EPIC goes live in the ED and hospital at Moffitt on October 1. Training for providers will occur mid July through September (to be scheduled) ; these will be 8 hours in one day. We are looking for superusers who will train on July 21 and then help at subsequent trainings and during go-live - superusers will get paid for their time! ALSO please do not schedule vacation or time away during the first two weeks of October.

First DEM unified clinical consultation policy: after a series of meetings between orthopedic and EM faculty at both SFGH and Moffitt, and review by our faculty at both sites, a unified policy (our first) on orthopedic consultation for both EDs has been developed. This policy helps ensure appropriate consultation but also independent management of the majority of cases (as well as the needs of our residents), and is consistent with most of our current practice and the current practice of other similar major academic EDs that we surveyed. Our goal is that this lead to more consistent and efficient practice, and if successful we will seek to develop additional policies with other departments with whom we have frequent interactions. The full policy will be emailed to all faculty. 

UCSF Fresno has successfully recruited two ultrasound fellows for the 2011-2012 year - Cameron Jones (UCSF-Fresno) and Denver Chao (Kern Medical Center), as well as two Wilderness Medicine/EMS fellows - Megann Young (Highland) and Ross Hooker (USC).

Michelle Lin will be giving Grand Rounds at Georgetown University in Washington DC on April 14.

Mary Mercer is the Invited Speaker for Grand Rounds at St Francis and St Mary's Hospitals on March 29 and April 7, 2011 Lecture title: "Disaster Preparedness for Physicians and Hospital Personnel."

The Wilderness Medicine Elective, directed by Judy Klein and Jake Miss, is currently being offered to students in all graduate schools at UCSF with approximately 100 students participating. In addition to didactic lectures on subjects such as high altitude illness, hypothermia, expedition medicine, snake and insect envenomations, toxic plants and mushrooms and marine envenomations, students get hand-on practice with backcountry trauma scenarios, devising splints, makeshift litters and improvising all sorts of medical equipment. You will never look at a garbage bag, safety pins, or duct tape the same way again!

Susan Promes is working on the SAEM Faculty Salary Survey. The data analysis has been completed and she is in the process of writing the manuscript.

Eric Isaacs just returned from the first half (8 days) of the Harvard Medical School Palliative Care Education and Practice course. He is looking forward to bringing some of the concepts back to San Francisco to enrich our practice and make the care of this challenging patient population more satisfying. He will also be travelling to Amsterdam in May to present research at the International Conference of Clinical Ethics Committees on Case Features and Systemic Pressures Impacting Incapacitated Patients Alone at a Safety Net Hospital. He has been working with Kate Ettinger, JD to develop a more consistent approach to decision making for this vulnerable population.

• Global Health: Jake Miss, Swati Singh, and Adrian Flores
•  Health Professions Education: Kristin Berona, Marianne Juarez, Aaron Kornblith, and Annemarie Sheets
• Health and Society: Kendall Allred

For more important meeting and event dates, see the new faculty Google calendar: http://www.google.com/calendar/embed?src=f5b8l06u05kngi6sarkt7hlk6k%40group.calendar.google.com&ctz=America/Los_Angeles&pvttk=0e86d14ff3686bc08aa593b683dd59e1   

Wednesday, May 4: Joint faculty meeting for UCSF and SFGH at the Faculty Alumni House at Parnassus, 10 AM - 3 PM. If you have not RSVP'd, please email michelle.konstantinovsky@ucsf.edu immediately.  

Tuesday, May 17: Susan Promes will be giving a faculty development  workshop in May from 1-5 PM at Parnassus, in room S-157. 

Competency-Based Education and Evaluation 
Patricia O'Sullivan, EdD
Susan Promes, MD 

http://medschool.ucsf.edu/workshops/10-11/Competencies.aspx

Publications

Diercks DB, Mehrotra A, Nazarian DJ, Promes SB, Decker WW, Fesmire FM. Clinical policy: critical issues in the evaluation of adult patients presenting to the emergency department with acute blunt abdominal trauma. Annals of Emergency Medicine, 2011 Apr; 57(4): 387-404.

