Active Research Projects

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Cardiac Arrest Study Collection

Determination of the Automatic External Defibrillator (AED) Application by Gender in Non-Traumatic Out-of-Hospital Cardiac Arrest

Funding Agency: None

The objective of this study is to determine if there are differences in AED application by gender in adult non-traumatic out-of-hospital cardiac arrest.


 System-Wide Cardiac Arrest Interventions Improve Neurologic Survival After Out-of-Hospital Cardiac Arrest

Funding Agency: None

The objectives of this study are to examine survival and neurologic outcome in adult nontraumatic out-of-hospital cardiac arrest in Denver, Colorado before and after the implementation of three system-wide interventions (“CPR First”, basic life support emphasis, and therapeutic hypothermia).

The objective of this study is to determine if there are differences in AED application by gender in adult non-traumatic out-of-hospital cardiac arrest.


 Determination of the Incidence and Rate of Survival of Non-Traumatic Out-of-Hospital Cardiac Arrest in Denver, Colorado

Funding Agency: None

The objectives of this study are to report the incidence of adult non-traumatic cardiac arrest and the surival proportions in Denver, Colorado by developing a county-wide registry of consecutive patients who experience cardiac arrest. Members of the collaborative study group represent all 10 adult acute-care receiving hospitals in Denver County.

Critical Care Study Collection

National Emergency Airway Registry (NEAR)

Funding Agency: None

The Emergency Departments at Denver Health Medical Center and the University of Colorado Anschutz Medical Campus are joining the National Emergency Airway Registry, a national, multi-site intubation registry coordinated by Brigham and Women's Hospital. The purpose of this registry is to characterize intubation practices on a national level in en effort to enhance patient safety.


 Adherence to Clinical Practice Guidelines in the Emergency Department

Funding Agency: Agency for Healthcare Research and Quality (AHRQ) and University of Colorado Department of Emergency Medicine

The purpose of this project is to retrospectively examine physician aderence to emergency department specific clinical practice guidelines and estimate associations between patient, provider and environmental factors related to to (1) acute coronary syndrome, (2) acute ST-elevation myocardial infarction, (3) community acquired pneumonia, (4) acute ischemic stroke, and (5) severe sepsis or septic shock.  This multi-site project will provide the first comprehensive and comparitive study on emergency department quality of care and barriers to care.


The AVERT Sepsis Investigation (Assessment Of Variability In Early Resuscitation And Treatment For Sepsis)

Funding Agency: Therapeautic Monitoring Systems (TMS)

To assess a combined variability index comprised of heart rate and respiratory rate variability as a predictor of clinical outcome in patients with sepsis. This is an observational study in which patients heart and respiratory rates are continuously monitored for four hours while in the emergency department after being diagnosed with sepsis. Defined clinical outcomes include change in SOFA Score over a four day period after admission, any need for mechanical ventilation or vasopressors and all-cause mortality.


 An Observational Study of Heart Rate Variability and Respiratory Rate Variability as Predictors of Injury Severity in Trauma Patients in the Pre-Hospital and ED Settings

Funding Agency: CHEETAH Corporation

To assess heart rate variability as a predictor of injury severity in the field for traumatically injured patients, and of a combined variability index comprised of heart rate and respiratory rate variability in the ED as a predictor of both injury severity and of the efficacy of resuscitation in the ED. This is an observational study with defined outcomes of: (1) injury severity (defined by the Injury Severity Score (ISS)); (2) need for emergent operative intervention (defined as surgical intervention within four hours of arrival to the ED); (3) development of multi-organ failure (defined by the Sequential Organ Failure Assessment (SOFA) Score) during hospitalization; and (4) in-hospital mortality. Secondary outcomes will include changes in serum lactate concentration from the prehospital setting through the patient’s ED stay.


 Derivation and Validation of a Mortality Prediction Rule in the ED for SIRS Patients

Funding Agency: AHRQ F32

Training grant research project to study predictors of mortality in ED patients with SIRS.


Fluid Resuscitation in Pediatric DKA

Funding Agency: None

The study objective is to determine if the volume of fluid administration, in pediatric patients with diabetic ketoacidosis (DKA), impacts the rate of bicarbonate normalization and time to discharge from the hospital.


BVM Handholding Techniques

Funding Agency: None

To study 3 different methods of BVM handholding technique in an airway model.


Epidemiology of SIRS in the Emergency Department

Funding Agency: None

To study the epidemiology of SIRS in admitted ED patients at Denver Health.

