Browsing by Author "Mills, Angela M."

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    Advancing Patient-centered Outcomes in Emergency Diagnostic Imaging: A Research Agenda
    (Wiley, 2015-12) Kanzaria, Hemal K.; McCabe, Aileen M.; Meisel, Zachary M.; LeBlanc, Annie; Schaffer, Jason T.; Bellolio, Fernanda; Vaughan, William; Merck, Lisa H.; Applegate, Kimberly E.; Hollander, Judd E.; Grudzen, Corita R.; Mills, Angela M.; Carpenter, Christopher R.; Hess, Erik P.; Department of Emergency Medicine, IU School of Medicine
    Diagnostic imaging is integral to the evaluation of many emergency department (ED) patients. However, relatively little effort has been devoted to patient-centered outcomes research (PCOR) in emergency diagnostic imaging. This article provides background on this topic and the conclusions of the 2015 Academic Emergency Medicine consensus conference PCOR work group regarding “Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization.” The goal was to determine a prioritized research agenda to establish which outcomes related to emergency diagnostic imaging are most important to patients, caregivers, and other key stakeholders and which methods will most optimally engage patients in the decision to undergo imaging. Case vignettes are used to emphasize these concepts as they relate to a patient's decision to seek care at an ED and the care received there. The authors discuss applicable research methods and approaches such as shared decision-making that could facilitate better integration of patient-centered outcomes and patient-reported outcomes into decisions regarding emergency diagnostic imaging. Finally, based on a modified Delphi process involving members of the PCOR work group, prioritized research questions are proposed to advance the science of patient-centered outcomes in ED diagnostic imaging.
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    Fallacy of Median Door-to-ECG Time: Hidden Opportunities for STEMI Screening Improvement
    (American Heart Association, 2022) Yiadom, Maame Yaa A.B.; Gong, Wu; Patterson, Brian W.; Baugh, Christopher W.; Mills, Angela M.; Gavin, Nicholas; Podolsky, Seth R.; Salazar, Gilberto; Mumma, Bryn E.; Tanski, Mary; Hadley, Kelsea; Azzo, Caitlin; Dorner, Stephen C.; Ulintz, Alexander; Liu, Dandan; Emergency Medicine, School of Medicine
    Background: ST‐segment elevation myocardial infarction (STEMI) guidelines recommend screening arriving emergency department (ED) patients for an early ECG in those with symptoms concerning for myocardial ischemia. Process measures target median door‐to‐ECG (D2E) time of 10 minutes. Methods and Results: This 3‐year descriptive retrospective cohort study, including 676 ED‐diagnosed patients with STEMI from 10 geographically diverse facilities across the United States, examines an alternative approach to quantifying performance: proportion of patients meeting the goal of D2E≤10 minutes. We also identified characteristics associated with D2E>10 minutes and estimated the proportion of patients with screening ECG occurring during intake, triage, and main ED care periods. We found overall median D2E was 7 minutes (IQR:4–16; range: 0–1407 minutes; range of ED medians: 5–11 minutes). Proportion of patients with D2E>10 minutes was 37.9% (ED range: 21.5%–57.1%). Patients with D2E>10 minutes, compared to those with D2E≤10 minutes, were more likely female (32.8% versus 22.6%, P=0.005), Black (23.4% versus 12.4%, P=0.005), non‐English speaking (24.6% versus 19.5%, P=0.032), diabetic (40.2% versus 30.2%, P=0.010), and less frequently reported chest pain (63.3% versus 87.4%, P<0.001). ECGs were performed during ED intake in 62.1% of visits, ED triage in 25.3%, and main ED care in 12.6%. Conclusions: Examining D2E>10 minutes can identify opportunities to improve care for more ED patients with STEMI. Our findings suggest sex, race, language, and diabetes are associated with STEMI diagnostic delays. Moving the acquisition of ECGs completed during triage to intake could achieve the D2E≤10 minutes goal for 87.4% of ED patients with STEMI. Sophisticated screening, accounting for differential risk and diversity in STEMI presentations, may further improve timely detection.
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    Unconditional care in academic emergency departments
    (Wiley, 2020-05-14) Kline, Jeffrey A.; Burton, John H.; Carpenter, Christopher R.; Meisel, Zachary F.; Miner, James R.; Newgard, Craig D.; Quest, Tammie; Martin, Ian B. K.; Holmes, James F.; Kaji, Amy H.; Bird, Steven B.; Coates, Wendy C.; Lall, Michelle D.; Mills, Angela M.; Ranney, Megan L.; Wolfe, Richard E.; Dorner, Stephen C.; Emergency Medicine, School of Medicine
    Recent news stories have explicitly stated that patients with symptoms of COVID-19 were "turned away" from emergency departments. This commentary addresses these serious allegations, with an attempt to provide the perspective of academic emergency departments (EDs) around the Nation. The overarching point we wish to make is that academic EDs never deny emergency care to any person.