Assessing adequacy of emergency provider documentation among interhospital transferred patients with acute aortic dissection

BACKGROUND: Acute aortic dissection(AoD) is a hypertensive emergency often requiring the transfer of patients to higher care hospitals; thus, clinical care documentation and compliance with the Emergency Medical Treatment and Active Labor Act(EMTALA) is crucial. The study assessed emergency providers(EP) documentation of clinical care and EMTALA compliance among interhospital transferred AoD patients.METHODS: This retrospective study examined adult patients transferred directly from a referring emergency department(ED) to a quaternary academic center between January 1, 2011 and September 30, 2015. The primary outcome was the percentage of records with adequate documentation of clinical care(ADoCC). The secondary outcome was the percentage of records with adequate documentation of EMTALA compliance(ADoEMTALA). RESULTS: There were 563 electronically identified patients with 287 included in the final analysis. One hundred and five(36.6%) patients had ADoCC while 166(57.8%) patients had ADoEMTALA. Patients with inadequate documentation of EMTALA(IDoEMTALA) were associated with a higher likelihood of not meeting the American Heart Association(AHA) ED Departure SBP guideline(OR 1.8, 95% CI 1.03–3.2, P=0.04). Male gender, handwritten type of documentation, and transport by air were associated with an increased risk of inadequate documentation of clinical care(IDoCC), while receiving continuous infusion was associated with higher risk of IDoEMTALA.CONCLUSION: Documentation of clinical care and EMTALA compliance by Emergency Providers is poor. Inadequate EMTALA documentation was associated with a higher likelihood of patients not meeting the AHA ED Departure SBP guideline. Therefore, Emergency Providers should thoroughly document clinical care and EMTALA compliance among this critically ill group before transfer.

Predictors associated with inappropriate transport of near shore spinal injuries

Purpose:Spinal injuries resulting in neurological damage cause significant morbidity.Swift neurosurgical intervention can mitigate negative outcomes.However,variable mechanisms of injury may be associated with inappropriate transport(IAT),which may delay necessary surgical interventions.Patients with near shore spinal injuries(NSSI)presented with unique mechanisms,so we investigated factors associated with IAT in patients with NSSI.Methods:We performed a multicenter retrospective study of all adult patients transported from a beach resort to 3 hospitals for suspected NSSI between 2006-2017.We excluded patients transferred to other facilities,and those not injured in the water.Primary outcome was IAT,defined as patients with NSSI requiring transfer to another trauma center.To avoid heterogeneity in our analysis,we further excluded patients without NSSI who were inappropriately transported to a level I trauma center.We used multivariable logistic regression to assess association of independent variables(such as demographic,environmental,and clinical factors)with outcome.Results:We analyzed 278 patients with suspected NSSI,and found 14(5.0%)had IAT.Compared to appropriately transported patients,diving was associated with higher percentages of IAT(28.6%vs.3.9%,p=0.014)and more were transported by air(50.0%vs.20.6%,p=0.01).In multivariable regression,patients'oxygenation saturation(odds ratio[OR]=0.8,95%confidence intervals[Cl]:077-0.98)and diving(OR=7.5,95%Cl:1.2-46)were significantly associated with IAT.Conclusion:Rate of IAT for patients with NSSI was low.However,first responders and emergency medicine providers should be aware that diving is associated with a higher likelihood of IAT.