EMS Study Collection

Prehospital Ketamine Use for Severe Agitation in the Setting of Synthetic Cannabinoid Toxicity

Funding Agency: None

This study aims to retrospectively describe the prehospital presentation and clinical course of patients who receive prehospital ketamine in the setting of severe agitation and synthetic cannabinoid toxicity. Results of this study will help physicians and paramedics recognize and treat synthetic cannabinoid exposures as well as understand the risks and benefits of using prehospital ketamine to treat exposures in the future.


An Evaluation of the Burden of Alcohol Consumption in an Urban EMS System

Funding Agency: None

The purpose of the study is to evaluate information related to the role of alcohol in EMS calls in order to describe the burden of alcohol on the Denver Health Paramedic Division (DHPD) system. We will evaluate information from calls that involved alcohol consumption to characterize the problem of alcohol, its impact on the DHPD system and resource utilization.

 

HIV Study Collection

Patient and Staff Satisfaction with Nontargeted and Targeted HIV Screening Strategies in the Emergency Department

Funding Agency: None

This project will determine if there are differences in patient and staff satisfaction among 3 different methods to screen for HIV in the Denver Health Emergency Department and Adult Urgent Care Center.


The HIV TESTING using ENHANCED SCREENING TECHNIQUES in EMERGENCY DEPARTMENTS (TESTED) Trial

Funding Agency: National Institute of Allergy and Infectious Diseases (NIAID)

Early identification of undiagnosed HIV infection remains a critical public health priority. The research proposed in this project will evaluate the effectiveness of 3 rapid HIV screening methods, including a novel targeted strategy, in urban emergency department settings in the United States. The results of this study will help inform public health practices of how best to identify patients with whom to test for HIV infection in this important clinical setting,  in an effort to improve the timeliness of diagnosis and linkage-to-care.

Specific Aim 1: To evaluate and compare the effectiveness of targeted and nontargeted rapid HIV screening strategies when fully-integrated into ED settings

Specific Aim 2: To measure and compare programmatic costs associated with implementation of targeted and nontargeted rapid HIV screening strategies when fully-integrated into ED settings

Specific Aim 3: To measure and compare ED operational processes and crowding when targeted and nontargeted rapid HIV screening strategies are fully-integrated into ED care

Click here to read the Study Protocol.


Rapid HIV Testing in Unscheduled Ambulatory Care Settings at Denver Health Medical Center

Funding Agency: Colorado HIV/AIDS Prevention Program

The purpose of this project is to evaluate rapid HIV testing in unscheduled ambulatory care settings at Denver Health Medical Center (DHMC). Rapid HIV testing has been performed at the DHMC ED since October 2004, in the Adult Urgent Care Center (AUCC) since September 2007, and in the Denver Emergency Center for Children (DECC), a pediatric emergent and urgent care center at DHMC, since October 2008. In all three of these settings physician-directed targeted rapid HIV testing is the standard of care.  In addition to this physician-directed diagnostic HIV testing, we utilize triage nurses to conduct an HIV risk assessment (the Denver HIV Risk Score) on all eligible unscheduled ambulatory care patients and target patients at increased risk for having undiagnosed HIV infection for testing.


Understanding HIV Screening Experiences in an Urban Pediatric Emergency Department: A Mixed Methods Study

Funding Agency: None

HIV screening was established in Denver Health Medical Center’s (DHMC) Denver Emergency Center for Children (DECC) in November 2009.  In April 2010, a closed-response self-administered HIV screening staff acceptance survey was distributed to all DECC staff in order to evaluate the HIV screening program. Staff was also given the opportunity to write comments in an open-ended format at the end of the survey.  The survey responses and comments identified a number of potential barriers to conducting HIV screening in a pediatric emergency department setting.  The purpose of this study is to report on the results from the survey and better understand the identified barriers associated with conducting HIV screening in a pediatric emergency department (ED). The specific aims of this study are to: (1) Report staff acceptance of non-targeted rapid HIV screening in a pediatric emergency department; (2) Identify potential barriers to performing HIV screening in the pediatric ED setting; (3) Identify strategies for overcoming identified barriers.

Public Health Study Collection

Clinical Associate Effect on the Public Health System of the Eastern Cape, South Africa

Funding Agency: American International Health Alliance

Clinical Associates (CA’s) are the South African version of Physician Assistants in the United States.  The role of the CA was recently recognized by the South African Health Professions Council and Walter Sisulu University in Mthatha, South Africa was the first medical school in the country to graduate a class of CA’s in December 2010.  A partnership has been developed between the University of Colorado and Walter Sisulu University to build capacity of the CA program in South Africa.  Active projects involve developing a feedback loop for curriculum development from recent graduates, assessing community and provider attitudes and perceptions to the new role of the CA, and assessing the effect introduction of CA’s have on patient transfers for emergent conditions.


