Maame Yaa A. B. Yiadom

All Publications

• Changes in low-acuity patient volume in an emergency department after launching a walk-in clinic. Journal of the American College of Emergency Physicians open Kurian, D., Sundaram, V., Naidich, A. G., Shah, S. A., Ramberger, D., Khan, S., Ravi, S., Patel, S., Ribeira, R., Brown, I., Wagner, A., Gharahbhagian, L., Miller, K., Shen, S., Yiadom, M. Y. 2023; 4 (4): e13011

  Abstract

  Unscheduled low-acuity care options are on the rise and are often expected to reduce emergency department (ED) visits. We opened an ED-staffed walk-in clinic (WIC) as an alternative care location for low-acuity patients at a time when ED visits exceeded facility capacity and the impending flu season was anticipated to increase visits further, and we assessed whether low-acuity ED patient visits decreased after opening the WIC.In this retrospective cohort study, we compared patient and clinical visit characteristics of the ED and WIC patients and conducted interrupted time-series analyses to quantify the impact of the WIC on low-acuity ED patient visit volume and the trend.There were 27,211 low-acuity ED visits (22.7% of total ED visits), and 7,058 patients seen in the WIC from February 26, 2018, to November 17, 2019. Low-acuity patient visits in the ED reduced significantly immediately after the WIC opened (P = 0.01). In the subsequent months, however, patient volume trended back to pre-WIC volumes such that there was no significant impact at 6, 9, or 12 months (P = 0.07). Had WIC patients been seen in the main ED, low-acuity volume would have been 27% of the total volume rather than the 22.7% that was observed.The WIC did not result in a sustained reduction in low-acuity patients in the main ED. However, it enabled emergency staff to see low-acuity patients in a lower resource setting during times when ED capacity was limited.

  View details for DOI 10.1002/emp2.13011

  View details for PubMedID 37484497

  View details for PubMedCentralID PMC10361543

• Maximizing Equity in Acute Coronary Syndrome Screening across Sociodemographic Characteristics of Patients. Diagnostics (Basel, Switzerland) Bunney, G., Bloos, S. M., Graber-Naidich, A., Pasao, M. A., Kabeer, R., Kim, D., Miller, K., Yiadom, M. Y. 2023; 13 (12)

  Abstract

  We compared four methods to screen emergency department (ED) patients for an early electrocardiogram (ECG) to diagnose ST-elevation myocardial infarction (STEMI) in a 5-year retrospective cohort through observed practice, objective application of screening protocol criteria, a predictive model, and a model augmenting human practice. We measured screening performance by sensitivity, missed acute coronary syndrome (ACS) and STEMI, and the number of ECGs required. Our cohort of 279,132 ED visits included 1397 patients who had a diagnosis of ACS. We found that screening by observed practice augmented with the model delivered the highest sensitivity for detecting ACS (92.9%, 95%CI: 91.4-94.2%) and showed little variation across sex, race, ethnicity, language, and age, demonstrating equity. Although it missed a few cases of ACS (7.6%) and STEMI (4.4%), it did require ECGs on an additional 11.1% of patients compared to current practice. Screening by protocol performed the worst, underdiagnosing young, Black, Native American, Alaskan or Hawaiian/Pacific Islander, and Hispanic patients. Thus, adding a predictive model to augment human practice improved the detection of ACS and STEMI and did so most equitably across the groups. Hence, combining human and model screening--rather than relying on either alone--may maximize ACS screening performance and equity.

  View details for DOI 10.3390/diagnostics13122053

  View details for PubMedID 37370948

  View details for PubMedCentralID PMC10297640

• Variation in ACS patient hospital resource utilization: Is it time for advanced NSTEMI risk stratification in the ED? The American journal of emergency medicine Saxena, M., Bloos, S. M., Graber-Naidich, A., Sundaram, V., Pasao, M., Yiadom, M. Y. 2023; 70: 171-174

  Abstract

  A majority of patients who experience acute coronary syndrome (ACS) initially receive care in the emergency department (ED). Guidelines for care of patients experiencing ACS, specifically ST-segment elevation myocardial infarction (STEMI) are well defined. We examine the utilization of hospital resources between patients with NSTEMI as compared to STEMI and unstable angina (UA). We then make the case that as NSTEMI patients are the majority of ACS cases, there is a great opportunity to risk stratify these patients in the emergency department.We examined hospital resource utilization measure between those with STEMI, NSTEMI, and UA. These included hospital length of stay (LOS), any intensive care unit (ICU) care time, and in-hospital mortality.The sample included 284,945 adult ED patients, of whom 1195 experienced ACS. Among the latter, 978 (70%) were diagnosed with NSTEMI, 225 (16%) with STEMI, and 194 with UA (14%). We observed 79.1% of STEMI patients receiving ICU care. 14.4% among NSTEMI patients, and 9.3% among UA patients. NSTEMI patients' mean hospital LOS was 3.7 days. This was shorter than that of non-ACS patients 4.75 days and UA patients 2.99. In-hospital mortality for NSTEMI was 1.6%, compared to, 4.4% for those with STEMI patients and 0% for UA. There are recommendations for risk stratification among NSTEMI patients to evaluate risk for major adverse cardiac events (MACE) that can be used in the ED to guide admission decisions and use of ICU care, thus optimizing care for a majority of ACS patients.

  View details for DOI 10.1016/j.ajem.2023.05.028

  View details for PubMedID 37327683

• Strategies to Mitigate Emergency Department Crowding and Its Impact on Cardiovascular Patients. European heart journal. Acute cardiovascular care Baugh, C. W., Freund, Y., Steg, P. G., Body, R., Maron, D. J., Yiadom, M. Y. 2023

  Abstract

  Emergency Department (ED) crowding is a worsening global problem caused by hospital capacity and other health system challenges. While patients across a broad spectrum of illnesses may be affected by crowding in the ED, patients with cardiovascular emergencies - such as acute coronary syndrome, malignant arrhythmias, pulmonary embolism, acute aortic syndrome, and cardiac tamponade - are particularly vulnerable. Because of crowding, patients with dangerous and time-sensitive conditions may either avoid the ED due to anticipation of extended waits, leave before their treatment is completed, or experience delays in receiving care. In this educational paper, we present the underlying causes of crowding and its impact on common cardiovascular emergencies using the input-throughput-output process framework for patient flow. In addition, we review current solutions and potential innovations to mitigate the negative effect of ED crowding on patient outcomes.

  View details for DOI 10.1093/ehjacc/zuad049

  View details for PubMedID 37163667

• Beyond chest pain: Incremental value of other variables to identify patients for an early ECG. The American journal of emergency medicine Bunney, G., Sundaram, V., Graber-Naidich, A., Miller, K., Brown, I., McCoy, A. B., Freeze, B., Berger, D., Wright, A., Yiadom, M. Y. 2023; 67: 70-78

  Abstract

  BACKGROUND: Chest pain (CP) is the hallmark symptom for acute coronary syndrome (ACS) but is not reported in 20-30% of patients, especially women, elderly, non-white patients, presenting to the emergency department (ED) with an ST-segment elevation myocardial infarction (STEMI).METHODS: We used a retrospective 5-year adult ED sample of 279,132 patients to explore using CP alone to predict ACS, then we incrementally added other ACS chief complaints, age, and sex in a series of multivariable logistic regression models. We evaluated each model's identification of ACS and STEMI.RESULTS: Using CP alone would recommend ECGs for 8% of patients (sensitivity, 61%; specificity, 92%) but missed 28.4% of STEMIs. The model with all variables identified ECGs for 22% of patients (sensitivity, 82%; specificity, 78%) but missed 14.7% of STEMIs. The model with CP and other ACS chief complaints had the highest sensitivity (93%) and specificity (55%), identified 45.1% of patients for ECG, and only missed 4.4% of STEMIs.CONCLUSION: CP alone had highest specificity but lacked sensitivity. Adding other ACS chief complaints increased sensitivity but identified 2.2-fold more patients for ECGs. Achieving an ECG in 10min for patients with ACS to identify all STEMIs will be challenging without introducing more complex risk calculation into clinical care.

