Hospital Based Violence Intervention Program and Trauma Recovery Center: The Department of Emergency Medicine, in partnership with the Departments of Trauma and Psychiatry, has ongoing projects both administering programming around the Hospital-Based Violence Intervention Program (HBVIP) and the Trauma Recovery Center (TRC) (see Social EM) as well as conducting ongoing research projects involving both HBVIP and the TRC. This involves evaluating program efficacy and impact, qualitative studies of different patients’ experiences with violence and trauma, and the impact of violence and trauma around Los Angeles County.
Medication Assisted Therapy/Substance Use Disorder: The Department of Emergency Medicine has a dedicated substance use disorder navigator to help individuals with substance use disorder. We also partner with the Whole Person Care Substance Use Disorder program to ensure that our patients are connected to care. We receive funding through the California Bridge Grant and are working in partnership with the Bridge program to assess opiate use disorder. We are also working across the Department of Health Services in partnership with Olive View Medical Center and LA County+USC to study medication assisted therapy for alcohol use disorder.
Social EM Curriculum for Residents: Dedicated didactic and interactive small group teaching sessions are set aside during conference and teaching rounds to strengthen residents’ foundations in understanding the social factors affecting our patients’ health. Topics have included violence, housing, incarceration, food insecurity, immigration, language, and gender identity, to name only a few. These sessions are designed to be practical, providing residents with both an understanding of the topic and how they can use it on their next shift.
Social EM Curriculum for SubIs: This study aims to determine the effect of a required educational intervention on the attitudes and understanding of third and fourth year medical students enrolled in the emergency medicine subinternship. Students will be randomized to receive the educational intervention either at the middle or end of their rotation. The goal is to evaluate the ability of medical students to address social barriers to care faced by patients presenting to the emergency department and how this changes after the required educational intervention.
The Impact of SB 1152: Senate Bill 1152 (SB1152) was passed on January 1st 2019. This bill was proposed in California to improve the discharge process for homeless patients and decrease “patient dumping” by hospitals. Under this legislation patients who are homeless must be provided food, weather-appropriate clothing, medications, referrals to social services, and transportation at time of discharge. This project intends to quantify the impact of SB1152 both on the hospital system as well as on patients experiencing homelessness. We will analyze the impact of SB1152 on the medical system using emergency department (ED) length of stay. We will use 30-day ED revisit data to quantify the impact of SB1152 on homeless patients. The major concern with homeless discharge planning is that patients are discharged when they are too sick or insufficiently resourced to care for themselves and they end up back in the hospital.
Chatbot Screening for Social Needs: This is a project that started out as a collaboration between the Department of Emergency Medicine at Harbor-UCLA and the Department of Human Centered Design and Engineering to develop, study, and deploy an automated way of screening for social determinants in the emergency department. The chatbot (think Alexa or Siri) is web based and can run on phones, tablets, or computers and asks patients about social needs. In the future it will connect patients to resources via the 1 Degree platform (www.1deg.org). The project has now expanded to a multi-center study including Harbor-UCLA, Harborview Medical Center (Seattle, WA), and New York-Presbyterian Hospital.
Pediatric Social Needs Screening: Multiple studies have demonstrated the utility of emergency department-based social needs screening and navigation, yet best practice guidelines are lacking. This project, through a randomized controlled trial directly investigates family preferences around screening during their child’s visit to the pediatric emergency department. Results may help inform patient and family navigation programs not just within Harbor UCLA but in other emergency departments as well.
Recently Completed Research
Early Convalescent Plasma for High-Risk Outpatients with Covid-19
The administration of Covid-19 convalescent plasma to high-risk outpatients within 1 week after the onset of symptoms of Covid-19 did not prevent disease progression.
Comparison of Outcomes of antibiotic Drugs and Appendectomy (CODA) trial
For the treatment of appendicitis, antibiotics were noninferior to appendectomy on the basis of results of a standard health-status measure. In the antibiotics group, nearly 3 in 10 participants had undergone appendectomy by 90 days. Participants with an appendicolith were at a higher risk for appendectomy and for complications than those without an appendicolith.
A Randomized Controlled Trial on the Effect of a Double Check on the Detection of Medication Errors
Study objective: The use of a double check by 2 nurses has been advocated as a key error-prevention strategy. This study aims to determine how often a double check is used for high-alert medications and whether it increases error detection.
A Multifaceted Intervention Improves Prescribing for Acute Respiratory Infection for Adults and Children in Emergency Department and Urgent Care Settings
Antibiotics are commonly prescribed during emergency department and urgent care center visits for viral acute respiratory infection. We evaluate the comparative effectiveness of an antibiotic stewardship intervention adapted for acute care ambulatory settings (adapted intervention) to a stewardship intervention that additionally incorporates behavioral nudges (enhanced intervention) in reducing inappropriate prescriptions.
