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Article: Exposure to point-of-care ultrasound in PA programs before employment.

Smalley, Courtney M

JAAPA : official journal of the American Academy of Physician Assistants

2021 Volume 34, Issue 2, Page(s) 42–45

Abstract: Objectives: Point-of-care ultrasound (POCUS) is integral to bedside evaluation of ED patients. This study examines POCUS exposure for physician assistants (PAs) before ED employment.: Methods: A retrospective cross-sectional survey was distributed ... ...

Abstract	Objectives: Point-of-care ultrasound (POCUS) is integral to bedside evaluation of ED patients. This study examines POCUS exposure for physician assistants (PAs) before ED employment. Methods: A retrospective cross-sectional survey was distributed electronically to PAs employed in 13 EDs across a healthcare system. Participants were queried on POCUS education during PA training. Findings were reported as percentages of total respondents, using descriptive statistics. Results: The response rate was 70.1%. Only 14.9% of respondents received POCUS exposure in PA school. Of those who received training, most (66.7%) received 5 or fewer hours and 94.1% strongly agree or agree that POCUS education should be integrated into PA education. Conclusion: In this survey, most PAs practicing in the ED did not receive POCUS education during training. Practice location and year of graduation may contribute to this finding. Healthcare systems should consider additional training for PAs working in EDs to bridge gaps in knowledge.
MeSH term(s)	Adult ; Cross-Sectional Studies ; Education/methods ; Emergency Service, Hospital ; Employment ; Female ; Humans ; Male ; Middle Aged ; Physician Assistants/education ; Point-of-Care Testing ; Retrospective Studies ; Ultrasonography ; Young Adult
Language	English
Publishing date	2021-01-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	2415226-2
ISSN	0893-7400 ; 1547-1896
ISSN (online)	0893-7400
ISSN	1547-1896
DOI	10.1097/01.JAA.0000731516.78984.f5
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Article ; Online: Female with Fever and Abdominal Pain after Pregnancy Termination.

Smalley, Courtney M / Serksnys, David

Annals of emergency medicine

2022 Volume 79, Issue 4, Page(s) 404–411

MeSH term(s)	Abdominal Pain/etiology ; Abortion, Induced ; Female ; Fever/etiology ; Humans ; Pregnancy
Language	English
Publishing date	2022-03-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	603080-4
ISSN	1097-6760 ; 0196-0644
ISSN (online)	1097-6760
ISSN	0196-0644
DOI	10.1016/j.annemergmed.2021.08.023
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Article ; Online: A Real-World Experience: Retrospective Review of Point-of-Care Ultrasound Utilization and Quality in Community Emergency Departments.

Smalley, Courtney M / Simon, Erin L / Muir, McKinsey R / Fertel, Baruch S

The western journal of emergency medicine

2023 Volume 24, Issue 4, Page(s) 685–692

Abstract: Introduction: Point-of-care ultrasound (POCUS) is commonly used in the emergency department (ED) as a rapid diagnostic tool. Emergency medicine (EM) has been an early adopter of POCUS with indications expanding over the last 10 years. While the ... ...