  View details for DOI 10.1016/j.ajem.2023.01.054

  View details for PubMedID 36806978

• Fallacy of Median Door-to-ECG Time: Hidden Opportunities for STEMI Screening Improvement. Journal of the American Heart Association Yiadom, M. Y., Gong, W., Patterson, B. W., Baugh, C. W., Mills, A. M., Gavin, N., Podolsky, S. R., Salazar, G., Mumma, B. E., Tanski, M., Hadley, K., Azzo, C., Dorner, S. C., Ulintz, A., Liu, D. 2022; 11 (9): e024067

  Abstract

  Background ST-segment elevation myocardial infarction (STEMI) guidelines recommend screening arriving emergency department (ED) patients for an early ECG in those with symptoms concerning for myocardial ischemia. Process measures target median door-to-ECG (D2E) time of 10minutes. Methods and Results This 3-year descriptive retrospective cohort study, including 676 ED-diagnosed patients with STEMI from 10 geographically diverse facilities across the United States, examines an alternative approach to quantifying performance: proportion of patients meeting the goal of D2E≤10minutes. We also identified characteristics associated with D2E>10minutes and estimated the proportion of patients with screening ECG occurring during intake, triage, and main ED care periods. We found overall median D2E was 7minutes (IQR:4-16; range: 0-1407minutes; range of ED medians: 5-11minutes). Proportion of patients with D2E>10minutes was 37.9% (ED range: 21.5%-57.1%). Patients with D2E>10minutes, compared to those with D2E≤10minutes, were more likely female (32.8% versus 22.6%, P=0.005), Black (23.4% versus 12.4%, P=0.005), non-English speaking (24.6% versus 19.5%, P=0.032), diabetic (40.2% versus 30.2%, P=0.010), and less frequently reported chest pain (63.3% versus 87.4%, P<0.001). ECGs were performed during ED intake in 62.1% of visits, ED triage in 25.3%, and main ED care in 12.6%. Conclusions Examining D2E>10minutes can identify opportunities to improve care for more ED patients with STEMI. Our findings suggest sex, race, language, and diabetes are associated with STEMI diagnostic delays. Moving the acquisition of ECGs completed during triage to intake could achieve the D2E≤10minutes goal for 87.4% of ED patients with STEMI. Sophisticated screening, accounting for differential risk and diversity in STEMI presentations, may further improve timely detection.

  View details for DOI 10.1161/JAHA.121.024067

  View details for PubMedID 35492001

• Pragmatic clinical trial design in emergency medicine: study considerations and design types. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Gettel, C. J., Yiadom, M. Y., Bernstein, S. L., Grudzen, C. R., Nath, B., Li, F., Hwang, U., Hess, E. P., Melnick, E. R. 2022

  Abstract

  Pragmatic clinical trials (PCTs) focus on correlation between treatment and outcomes in real-world clinical practice, yet a guide highlighting key study considerations and design types for emergency medicine investigators pursuing this important study type is not available. Investigators conducting ED-based PCTs face multiple decisions within the planning phase to ensure robust and meaningful study findings. The PRagmatic Explanatory Continuum Indicator Summary 2 (PRECIS-2) tool allows trialists to consider both pragmatic and explanatory components across nine domains, shaping the trial design to the purpose intended by the investigators. Aside from the PRECIS-2 tool domains, ED-based investigators conducting PCTs should also consider randomization techniques, human subjects concerns, and integration of trial components within the electronic health record. The authors additionally highlight the advantages, disadvantages, and rationale for the use of four common randomized study design types to be considered in PCTs: parallel, crossover, factorial, and stepped-wedge. With increasing emphasis on the conduct of PCTs, emergency medicine investigators will benefit from a rigorous approach to clinical trial design.

  View details for DOI 10.1111/acem.14513

  View details for PubMedID 35475533

• ECG to Activation: Not an Appropriate Physician Metric, but a Worthy Process Metric. The Journal of emergency medicine Berger, D. A., Yiadom, M. Y. 1800; 62 (1): 129-130

  View details for DOI 10.1016/j.jemermed.2021.07.019

  View details for PubMedID 35090729

• Understanding timely STEMI treatment performance: A 3-year retrospective cohort study using diagnosis-to-balloon-time and care subintervals. Journal of the American College of Emergency Physicians open Yiadom, M. Y., Olubowale, O. O., Jenkins, C. A., Miller, K. F., West, J. L., Vogus, T. J., Lehmann, C. U., Antonello, V. D., Bernard, G. R., Storrow, A. B., Lindsell, C. J., Liu, D. 2021; 2 (1): e12379

  Abstract

  From the perspective of percutaneous coronary intervention (PCI) centers, locations of ST-segment elevation myocardial infarction (STEMI) diagnosis can include a referring facility, emergency medical services (EMS) transporting to a PCI center, or the PCI center's emergency department (ED). This challenges the use of door-to-balloon-time as the primary evaluative measure of STEMI treatment pathways. Our objective was to identify opportunities to improve care by quantifying differences in the timeliness of STEMI treatment mobilization based on the location of the diagnostic ECG.This 3-year, single-center, retrospective cohort study classified patients by diagnostic ECG location: referring facility, EMS, or PCI center ED. We quantified door-to-balloon-time and diagnosis-to-balloon-time with its care subintervals.Of 207 ED STEMI patients, 180 (87%) received PCI. Median diagnosis-to-balloon-times were shortest among the ED-diagnosed (78 minutes [interquartile range (IQR), 61-92]), followed by EMS-identified patients (89 minutes [IQR, 78-122]), and longest among those referred (140 minutes [IQR, 119-160]), reflecting time for transport to the PCI center. Conversely, referred patients had the shortest median door-to-balloon-times (38 minutes [IQR, 34-43]), followed by the EMS-identified (64 minutes [IQR, 47-77]), whereas ED-diagnosed patients had the longest (89 minutes [IQR, 70-114]), reflecting diagnosis and catheterization lab activation frequently occurring before PCI center ED arrival for referred and EMS-identified patients.Diagnosis-to-balloon-time and its care subintervals are complementary to the traditional door-to-balloon-times as measures of the STEMI treatment process. Together, they highlight opportunities to improve timely identification among ED-diagnosed patients, use of out-of-hospital cath lab activation for EMS-identified patients, and encourage pathways for referred patients to bypass PCI center EDs.

