Timothy Kelly, MD, MPH

All Publications

• Bereavement scheduling policy for emergency medicine residents: A descriptive pilot study. AEM education and training Kelly, T. D., de Venecia, B. T., Pang, P. S., Turner, J. S., Reed, K. D., Pettit, K. E. 2024; 8 (4): e11009

  Abstract

  The Accreditation Council for Graduate Medical Education has tasked residency programs to prioritize resident wellness, reduce trainee stress, and prevent burnout. Grief and bereavement can significantly impact residents' wellness during difficult clinical training schedules. There are no best practices on how to support residents during this time.In a split academic county emergency medicine (EM) residency, this pilot study documents a resident-driven change to scheduling practices for bereavement leave. An advisory group of residents, chief residents, and program directors informally polled peer institutions to develop bereavement leave guidelines. Considerations were made to balance resident wellness, education, and patient care in developing a bereavement scheduling policy.The bereavement policy was adopted in January 2023, aiming to "support the resident during a difficult time and reduce concerns around shift coverage" following the death of a family member without impacting sick call. The number of covered days depended on the relationship of the resident to the deceased. Residents covering bereavement days for their peers were financially compensated. During the first 7 months following implementation, five residents utilized the policy. These residents noted this to be the most positive impact on the residency during the past year. Based on resident feedback, the scope was expanded to include grave medical illness of a family member as an implementation criterion.This article outlines the creation, implementation, and benefits of a bereavement scheduling policy within an EM residency. Describing this approach will provide guidance for other residencies to adopt similar wellness-focused strategies.

  View details for DOI 10.1002/aet2.11009

  View details for PubMedID 38993542

  View details for PubMedCentralID PMC11234136

• Correspondence on 'Methocarbamol versus diazepam in acute low back pain in the emergency department: a randomised double-blind clinical trial' by Sharifi et al. Emergency medicine journal : EMJ Kelly, T. D., Lee, J. B., Oswald, J. C. 2024

  View details for DOI 10.1136/emermed-2024-214123

  View details for PubMedID 38991659

• Targeted Drug Delivery for the Treatment of Abdominal Pain in Chronic Pancreatitis: A Retrospective Case Series. Cureus Cooper, G. P., Progar, V., Grott, K., Patel, F., Mon, J., Bick, B., Kelly, T. D., Rahimi Darabad, R. 2024; 16 (3): e57285

  Abstract

  Abdominal pain secondary to chronic pancreatitis (CP) is difficult to manage and often requires chronic oral opioid therapy (OOT). Targeted drug delivery (TDD) allows for a diminished dose of opioid intake and improved pain levels. TDD has been used in different pain syndromes with only limited reports in CP.The objective of this article is to perform a retrospective review of CP patients treated with TDD versus OOT to compare chronic pain control and consumed morphine-equivalent doses.Patients receiving TDD between September 2011 and August 2018 were included. All patients were weaned off oral opioids one week before intrathecal trial and pump implantation. Patients with intrathecal trials providing at least 50% pain relief underwent pump implantation. Data were collected while on OOT and at two weeks, three months, and nine months post-implant. Data were analyzed with Microsoft Excel 365 MSO using means and standard deviations. P-values were calculated using a two-tailed student's t-test with paired two-sample means.Twenty-three patients were analyzed. Pre-trial average pain score was 6.5/10 with a mean improvement with trials greater than 71%. The mean chronic baseline oral morphine milligram equivalents (MME) was 188. The mean MME on TDD at two weeks (0.36), three months (1.39), and nine months (2.47) were significantly lower than OOT. Mean pain scores were 6, 4.9, and 5.6 at two weeks, three months, and nine months, respectively, compared to 6.5 on OOT.The results of this study indicate that TDD provides improved pain control with significantly lower opioid doses.