Abstract	Introduction: Point-of-care ultrasound (POCUS) is commonly used in the emergency department (ED) as a rapid diagnostic tool. Emergency medicine (EM) has been an early adopter of POCUS with indications expanding over the last 10 years. While the literature describes widespread use among academic sites, there is little data on clinical POCUS utilization at non-academic EDs. We sought to describe community emergency physician (EP) use of POCUS by quantifying the number and type of studies performed, characteristics of the performing physician, and quality metrics. Methods: Prior to the study period, all EPs underwent a standardized training and credentialing program. A retrospective review of all POCUS studies across 11 non-academic EDs from October 1, 2018-September 30, 2020 was performed by fellowship-trained physicians, who identified physician, exam type, and residency graduation year. The studies were then cross-referenced with quality review reports that assessed image acquisition, image interpretation, and image labeling. We performed descriptive statistics. Results: During the study period, 5,099 POCUS studies were performed by 170 EPs. Exams most frequently performed were cardiac (24%), focused assessment of sonography in trauma (21.7%), and pregnancy (16.2%). Recent EM residency graduates (<10 years) were higher utilizers of POCUS with a group mean of 1.3 exams per 100 patients. Of the studies done, 86% had no quality issues. Conclusion: Community POCUS demonstrates a heavy focus on core exams performed by recent EM residency graduates with minimal quality issues after a standardized training program. This study is the first to quantify actual community POCUS use in multiple EDs and may impact credentialing and skills maintenance requirements.
MeSH term(s)	Humans ; Point-of-Care Systems ; Retrospective Studies ; Point-of-Care Testing ; Emergency Service, Hospital ; Internship and Residency ; Ultrasonography/methods
Language	English
Publishing date	2023-06-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	2375700-0
ISSN	1936-9018 ; 1936-9018
ISSN (online)	1936-9018
ISSN	1936-9018
DOI	10.5811/westjem.58965
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Article ; Online: Expanding pediatric emergency medicine to treat young adults during the COVID pandemic.

Grover, Purva / Smalley, Courtney M / Mhsa, McKinsey Muir / Fertel, Baruch S

The American journal of emergency medicine

2021 Volume 50, Page(s) 808–809

MeSH term(s)	Adult ; Age Factors ; COVID-19/epidemiology ; COVID-19/therapy ; Emergency Service, Hospital/organization & administration ; Female ; Health Services Accessibility/organization & administration ; Humans ; Male ; Pediatric Emergency Medicine/organization & administration ; Young Adult
Language	English
Publishing date	2021-03-20
Publishing country	United States
Document type	Letter
ZDB-ID	605890-5
ISSN	1532-8171 ; 0735-6757
ISSN (online)	1532-8171
ISSN	0735-6757
DOI	10.1016/j.ajem.2021.03.044
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Article ; Online: Standardizing Point-of-Care Ultrasound Credentialing Across a Large Health Care System.

Smalley, Courtney M / Fertel, Baruch S / Broderick, Erin

Joint Commission journal on quality and patient safety

2020 Volume 46, Issue 8, Page(s) 471–476

Abstract: Background: Point-of-care ultrasound (POCUS) is becoming prevalent in the daily practice of bedside clinicians. As large health care systems standardize practice patterns, an organized approach of credentialing physicians in POCUS is paramount for ... ...

Abstract	Background: Point-of-care ultrasound (POCUS) is becoming prevalent in the daily practice of bedside clinicians. As large health care systems standardize practice patterns, an organized approach of credentialing physicians in POCUS is paramount for quality and patient safety. This study describes a systematic approach of credentialing a diverse group of community emergency physicians (EPs) across a large health care system. Methods: A multimodal POCUS credentialing initiative for EPs was implemented across 11 hospitals between January 1, 2017, and July 1, 2018, that included (1) standardization of POCUS credentialing for all hospitals in the system, (2) tiered POCUS credentialing (Basic and Intermediate) for manageable attainment of goals with a required POCUS course, (3) automatic privileges for EPs who completed residency or practice-based POCUS pathways prior to employment, and (4) implementation of a practice-based pathway for competency assessment for noncredentialed physicians. Key factors for implementation included executive administrative support, dedicated POCUS courses, equipment standardization, a robust electronic medical record capable of logging training scans, and competency assessment for attainment of privileges. Results: Through the initiative, 78/106 EPs achieved Intermediate credentialing, and 28/106 were without POCUS privileges. All 28 noncredentialed EPs completed the required Basic POCUS course. Almost half (13/28) completed the initiative and became credentialed. From 2016 to 2018, the number of EPs performing scans increased from 52 to 112, and the number of POCUS scans increased from 928 to 3,007. Conclusion: A standardized POCUS credentialing initiative can be successfully implemented in large health care systems. Other specialties can use this initiative to implement POCUS into their daily practice.
MeSH term(s)	Credentialing ; Delivery of Health Care ; Humans ; Internship and Residency ; Point-of-Care Systems ; Ultrasonography
Language	English
Publishing date	2020-03-20
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	1189890-2
ISSN	1938-131X ; 1549-425X ; 1553-7250 ; 1070-3241 ; 1549-3741
ISSN (online)	1938-131X ; 1549-425X
ISSN	1553-7250 ; 1070-3241 ; 1549-3741
DOI	10.1016/j.jcjq.2020.03.009
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Article: Point-of-Care Ultrasound Training and Credentialing for mid-late Career Emergency Physicians: Is it worth it?

