Emergency Procedures Important to the Training of Emergency Medicine Residents: Who Performs Them in the Emergency Department?

Gallagher, E. John; Coffey, J. Calvin; Lombardi, Gary; Saef, S.H.

doi:10.1111/j.1553-2712.1995.tb03602.x

Cited by 18 publications

(12 citation statements)

References 16 publications

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“…Gallagher et al recently reported the results of a cross-sectional survey of EM residents, in which they found that EPs in EDs that have active EM residents perform on average 50% of a set of index procedures. 9 Numerous other authors have reported experience in teaching EM procedural skills. 10,11 Some authors have used animal laboratory settings [12][13][14] and procedures on the newly dead in the ED 15,16 as well as computer-based technologies in teaching EM procedural skills.…”

Section: Discussionmentioning

confidence: 99%

Procedural Competency in Emergency Medicine: The Current Range of Resident Experience

Hayden

Panacek

1999

Academic Emergency Medicine

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Abstract. Objectives:To evaluate the recorded range of procedures tracked by emergency medicine (EM) programs, and to determine whether differences in procedural experience occur in various types of residency or hospital settings. Methods: The program directors of 112 approved EM programs were asked to send actual procedure logs. The requested information included the average total number of a given procedure per graduating resident, for all procedures that were tracked. Data were categorized by program format, hospital type, and ED volume. To assess the global procedural experience among programs, a set of 22 ''index procedures'' were identified; all procedures the EM residency review committee (RRC-EM) required to be tracked were included in this set. The means per graduating resident for each index procedure were added together to generate a ''mean index procedure sum'' (MIPS) per graduating resident for each residency program. These MIPSs for a residency were then compared by program format, hospital type, and ED volume. A similar analysis was performed for all resuscitations, and a ''mean index resuscitation sum'' (MIRS) per graduating resident was generated. Results: An overall response rate of 82% was achieved; a number of programs had not graduated a residency class and were not included. Sixtyfive of 85 eligible programs (76%) provided procedural data. The average number of a given procedure per graduating resident (95% CI in parentheses) for selected procedures is as follows: oral intubation 65 (46 to 85), intubation unspecified 75 (62 to 87), nasal intubation 6 (4 to 9), cricothyroidotomy 2 (1 to 2), subclavian catheter 23 (16 to 30), chest tubes 17 (14 to 20), intraosseous line 2 (1 to 3), thoracotomy 3 (2 to 5), and vaginal deliveries 17 (13 to 21). The only statistically significant differences in subgroup comparisons were in diagnostic peritoneal lavage, trauma resuscitations, and pediatric medical resuscitations when compared by postgraduate year format, and intubation-unspecified and cricothyroidotomy when compared by hospital type. There was no statistically significant difference when MIPSs were compared by format, hospital type, or ED volume. Conclusions: To the authors' knowledge, this is the first study of the range of EM resident procedure experience across the spectrum of EM residency types and settings. Overall, there are few statistically significant differences in procedure experience among different program formats. Similar experiences are recorded in a variety of different hospital types or ED volumes. However, some programs report very limited EM resident experience with selected critical procedures. There is a large variation in the types and numbers of procedures recorded by EM programs. Key words: emergency medicine; procedure; resident physician. ACA-DEMIC EMERGENCY MEDICINE 1999; 6:728-735 D OCUMENTING proficiency in procedural skills is becoming increasingly important for all physician training programs, including emergency medicine (EM). The core content in EM 1 contains 8...