Multicenter Comparison of Nonsupine Versus Supine Positioning During Intubation in the Emergency Department: A National Emergency Airway Registry (NEAR) Study
Head-up positioning for preoxygenation and ramping for morbidly obese patients are well-accepted techniques, but the effect of head-up positioning with full torso elevation for all intubations is controversial. We compared first-pass success, adverse events, and glottic view between supine (SP) and nonsupine (NSP) positioning for emergency department (ED) patients undergoing orotracheal intubation.
Screening for Adolescent Alcohol Use in the Emergency Department: What Does It Tell Us About Cannabis, Tobacco, and Other Drug Use?
The pediatric emergency department (PED) represents an opportune time for alcohol and drug screening. The National Institute of Alcohol Abuse and Alcoholism (NIAAA) recommends a two-question alcohol screen for adolescents as a predictor of alcohol and drug misuse. A multi-site PED study was conducted to determine the association between the NIAAA two-question alcohol screen and adolescent cannabis use disorders (CUD), cigarette smoking, and lifetime use of other drugs.
Buccally Absorbed vs Intravenous Prochlorperazine for Treatment of Migraines Headaches
Randomized double-blind clinical trial to compare the efficacy of buccally absorbed prochlorperazine (BAP) to intravenous prochlorperazine (IVP) for the abortive treatment of migraine headaches.
Teaching Endotracheal Intubation Using a Cadaver Versus a Manikin-based Model: A Randomized Controlled Trial
The optimal method to train novice learners to perform endotracheal intubation (ETI) is unknown. The study objective was to compare two models: unembalmed cadaver vs simulation manikin.
Subdissociative-dose Ketamine Is Effective for Treating Acute Exacerbations of Chronic Pain
Subdissociative-dose ketamine (SDDK) is used to treat acute pain. This study was a randomized double-blind placebo-controlled trial that sought to determine if SDDK is effective in relieving acute exacerbations of chronic pain.
The Effect of Implementation of the American Heart Association Mission Lifeline PreAct Algorithm for Prehospital Cardiac Catheterization Laboratory Activation on the Rate of “False Positive” Activations
Emergency Medical Services (EMS) systems have developed protocols for prehospital activation of the cardiac catheterization laboratory for patients with suspected ST-elevation myocardial infarction (STEMI) to decrease first-medical-contact-to-balloon time (FMC2B). The rate of “false positive” prehospital activations is high. In order to decrease this rate and expedite care for patients with true STEMI, the American Heart Association developed the Mission Lifeline PreAct STEMI algorithm, which was implemented in Los Angeles County (LAC) in 2015. The hypothesis of this study was that implementation of the PreAct algorithm would increase the positive predictive value (PPV) of prehospital activation. This is an observational pre-/post-study of the effect of the implementation of the PreAct algorithm for patients with suspected STEMI transported to one of five STEMI Receiving Centers (SRCs) within the LAC Regional System.
A Prospective, Randomized Trial of Intravenous Hydroxocobalamin Versus Noradrenaline or Saline for Treatment of Lipopolysaccharide-Induced Hypotension in a Swine Model
Early, non-clinical studies support the use of hydroxocobalamin to treat sepsis-induced hypotension, but there is no translational, large animal model. The objective of this study was to compare survival in a sepsis model where large swine had endotoxaemia induced with lipopolysaccharide (LPS) and were treated with intravenous hydroxocobalamin (HOC), noradrenaline (NA), or saline.
Selected Recent Publications from 2018-Present
- Social Determinants of Health and Health Disparities Among Immigrants and Their Children
- Undocumented Patients in the Emergency Department: Challenges and Opportunities
- Material Needs of Emergency Department Patients: A Systematic Review
- Emergency Department and Primary Care Use by Refugees Compared to Non-refugee Controls
- Advancing the Biosocial Perspective in the Clinical Training Environment
- Building Immigration-Informed, Cross-Sector Coalitions: Findings From the Los Angeles County Health Equity for Immigrants Summit
- Unconditional Care in Academic Emergency Departments
- Language Assistance for the Care of Limited English Proficiency (LEP) Patients in the Emergency Department: A Survey of Providers and Staff
- First Trimester Pregnancy Emergencies: Recognition and Management
- Abdominal Vascular Catastrophes
- Altered Mental Status: Current Evidence-based Recommendations for Prehospital Care
- Prehospital Care for the Adult and Pediatric Seizure Patient: Current Evidence-based Recommendations
- Man With Bilateral Leg Swelling
- Emergency Department Management of Patients With Complications of Bariatric Surgery
- Emergency Department Management of Patients With Thermal Burns
- Lung Ultrasound for Diagnosis of Pneumonia in Children
- Propensity Scores
- Confounding by Indication
- Logistic Regression Diagnostics
- Number Needed to Treat
- The Randomized Embedded Multifactorial Adaptive Platform for Community-acquired Pneumonia (REMAP-CAP) Study
- Adaptive and Platform Trials in Remote Damage Control Resuscitation
- Rigorous Clinical Trial Design in Public Health Emergencies Is Essential
- Methodology and Demographics of a Brief Adolescent Alcohol Screen Validation Study
- Rationale and Design of an Adaptive Phase 2b/3 Clinical Trial of Selepressin for Adults in Septic Shock
- The Performance of Fixed-Horizon, Look-Ahead Procedures Compared to Backward Induction in Bayesian Adaptive-Randomization Decision-Theoretic Clinical Trial Design
- Practical Guide to Implementation Science
- Practical Guide to Cost-effectiveness Analysis
- Practical Guide to Qualitative Analysis
- Modeling Epidemics With Compartmental Models
- An Implementation Science Approach to Antibiotic Stewardship in Emergency Departments and Urgent Care Centers
- Professionalism Milestones Assessments Used by Emergency Medicine Residency Programs: A Cross-sectional Survey
- Impact of a Mentorship Program on Medical Student Burnout
- Scholarly Tracks in Emergency Medicine Residency Programs Are Associated With Increased Choice of Academic Career
- A Targeted Mindfulness Curriculum for Medical Students During Their Emergency Medicine Clerkship Experience
- Academic Career Preparation for Residents – Are We on the Right Track?