  View details for DOI 10.1002/emp2.12379

  View details for PubMedID 33644777

  View details for PubMedCentralID PMC7890036

• Comparing the Timeliness of Treatment in Younger vs. Older Patients with ST-Segment Elevation Myocardial Infarction: A Multi-Center Cohort Study. The Journal of emergency medicine Bloos, S. M., Kaur, K. n., Lang, K. n., Gavin, N. n., Mills, A. M., Baugh, C. W., Patterson, B. W., Podolsky, S. R., Salazar, G. n., Mumma, B. E., Tanski, M. n., Hadley, K. n., Roumie, C. n., McNaughton, C. D., Yiadom, M. Y. 2021

  Abstract

  ST-segment elevation myocardial infarction (STEMI) predominantly affects older adults. Lower incidence among younger patients may challenge diagnosis.We hypothesize that among patients ≤ 50 years old, emergent percutaneous coronary intervention (PCI) for STEMI is delayed when compared with patients aged > 50 years.This 3-year, 10-center retrospective cohort study included emergency department (ED) STEMI patients ≥ 18 years of age treated with emergent PCI. We excluded patients with an electrocardiogram (ECG) completed prior to ED arrival or a nondiagnostic initial ECG. Our primary outcome was door-to-balloon (D2B) time. We compared characteristics and outcomes among younger vs. older STEMI patients, and among age subgroups.There were 576 ED STEMI PCI patients, of whom 100 were ≤ 50 years old and 476 were > 50 years old. Median age was 44 years in the younger cohort (interquartile range [IQR] 41-47) vs. 62 years (IQR 57-70) among older patients. Median D2B time for the younger cohort was 76.5 min (IQR 67.5-102.5) vs. 81.0 min (IQR 65.0-105.5) in the older cohort (p = 0.91). This outcome did not change when ages 40 or 45 years were used to demarcate younger vs. older. The younger cohort had a higher prevalence of nonwhite races (38% vs. 21%; p < 0.001) and those currently smoking (36% vs. 23%; p = 0.005). The very young (≤30 years; 6/576) and very old (>80 years; 45/576) had 5.51 and 2.2 greater odds of delays.We found no statistically significant difference in D2B times between patients ≤ 50 years old and those > 50 years old. Nonwhite patients and those who smoke were disproportionately represented within the younger population. The very young and very old had higher odds of D2B times > 90 min.

  View details for DOI 10.1016/j.jemermed.2021.01.031

  View details for PubMedID 33676790

• Managing and Measuring Emergency Department Care: Results of the Fourth Emergency Department Benchmarking Definitions Summit Academic Emergency Medicine Yiadom, M. A. 2020; 27 (7): 600-611

  Abstract

  A shared language and vocabulary are essential for managing emergency department (ED) operations. This Fourth Emergency Department Benchmarking Alliance (EDBA) Summit brought together experts in the field to review, update, and add to key definitions and metrics of ED operations.Summit objectives were to review and revise existing definitions, define and characterize new practices related to ED operations, and introduce financial and regulatory definitions affecting ED reimbursement.Forty-six ED operations, data management, and benchmarking experts were invited to participate in the EDBA summit. Before arrival, experts were provided with documents from the three prior summits and assigned to update the terminology. Materials and publications related to standards of ED operations were considered and discussed. Each group submitted a revised set of definitions prior to the summit. Significantly revised, topical, or controversial recommendations were discussed among all summit participants. The goal of the in-person discussion was to reach consensus on definitions. Work group leaders made changes to reflect the discussion, which was revised with public and stakeholder feedback.The entire EDBA dictionary was updated and expanded. This article focuses on an update and discussion of definitions related to specific topics that changed since the last summit, specifically ED intake, boarding, diversion, and observation care. In addition, an extensive new glossary of financial and regulatory terminology germane to the practice of emergency medicine is included.A complete and precise set of operational definitions, time intervals, and utilization measures is necessary for timely and effective ED care. A common language of financial and regulatory definitions that affect ED operations is included for the first time. This article and its companion dictionary should serve as a resource to ED leadership, researchers, informatics and health policy leaders, and regulatory bodies.

  View details for DOI 10.1111/acem.13978

• Potential impact of cardiology phone-consultation for patients risk-stratified by the HEART pathway. Clinical and experimental emergency medicine Monahan, K., Pan, M., Opara, C., Yiadom, M. Y., Munoz, D., Holmes, B. B., Stephen, D., Swiger, K. J., Collins, S. P. 2019; 6 (3): 196-203

  Abstract

  Bedside consultation by cardiologists may facilitate safe discharge of selected patients from the emergency department (ED) even when admission is recommended by the History, Electrocardiogram, Age, Risk factors, Troponin (HEART) pathway. If bedside evaluation is unavailable, phone consultation between emergency physicians and cardiologists would be most impactful if the resultant disposition is discordant with the HEART pathway. We therefore evaluate discordance between actual disposition and that suggested by the HEART pathway in patients presenting to the ED with chest pain for whom cardiology consultation occurred exclusively by phone and to assess the impact of phone-consultation on disposition.We performed a single-center, retrospective study of adults presenting to the ED with chest pain whose emergency physician had a phone consultation with a cardiologist. Actual disposition was abstracted from the medical record. HEART pathway category (low-risk, discharge; high-risk, admit) was derived from ED documentation. For discharged patients, major adverse cardiac events were assessed at 30 days by chart review and phone follow-up.For the 170 patients that had cardiologist phone consultation, discordance between actual disposition and the HEART pathway was 17%. The HEART pathway recommended admission for nearly 80% of discharged patients. Following cardiologist phone-consultation, 10% of high-risk patients were discharged, with the majority having undergone a functional study recommended by the cardiologist. At 30 days, discharged patients had experienced no episodes of major adverse cardiac events or rehospitalization for cardiac reasons.For patients presenting to the ED with chest pain, cardiology phone-consultation has the potential to safely impact disposition, primarily by facilitating functional testing in high-risk individuals.

  View details for DOI 10.15441/ceem.18.066

  View details for PubMedID 31295990

  View details for PubMedCentralID PMC6774010

• Measuring outcome differences associated with STEMI screening and diagnostic performance: a multicentred retrospective cohort study protocol. BMJ open Yiadom, M. Y., Mumma, B. E., Baugh, C. W., Patterson, B. W., Mills, A. M., Salazar, G., Tanski, M., Jenkins, C. A., Vogus, T. J., Miller, K. F., Jackson, B. E., Lehmann, C. U., Dorner, S. C., West, J. L., Wang, T. J., Collins, S. P., Dittus, R. S., Bernard, G. R., Storrow, A. B., Liu, D. 2018; 8 (5): e022453

  Abstract

  Advances in ST-segment elevation myocardial infarction (STEMI) management have involved improving the clinical processes connecting patients with timely emergency cardiovascular care. Screening upon emergency department (ED) arrival for an early ECG to diagnose STEMI, however, is not optimal for all patients. In addition, the degree to which timely screening and diagnosis are associated with improved time to intervention and postpercutaneous coronary intervention outcomes, under more contemporary practice conditions, is not known.We present the methods for a retrospective multicentre cohort study anticipated to include 1220 patients across seven EDs to (1) evaluate the relationship between timely screening and diagnosis with treatment and postintervention clinical outcomes; (2) introduce novel measures for cross-facility performance comparisons of screening and diagnostic care team performance including: door-to-screening, door-to-diagnosis and door-to-catheterisation laboratory arrival times and (3) describe the use of electronic health record data in tandem with an existing disease registry.The completion of this study will provide critical feedback on the quality of screening and diagnostic performance within the contemporary STEMI care pathway that can be used to (1) improve emergency care delivery for patients with STEMI presenting to the ED, (2) present novel metrics for the comparison of screening and diagnostic care and (3) inform the development of screening and diagnostic support tools that could be translated to other care environments. We will disseminate our results via publication and quality performance data sharing with each site. Institutional ethics review approval was received prior to study initiation.

