Systemic racism is associated with suboptimal treatment of acute and chronic pain. In pediatric emergency department patients with long-bone fractures, minority children were more likely to receive analgesics and achieve at least a 2-point reduction in pain, but they were less likely to receive opioids and achieve optimal pain reduction.

This randomized controlled trial compared the performance of an educational video game to traditional didactic education via an electronic application for teaching emergency department physicians appropriate triage of trauma patients. Following completion of either the game or traditional education, participants completed several case simulations. Those who completed the game performed better than those receiving traditional education on the simulations, and the effect persisted in a subsample retested 6 months later.

Severe sepsis has been a focus of quality efforts. This retrospective study contrasted community-acquired sepsis with health care–associated sepsis. In line with definitions of health care–associated infections, investigators defined health care–associated severe sepsis as patients hospitalized with severe sepsis with an infection present at admission, where the patient was admitted from an inpatient nursing facility, was on hemodialysis, or was readmitted within 30 days to the same hospital. They separately considered hospital-acquired sepsis cases in which the patients did not have an infection at hospital admission. Both health care–associated and hospital-acquired sepsis, which together accounted for about one-third of cases, had a higher mortality rate and were more severe and costly than community-acquired severe sepsis. This adds to the evidence that health care–associated infections cause significant harm and costs to patients. In a related study, researchers examined readmissions following severe sepsis and found substantial variation in readmission rates, with an overall rate of about 20%, suggesting that targeting sepsis in readmission prevention efforts may be helpful.

This survey of emergency medical services (EMS) personnel found that lower perceived safety culture was associated with an increased risk of adverse events in patients and an increased risk of injury in EMS providers.

… Am J Med Qual … This study established a consensus definition … events in ground transport emergency medical services.  Am J Med Qual . 2012;27(2):139-146. doi:10.1177/1062860611415515 …

This survey found that the perception of safety culture varied widely among prehospital emergency medical service agencies, with air medical emergency services tending to report slightly more positive views on safety.

… journal of the American College of Medical Quality … Am J Med Qual … This article reports on the development and …

Out-of-hospital intubation errors were not associated with mortality but were associated with an increased rate of pneumonia.

This study of closed malpractice claims against prehospital emergency medical services found that clinical management was an infrequent source of malpractice allegations, trailing emergency vehicle accidents and patient handling mishaps.

The investigators found that errors occur in 22% of emergency intubation attempts. They question whether this finding illustrates a larger problem concerning the safety and quality of out-of-hospital emergency care.