Resource Allocation in the Public Health System of the Western Cape, South Africa

Funding Agency: Department of Health, Provincial Government of the Western Cape, South Africa

This project systematically assesses patients transferred from primary level hospitals to secondary level hospitals to uncover addressable limitations in resources that would lead to decreased transfers and improved patient care.


Screening, Brief Intervention, and Referral to Treatment Program (part of SBIRT Colorado)

Funding Agency: Substance Abuse and Mental Health Service Administration/Center for Substance Abuse Treatment (SAMHSA/CSAT)

The Colorado and Denver Health Screening, Brief Intervention and Referral to Treatment Program is about universal screening for substance use. Substances screened for currently include; tobacco, alcohol, illicits and prescription drug misuse. It is about screening and picking up At-Risk users earlier, and having medical providers have a 'Brief Conversation' with patients around their substance use. There are good efficacy data showing that providing this service in various clinical sites leads to at least harm reduction at 6-12 months and may lead to decreased use of harmful substances overall. At Denver Health, the SBIRT project is in the Emergency Department, the Adult Urgent Care Clinic (AUCC) and the Denver Metro Health (STD) Clinic. We have a team of 10 SBIRT personnel including our program manager, a certified addictions counselor, and 8 health educators. The health educators provide more in-depth screening using the ASSIST tool, collecting data and providing brief motivational interviewing to patients, along with referrals to treatment when necessary.


Interviewing the Interviewers: Re-Assessment of a Quality Improvement Project for the SBIRT Program at Denver Health

Funding Agency: None

This project surveys staff knowledge and attitudes towards the SBIRT Program at Denver Health and will compare current survey results from an identical survey that was administered in 2007, shortly after the initiation of the SBIRT Program.


At-Risk Intervention and Mentoring (AIM)

Funding Agency: None

AIM is Denver Health's hospital-based violence intervention program that utilizes the teachable bedside moment with culturally competent outreach workers who provide one-on-one mentoring for at-risk youth ages 10-24 years old. Eligible youth present to the emergency department with a traumatic injury and AIM assists in connecting them to the resources that directly relate to their at-risk behaviors.


Smoking Intervention with Trauma Patients

Funding Agency: None

This multi-center pilot study of eight academic trauma centers seeks to establish the feasibility of training emergency physicians, trauma surgeons, orthopedic surgeons, and nurses in tobacco control and performing a simple ask-advise-refer intervention.


Clinical Evaluation of Alcohol Intoxication in Pediatric Populations

Funding Agency: None

This project will attempt to establish guidelines for the observation and management of children presenting with concern for alcohol intoxication by understanding the differences in metabolism of alcohol and determination of clinical sobriety in children.


Epidemiology and Inpatient Management of Patients Hospitalized for Acute Asthma: 37th Multicenter Airway Research Collaboration (MARC-37) Study

Funding Agency: Massachusetts General Hospital via Novartis Pharmaceuticals

This is a multi-site chart review project examining patients hospitalized with acute asthma in 25 hospitals across the United States.

Trauma Study Collection

Emergency Department Variation in Traumatic Brain Injury Care: A Multi-Institution Retrospective Cohort Study

Funding Agency: None

This retrospective chart review will compare variation in treatment practices by paramedics and emergency physicians caring for patients with severe traumatic brain injuries. This project will help to define the amount of variation in treatment practices by paramedics and emergency physicians across two institutions, which will lay the groundwork for a larger, more comprehensive national project.


 Clinical Predictors of False-Negative FAST Examinations in Pediatric Patients with Blunt Abdominal Trauma

Funding Agency: None

This retrospective cohort study will examine outcomes and associations between patient and injury characteristics with false-negative FAST examinations in pediatric patients with blunt abdominal trauma. The Focused Assessment with Songraphy in Trauma (FAST examination) is an ultrasound examination commonly performed in the Emgergncy Department to screen trauma patients for intra-abdominal bleeding. Study results will inform the appropriate application of the FAST examination and help to reduce missed injuries in trauma patients.


 Prediction of Post-Injury Multiple Organ Failure: Derivation and Validation of the Denver Trauma Organ Failure Score

Funding Agency: NIGMS

This study will use prospectively-collected data to (1) systematically derive an instrument to predict the development of multiple organ failure after trauma using multivariable logistic regression analysis; and (2) use 10-fold cross validation to internally validate the clinical prediction instrument derived to predict multiple organ failure after trauma.