  View details for DOI 10.1136/bmjopen-2018-022453

  View details for PubMedID 29724744

  View details for PubMedCentralID PMC5942471

• Measuring Emergency Department Acuity. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Yiadom, M. Y., Baugh, C. W., Barrett, T. W., Liu, X., Storrow, A. B., Vogus, T. J., Tiwari, V., Slovis, C. M., Russ, S., Liu, D. 2018; 25 (1): 65-75

  Abstract

  Emergency department (ED) acuity is the general level of patient illness, urgency for clinical intervention, and intensity of resource use in an ED environment. The relative strength of commonly used measures of ED acuity is not well understood.We performed a retrospective cross-sectional analysis of ED-level data to evaluate the relative strength of association between commonly used proxy measures with a full spectrum measure of ED acuity. Common measures included the percentage of patients with Emergency Severity Index (ESI) scores of 1 or 2, case mix index (CMI), academic status, annual ED volume, inpatient admission rate, percentage of Medicare patients, and patients seen per attending-hour. Our reference standard for acuity is the proportion of high-acuity charts (PHAC) coded and billed according to the Centers for Medicare and Medicaid Service's Ambulatory Payment Classification (APC) system. High-acuity charts included those APC 4 or 5 or critical care. PHAC was represented as a fractional response variable. We examined the strength of associations between common acuity measures and PHAC using Spearman's rank correlation coefficients (rs ) and regression models including a quasi-binomial generalized linear model and linear regression.In our univariate analysis, the percentage of patients ESI 1 or 2, CMI, academic status, and annual ED volume had statistically significant associations with PHAC. None explained more than 16% of PHAC variation. For regression models including all common acuity measures, academic status was the only variable significantly associated with PHAC.Emergency Severity Index had the strongest association with PHAC followed by CMI and annual ED volume. Academic status captures variability outside of that explained by ESI, CMI, annual ED volume, percentage of Medicare patients, or patients per attending per hour. All measures combined only explained only 42.6% of PHAC variation.

  View details for DOI 10.1111/acem.13319

  View details for PubMedID 28940546

  View details for PubMedCentralID PMC5764775

• Change in Care Transition Practice for Patients With Nonspecific Chest Pain After Emergency Department Evaluation 2006 to 2012 ACADEMIC EMERGENCY MEDICINE Yiadom, M. B., Baugh, C. W., Jenkins, C. A., Collins, S. P., Bhatia, M. C., Dittus, R. S., Storrow, A. B. 2017; 24 (12): 1527-1530

  Abstract

  From 2005 to 2010 health care financing shifts in the United States may have affected care transition practices for emergency department (ED) patients with nonspecific chest pain (CP) after ED evaluation. Despite being less acutely ill than those with myocardial infarction, these patients' management can be challenging. The risk of missing acute coronary syndrome is considerable enough to often warrant admission. Diagnostic advances and reimbursement limitations on the use of inpatient admission are encouraging the use of alternative ED care transition practices. In the setting of these health care changes, we hypothesized that there is a decline in inpatient admission rates for patients with nonspecific CP after ED evaluation.We retrospectively used the Nationwide ED Sample to quantify total and annual inpatient hospital admission rates from 2006 to 2012 for patients with a final ED diagnosis of nonspecific CP. We assessed the change in admission rates over time and stratified by facility characteristics including safety-net hospital status, U.S. geographic region, urban/teaching status, trauma-level designation, and hospital funding status.The admission rate for all patients with a final ED diagnosis of nonspecific CP declined from 19.2% in 2006 to 11.3% in 2012. Variability across regions was observed, while metropolitan teaching hospitals and trauma centers reflected lower admission rates.There was a 41.1% decline in inpatient hospital admission for patients with nonspecific CP after ED evaluation. This reduction is temporally associated with national policy changes affecting reimbursement for inpatient admissions.

  View details for DOI 10.1111/acem.13279

  View details for Web of Science ID 000417645200012

  View details for PubMedID 28833882

  View details for PubMedCentralID PMC5755372

• Acute Coronary Syndrome Screening and Diagnostic Practice Variation. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Yiadom, M. Y., Liu, X., McWade, C. M., Liu, D., Storrow, A. B. 2017; 24 (6): 701-709

  Abstract

  In the absence of the existing acute coronary syndrome (ACS) guidelines directing the clinical practice implementation of emergency department (ED) screening and diagnosis, there is variable screening and diagnostic clinical practice across ED facilities. This practice diversity may be warranted. Understanding the variability may identify opportunities for more consistent practice.This is a cross-sectional clinical practice epidemiology study with the ED as the unit of analysis characterizing variability in the ACS evaluation across 62 diverse EDs. We explored three domains of screening and diagnostic practice: 1) variability in criteria used by EDs to identify patients for an early electrocardiogram (ECG) to diagnose ST-elevation myocardial infarction (STEMI), 2) nonuniform troponin biomarker and formalized pre-troponin risk stratification use for the diagnosis of non-ST-elevation myocardial infarction (NSTEMI), and 3) variation in the use of noninvasive testing (NIVT) to identify obstructive coronary artery disease or detect inducible ischemia.We found that 85% of EDs utilize a formal triage protocol to screen patients for an early ECG to diagnose STEMI. Of these, 17% use chest pain as the sole criteria. For the diagnosis of NSTEMI, 58% use intervals ≥4 hours for a second troponin and 34% routinely risk stratify before troponin testing. For the diagnosis of noninfarction ischemia, the median percentage of patients who have NIVT performed during their ED visit is 5%. The median percentage of patients referred for NIVT in hospital (observation or admission) is 61%. Coronary CT angiography is used in 66% of EDs. Exercise treadmill testing is the most frequently reported first-line NIVT (42%).Our results suggest highly variable ACS screening and clinical practice.

  View details for DOI 10.1111/acem.13184

  View details for PubMedID 28261908

• Performance of Emergency Department Screening Criteria for an Early ECG to Identify ST-Segment Elevation Myocardial Infarction. Journal of the American Heart Association Yiadom, M. Y., Baugh, C. W., McWade, C. M., Liu, X., Song, K. J., Patterson, B. W., Jenkins, C. A., Tanski, M., Mills, A. M., Salazar, G., Wang, T. J., Dittus, R. S., Liu, D., Storrow, A. B. 2017; 6 (3)

  Abstract

  Timely diagnosis of ST-segment elevation myocardial infarction (STEMI) in the emergency department (ED) is made solely by ECG. Obtaining this test within 10 minutes of ED arrival is critical to achieving the best outcomes. We investigated variability in the timely identification of STEMI across institutions and whether performance variation was associated with the ED characteristics, the comprehensiveness of screening criteria, and the STEMI screening processes.We examined STEMI screening performance in 7 EDs, with the missed case rate (MCR) as our primary end point. The MCR is the proportion of primarily screened ED patients diagnosed with STEMI who did not receive an ECG within 15 minutes of ED arrival. STEMI was defined by hospital discharge diagnosis. Relationships between the MCR and ED characteristics, screening criteria, and STEMI screening processes were assessed, along with differences in door-to-ECG times for captured versus missed patients. The overall MCR for all 7 EDs was 12.8%. The lowest and highest MCRs were 3.4% and 32.6%, respectively. The mean difference in door-to-ECG times for captured and missed patients was 31 minutes, with a range of 14 to 80 minutes of additional myocardial ischemia time for missed cases. The prevalence of primarily screened ED STEMIs was 0.09%. EDs with the greatest informedness (sensitivity+specificity-1) demonstrated superior performance across all other screening measures.The 29.2% difference in MCRs between the highest and lowest performing EDs demonstrates room for improving timely STEMI identification among primarily screened ED patients. The MCR and informedness can be used to compare screening across EDs and to understand variable performance.