Presentations/Lectures

Susan Promes was an invited speaker for UCSF GME Grand Rounds. Her talk was called "Every Physician is a Teacher - 10 Tips to Improve Clinical Teaching." She spoke about the Learning Prescriptions, the One Minute Preceptor Model, SNAPPS, Activated Demonstrations and much more.  If you want more information on this clinical teaching techniques, be sure to ask her.

Below are brief summaries of current research taking place in the Department:  

Determining the role of ultrasound in Disaster Medical Assistance Teams response to disasters. With Jenny Wilson and Brian Blaisch. 

Evaluating the factors associated with frequent use of Emergency Medical Services by adults. With Kennedy Hall and Maria Raven. 

Developing computer modeling to predict ambulance diversion by Emergency Departments and identify causes. With Mary Mercer, Kip Delgado and Leslie Meng.

Renee Hsia:

I am working on various projects related to ED and trauma center access for vulnerable populations, and the effects of closure (both permanent and temporary, such as diversion) on patient outcomes with time-sensitive conditions. I have several projects on ED crowding in a collaboration with Dr. Benjamin Sun (UCLA) and his research team as well as a collaboration with 5 CTSA sites (Stanford, OHSU, Oregon, Davis, UCSF) on trauma/EMS triage.

Michelle Lin:

Critical Appraisal of EM Educational Research: The Best Publications of 2010.

Three years ago, I gathered this team of authors to annually assess education research publications relevant to EM. As a team of experts, we rank the quality of articles based on a priori criteria with a heavy focus on methodology. Collaborators: Philip Shayne (Emory), Wendy Coates (Harbor-UCLA), Sue Farrell (Brigham), Gloria Kuhn (Wayne State), Lauren Maggio (Stanford), Jonathan Fisher (Beth Israel).

Implementation of National Virtual Simulation Cases for EM Clerkships: Digital Instruction in Emergency Medicine (DIEM)

This is the culmination of my building a pilot Flash-based case on chest pain where users can work through a virtual simulation case in a choose-your-own-adventure approach. Many EM clerkships are increasingly requiring that their students participate in the case. The case allows them to make errors, administer medications, order imaging, and order labs while a real-time clock runs. Results come back realistically in a delayed fashion. They can discharge home, consult, admit whoever they want. They also write up the ED chart. The timeline of their actions are emailed to the student for feedback and students are debriefed. Clerkship directors will have access to the rich data available for formative feedback to their student. Collaborators: Corey Heitz (Virginia Tech Carillon), Jonathan Fisher (Beth Israel), Laurie Thibodeau (Albany), Sorabh Khandelwal (Ohio State).

A Novel Teaching Approach in Medical Education Using A Faculty Blog: A 2-Year Perspective.

Over the past (almost) 2 years, I have been collecting lots of Google Analytics data on traffic on my website. These make for interesting discussion about how Web 2.0 tools such as blogs are going to play a role in medical education. Collaborators: Stella Yiu (Ottawa), Fred Wu (CEP in Visalia), Demian Szyld (NYU).

The Epidemiology of Health Care for Pediatric Patients in Vietnam

My non-profit group KidsCareEverywhere has just concluded a 2-person, 6-month internship program in Vietnam under the auspices of the Vietnam Minister of Health. These interns traveled to over 10 hospitals throughout Vietnam to conduct training courses on the use of PEMSoft (pediatric EM software), collect real-time epidemiology reports of pediatric diseases and management plans, and collect data on actual PEMSoft usage in the Emergency Departments a few weeks after software installation. Collaborators: Ronald Dieckmann, Jamie Sharp, Alex Miller, Trevor Brooks.

Mary Mercer:

Disaster Preparedness of Emergency Department Staff.

PI of a muliti-site survey-based study of emergency department staff at 5 Bay Area hospitals. The study examines the attitudes and behaviors of ED staff towards personal disaster preparedness and response.