  View details for DOI 10.7759/cureus.57285

  View details for PubMedID 38690495

  View details for PubMedCentralID PMC11058739

• Peripartum Cardiac Arrest with Terminal QRS Distortion: A Case Report. Clinical practice and cases in emergency medicine Kelly, T. D., Harrison, N. E. 2024; 8 (1): 22-25

  Abstract

  Peripartum cardiac arrest is increasing in incidence. While pulmonary embolism (PE) remains an important cause of peripartum morbidity and mortality, other cardiovascular emergencies such as myocardial infarction (MI) are now the leading cause of pregnancy-related death. Emergency physicians (EP) need to be well versed in subtle electrocardiographic (ECG) signs of coronary ischemia to better care for peripartum patients in cardiac arrest.A 38-year-old gravida 2 parity1 female three days post-partum presented in cardiac arrest. After approximately 12 minutes of Advanced Cardiac Life Support including electric defibrillation, the patient experienced sustained return of spontaneous circulation. The physician team was primarily concerned for PE based on an initial ECG demonstrating terminal QRS distortion in V2 but no ST-segment elevation myocardial infarction (STEMI). Computed tomography angiography (CTA) of the chest did not reveal PE. Repeat ECG after CTA demonstrated STEMI criteria, and the patient was emergently taken to the cardiac catheterization laboratory where she was found to have 99% occlusion of the left anterior descending artery.Emergency physicians should have a high index of suspicion for MI when managing peripartum patients in cardiac arrest. The ECG findings specific for coronary-occlusive acute MI but not included in the classic STEMI criteria increase accuracy and prevent delays in diagnosis; however, the clinical uptake of this paradigm has been slow. Early recognition of terminal QRS distortion can help EPs more rapidly diagnose the etiology of cardiac arrest.

  View details for DOI 10.5811/cpcem.1323

  View details for PubMedID 38546305

  View details for PubMedCentralID PMC10966496

• Peripheral Nerve Stimulation in Chronic Knee Pain: A Case Series. Cureus Kelly, T. D., Pazzol, M. L., Rahimi Darabad, R. 2023; 15 (12): e50127

  Abstract

  Introduction Chronic knee pain is increasing in prevalence and is associated with substantial limitations in functional mobility. Peripheral nerve stimulation (PNS) has been increasingly used to treat various chronic pain conditions. However, there is a paucity of research exploring the potential therapeutic benefit of PNS for chronic knee pain. Methods This research is a retrospective case series of all patients who received PNS for the treatment of chronic knee pain performed at a single-center academic medical institution between March 2021 and June 2022. The primary outcome was percent pain reduction six months after implantation. Outcome data was obtained via chart review and phone calls to patients. Secondary outcomes included percent pain reduction two weeks and two months after implantation and adverse medical events related to the procedure and nerve stimulation. Results Fourteen individual patients received PNS for chronic knee pain during the study period. Three of these patients received bilateral PNS for a total of 17 cases. The mean percent pain reduction six months after implantation was 52% (SD=28.2) (N=12). A total of 75.0% of participants (9/12) reported ≥50% reductions in pain six months after implantation. No adverse events were reported relating to the implantation procedure and/or nerve stimulation. Conclusion PNS is a safe and efficacious treatment modality for chronic knee pain with demonstrated long-term benefit. Further research should clarify patient factors associated with improved treatment response.

  View details for DOI 10.7759/cureus.50127

  View details for PubMedID 38186428

  View details for PubMedCentralID PMC10771261

• Improving Uptake of Emergency Department-initiated Buprenorphine: Barriers and Solutions WESTERN JOURNAL OF EMERGENCY MEDICINE Kelly, T. D., Hawk, K. F., Samuels, E. A., Strayer, R. J., Hoppe, J. A. 2022; 23 (4): 461-467

  Abstract

  Emergency departments (ED) are increasingly providing buprenorphine to persons with opioid use disorder. Buprenorphine programs in the ED have strong support from public health leaders and emergency medicine specialty societies and have proven to be clinically effective, cost effective, and feasible. Even so, few ED buprenorphine programs currently exist. Given this imbalance between evidence-based practice and current practice, proven behavior change approaches can be used to guide local efforts to expand ED buprenorphine capacity. In this paper, we use the theory of planned behavior to identify and address the 1) clinician factors, 2) institutional factors, and 3) external factors surrounding ED buprenorphine implementation. By doing so, we seek to provide actionable and pragmatic recommendations to increase ED buprenorphine availability across different practice settings.

