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D G Perina

Publications and source records attributed to D G Perina.

7 recordsLinked to original sources
PubMed2000

A survey of academic departments of emergency medicine regarding operation and clinical practice.

STUDY OBJECTIVE: To survey academic departments of emergency medicine concerning their operation and clinical practice. METHODS: A survey was mailed to the chairs of all 56 academic departments of emergency medicine in the United States requesting information concerning operations and clinical activity in budget year 1997-1998 compared with 1995-1996. These results were then compared with a similar survey conducted in the fall of 1996, examining the 1995-1996 academic year compared with the 1994-1995 academic year. RESULTS: Forty-one (73%) academic departments of emergency medicine responded. For 1997-1998, compared with 1995-1996, 24 (59%) academic departments of emergency medicine reported an increase in emergency department patient volume; 10 (24%) reported a decrease. Twenty-four (51%) academic departments of emergency medicine reported an increase in ED patient severity, whereas 7 (15%) reported a decrease. Twenty-five (61%) academic departments of emergency medicine reported an increase in net clinical revenue for emergency medicine services, and 9 (22%) reported a decrease. Only 9 (22%) academic departments of emergency medicine reported other academic departments within their university/medical center aggressively directing patients away from the ED compared with 14 (30%) in the previous study. The percentage of academic departments of emergency medicine using midlevel providers remained essentially the same over time (68% versus 66%). In both studies, midlevel providers were used most commonly in a fast-track setting. Only 37% of academic departments of emergency medicine reported having an observation unit; staffing in all cases was by emergency physicians. Since the last survey, 38 (93%) academic departments of emergency medicine reported their medical center or hospital negotiating with managed care organizations to provide services. Unfortunately, only 41% of chairs were involved in these discussions. Between January 1, 1997, and the 1998 fall survey, 29% of academic departments of emergency medicine reported their university merging with another university system, and 19% reported such mergers being discussed. Similarly, between January 1, 1997, and fall 1998, 22% of academic departments of emergency medicine reported their institution merging with a private entity, whereas 16% reported ongoing discussions. CONCLUSION: Academic departments of emergency medicine have experienced some encouraging trends: an increase in ED patient volume, patient severity, and net clinical revenue during the study period. Midlevel providers continue to be used primarily in fast-track areas of EDs. An area of potential growth for academic departments of emergency medicine is observation medicine, because only one third of academic departments of emergency medicine have such a unit. Academic medical centers have experienced a significant increase in merger activity during the study period.

Academic Medical Centers↗
PubMed1998

Academic departments of emergency medicine: the effects of managed care.

OBJECTIVE: To survey academic departments of emergency medicine (ADEMs) concerning the effects of managed care on their operation and practice. METHODS: A 38-question survey was mailed to the chairs of all 52 ADEMs in the United States requesting information concerning managed care activity and its effects on ADEMs in academic years 1994-1995 and 1995-1996. RESULTS: Forty-seven ADEMs (90.3%) responded. When comparing the 1995-1996 and 1994-1995 academic years, the following changes were noted: decreased overall growth in ED patient volume (38.3% vs 51.1%), larger percentage of respondents reporting an actual decrease in ED patient volume (38% vs 27.6%), less growth in ED gross revenue (43.7% vs 52.1%), larger percentage of ADEMs reporting actual decreased gross revenues (25% vs 12.5%), increase in ED patient acuity (76.6% vs 59.6%), and relative stability in the number of EM faculty (40.4% vs 44.7% reporting no change in faculty number). Two-thirds of ADEMs used mid-level providers (i.e., physician assistants, nurse practitioners), most commonly in a fast-track setting (41%). Thirty percent of ADEMs reported that other academic departments actively directed patients away from the ED, with pediatrics, family medicine, and internal medicine the most active. Ninety-eight percent of ADEMs reported ongoing negotiations between their institution or hospital and managed care organizations (MCOs); only 54.3% of ADEMs were involved in these negotiations. Twenty-eight percent of ADEMs reported MCOs have had an effect on their emergency medical services system, with 37% indicating HMOs routinely discouraged their enrollees from using 9-1-1 services and 16% reporting HMOs provided 9-1-1 services to take patients only to participating hospital EDs. CONCLUSION: ADEMs have experienced significant changes in nearly every aspect of their practice over the two academic years under study, much of which is due to managed care. ADEMs must take a leadership role in dealing with MCOs.

Academic Medical Centers↗
PubMed1987

Propafenone ingestion.

Propafenone is a type 1c antiarrhythmic drug that recently has become available for clinical trials within the United States. We present the case of a 2-year-old child who accidentally ingested 1,800 mg (133 mg/kg) of propafenone. The patient subsequently developed cardiac conduction abnormalities and generalized seizures. Following the administration of IV phenytoin, cardiopulmonary collapse occurred. The patient had a successful outcome with aggressive cardiopulmonary life support.

Bundle-Branch Block↗
PubMedDate not supplied

Resident perspectives of EMS as a subspecialty.

OBJECTIVE: Emergency medical services (EMS) is frequently considered to be a subspecialty of emergency medicine (EM) despite the unavailability of subspecialty certification. An assessment of future interest in EMS subspecialization and the perceived educational needs of potential EMS physicians was performed in order to provide data to leaders responsible for development of this subspecialty area. METHODS: A survey concerning EMS subspecialization issues was distributed to 2,464 members of the Emergency Medicine Residents Association (EMRA). Questions addressed demographic information, interest in EMS, educational issues, and desired credentials. The response rate was 30% (n = 737). All surveys were analyzed by the Pearson chi-square probability and Mantel-Haenszel tests for linear association. RESULTS: A moderate to very high interest in EMS medical direction was expressed by 84% of the respondents, with 14% interested in full-time EMS positions. This interest increased with years of training (p < 0.0001). Almost 89% believed that EMS physicians should have special preparations prior to practice beyond EM residency training. Fewer than half (44%) thought that an EM residency provided sufficient preparation for a significant role in EMS, and this perception increased in intensity with years of training (p < 0.0052). Interest in EMS fellowships (24%) would increase to 36% if subspecialty certification were available (p < 0.0001). Thirty-nine percent believed subcertification should be required of all EMS medical directors if available. CONCLUSIONS: Many EM residents have an interest in active participation in EMS on either a part-time or a full-time basis. Most respondents think EMS is a unique area requiring focused education beyond an EM residency. Interest in EMS fellowships would greatly increase if subspecialty certification were available.

Adult↗