Model of Hospital Flow, Capacity and Ambulance Diversion at San Francisco General Hospital.

Jeanne Noble, Teri Reynolds and John Stein have initiated a research project in Chiapas, Mexico to assess the feasibility and clinical impact of training local physicians in bedside ultrasound. After completion of a 3 week training course, the ability of providers to adequately perform bedside ultrasound and the impact of ultrasound on clinical decision-making will be measured. This study is modelled after a similiar project completed by Dr. Reynolds in Tanzania.  

Differences in treatment outcomes between stroke systems of care.

Diagnostic accuracy of stroke recognition in the prehospital system

comparative accuracy of emergency medical dispatch algorithms for stroke recognition.

Validation of non-weighted probabilistic method of linking prehospital records with hospital records using a weighted probabilistic linkage algorithm.

Assessing patient/family experiences towards enrollment in emergency research using exception from informed consent, using a qualitative approach.

Association between prevalence of prehospital secondary brain insults and clinical outcomes in a cohort of patients with intracranial hemorrhage.

Teri Reynolds:

Use of bedside ultrasound of the IVC to evaluate volume status and fluid responsiveness in limited-resource settings.

Feasibility and impact of training pediatric critical care fellows in basic ultrasound.

Factors affecting the implementation of trauma data collection in an urban public emergency department in Dar es Salaam, Tanzania. 

Karl Sporer:

Emergency Medical Dispatch

This area of research examines the effectiveness of the 911 dispatch process to define the correct resource to send to the patient. My team has completed 5-6 manuscripts on the subject making us one of the few experts in this area. These systems are used in most US and many international communities. Optimizing this system can help almost all EMS systems. We are currently collaborating with one of the world experts in this field to share our data and analysis.

Collaborators: Prasha Govindarian, Alan Craig (Toronto EMS), Jeff Clawson

Prehospital Triage of Trauma Patients

This study linked the trauma triage criteria used by local paramedics to make the decision to deliver a patient to the trauma center with the trauma registry. This will allow us to examine the effectiveness of these criteria to predict need for a trauma center.

Collaborators: Renee Hsia

Economic Impact of patients with Methamphetamine

This project stems from my former work with the San Francisco Treatment Research Center. The data from SFGH has been acquired and is in process of analysis with a manuscript expected in the fall of 2011.

Collaborators: Carmen Masson, Dept of Psychiatry

RAMPART

As the EMS Liasion and Co-PI of the Neurologic Emergency Treatment Trials Network, I receive 10% salary support and am involved in the implementations of their research trials. This multicenter prehospital study that compares intramuscular versus intravenous benzodiazepines in the treatment of patient who present with status epilepticus was completed in January 2011.

Collaborators: Claude Hemphill (Neurology), Alan Gelb

AMS Patients in the ED

This is a new avenue of research on patients who present to the ED with an abnormal mental state. This study has had an Exempt from Informed Consent approved by our CHR and data collection on this descriptive study and confidence of diagnosis study of patients has been completed. This study was supported by a Howard Hughes Research Fellowship and School of Medicine Dean's Fund.

Nathan Teismann, Patrick Lenaghan, John Stein, Ralph Wang, and Ari Green are working on a study comparing assessment of optic disk swelling using point-of-care ultrasound with a formal assessment in Neuro-ophtho clinic including a dilated exam and optical coherence tomography.

Ellen Weber:

My main focus of research remains flow and quality. I have been collaborating with my colleague at the University of Sheffield on outcomes related to the four-hour ED throughput target in the UK,. We have submitted a grant to study what happens to admitted patients from the ED under this rule as well as one to develop quality indicators for EM in the UK. I just completed a study in our own department showing that over half of high acuity patients do not complete triage within the recommended ESI guidelines. We will restudy this after the new triage module is introduced in Epic. I've been collaborating on studies on treatment of patients on warfarin in the ED, treatment of pediatric asthma patients, and patients who visit the ED at the end of life. I hope to be collaborating with John Stein on a project using RFID to monitor patient flow.