 40: 169-172. PMID: 33272871, DOI: 10.1016/j.ajem.2020.10.058.Peer-Reviewed Original ResearchConceptsED boardingHospitalization costsED crowdingHospital spendingHospital care accessMultivariate linear regression analysisED patient volumeCost of careQuality of careEmergency department boardingCross-sectional analysisPublic health crisisED lengthEffective careCare accessHospital levelInpatient bedsED characteristicsLinear regression analysisPatient volumeCareMedicare spendingMultivariate regressionPatientsRegression analysisLess 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 challengesStaffCareNational Assessment of Surprise Coverage Gaps Provided to Simulated Patients Seeking Emergency Care
Parwani V, Ulrich A, Rothenberg C, Kinsman J, Duhaime M, Thomas M, Venkatesh A. National Assessment of Surprise Coverage Gaps Provided to Simulated Patients Seeking Emergency Care. JAMA Network Open 2020, 3: e206868. PMID: 32412634, PMCID: PMC7229522, DOI: 10.1001/jamanetworkopen.2020.6868.Peer-Reviewed Original Research
2019
Rapid Diagnosis and Treatment of Patients with Acute Type A Aortic Dissection and Malperfusion Syndrome May Normalize Survival to that of Patients with Uncomplicated Type A Aortic Dissection
Bin Mahmood SU, Mori M, Luo J, Zhang Y, Safdar B, Ulrich A, Geirsson A, Elefteriades JA, Mangi AA. Rapid Diagnosis and Treatment of Patients with Acute Type A Aortic Dissection and Malperfusion Syndrome May Normalize Survival to that of Patients with Uncomplicated Type A Aortic Dissection. Aorta 2019, 07: 042-048. PMID: 31529427, PMCID: PMC6748843, DOI: 10.1055/s-0039-1691790.Peer-Reviewed Original ResearchAcute Type A DissectionType A Aortic DissectionA Aortic DissectionMalperfusion syndromeAortic dissectionAcute Type A Aortic DissectionType A DissectionTreatment of patientsMultivariate regression analysisAortic surgeryMidterm outcomesConsecutive patientsOperative outcomesRetrospective reviewMean admissionPoor prognosisIncision intervalContemporary outcomesComparable outcomesPatientsSyndromeMalperfusionBivariate analysisRapid diagnosisOperating roomEffects 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 improvementPatientsA Qualitative Study of Risks Related to Interhospital Transfer of Patients with Nontraumatic Intracranial Hemorrhage
Finn EB, Campbell Britton MJ, Rosenberg AP, Sather JE, Marcolini EG, Feder SL, Sheth KN, Matouk CC, Pham LTL, Ulrich AS, Parwani VL, Hodshon B, Venkatesh AK. A Qualitative Study of Risks Related to Interhospital Transfer of Patients with Nontraumatic Intracranial Hemorrhage. Journal Of Stroke And Cerebrovascular Diseases 2019, 28: 1759-1766. PMID: 30879712, PMCID: PMC8354217, DOI: 10.1016/j.jstrokecerebrovasdis.2018.12.048.Peer-Reviewed Original ResearchMeSH KeywordsAttitude of Health PersonnelCooperative BehaviorDelivery of Health Care, IntegratedHealth Knowledge, Attitudes, PracticeHumansInterdisciplinary CommunicationInterviews as TopicIntracranial HemorrhagesPatient Care TeamPatient SafetyPatient TransferProfessional Practice GapsPrognosisQualitative ResearchRisk AssessmentRisk FactorsTime FactorsConceptsNontraumatic intracranial hemorrhageInterhospital transferCare transitionsIntracranial hemorrhageClinical practiceNeurocritical careSpecialized neurocritical careEmergency medicine providersQuality improvement initiativesAcademic medical centerInsufficient communicationPatient populationMedical CenterMedicine providersProviders' perceptionsHealth professionalsHospitalHemorrhageProvider questionsPatientsImprovement initiativesClinicians' voicesData saturationUnique risksConstant comparative method
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 effortsSpontaneous rupture of the ascending aorta
Bin Mahmood SU, Ulrich A, Safdar B, Geirsson A, Mangi AA. Spontaneous rupture of the ascending aorta. Journal Of Cardiac Surgery 2018, 33: 107-114. PMID: 29405382, DOI: 10.1111/jocs.13535.Peer-Reviewed Original ResearchConceptsAortic ruptureAortic diameterSpontaneous ruptureHereditary connective tissue disordersHigh-risk patientsConnective tissue disordersOperating room timeRisk of ruptureOperative mortalityChest painMedian doorMost patientsAortic diseaseTissue disordersRoom timePatientsRapid diagnosisSuccessful managementMultidisciplinary approachEmergency protocolsAortaRuptureHypertensionPainEtiology
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
2014
The Initial Response to the Boston Marathon Bombing
Gates JD, Arabian S, Biddinger P, Blansfield J, Burke P, Chung S, Fischer J, Friedman F, Gervasini A, Goralnick E, Gupta A, Larentzakis A, McMahon M, Mella J, Michaud Y, Mooney D, Rabinovici R, Sweet D, Ulrich A, Velmahos G, Weber C, Yaffe MB. The Initial Response to the Boston Marathon Bombing. Annals Of Surgery 2014, 260: 960-966. PMID: 25386862, PMCID: PMC5531449, DOI: 10.1097/sla.0000000000000914.Peer-Reviewed Original ResearchConceptsTrauma centerExcellent outcomesUrgent surgical interventionLower extremity soft tissueInitial responseExtremity soft tissueMultidisciplinary care deliveryMultiple casualty incidentsUnderwent amputationHospital mortalityBony injuriesSurgical interventionMedical responseLower extremitiesAdequate preparationPatientsCare deliveryField tourniquetsOperating roomOptimal outcomesSoft tissueImmediate fatalitiesOutcomesCasualty incidentsCentral database
2012
Time Series Analysis of Emergency Department Length of Stay per 8-Hour Shift
Rathlev NK, Obendorfer D, White LF, Rebholz C, Magauran B, Baker W, Ulrich A, Fisher L, Olshaker J. Time Series Analysis of Emergency Department Length of Stay per 8-Hour Shift. Western Journal Of Emergency Medicine 2012, 13: 163-168. PMID: 22900106, PMCID: PMC3415804, DOI: 10.5811/westjem.2011.7.6743.Peer-Reviewed Original ResearchElective surgical admissionsEmergency department lengthHospital occupancySurgical admissionsED patientsIntensive care unit admissionResuscitation casesCare unit admissionAdult ED patientsInner-city teaching hospitalMean emergency department lengthNumber of nursesPrevious shiftED dischargeUnit admissionHospital admissionMore patientsED nursesTeaching hospitalAdditional admissionsAdmissionPatientsShift 1LOSAverage time series analysis
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 disagreement