Jim Anderson

Cross-cultural perspectives on intimate partner violence.

&NA; Addressing intimate partner violence through an ecological model and viewing it as a matter of public health can improve identification, treatment, and prevention.

fast-track areas in the emergency department: Are they ethical?

largely based on prejudice or a lack of understanding rather than empiric evidence of a difference in the quality of care.2 Respect for patient autonomy does not require providing all services requested but only that competent patients have the right to decide among reasonable medical options.3 To be in line with the principle of autonomy and informed consent, (1) the care provided in an FTA should be comparable and equivalent to that provided by physicians in the ED, and (2) all patients should be explicitly told that a PA is seeing them. Nonmaleficence requires that PAs not create an unnecessary harm and that we follow the standard of care. Studies have shown that FTAs have reduced rates of patients who left without being seen (LWBS) and have decreased length of stay (LOS) and overall wait time.4,5 Furthermore, this is accomplished without differences in mortality and unscheduled revisits.4,5 The emergency care system has been shown to be oriented toward the efficient care of high-acuity patients but less effective for lowacuity patients, even though a vast majority of ED visits involve lowacuity patients.6 This adds perspective to how PAs may be useful in an attempt to deliver higher quality care to low-acuity patients. The validity of measuring quality of care is highly debated, with one study concluding that mortality is a good measure for patients with acute illnesses who are not supposed to die but is ineffective when used to measure persons with chronic disease.7 To be in line with notions of nonmaleficence, (1) FTAs should improve the efficiency of the entire ED as a whole and should allow more patients to be ›HYPOTHETICAL CASE A 46-year-old female comes into an emergency department (ED) that, like many other emergency facilities, is often affected by overcrowding. In an attempt to compensate for the increased demand for services, the ED has created a fast-track area (FTA). The PA on duty in the FTA sees the patients who are considered “nonurgent” based on diagnostic group, probability of discharge, acuity by triage criteria, and acuity of care. The woman presents with fever (temperature, 101°F), chills, and abdominal pain. The triage nurse decides that the patient is nonurgent and places her in the FTA queue. The administration has explained that the role of the PA is to expedite care in order for more patients to be seen in the ED. The PA examines the patient and suspects that she is mildly dehydrated from her fever. However, the PA is unsure whether to start IV fluids, which might be indicated if the patient were being seen in the normal track of the ED. The PA also wants to order diagnostic tests, including CBC, blood culture, CT of the abdomen, and urinalysis. Starting IV fluids and running tests will require more time and resources. The patient is uninsured, and the PA is concerned that this lack of insurance might have been a contributing factor in the decision to place her in the FTA.

Should PAs assess and address the impact of implicit bias on patient care

divergent findings resulting from identifying the life course of explicit racial preferences. Baron and Banaji’s work indicated that the level of implicit bias and racial preference stays about the same during a life span,2 a view supported by others.3 Aboud’s classic 1980 look at explicit racial preferences showed a surprising difference, with racial preferences decreasing over time from an initial assessment of 6-yearolds.4 These papers underscore the key distinction between implicit and explicit biases, a distinction necessary for clinicians to understand in order to grasp the role of implicit bias.