Molly A. Phelps

Delayed emergency department presentation in critically ill patients.

Objectives To determine the frequency and causes of delayed emergency department presentation in critically ill patients who did not have acute myocardial infarction and to evaluate whether factors such as age, gender, prior medical advice, lack of insurance, or low educational level are associated with delayed presentation. Design Prospective, descriptive analysis. Setting Emergency department and medical intensive care unit of an urban county hospital. Patients All adult patients admitted from the emergency department to the medical intensive care unit for reasons other than unstable angina, acute myocardial infarction, or stroke over two 9-wk blocks. Interventions Within 72 hrs of intensive care unit admission, patients or their families were interviewed to determine time elapsed between the onset of symptoms and patient emergency department presentation and to elicit reasons for delays in seeking medical treatment. Measurements and Main Results We interviewed 155 of 173 (90%) of eligible patients and found that 58% waited >24 hrs before presenting to the emergency department. The most commonly cited primary reason for delays were beliefs that symptoms were not serious enough for emergency care (31%) and that symptoms would resolve spontaneously (29%). Most (55%) sought medical treatment only at the urging of family members or other advocates. Although variables such as lack of insurance and low educational level were not associated with delayed presentation, male gender and having sought medical advice before presenting to the emergency department were significantly associated with delay (p = .036 for each). Conclusions Because of poor understanding of the gravity and natural progression of their symptoms, most critically ill patients waited >24 hrs to present to our emergency department. Education on warning symptom recognition for serious illnesses may be warranted not only for patients themselves but also for family members and caregivers.

EMS activation in a cohort of critically ill patients

The objective of this study was to examine Emergency Medical Services (EMS) activation in a cohort of critically ill patients and to evaluate whether factors such as perceived difficulty of access to emergency care, insurance status, and educational level are associated with EMS use. Patients admitted from the emergency department to the intensive care unit (ICU) of an urban county hospital for diagnoses other than acute cardiac conditions or stroke were interviewed about EMS use. Overall EMS use was found to be 52%. Primary reasons for not activating EMS were a belief that symptoms were not serious (36%) or that self-transport was faster (25%). The only factors significantly associated with bypassing EMS were car ownership, lack of health insurance, and self-decision to go to an emergency department. Sixty-eight percent of the sample reported little difficulty in accessing emergency care. In conclusion, because of a belief that symptoms were not serious or self-transport would be faster, nearly half of the critically ill patient sample did not activate EMS. Patient education about warning sign recognition for serious illnesses and about the potential benefits derived from EMS should be improved.

A beginner's guide to research in emergency medicine.

Before dedicating already-scarce time and energy to Emergency Medicine (EM) research, students must assess their underlying intentions. There are many reasons to seek out research opportunities, such as exploring a career in academic EM or developing a relationship with a faculty mentor. Some students have had no exposure to clinical research and wish to try something new, whereas others opt for research externships to evaluate potential residency programs. The only wrong reason to do EM research is the common misconception that such experience is a requirement for successful residency applicants. A recent survey of residency directors ranked research publications nearly last in a list of qualities sought in prospective candidates (1). Programs welcome students with demonstrated commitment to scientific inquiry; however, if research is not intrinsically compelling to you, spend time on other pursuits that will better present you as a well-rounded applicant.