Impact of Health Information Exchange on Emergency Medicine Clinical Decision Making.

INTRODUCTION: The objective of the study was to understand the immediate utility of health information exchange (HIE) on emergency department (ED) providers by interviewing them shortly after the information was retrieved. Prior studies of physician perceptions regarding HIE have only been performed outside of the care environment. METHODS: Trained research assistants interviewed resident physicians, physician assistants and attending physicians using a semi-structured questionnaire within two hours of making a HIE request. The responses were recorded, then transcribed for qualitative analysis. The transcribed interviews were analyzed for emerging qualitative themes. RESULTS: We analyzed 40 interviews obtained from 29 providers. Primary qualitative themes discovered included the following: drivers for requests for outside information; the importance of unexpected information; historical lab values as reference points; providing context when determining whether to admit or discharge a patient; the importance of information in refining disposition; improved confidence of provider; and changes in decisions for diagnostic imaging. CONCLUSION: ED providers are driven to use HIE when they're missing a known piece of information. This study finds two additional impacts not previously reported. First, providers sometimes find additional unanticipated useful information, supporting a workflow that lowers the threshold to request external information. Second, providers sometimes report utility when no changes to their existing plan are made as their confidence is increased based on external records. Our findings are concordant with previous studies in finding exchanged information is useful to provide context for interpreting lab results, making admission decisions, and prevents repeat diagnostic imaging.

Shock therapy. How donut magnets can suspend inappropriate ICD shocks.

EMS crews encounter implantable cardioverter defibrillators (ICDs) daily, but these encounters rarely involve ICDs firing repeatedly on an awake, alert and understandably frightened individual. But that's exactly what happened when an EMS crew from Cottage Grove, Minn., responded to a man with a known heart condition who reported that his implantable defibrillator was firing inappropriately.

Effect of paramedic student internship on performance on the National Registry Written Exam.

BACKGROUND: Paramedic students are exposed to numerous patient contacts during their required internship experience. There is no current research examining paramedic student internship experience in relation to performance on the written portion of the National Registry Exam (NRE-W). METHODS. A retrospective review from 2001 to 2006 of student records from FISDAP was completed. Three hundred ninety-six students met the inclusion criteria: 1) graduate of a paramedic program, 2) consent to access data, 3) internship data previously verified, and 4) NRE-W results available. Pearson correlation coefficients were used to determine if the number of advanced life support (ALS) runs (run with an i.v. and ECG, or one medication administered), hospital patient contacts (PCs), field PCs, total PCs (hospital PCs + field PCs), student team lead runs (TLs), in-hospital clinical hours, field internship hours, or total hours (in-hospital clinical hours + field internship hours) were associated with passing the NRE-W. Logistic regression was used to determine predictors of success on the NRE-W. RESULTS: The number of ALS runs and total PCs were the only variables associated with passing the NRE-W (p=0.003, 95% CI 0.05-0.24; p=0.047, 95% CI=0.00-0.20, respectively). These variables were also predictors for passing the NRE-W (OR = 1.015, 95% CI 1.005-1.025; OR=0.003, 95% CI 1.000-1.006, respectively). CONCLUSIONS: In this sample, the number of ALS runs students completed was the strongest clinical and field internship predictor of passing the NRE-W. The number of ALS runs and total PCs paramedic students complete need to be evaluated by paramedic programs.