Smalley, Courtney M / Simon, Erin L / Muir, Mckinsey R / Delgado, Fernando / Fertel, Baruch S

POCUS journal

2021 Volume 6, Issue 2, Page(s) 56–57

Language	English
Publishing date	2021-11-23
Publishing country	Canada
Document type	Journal Article
ISSN	2369-8543
ISSN	2369-8543
DOI	10.24908/pocus.v6i2.14891
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Article ; Online: Computed Tomography Utilization for Patients Presenting with Chest Pain.

Simon, Erin L / Krizo, Jessica / Septaric, Kristen / Citozi, Enri / Smalley, Courtney M / Shaffer, Austin / Mangira, Caroline / Fertel, Baruch S

The American journal of emergency medicine

2023 Volume 74, Page(s) 100–103

Abstract: Introduction: Computed tomography (CT) is routinely used in the emergency department (ED) due to its ease of access and its ability to rapidly rule in or out many serious conditions. Freestanding emergency departments (FSEDs) have become increasingly ... ...

Abstract	Introduction: Computed tomography (CT) is routinely used in the emergency department (ED) due to its ease of access and its ability to rapidly rule in or out many serious conditions. Freestanding emergency departments (FSEDs) have become increasingly used as an alternative to hospital-based emergency departments (HBEDs). The objective of this study was to investigate if the utilization rate of CT differs between FSEDs and HBEDs for chest pain. Methods: A retrospective evaluation of patients presenting to 17 EDs within a large integrated healthcare system between May 1, 2019 - April 30, 2021 with a chief complaint chest pain. Categorical variables are presented as frequencies and percentages. Continuous variables are presented as mean and standard deviation. Multiple logistic regression was used to assess the effect of facility on CT utilization for chest pain. Results: There were 67,084 patient encounters included in the study. Patients were predominately female (55%), white (61%), and insured through Medicare/Medicaid (59%). After controlling for predictive variables which included Charlson Comorbidity Index, ESI, age, sex, and race, patients who presented to FSEDs with chest pain were less likely to have a CT than those who presented to a HBED (AOR = 0.85, CI (0.81-0.90). Conclusion: CT scans of the chest are utilized less frequently at FSEDs compared to HBEDs for patient presenting with chest pain.
MeSH term(s)	Humans ; United States ; Female ; Aged ; Retrospective Studies ; Medicare ; Tomography, X-Ray Computed ; Chest Pain/diagnostic imaging ; Chest Pain/etiology ; Thorax ; Emergency Service, Hospital
Language	English
Publishing date	2023-09-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	605890-5
ISSN	1532-8171 ; 0735-6757
ISSN (online)	1532-8171
ISSN	0735-6757
DOI	10.1016/j.ajem.2023.09.038
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Article ; Online: Agitation Management in the Emergency Department with Physical Restraints: Where Do These Patients End Up?

Simon, Erin L / Smalley, Courtney M / Muir, McKinsey / Mangira, Caroline Mangira / Pence, Rylee / Wahi-Singh, Bhanu / Delgado, Fernando / Fertel, Baruch S

The western journal of emergency medicine

2023 Volume 24, Issue 3, Page(s) 454–460

Abstract: Introduction: Agitation is frequently encountered in the emergency department (ED) and can range from psychomotor restlessness to overt aggression and violent behavior. Among all ED patients, 2.6% present with agitation or become agitated during their ... ...