  View details for DOI 10.1161/JAHA.116.003528

  View details for PubMedID 28232323

  View details for PubMedCentralID PMC5523988

• Documentation of HEART score discordance between emergency physician and cardiologist evaluations of ED patients with chest pain. The American journal of emergency medicine Wu, W. K., Yiadom, M. Y., Collins, S. P., Self, W. H., Monahan, K. 2017; 35 (1): 132-135

  Abstract

  A triage cardiology program, in which cardiologists provide consultation to the Emergency Department (ED), may safely reduce admissions. For patients with chest pain, the HEART Pathway may obviate the need for cardiology involvement, unless there is a difference between ED and cardiology assessments. Therefore, in a cohort concurrently evaluated by both specialties, we analyzed discordance between ED and cardiology HEART scores.We performed a single-center, cross-sectional, retrospective study of adults presenting to the ED with chest pain who had a documented bedside evaluation by a triage cardiologist. Separate ED and cardiology HEART scores were computed based on documentation by the respective physicians. Discrepancies in HEART score between ED physicians and cardiologists were quantified using Cohen κ coefficient.Thirty-three patients underwent concurrent ED physician and cardiologist evaluation. Twenty-three patients (70%) had discordant HEART scores (κ = 0.13; 95% confidence interval, -0.02 to 0.32). Discrepancies in the description of patients' chest pain were the most common source of discordance and were present in more than 50% of cases. HEART scores calculated by ED physicians tended to overestimate the scores calculated by cardiologists. When categorized into low-risk or high-risk by the HEART Pathway, more than 25% of patients were classified as high risk by the ED physician, but low risk by the cardiologist.There is substantial discordance in HEART scores between ED physicians and cardiologists. A triage cardiology system may help refine risk stratification of patients presenting to the ED with chest pain, even when the HEART Pathway tool is used.

  View details for DOI 10.1016/j.ajem.2016.09.058

  View details for PubMedID 27745728

  View details for PubMedCentralID PMC6805131

• Implementing Data Definition Consistency for Emergency Department Operations Benchmarking and Research. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Yiadom, M. Y., Scheulen, J., McWade, C. M., Augustine, J. J. 2016; 23 (7): 796-802

  Abstract

  The objective was to obtain a commitment to adopt a common set of definitions for emergency department (ED) demographic, clinical process, and performance metrics among the ED Benchmarking Alliance (EDBA), ED Operations Study Group (EDOSG), and Academy of Academic Administrators of Emergency Medicine (AAAEM) by 2017.A retrospective cross-sectional analysis of available data from three ED operations benchmarking organizations supported a negotiation to use a set of common metrics with identical definitions. During a 1.5-day meeting-structured according to social change theories of information exchange, self-interest, and interdependence-common definitions were identified and negotiated using the EDBA's published definitions as a start for discussion. Methods of process analysis theory were used in the 8 weeks following the meeting to achieve official consensus on definitions. These two lists were submitted to the organizations' leadership for implementation approval.A total of 374 unique measures were identified, of which 57 (15%) were shared by at least two organizations. Fourteen (4%) were common to all three organizations. In addition to agreement on definitions for the 14 measures used by all three organizations, agreement was reached on universal definitions for 17 of the 57 measures shared by at least two organizations. The negotiation outcome was a list of 31 measures with universal definitions to be adopted by each organization by 2017.The use of negotiation, social change, and process analysis theories achieved the adoption of universal definitions among the EDBA, EDOSG, and AAAEM. This will impact performance benchmarking for nearly half of US EDs. It initiates a formal commitment to utilize standardized metrics, and it transitions consistency in reporting ED operations metrics from consensus to implementation. This work advances our ability to more accurately characterize variation in ED care delivery models, resource utilization, and performance. In addition, it permits future aggregation of these three data sets, thus facilitating the creation of more robust ED operations research data sets unified by a universal language. Negotiation, social change, and process analysis principles can be used to advance the adoption of additional definitions.

  View details for DOI 10.1111/acem.12988

  View details for PubMedID 27121149

  View details for PubMedCentralID PMC6805130

• Consensus statement on advancing research in emergency department operations and its impact on patient care. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Yiadom, M. Y., Ward, M. J., Chang, A. M., Pines, J. M., Jouriles, N., Yealy, D. M. 2015; 22 (6): 757-64

  Abstract

  The consensus conference on "Advancing Research in Emergency Department (ED) Operations and Its Impact on Patient Care," hosted by The ED Operations Study Group (EDOSG), convened to craft a framework for future investigations in this important but understudied area. The EDOSG is a research consortium dedicated to promoting evidence-based clinical practice in emergency medicine. The consensus process format was a modified version of the NIH Model for Consensus Conference Development. Recommendations provide an action plan for how to improve ED operations study design, create a facilitating research environment, identify data measures of value for process and outcomes research, and disseminate new knowledge in this area. Specifically, we call for eight key initiatives: 1) the development of universal measures for ED patient care processes; 2) attention to patient outcomes, in addition to process efficiency and best practice compliance; 3) the promotion of multisite clinical operations studies to create more generalizable knowledge; 4) encouraging the use of mixed methods to understand the social community and human behavior factors that influence ED operations; 5) the creation of robust ED operations research registries to drive stronger evidence-based research; 6) prioritizing key clinical questions with the input of patients, clinicians, medical leadership, emergency medicine organizations, payers, and other government stakeholders; 7) more consistently defining the functional components of the ED care system, including observation units, fast tracks, waiting rooms, laboratories, and radiology subunits; and 8) maximizing multidisciplinary knowledge dissemination via emergency medicine, public health, general medicine, operations research, and nontraditional publications.

  View details for DOI 10.1111/acem.12695

  View details for PubMedID 26014365

  View details for PubMedCentralID PMC4724862

• Diagnostic implications of an elevated troponin in the emergency department. Disease markers Yiadom, M. Y., Jarolim, P., Jenkins, C., Melanson, S. E., Conrad, M., Kosowsky, J. M. 2015; 2015: 157812

  Abstract

  To determine the proportion of initial troponin (cTn) elevations associated with Type I MI versus other cardiovascular and noncardiovascular diagnoses in an emergency department (ED) and whether or not a relationship exists between the cTn level and the likelihood of Type I MI.In the ED, cTn is used as a screening test for myocardial injury. However, the differential diagnosis for an initial positive cTn result is not clear.Hospital medical records were retrospectively reviewed for visits associated with an initial positive troponin I-ultra (cTnI), ≥0.05 μg/L. Elevated cTnI levels were stratified into low (0.05-0.09), medium (0.1-0.99), or high (≥1.0). Discharge diagnoses were classified into 3 diagnostic groups (Type I MI, other cardiovascular, or noncardiovascular).Of 23,731 ED visits, 4,928 (21%) had cTnI testing. Of those tested, 16.3% had initial cTnI ≥0.05. Among those with elevated cTn, 11% were classified as Type I MI, 34% had other cardiovascular diagnoses, and 55% had a noncardiovascular diagnosis. Type I MI was more common with high cTnI levels (41% incidence) than among subjects with medium (9%) or low (6%).A positive cTn is most likely a noncardiovascular diagnosis, but Type I MI is far more common with cTnI levels ≥1.0.

