Other Components & Core Competencies

Question 1

What represents the largest percentage of medical errors in ED setting?

Answer 1

Medication errors

Question 2

Classes of recommendation

Answer 2

Class I - Benefit»_space;> Risk; procedure/tx SHOULD be performed/administered
Class IIa - Benefit»_space; Risk; It is REASONABLE to perform procedure/administer tx
Class IIb - Benefit >/= Risk; Procedure/Tx MAY BE CONSIDERED
Class III - Risk >/= Benefit; Procedure/Tx should NOT be performed

Question 3

Level A vs. Level B vs. Level C recommendations

Answer 3

Level A: multiple populations evaluated and data derived from multiple RCTs or meta-analyses

Level B: limited populations evaluated and data derived from a single RCT or non-randomized studies

Level C: very limited populations evaluated and only consensus opinion of experts, case studies, or standard of care

Question 4

Which clinical decision rule commonly used in emergency medicine practice meets Level 1 criteria for ease of use, rate of use, and effect on patient satisfaction?

Answer 4

Ottawa Ankle rules

Question 5

Level I Trauma Center Categorization

Answer 5

• Highest level of surgical care to trauma patients
• Regional referral center
• Required to have full range of specialists available 24 hours a day
• Capacity to provide advanced, tertiary care
• Research program
• Provides public education

Question 6

Level II Trauma Center Categorization

Answer 6

• Works in collaboration with a Level I center
• Capable of providing definitive care similar to Level I but unable to provide as intricate treatment
• Required to have some specialty and surgical specialists available 24 hours a day
• Not required to have an ongoing research or a surgical residency program

Question 7

Level III Trauma Center Categorization

Answer 7

• Does not have the full availability of specialists but does have resources for emergency resuscitation, surgery, and intensive care of most trauma patients
• Has transfer agreements with Level I or Level II trauma centers that provide back-up resources for the care of exceptionally severe injuries

Question 8

Level IV Trauma Center Categorization

Answer 8

• Provides initial evaluation, stabilization, diagnostic capabilities, and transfer to a higher level of care
• A trauma-trained nurse is immediately available, and physicians are available upon the patient’s arrival to the ED
• Transfer agreements exist with other trauma centers of higher levels

Question 9

What entity is responsible for designating trauma centers and regionalization of trauma care?

Answer 9

Individual states

Question 10

What is the definition of cost-effectiveness analysis?

Answer 10

Cost and benefits are measured independently and the relative value of an intervention measured as the additional cost to achieve an incremental health benefit is determined

Question 11

What is cost-utility analysis?

Answer 11

A type of cost-effectiveness analysis where life expectancy, adjusted for the benefits and/or harms associated with the specific strategy, is the metric whereby effectiveness is measured

Question 12

What is cost-benefit analysis?

Answer 12

Assigns a monetary value to health outcomes - not generally done in healthcare

Question 13

What is cost-identification analysis?

Answer 13

Examining costs of care with the assumption that there are equal health benefits for each potential option

Question 14

What is the incremental cost-effectiveness ratio?

Answer 14

The ratio between the difference in costs and the difference in benefits of two interventions

Question 15

What are four different types of costs?

Answer 15

Direct medical costs
Direct nonmedical costs (e.g. transportation to hospital)
Time or indirect morbidity and mortality (e.g. lost wages from missed work)
Intangible (e.g. pain and suffering)

Question 16

What is second victim syndrome?

Answer 16

Emotional trauma a health care worker experiences after being involved in an adverse patient event

Question 17

Number needed to treat equation

Answer 17

1/[(c/(c+d)) - (a/(a+b))]

Inverse of Absolute Risk Reduction

Question 18

What is the odds ratio?

Answer 18

The chance of having the outcome of each group

A/b)/(c/d

Question 19

What is the relative risk?

Answer 19

Ratio of the experimental group to the control group

A/a+b) / (c/c+d

Question 20

What is positive predictive value

Answer 20

TP/TP + FP

Question 21

What is negative predictive value

Answer 21

TN/TN+FN

Question 22

What is sensitivity?

Answer 22

TP/TP+FN

Question 23

What is specificity?

Answer 23

TN/TN+FP

Question 24

Primary vs. secondary vs. tertiary prevention

Answer 24

Primary: no disease, prevent dz well before it develops and reduce risk factors

Secondary: Early detection of disease

Tertiary: treat established disease to prevent deterioration, or modifying risk factors of current disease

Question 25

What is type I error?

Answer 25

Also called alpha Occurs when an apparent difference between two tx groups is found during the course of a study, when the intervention actually had no real effect Null hypothesis incorrectly rejected

Question 26

How does type I error arise?

Answer 26

When bias is introduced into a study or confounding variables are not accounted for during the design or analysis phases

Question 27

What is type II error?

Answer 27

Also called beta error Presumption that no difference exists between treatment groups when a difference does actually exist Null hypothesis incorrectly accepted

Question 28

What is the student t-test

Answer 28

Used to compare continuous variables (such as HR, BP or RR) between two groups and assumes data in both groups have a normal distribution and equal variance

Question 29

What is Wilcoxon rank-sum (i.e. Mann-Whitney U) test

Answer 29

Compares continuous variables (HR, BP, RR) between two groups, but does not require data to be normally distributed (as the student t-test does)

Question 30

What statistical test can be used to determine if a data set is normally distributed?

Answer 30

Shapiro-Wilk test

Question 31

Exclusions for organ donation

Answer 31

- Severe untreated systemic sepsis - AIDS - Active viral hepaptis B or C, CMV, West Nile, rabies, disseminated TB, zika virus (treated hep c okay) - Viral encephalitis - Active extracranial malignancy - Risk of rare viral or prion protein illness - Recipients of cadaver human pituitary growth hormone - Undiagnosed acute or progressive neurological disorder with or without dementia

Question 32

Can patients with HIV donate organs?

Answer 32

Yes as long as they go to an HIV-positive recipient

Question 33

What provides liability coverage for a physician after their policy expires or is canceled?

Answer 33

Tail coverage - covers for medical incidents that occur during policy period, even if claim is filed after policy has expired or has been canceled

Question 34

Medical examiner investigations

Answer 34

- Public health dangers - Prisoners - Violence - Unusual, suspicious manner - Children

Question 35

Most prevalent type of malpractice claim made in the US against emergency department providers?

Answer 35

Missed or delayed diagnosis

Question 36

4 elements of negligence

Answer 36

1. Duty to perform with reasonable care 2. Failure to perform that duty as a reasonable practitioner 3. Some damage or injury must occur 4. A causal relationship must exist between the failure to perform and the alleged injury