Abstract	Introduction: Agitation is frequently encountered in the emergency department (ED) and can range from psychomotor restlessness to overt aggression and violent behavior. Among all ED patients, 2.6% present with agitation or become agitated during their ED visit. We aimed to determine ED disposition for patients requiring agitation management with physical restraints. Methods: This was a retrospective cohort of all adult patients who presented to one of 19 EDs in a large integrated healthcare system and received agitation management with physical restraints between January 1, 2018-December 31, 2020. Categorical variables are presented as frequency and percentages, and continuous variables are presented as medians and interquartile range. Results: There were 3,539 patients who had agitation management with physical restraints included in this study. In total 2,076 (58.8%) were admitted to the hospital (95% CI [confidence interval] 0.572-0.605), and of those 81.4% were admitted to a primary medical floor and 18.6% were medically cleared and admitted to a psychiatric unit. Overall, 41.2% were able to be medically cleared and discharged from the ED. Mean age was 40.9 years, 2,140 were male (59.1%), 1,736 were White (50.3%), and 1,527 (43%) were Black. We found 26% had abnormal ethanol, (95% CI 0.245-0.274) and 54.6% had an abnormal toxicology screen (95% CI 0.529-0.562). A significant number were administered a benzodiazepine or antipsychotic in the ED (88.44%) (95% CI 0.874-0.895). Conclusion: The majority of patients who had agitation management with physical restraints were admitted to the hospital; of those patients, 81.4% were admitted to a primary medical floor and 18.6% were admitted to a psychiatric unit.
MeSH term(s)	Adult ; Humans ; Male ; Female ; Restraint, Physical ; Retrospective Studies ; Antipsychotic Agents ; Emergency Service, Hospital ; Psychomotor Agitation/therapy
Chemical Substances	Antipsychotic Agents
Language	English
Publishing date	2023-05-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	2375700-0
ISSN	1936-9018 ; 1936-9018
ISSN (online)	1936-9018
ISSN	1936-9018
DOI	10.5811/westjem.59466
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Article ; Online: Risk Factors for Trimethoprim and Sulfamethoxazole-Resistant Escherichia Coli in ED Patients with Urinary Tract Infections.

Wesolek, Jessica L / Wu, Janet Y / Smalley, Courtney M / Wang, Lu / Campbell, Matthew J

The American journal of emergency medicine

2022 Volume 56, Page(s) 178–182

Abstract: Background: While trimethoprim-sulfamethoxazole (TMP-SMX) is recommended as one of the first-line empiric therapies for treatment of acute uncomplicated cystitis, institutions that observe resistance rates exceeding 20% for Escherichia coli (E. coli) ... ...

Abstract	Background: While trimethoprim-sulfamethoxazole (TMP-SMX) is recommended as one of the first-line empiric therapies for treatment of acute uncomplicated cystitis, institutions that observe resistance rates exceeding 20% for Escherichia coli (E. coli) should utilize alternative empiric antibiotic therapy per the Infectious Diseases Society of America (IDSA). Identifying risk factors associated with TMP-SMX resistance in E. coli may help guide empiric antibiotic prescribing for urinary tract infections (UTIs). Methods: This multicenter, retrospective study included adult patients who were discharged from 12 emergency departments (EDs) with a urine culture positive for E. coli between January 1, 2019 and December 31, 2019. Logistic regression was used to assess the relationship between potential risk factors and TMP-SMX resistance. The overall institutional antimicrobial resistance rates for E. coli were compared to the rates seen in the study population of ED urinary isolates. Results: Among 427 patients included from a randomized sample of 500 with a urine culture positive for E. coli, 107 (25.1%) were resistant to TMP-SMX. Three predictors of TMP-SMX resistance were identified: recurrent UTI (OR 2.27 [95% CI 1.27-3.99]), genitourinary abnormalities (OR 2.31 [95% CI 1.17-4.49]), and TMP-SMX use within 90 days (OR 8.77 [95% CI 3.19-28.12]). When the antibiotic susceptibilities for this ED cohort were compared to the institutional antibiogram, the TMP-SMX resistance rate was found to be higher in the ED population (25.1% vs 20%). Conclusions: TMP-SMX should likely be avoided as first-line therapy for UTI in patients who have recurrent UTIs, genitourinary abnormalities, or have previously received TMP-SMX within the past 90 days. The use of an ED-specific antibiogram should be considered for assessing local resistance rates in this population.
MeSH term(s)	Adult ; Anti-Bacterial Agents/pharmacology ; Anti-Bacterial Agents/therapeutic use ; Cystitis/drug therapy ; Drug Resistance, Bacterial ; Escherichia coli ; Escherichia coli Infections/drug therapy ; Escherichia coli Infections/epidemiology ; Humans ; Retrospective Studies ; Risk Factors ; Trimethoprim, Sulfamethoxazole Drug Combination/pharmacology ; Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use ; Urinary Tract Infections/drug therapy ; Urinary Tract Infections/epidemiology
Chemical Substances	Anti-Bacterial Agents ; Trimethoprim, Sulfamethoxazole Drug Combination (8064-90-2)
Language	English
Publishing date	2022-03-31
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Randomized Controlled Trial
ZDB-ID	605890-5
ISSN	1532-8171 ; 0735-6757
ISSN (online)	1532-8171
ISSN	0735-6757
DOI	10.1016/j.ajem.2022.03.052
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Article ; Online: Successful outcome of shell fractures in freshwater turtles treated with plate or screws and wire fixation techniques: 51 cases (2014-2019).