  View details for DOI 10.1155/2015/157812

  View details for PubMedID 25960590

  View details for PubMedCentralID PMC4415742

• Emergency Department Treatment of Acute Coronary Syndromes EMERGENCY MEDICINE CLINICS OF NORTH AMERICA Yiadom, M. B. 2011; 29 (4): 699-+

  Abstract

  Acute coronary syndrome (ACS) is a broad term encompassing a spectrum of acute myocardial ischemia and injury ranging from unstable angina and non-ST-segment elevation myocardial infarction to ST-segment elevation myocardial infarction. ACS accounts for approximately 1.2 million hospital admissions in the United States annually. The aging of the United States population, along with the national obesity epidemic and the associated increase in metabolic syndrome, means that the number of individuals at risk for ACS will continue to increase for the foreseeable future. This article reviews the current evidence and guidelines for the treatment of patients along the continuum of ACS.

  View details for DOI 10.1016/j.emc.2011.09.016

  View details for Web of Science ID 000297383100005

  View details for PubMedID 22040701

• Acute Coronary Syndrome Clinical Presentations and Diagnostic Approaches in the Emergency Department EMERGENCY MEDICINE CLINICS OF NORTH AMERICA Yiadom, M. B. 2011; 29 (4): 689-+

  Abstract

  This article discusses clinical presentations and diagnostic approaches to acute coronary syndrome in the emergency department.

  View details for DOI 10.1016/j.emc.2011.08.006

  View details for Web of Science ID 000297383100004

  View details for PubMedID 22040700

• Management strategies for patients with low-risk chest pain in the emergency department. Current treatment options in cardiovascular medicine Yiadom, M. Y., Kosowsky, J. M. 2011; 13 (1): 57-67

  Abstract

  OPINION STATEMENT: There is abundant evidence to guide the management of chest pain patients with a confirmed or reasonably suspected diagnosis of acute coronary syndrome (ACS). But when it comes to the low-risk chest pain patient in the emergency department, there is limited evidence to support one approach over another. As a result, the evaluation of low-risk chest pain represents a distinct challenge for the emergency physician. Missing a diagnosis of ACS is certainly undesirable. However, the overuse of technology can result in misleading test results in populations with a low incidence of coronary disease. In this article, we dispel several myths surrounding low-risk chest pain and put forward a number of common-sense recommendations. We endorse taking a focused but thorough chest pain history; encourage the use of serial electrocardiogram, particularly for patients with ongoing or changing symptoms; comment on the interpretation of cardiac biomarkers in the era of highly sensitive troponin assays, drawing a distinction between myocardial injury and myocardial infarction; discuss the role of coronary computed tomography angiography as a test for coronary artery disease, rather than for ACS; and caution against the reflexive use of provocative testing in low-risk chest pain patients.

  View details for DOI 10.1007/s11936-010-0108-3

  View details for PubMedID 21153720

• Trends of Academic Faculty Identifying as Hispanic at US Medical Schools, 1990-2021. Journal of graduate medical education Saxena, M. R., Ling, A. Y., Carrillo, E., Alvarez, A., Yiadom, M. Y., Bennett, C. L., Gallegos, M. 2023; 15 (2): 175-179

  Abstract

  Background: According to recent census data, Hispanic and Latino populations comprise the largest minority group in the United States. Despite ongoing efforts for improved diversity, equity, and inclusion, Hispanics remain underrepresented in medicine (UIM). In addition to well-established benefits to patient care and health systems, physician diversity and increased representation in academic faculty positively impact the recruitment of trainees from UIM backgrounds. Disproportionate representation (as compared to increases of certain underrepresented groups in the US population) has direct implications for recruitment of UIM trainees to residency programs.Objective: To examine the number of full-time US medical school faculty physicians who self-identify as Hispanic in light of the increasing Hispanic population in the United States.Methods: We analyzed data from the Association of American Medical Colleges from 1990 to 2021, looking at those academic faculty who were classified as Hispanic, Latino, of Spanish Origin, or of Multiple Race-Hispanic. We used descriptive statistics and visualizations to illustrate the level of representation of Hispanic faculty by sex, rank, and clinical specialty over time.Results: Overall, the proportion of faculty studied who identified as Hispanic increased from 3.1% (1990) to 6.01% (2021). Moreover, while the proportion of female Hispanic academic faculty increased, there remains a lag between females versus males.Conclusions: Our analysis shows that the number of full-time US medical school faculty who self-identify as Hispanic has not increased, though the population of Hispanics in the United States has increased.

  View details for DOI 10.4300/JGME-D-22-00384.1

  View details for PubMedID 37139207

• Effectiveness, safety, and efficiency of a drive-through care model as a response to the COVID-19 testing demand in the United States. Journal of the American College of Emergency Physicians open Ravi, S., Graber-Naidich, A., Sebok-Syer, S. S., Brown, I., Callagy, P., Stuart, K., Ribeira, R., Gharahbaghian, L., Shen, S., Sundaram, V., Yiadom, M. Y. 2022; 3 (6): e12867

  Abstract

  Objectives: Here we report the clinical performance of COVID-19 curbside screening with triage to a drive-through care pathway versus main emergency department (ED) care for ambulatory COVID-19 testing during a pandemic. Patients were evaluated from cars to prevent the demand for testing from spreading COVID-19 within the hospital.Methods: We examined the effectiveness of curbside screening to identify patients who would be tested during evaluation, patient flow from screening to care team evaluation and testing, and safety of drive-through care as 7-day ED revisits and 14-day hospital admissions. We also compared main ED efficiency versus drive-through care using ED length of stay (EDLOS). Standardized mean differences (SMD)>0.20 identify statistical significance.Results: Of 5931 ED patients seen, 2788 (47.0%) were walk-in patients. Of these patients, 1111 (39.8%) screened positive for potential COVID symptoms, of whom 708 (63.7%) were triaged to drive-through care (with 96.3% tested), and 403 (36.3%) triaged to the main ED (with 90.5% tested). The 1677 (60.2%) patients who screened negative were seen in the main ED, with 440 (26.2%) tested. Curbside screening sensitivity and specificity for predicting who ultimately received testing were 70.3% and 94.5%. Compared to the main ED, drive-through patients had fewer 7-day ED revisits (3.8%vs 12.5%, SMD=0.321), fewer 14-day hospital readmissions (4.5%vs 15.6%, SMD=0.37), and shorter EDLOS (0.56vs 5.12hours, SMD=1.48).Conclusion: Curbside screening had high sensitivity, permitting early respiratory isolation precautions for most patients tested. Low ED revisit, hospital readmissions, and EDLOS suggest drive-through care, with appropriate screening, is safe and efficient for future respiratory illness pandemics.

