Browsing by Author "Ulintz, Alexander"

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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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    Pediatric emergency department use by Afghan refugees at a temporary housing facility
    (Wiley, 2023-04-17) Ulintz, Alexander; Anderson, Katherine; Shah, Ishani; Khan, Maria; Weinstein, Elizabeth; Peterson, Rachel; Emergency Medicine, School of Medicine
    Objectives: In August 2021, "Operation Allies Welcome" evacuated 76,000 Afghan refugees to 8 US temporary housing facilities. The impact of refugee influx on local emergency department (ED) use and the resources needed during resettlement are poorly described. We report the frequency of pediatric ED visits and characterize the ED resources needed by pediatric Afghan refugees from 1 temporary housing facility. Methods: This single-center, retrospective cohort study identified participants via a refugee identifier in the medical record. The primary outcome was the frequency and timing of pediatric ED visits; secondary outcomes included resources used during ED evaluation and management. Trained reviewers collected data using a predefined instrument and descriptive statistics are reported. Results: This study included 175 pediatric ED visits by Afghan refugees. The highest volumes (n = 73, 42%) occurred 3-5 weeks after evacuation. Common presenting complaints included fever (36%), gastrointestinal (15%), and respiratory (13%). Resources used included radiography (64%), lab testing (63%), and medication (78%). Specialist consultation occurred in 43% of visits; infectious diseases (17%) and neurology (15%) were the most common. Discharge (61%) was more common than admission (39%), though 31% of discharged patients had a repeat ED visit. Only 51% attended a recommended follow-up appointment. Conclusion: In this study, most pediatric ED visits by refugees occurred within 5 weeks of arrival. Most patients were discharged after diagnostic testing, medication, and specialist consultation, but repeat ED visits were common. These patterns have important implications in preparing for future mass displacement events.