Patson, Courtney N / Lemley, Erin M / Smalley, Eric W / Doss, Grayson A / Mans, Christoph

Journal of the American Veterinary Medical Association

2022 Volume 260, Issue 7, Page(s) 1–6

Abstract: Objective: To evaluate the outcome of surgical fixation of shell fractures in rehabilitated wild freshwater turtles.: Animals: 51 freshwater turtles with 86 shell fractures.: Procedures: The medical record database of a wildlife rehabilitation ... ...

Abstract	Objective: To evaluate the outcome of surgical fixation of shell fractures in rehabilitated wild freshwater turtles. Animals: 51 freshwater turtles with 86 shell fractures. Procedures: The medical record database of a wildlife rehabilitation center in Wisconsin was searched from 2014 through 2019 for records of freshwater turtles with shell fractures repaired with a plate technique, screws and wire technique, or both. Signalment, fracture location, therapeutic approach (including the type of hardware used for repair), dry-docking duration, time to hardware removal, postremoval care, and outcome were evaluated. Results: 36 of 51 (71%) turtles with shell fractures experienced successful fracture healing following surgical hardware fixation, and 33 (65%) were released. Shells of 38 (75%) turtles were repaired with plates only, 5 (10%) turtles with wire only, and 8 (16%) turtles with a combination of plates and screws and wires. Of the 51 turtles, 13 (25%) did not survive > 4 weeks following hardware repair, leaving 38 animals available to assess fracture healing. Median time to start staged removal was 42 days (range, 35 to 49 days) and to complete removal of the applied hardware was 56 days (range, 26 to 77 days). Complications associated with placement of the hardware occurred in 6 of 38 (16%) turtles. Complications included screw hole infection (4/38 [11%]), fracture necrosis (1/38 [3%]), and deep screw hole penetration (1/38 [3%]). Clinical relevance: Results indicated that shell fractures in freshwater turtles treated with surgical fixation techniques had a successful outcome. Most complications were minor, and fractures improved with time, resulting in acceptable fracture healing for release.
MeSH term(s)	Animals ; Bone Plates/veterinary ; Bone Screws/veterinary ; Bone Wires ; Fracture Fixation, Internal/methods ; Fracture Fixation, Internal/veterinary ; Fractures, Bone/surgery ; Fractures, Bone/veterinary ; Fresh Water ; Retrospective Studies ; Treatment Outcome ; Turtles/surgery
Language	English
Publishing date	2022-01-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	390811-2
ISSN	1943-569X ; 0003-1488
ISSN (online)	1943-569X
ISSN	0003-1488
DOI	10.2460/javma.21.09.0430
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