  View details for DOI 10.1002/emp2.12867

  View details for PubMedID 36570369

• Three decades of demographic trends among academic emergency physicians. Journal of the American College of Emergency Physicians open Cleveland Manchanda, E. C., Ling, A. Y., Bottcher, J. L., Marsh, R. H., Brown, D. F., Bennett, C. L., Yiadom, M. Y. 2022; 3 (4): e12781

  Abstract

  Purpose: To describe trends in emergency medicine faculty demographics, examining changes in the proportion of historically underrepresented groups including female, Black, and Latinx faculty over time.Methods: Data from the Association of American Medical Colleges faculty roster (1990-2020) were used to assess the changing demographics of full-time emergency medicine faculty. Descriptive statistics, graphic visualizations, and logistic regression modeling were used to illustrate trends in the proportion of female, Black, and Latinx faculty. Odds ratios (OR) were used to describe the estimated annual rate of change of underrepresented demographic groups.Results: The number of full-time emergency medicine faculty increased from 214 in 1990 to 5874 in 2020. Female emergency medicine faculty demonstrated increases in representation overall, from 35 (16.36%) in 1990 to 2247 (38.25%) in 2020, suggesting a 3% estimated annual rate of increase (OR 1.03, 95% CI 1.03-1.04) and within each academic rank. A very small positive trend was noted among Latinx faculty (n=3, 1.40% in 1990 to n=326, 5.55% in 2020; OR 1.01, 95% CI 1.01-1.02), whereas an even smaller, statistically insignificant increase was observed among Black emergency medicine faculty during the 31-year study period (N=9, 4.21% in 1990 and N=266, 4.53% in 2020; OR 1.00, 95% CI 0.99-1.00).Conclusions: Although female physicians have progressed toward equitable representation among academic emergency medicine faculty, no meaningful progress has been made toward racial parity. The persistent underrepresentation of Black and Latinx physicians in the academic emergency medicine workforce underscores the need for urgent structural changes to address contemporary manifestations of racism in academic medicine and beyond.

  View details for DOI 10.1002/emp2.12781

  View details for PubMedID 35982985

• OPERATIONALIZING A PANDEMIC-READY, TELEMEDICINE-ENABLED DRIVE-THROUGH AND WALK-IN CORONAVIRUS DISEASE GARAGE CARE SYSTEM AS AN ALTERNATIVE CARE AREA: A NOVEL APPROACH IN PANDEMIC MANAGEMENT JOURNAL OF EMERGENCY NURSING Callagy, P., Ravi, S., Khan, S., Yiadom, M. B., McClellen, H., Snell, S., Major, T. W., Yefimova, M. 2021; 47 (5): 721-732

  Abstract

  Emergency departments face unforeseen surges in patients classified as low acuity during pandemics such as the coronavirus disease pandemic. Streamlining patient flow using telemedicine in an alternative care area can reduce crowding and promote physical distancing between patients and clinicians, thus limiting personal protective equipment use. This quality improvement project describes critical elements and processes in the operationalization of a telemedicine-enabled drive-through and walk-in garage care system to improve ED throughput and conserve personal protective equipment during 3 coronavirus disease surges in 2020.Standardized workflows were established for the operationalization of the telemedicine-enabled drive-through and walk-in garage care system for patients presenting with respiratory illness as quality improvement during disaster. Statistical control charts present interrupted time series data on the ED length of stay and personal protective equipment use in the week before and after deployment in March, July, and November 2020.Physical space, technology infrastructure, equipment, and staff workflows were critical to the operationalization of the telemedicine-enabled drive-through and walk-in garage care system. On average, the ED length of stay decreased 17%, from 4.24 hours during the week before opening to 3.54 hours during the telemedicine-enabled drive-through and walk-in garage care system operation. There was an estimated 25% to 41% reduction in personal protective equipment use during this time.Lessons learned from this telemedicine-enabled alternative care area implementation can be used for disaster preparedness and management in the ED setting to reduce crowding, improve throughput, and conserve personal protective equipment during a pandemic.

  View details for DOI 10.1016/j.jen.2021.05.010

  View details for Web of Science ID 000762175400001

  View details for PubMedID 34303530

  View details for PubMedCentralID PMC8173460

• Examining Parity among Black and Hispanic Resident Physicians. Journal of general internal medicine Bennett, C. L., Yiadom, M. Y., Baker, O. n., Marsh, R. H. 2021

  Abstract

  The US physician workforce does not represent the racial or ethnic diversity of the population it serves.To assess whether the proportion of US physician trainees of Black race and Hispanic ethnicity has changed over time and then provide a conceptual projection of future trends.Cross-sectional, retrospective, analysis based on 11 years of publicly available data paired with recent US census population estimates.A total of 86,303 (2007-2008) to 103,539 (2017-2018) resident physicians in the 20 largest US Accreditation Council for Graduate Medical Education resident specialties.Changes in proportion of physician trainees of Black race and Hispanic ethnicity per academic year. Projected number of years it will then take, for specialties with positive changes, to reach proportions of Black race and Hispanic ethnicity comparable to that of the US population.Among the 20 largest specialty training programs, Radiology was the only specialty with a statistically significant increase in the proportion of Black trainees, but it could take Radiology 77 years to reach levels of Black representation comparable to that of the US population. Obstetrics/Gynecology, Emergency Medicine, Internal Medicine/Pediatrics, and Orthopedic Surgery demonstrated a statistically significant increase in the proportion of Hispanic trainees, but it could take these specialties 35, 54, 61, and 93 years respectively to achieve Hispanic representation comparable to that of the US population.Among US residents in the 20 largest specialties, no specialty represented either the Black or Hispanic populations in proportions comparable to the overall US population. Only a small number of specialties demonstrated statistically significant increases. This conceptual projection suggests that current efforts to promote diversity are insufficient.

  View details for DOI 10.1007/s11606-021-06650-7

  View details for PubMedID 33629264

• Impact of a Follow-up Telephone Call Program on 30-Day Readmissions (FUTR-30): A Pragmatic Randomized Controlled Real-world Effectiveness Trial. Medical care Yiadom, M. Y., Domenico, H. J., Byrne, D. W., Hasselblad, M., Kripalani, S., Choma, N., Tucker-Marlow, S., Gatto, C. L., Wang, L., Bhatia, M. C., Morrison, J., Harrell, F. E., Hartert, T. V., Lindsell, C. J., Bernard, G. R. 2020; 58 (9): 785-792

  Abstract

  Telephone call programs are a common intervention used to improve patients' transition to outpatient care after hospital discharge.To examine the impact of a follow-up telephone call program as a readmission reduction initiative.Pragmatic randomized controlled real-world effectiveness trial.We enrolled and randomized all patients discharged home from a hospital general medicine service to a follow-up telephone call program or usual care discharge. Patients discharged against medical advice were excluded. The intervention was a hospital program, delivering a semistructured follow-up telephone call from a nurse within 3-7 days of discharge, designed to assess understanding and provide education, and assistance to support discharge plan implementation.Our primary endpoint was hospital inpatient readmission within 30 days identified by the electronic health record. Secondary endpoints included observation readmission, emergency department revisit, and mortality within 30 days, and patient experience ratings.All 3054 patients discharged home were enrolled and randomized to the telephone call program (n=1534) or usual care discharge (n=1520). Using a prespecified intention-to-treat analysis, we found no evidence supporting differences in 30-day inpatient readmissions [14.9% vs. 15.3%; difference -0.4 (95% confidence interval, 95% CI), -2.9 to 2.1; P=0.76], observation readmissions [3.8% vs. 3.6%; difference 0.2 (95% CI, -1.1 to 1.6); P=0.74], emergency department revisits [6.1% vs. 5.4%; difference 0.7 (95% CI, -1.0 to 2.3); P=0.43], or mortality [4.4% vs. 4.9%; difference -0.5 (95% CI, -2.0 to 1.0); P=0.51] between telephone call and usual care groups.We found no evidence of an impact on 30-day readmissions or mortality due to the postdischarge telephone call program.