  View details for DOI 10.5811/westjem.2022.2.52978

  View details for Web of Science ID 000987699100024

  View details for PubMedID 35980414

  View details for PubMedCentralID PMC9391022

• High-Altitude Pulmonary Edema in Colorado Children: A Cross-Sectional Survey and Retrospective Review HIGH ALTITUDE MEDICINE & BIOLOGY Kelly, T. D., Meier, M., Weinman, J. P., Ivy, D., Brinton, J. T., Liptzin, D. R. 2022; 23 (2): 119-124

  Abstract

  Kelly, Timothy D., Maxene Meier, Jason P. Weinman, Dunbar Ivy, John T. Brinton, and Deborah R. Liptzin. High-altitude pulmonary edema in Colorado children: a cross-sectional survey and retrospective review. High Alt Med Biol. 23:119-124, 2022. Introduction: Few studies of high-altitude pulmonary edema (HAPE) are specific to the pediatric population. The purpose of this investigation was to further characterize the radiographic patterns of pediatric HAPE, and to better understand ongoing risk following an initial pediatric HAPE episode. Methods: This study uses both a retrospective chart review and cross-sectional survey. Pediatric patients with HAPE at a single quaternary referral center in the Rocky Mountain Region were identified between the years 2013 and 2020. Patients were eligible if they presented with a clinical diagnosis of HAPE and had a viewable chest radiograph (CXR). Surveys were sent to eligible patients/families to gather additional information relating to family history, puberty, and HAPE recurrence. Results: Forty-two individuals met criteria for clinical diagnosis of HAPE with a viewable CXR. A majority of CXRs (24/42, 57.1%) demonstrated predominant right-sided involvement. Similarly, 24 CXRs (24/42, 57.1%) demonstrated predominant upper lobe involvement. Twenty-one (21/42, 50%) surveys were completed. A minority of individuals went on to experience at least one other HAPE episode (8/19, 42.1%). Conclusion: The most common radiographic pattern seen in pediatric HAPE is pulmonary edema that favors the right lung and upper lobes. After an initial HAPE presentation, some children will experience additional HAPE episodes.

  View details for DOI 10.1089/ham.2021.0121

  View details for Web of Science ID 000781360300001

  View details for PubMedID 35384735

• 'Gun shop projects' for suicide prevention in the USA: current state and future directions INJURY PREVENTION Polzer, E., Brandspigel, S., Kelly, T., Betz, M. 2021; 27 (2): 150-154

  Abstract

  To describe community-driven suicide prevention partnerships between firearm retailers and public health officials ('gun shop projects'), including common elements and challenges.We conducted qualitative interviews with leaders from state-level and national-level partnerships to determine common features, challenges and strategies used by these groups. Data were coded via theme analysis; two independent coders followed a shared codebook developed in an iterative fashion and with high inter-rater reliability.Across 10 interviews, data revealed four main themes: (1) community building was a cornerstone of these efforts; (2) appropriate messaging and language were vital to successes; (3) groups employed various educational and outreach campaigns and (4) groups identified common challenges and obstacles.Gun shop project partnerships between firearm retailers and public health officials show promise, with thematic data demonstrating common trends and steps towards successful programme implementation. Evaluative data are needed to determine the impact of these efforts on suicide prevention in local communities.