- The Emergency Physician as Medical School Leader
- The Uphill Battle of Performing Education Scholarship: Barriers Educators and Education Researchers Face
- Systemwide Clinical Ultrasound Program Development: An Expert Consensus Model
- Improving the Ability of ED Physicians to Identify Subclinical/Electrographic Seizures on EEG After a Brief Training Module
- Resident Clinical Experience in the Emergency Department: Patient Encounters by Postgraduate Year
- Identifying the Emergency Medicine Personality: A Multisite Exploratory Pilot Study
- A Workforce Development Research Agenda for Pediatric Care in the Emergency Department
- The Patient-Centered Emergency Department
- Pediatric Readiness in the Emergency Department
- Standards of Care for Children in Emergency Departments: International Federation of Emergency Medicine Agenda for the Care of Children
- Access to High Pediatric-Readiness Emergency Care in the United States
- Parent and Nurse Satisfaction Using Pacidose® Oral Medication Delivery Device in the Pediatric Emergency Department: A Pilot Study
- Dexamethasone Versus Prednisone for Pediatric Acute Asthma Exacerbations: Specialists’ Practice Patterns
- Discontinuing Involuntary Mental Health Holds for Children: Does Psychiatrist Specialty Matter? A Pilot Study
- Patterns and Outcomes of Paediatric Trauma at a Tertiary Teaching Hospital in Kenya
- Emergency and Definitive Care for Children in the United States: The Perfect Storm
- Statewide Pediatric Facility Recognition Programs and Their Association With Pediatric Readiness in Emergency Departments in the United States
- Establishing the Key Outcomes for Pediatric Emergency Medical Services Research
- Variations in Cardiac Arrest Regionalization in California
- Emergency Medical Services Utilization by Children
- The Evolution of Trauma in Los Angeles County Over More Than a Decade
- Racial and Ethnic Differences in Outcomes After Out-Of-Hospital Cardiac Arrest: Hispanics and Blacks May Fare Worse Than non-Hispanic Whites
- Is Door-to-Needle Time Reduced for Emergency Medical Services Transported Stroke Patients Routed Directly to the Computed Tomography Scanner on Emergency Department Arrival?
- Tabletop Application of SALT Triage to 10, 100, and 1000 Pediatric Victims
- Application of the “Plan-Do-Study-Act” Model to Improve Survival After Cardiac Arrest in Korea: A Case Study
- High-School Students Can Stop the Bleed: A Randomized, Controlled Educational Trial
- Increased Access to and Use of Endovascular Therapy Following Implementation of a 2-Tiered Regional Stroke System
- State of the Journal: Women First Authors, Peer Reviewers, and Editorial Board Members at Annals of Emergency Medicine
- The Role of Education in the Implementation of Shared Decision Making in Emergency Medicine: A Research Agenda
- Marijuana Self-Report Compared With Testing in Trauma Patients Before and After Legalization
- Predictors of Ischemic Bowel in Patients With Incarcerated Hernias
- Follow-up Trends After Emergency Department Discharge for Acutely Symptomatic Hernias
- Chance to Cut: Defining a Negative Exploration Rate in Patients With Suspected Necrotizing Soft Tissue Infection
- Characterizing Injury at a Tertiary Referral Hospital in Kenya
- A Randomized Trial of a Behavioral Intervention to Decrease Hospital Length of Stay by Decreasing Bedrest
- Expected Practice as a Novel Antibiotic Stewardship Intervention
- Evolution of the Strategies to Innovate Emergency Care Clinical Trials Network (SIREN)
- Video Versus Direct and Augmented Direct Laryngoscopy in Pediatric Tracheal Intubations
- Therapeutic Hypothermia in Organ Donors: Follow-up and Safety Analysis
- Effect of Selepressin vs Placebo on Ventilator- And Vasopressor-Free Days in Patients With Septic Shock: The SEPSIS-ACT Randomized Clinical Trial