  View details for DOI 10.1097/MLR.0000000000001353

  View details for PubMedID 32732787

• Public Health Rationale for Investments in Emergency Medicine in Developing Countries - Ghana as a Case Study. The Journal of emergency medicine Yiadom, M. Y., McWade, C. M., Awoonor-Williams, K., Appiah-Denkyira, E., Moresky, R. T. 2018; 55 (4): 537-543

  Abstract

  Ghana is a developing country that has strategically invested in expanding emergency care services as a means of improving national health outcomes.Here we present Ghana as a case study for investing in emergency care to achieve public health benefits that fuel for national development.Ghana's health leadership has affirmed emergency care as a necessary adjunct to its preexisting primary health care model. Historically, developing countries prioritize primary care efforts and outpatient clinic-based health care models. Ghana has added emergency medicine infrastructure to its health care system in an effort to address the ongoing shift in disease epidemiology as the population urbanizes, mobilizes, and ages. Ghana's investments include prehospital care, personnel training, health care resource provision, communication improvements, transportation services, and new health facilities. This is in addition to re-educating frontline health care providers and developing infrastructure for specialist training. Change was fueled by public support, partnerships between international organizations and domestic stakeholders, and several individual champions.Emergency medicine as a horizontal component of low- to middle-income countries' health systems may fuel national health and economic development. Ghana's experience may serve as a model.

  View details for DOI 10.1016/j.jemermed.2018.07.021

  View details for PubMedID 30181077

• Randomised controlled pragmatic clinical trial evaluating the effectiveness of a discharge follow-up phone call on 30-day hospital readmissions: balancing pragmatic and explanatory design considerations. BMJ open Yiadom, M. Y., Domenico, H., Byrne, D., Hasselblad, M. M., Gatto, C. L., Kripalani, S., Choma, N., Tucker, S., Wang, L., Bhatia, M. C., Morrison, J., Harrell, F. E., Hartert, T., Bernard, G. 2018; 8 (2): e019600

  Abstract

  Hospital readmissions within 30 days are a healthcare quality problem associated with increased costs and poor health outcomes. Identifying interventions to improve patients' successful transition from inpatient to outpatient care is a continued challenge.This is a single-centre pragmatic randomised and controlled clinical trial examining the effectiveness of a discharge follow-up phone call to reduce 30-day inpatient readmissions. Our primary endpoint is inpatient readmission within 30 days of hospital discharge censored for death analysed with an intention-to-treat approach. Secondary endpoints included observation status readmission within 30 days, time to readmission, all-cause emergency department revisits within 30 days, patient satisfaction (measured as mean Hospital Consumer Assessment of Healthcare Providers and Systems scores) and 30-day mortality. Exploratory endpoints include the need for assistance with discharge plan implementation among those randomised to the intervention arm and reached by the study nurse, and the number of call attempts to achieve successful intervention delivery. Consistent with the Learning Healthcare System model for clinical research, timeliness is a critical quality for studies to most effectively inform hospital clinical practice. We are challenged to apply pragmatic design elements in order to maintain a high-quality practicable study providing timely results. This type of prospective pragmatic trial empowers the advancement of hospital-wide evidence-based practice directly affecting patients.Study results will inform the structure, objective and function of future iterations of the hospital's discharge follow-up phone call programme and be submitted for publication in the literature.NCT03050918; Pre-results.

  View details for DOI 10.1136/bmjopen-2017-019600

  View details for PubMedID 29444787

  View details for PubMedCentralID PMC5829894

• Diagnostic Utility of Neuregulin for Acute Coronary Syndrome. Disease markers Yiadom, M. Y., Greenberg, J., Smith, H. M., Sawyer, D. B., Liu, D., Carlise, J., Tortora, L., Storrow, A. B. 2016; 2016: 8025271

  Abstract

  The purpose of this study was to determine the diagnostic test characteristics of serum neuregulin-1β (NRG-1β) for the detection of acute coronary syndrome (ACS). We recruited emergency department patients presenting with signs and symptoms prompting an evaluation for ACS. Serum troponin and neuregulin-1β levels were compared between those who had a final discharge diagnosis of myocardial infarction (STEMI and NSTEMI) and those who did not, as well as those who more broadly had a final discharge diagnosis of ACS (STEMI, NSTEMI, and unstable angina). Of 319 study participants, 11% had evidence of myocardial infarction, and 19.7% had a final diagnosis of ACS. Patients with MI had median neuregulin levels of 0.16 ng/mL (IQR [0.16-24.54]). Compared to the median of those without MI, 1.46 ng/mL (IQR [0.16-15.02]), there was no significant difference in the distribution of results (P = 0.63). Median neuregulin levels for patients with ACS were 0.65 ng/mL (IQR [0.16-24.54]). There was no statistical significance compared to those without ACS who had a median of 1.40 ng/mL (IQR [0.16-14.19]) (P = 0.95). Neuregulin did not perform successfully as a biomarker for acute MI or ACS in the emergency department.

  View details for DOI 10.1155/2016/8025271

  View details for PubMedID 27110055

  View details for PubMedCentralID PMC4823486

• CLOPIDOGREL USE IN ST-ELEVATION MYOCARDIAL INFARCTION (STEMI) JOURNAL OF EMERGENCY MEDICINE Yiadom, M. B. 2010; 39 (2): 217-218

  View details for DOI 10.1016/j.jemermed.2008.08.025

  View details for Web of Science ID 000281290000017

  View details for PubMedID 19168312

• Efficacy of ShotBlocker in reducing pediatric pain associated with intramuscular injections Drago, L. A., Singh, S. B., Douglass-Bright, A., Yiadom, M., Baumann, B. M. W B SAUNDERS CO-ELSEVIER INC. 2009: 536-543

  Abstract

  The aim of the study was to determine the efficacy of ShotBlocker (Bionix, Toledo, Ohio) in reducing pediatric pain with intramuscular (IM) injections.A prospective randomized controlled trial was conducted in children aged 2 months to 17 years who required an IM injection. Children were randomized to the no-intervention group or the ShotBlocker group. Demographic data and the number of IM injections were recorded. Perceived pain scores were obtained from nurses and caregivers using a 6-point Likert-type scale. Baker Wong Faces scale was used in children 36 months or older. Difficulty using the device was also rated by nurses on a 6-point scale.One hundred sixty-five children were enrolled with 80 in the no-intervention arm and 85 in the ShotBlocker arm. The mean age of children was 45 months and 56% were male. Perceived pain scores by nurses were higher for the no-intervention group (2.6 vs 1.8, P < .001) as well as by caregivers (2.6 vs 2.1, P = .04). Children aged 36 months and older (n = 64) did not report a difference in pain scores (1.5 vs 1.3, P = .6); however, in a subgroup of children 72 months or older, pain scores trended higher in the no-intervention group (1.3 vs 0.5, P = .051). Nurse-perceived difficulty of ShotBlocker use was low 1.39 (+/-1.1).Nurses and caregivers noted lower pain scores in children assigned to the ShotBlocker group. These differences were not as evident when children rated their own pain.

  View details for DOI 10.1016/j.ajem.2008.04.011

  View details for Web of Science ID 000266940800004

  View details for PubMedID 19497458

• Pneumothorax in a blunt trauma patient JOURNAL OF EMERGENCY MEDICINE Yiadom, M. B., Platz, E., Brown, D. M., Nadel, E. S. 2008; 35 (2): 199-203

  View details for DOI 10.1016/j.jemermed.2008.05.014

  View details for Web of Science ID 000258475700015

  View details for PubMedID 18599250