  View details for DOI 10.1136/injuryprev-2020-043648

  View details for Web of Science ID 000634765600009

  View details for PubMedID 32213533

• Physician attitudes on buprenorphine induction in the emergency department: results from a multistate survey CLINICAL TOXICOLOGY Zuckerman, M., Kelly, T., Heard, K., Zosel, A., Marlin, M., Hoppe, J. 2021; 59 (4): 279-285

  Abstract

  Emergency Departments (ED) are rapidly becoming an important location for initiation of buprenorphine (EDBUP) for the treatment of opioid use disorder (OUD). Previous investigations of emergency medicine physicians' perceived barriers and attitudes toward EDBUP exclusively sampled from urban, academic-affiliated physicians. We administered a multistate survey to an institutionally and geographically diverse collection of emergency medicine physicians to better understand the professional opinions of EDBUP implementation across a variety of practice settings.This cross-sectional survey study used an online survey instrument to convenience sample emergency medicine physicians. In order to sample from various practice environments, participants were identified from (1) statewide ACEP chapters and (2) Facebook groups exclusive to emergency medicine physicians. The survey explored physicians' attitudes of EDBUP adoption and the perceived barriers to doing so.162 emergency medicine physicians completed the survey. 76% of respondents agreed that emergency medicine physicians should offer EDBUP in the treatment of OUD. When stratified by practice setting and X-waiver status, 96% of X-waivered physicians, 73% of academic physicians, 49% of non-academic physicians, and 34% of non-X-waivered physicians felt comfortable initiating EDBUP. Lack of access to outpatient MOUD referral was the most frequently cited barrier to EDBUP across all practice settings.An institutionally and geographically diverse group of emergency medicine physicians endorsed substantial support for EDBUP. Emergency medicine physicians practicing in different clinical environments endorsed similar barriers to EDBUP implementation.

  View details for DOI 10.1080/15563650.2020.1805461

  View details for Web of Science ID 000564965400001

  View details for PubMedID 32870039

• A novel social work approach to emergency department buprenorphine induction and warm hand-off to community providers AMERICAN JOURNAL OF EMERGENCY MEDICINE Kelly, T., Khoshnoud, A., Hoppe, J. A., Zuckerman, M., Heard, K., Sholl, B. 2020; 38 (6): 1286-1290

  Abstract

  Medications for opioid use disorder (MOUD) is considered gold standard treatment for persons with an opioid use disorder and can be successfully initiated in emergency departments (EDBUP). Perceived provider barriers to EDBUP adoption include increased provider work, lack of provider knowledge about outpatient MOUD resources, and a lack of viable MOUD treatment options within health systems. We evaluated the feasibility of a novel EDBUP institutional design that utilizes the social work team to drive ED care for patients with OUD and coordinate MOUD referral to existing community resources.This is a retrospective, cohort, single-center study describing patient outcomes in a social work driven EDBUP program with referral to community MOUD providers. ED patients with OUD were identified via patient request, standardized nurse screening, or ED provider concern. All identified patients received an urgent social work consult to explore willingness to seek treatment for OUD. Social workers developed individualized follow up plans with participating patients. Clinical data was abstracted from the Electronic Health Record. Social workers tracked continuity with outpatient MOUD services in a clinical care database.From June 1, 2018 through August 31, 2019, 120 patients opted for ED buprenorphine induction. 61% presented to initial outpatient intake appointment and 39% remained engaged in treatment after 30 days.EDs can effectively utilize the expertise of social workers to drive EDBUP and coordinate outpatient MOUD referrals. Our interdisciplinary EDBUP program structure is feasible and has the potential to yield meaningful reductions in physician workload and ED cost.

  View details for DOI 10.1016/j.ajem.2019.12.038

  View details for Web of Science ID 000542946100066

  View details for PubMedID 31959523

• Firearm Storage Maps: A Pragmatic Approach to Reduce Firearm Suicide During Times of Risk ANNALS OF INTERNAL MEDICINE Kelly, T., Brandspigel, S., Polzer, E., Betz, M. E. 2020; 172 (5): 351-+

  View details for DOI 10.7326/M19-2944

  View details for Web of Science ID 000520159500009

  View details for PubMedID 31958811