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Section: Discussionmentioning

confidence: 99%

Procedural Competency in Emergency Medicine: The Current Range of Resident Experience

Hayden

Panacek

1999

Academic Emergency Medicine

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“…DJP imported, merged, and organized the data, performed all statistical analyses, prepared all tables, and contributed, by writing or editing, to all sections of the manuscript. dency training in emergency medicine emphasizes airway management, including use of rapid sequence intubation (RSI), defined as intubation after rapid induction and paralysis (1,2). Several previous studies, mostly with small samples, have reported intubation success rates within single institutions, but comprehensive large multicenter studies are lacking (3)(4)(5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

Emergency Airway Management: A Multi-Center Report of 8937 Emergency Department Intubations

Walls

Brown

Bair

et al. 2011

The Journal of Emergency Medicine

218

182

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“…This literature and a number of airway courses (e.g., the U.S. based Airway Course® and the Canadian-based Airway Interventions and Management Education Program -AIME®) suggest RSI be considered the default method of intubation unless a contraindication precludes it. In the U.S. and Canada, EP manage the vast majority of patients requiring emergency intubation [1][2][3][4][5][6][7] and, in most of these centres, neuromuscular blocking agents (NMBAs) are used to facilitate intubation as part of a rapid-sequence intubation. 1,[3][4][5][6]8 This practice has raised some concern in the anesthesia community.…”

Section: Conclusion : Le Rôle Des Non-anesthésiologistes Dans L'assismentioning

confidence: 99%

Acute airway management in the emergency department by non-anesthesiologists

Kovács

Law

Ross

et al. 2004

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : The responsibility of acute airway management often falls into the hands of non-anesthesiologists. Emergency physicians now routinely use neuromuscular blockade to facilitate intubation. The literature in support of this practice has almost exclusively been published in emergency medicine (EM) journals. This body of literature is presented and issues of educational support are discussed.S So ou ur rc ce e: : A narrative review of the literature on the practice of airway management by non-anesthesiologists.P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : A significant proportion of acute airway management occurring outside the operating room is being performed by non-anesthesiologists. Rapid sequence intubation (RSI) is recognized as a core procedure within the domain of EM. RSI is being performed routinely by emergency physicians practicing in larger centres. Anesthesiologist support for the practice of RSI by nonanesthesiologists has been weak. Formal educational support outside of postgraduate training in the form of dedicated programs for advanced airway management are now being offered. The majority of the literature on the use of RSI by non-anesthesiologists represents retrospective case series, observational studies and registry data published in EM journals. The reported success rates for RSI performed by non-anesthesiologists is high. Complication rates are significant, however reporting consistency has been poor. C Co on nc cl lu us si io on ns s: : The role of non-anesthesiologists in acute airway management is significant. Despite shortcomings in methodology, current evidence and practice supports the use of RSI by trained emergency physicians. Constructive collaborative efforts between anesthesiology and EM need to occur to ensure that educational needs are met and that competent airway management is provided. Objectif : La responsabilité de l'assistance respiratoire d'urgence revient souvent à des médecins non-anesthésiologistes. Les urgentistes utilisent maintenant de routine le bloc neuromusculaire pour faciliter l'intubation. La documentation à l'appui de cette pratique a été publiée presque exclusivement dans les journaux de médecine d'urgence (MU). Nous présentons l'ensemble de ces documents et exposons les questions de formation. Source : Une revue traditionnelle de la documentation sur la pratique de l'assistance respiratoire par des non-anesthésiologistes. Constatations principales : Une proportion significative de l'assistance respiratoire d'urgence, réalisée à l'extérieur de la salle d'opéra-tion, relève de non-anesthésiologistes. L'intubation en séquence rapide (ISR) est reconnue comme une intervention centrale dans le domaine de la MU. L'ISR est généralement réalisée par des urgentistes dans les grands centres. Le soutien anesthésiologique pour la pratique de l'ISR

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Emergency Procedures Important to the Training of Emergency Medicine Residents: Who Performs Them in the Emergency Department?

Cited by 18 publications

References 16 publications

Procedural Competency in Emergency Medicine: The Current Range of Resident Experience

Procedural Competency in Emergency Medicine: The Current Range of Resident Experience

Emergency Airway Management: A Multi-Center Report of 8937 Emergency Department Intubations

Acute airway management in the emergency department by non-anesthesiologists

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