Caroline Boulouffe

Does offering pricing information to resident physicians in the emergency department potentially reduce laboratory and radiology costs

Objectives The aim of this study was to establish whether price list information could reduce laboratory and radiological examination costs in emergency departments (EDs). Materials and methods A prospective survey of adult (>16 years old) admissions was conducted at the ED of a university hospital in Belgium. Nine resident emergency physicians were followed for a span of 6 months, which was divided into 2-month periods: control (October and November 2011), intervention (December 2011 to January 2012), and washout (February and March 2012). Laboratory and radiological costs for each of the daily admissions were calculated during the respective periods and compared. Results A total of 3758 patients were registered: 1093 in period 1 (control), 1329 in period 2 (intervention), and 1336 in period 3 (washout). We observed significant reductions in examination costs: 10.73% (P=0.015) for laboratory and 33.66% (P<0.001) for radiological costs in period 2 versus period 1; 5.02% (P=0.014) for laboratory and 40.00% (P<0.001) for radiological costs in period 3 versus period 1. In addition, we found that laboratory examination costs increased slightly between periods 2 and 3 (+6.4%), whereas costs related to radiologic examinations continued to decrease (−10.16%); however, these differences were not statistically significant. Conclusion We conclude that the distribution of price lists at EDs promotes cost awareness, which can result in significant decreases in examination costs.

Assessing clinical reasoning using a script concordance test with electrocardiogram in an emergency medicine clerkship rotation

Objectives Script concordance tests (SCTs) can be used to assess clinical reasoning, especially in situations of uncertainty, by comparing the responses of examinees with those of emergency physicians. The examinees answers are scored based on the level of agreement with responses provided by a panel of experts. Emergency physicians are frequently uncertain in the interpretation of ECGs. Thus, the aim of this study was to validate an SCT combined with an ECG. Methods An SCT-ECG was developed. The test was administered to medical students, residents and emergency physicians. Scoring was based on data from a panel of 12 emergency physicians. The statistical analyses assessed the internal reliability of the SCT (Cronbachs α) and its ability to discriminate between the different groups (ANOVA followed by Tukeys post hoc test). Results The SCT-ECG was administered to 21 medical students, 19 residents and 12 emergency physicians. The internal reliability was satisfactory (Cronbachs α=0.80). Statistically significant differences were found between the groups (F0.271=21.07; p<0.0001). Moreover, significant differences (post hoc test) were detected between students and residents (p<0.001), students and experts (p<0.001), and residents and experts (p=0.017). Conclusions This SCT-ECG is a valid tool to assess clinical reasoning in a context of uncertainty due to its high internal reliability and its ability to discriminate between different levels of expertise.

Severe hiccups and intravenous lidocaine.

Abstract We report the case of a patient in whom the use of intravenous lidocaine to treat incapacitating hiccups was a success. Intravenous lidocaine should be considered as an alternative treatment for severe hiccups when classical medications are ineffective or produce side effects.

Sulfonylurea-induced hypoglycaemia: use of octreotide.

Abstract Sulfonylurea compounds are commonly used to treat type 2 diabetes mellitus. The case of an old alcoholic addicted diabetic patient treated with gliquidone developing recurrent and prolonged hypoglycaemias refractory to dextrose administration is related. According to the emergency literature, the use of octreotide in sulfonyureainduced hypoglycaemia refractory to dextrose administration is related to overdoses of SUA. Use of octreotide with our patient allowed stabilization of the glycaemia.

Bluish vomiting: A rare clinical presentation of poisoning

Abstract Bluish vomiting is a symptom of poisoning that is rarely seen in Western emergency departments. Consequently, physicians are not aware of the diagnosis, complications, and treatment of this unusual form of intoxication. In this article, we report a case of bluish vomiting that occurred after an accidental ingestion of copper sulphate. In the discussion, we review three life-threatening causes of bluish vomiting (copper sulphate, boric acid, and paraquat ingestion), and we discuss their respective clinical manifestations, specificities, complications, and management therapies.