 Morbidity of Tube Thoracostomy for Trauma in South African Tuberculosis and/or HIV Patients

Funding Agency: Department of Health, Provincial Government of the Western Cape, South Africa

This project looks at the morbidity of tube thoracostomy in trauma patients with concurrent tuberculosis and/or HIV infections. The end goal is development of a clinical decision rule which will allow certain patients with penetrating trauma to the torso who do not require tube thoracostomy and can be managed conservatively.


 Prehospital Intubation in Moderate to Severe Head Injury is Associated with Worse Outcomes

Funding Agency: Emergency Medicine Foundation Emergency Medicine Basic Research Skills (EMBRS) Grant

This project will evaluate outcomes of prehospital airway management strategies, including nasotracheal intubation, in moderate to severe traumatic brain injury.


Geographic Information Systems (GIS) Mapping of Penetrating Traumatic Injury in Cape Town, Africa

Funding Agency: None

We have cataloged the patients presenting to a large trauma center in Cape Town, South Africa with penetrating traumatic injuries, noting time of injury, location, and several other descriptors. The study aims to use the well-accepted Geographic Information Systems (GIS) system to analyze where these injuries take place in an effort to eventually guide prevention policies.


 Color Coded Pre-Filled Syringes

Funding Agency: None

This is a simulation project testing the effectiveness of color-coded, pre-filled medication syringes correlated to the Broselow tape and the impact on  time to drug delivery and incidence of medication dosage error.

Ultrasound Study Collection

Teaching Bedside Lung Ultrasound to Novice Learners: Web-Based E-Learning Versus Traditional Classroom Lecture

Funding Agency: None

This project will assess whether web-based teaching is as effective as traditional classroom lectures in improving proficiency of novice learners in recognizing pheumothorax and pleural effusion on ultrasound. 


Critical Care Ultrasound: A Survey of Physicians

Funding Agency: None

This project will describe the current prevalence of point-of-care ultrasound use for specific critical care applications amongst physicians with critical care interest or experience. Additionally, this project will identify barriers to implementation of point-of-care ultrasound in clinical practice. 


Does a Two-Week Ultrasound Curriculum Progress Emergency Medicine Residents to a Level 3 Goal Directed Ultrasound Milestone?

Funding Agency: None

This project examines the effectiveness of a targeted education program in increasing ultrasound patient hand-offs between Denver Health Emergency Medicicne Residents and Denver Health Hospitalists. 


 Measurement of Optic Nerve Sheath Diameter by Ultrasound as Proxy for Intracranial Pressure Before Lumbar Puncture in South African Patients with Suspected M. Tuberculosis Meningitis

Funding Agency: Stellenbosch University, South Africa

Cerebral herniation during lumbar puncture is more common in patients with M. tuberculosis meningitis than most other kinds of bacterial meningitis.  In a population with a high incidence of tuberculosis this leads to substantial morbidity and mortality.  It is estimated by local researchers that three to four children a week die due to cerebral herniation during lumbar puncture in the Western Cape of South Africa.  Computed tomography is not accurate in predicting elevated intracranial pressure due to meningitis, particularly in a pediatric population.  We are working on validation of measurement of optic nerve sheath diameter by ultrasound as a proxy for intracranial pressure to help identify patients in this population who are at risk for herniation during lumbar puncture.


Ultrasound for Penetrating Trauma in Resource Limited Environments

Funding Agency: Stellenbosch University, South Africa

This project evaluates the utility of Focused Assessment Sonography in Trauma (FAST) for patients with penetrating trauma to the torso in resource limited environments.


Dehydration Resuscitation Index by ED Ultrasonography: The Dried US Study

Funding Agency: None

The DRIED-US study is a prospective, observational investigation of the use of bedside ultrasonography in the assessment of children with dehydration. As demonstrated in a prior study, the ratio of the Inferior Vena Cava (IVC) diameter over the Abdominal Aorta diameter (IVC/Ao), henceforth referred to as the Dehydration Resuscitation Index (DRI) ratio is lower in children with dehydration compared to age/weight matched controls. The DRIED-US study investigators hypothesize that the DRI ratio will correlate with the Clinical Dehydration Scale (CDS), a recently validated clinical scoring system of dehydration severity. We will also compare the DRI ratio with the interval change in pre- and post-rehydration weight of dehydrated children, aged 3 to 60 months. We theorize that the DRI ratio will predict the need for oral versus intravenous fluid administration and will correlate with the volume of fluid required for clinical rehydration. Lastly we intend to demonstrate a correlation between the initial DRI ratio and the length of stay in the emergency department/hospital. An age/weight matched control group will be used to further demonstrate the validity of the DRI ratio as a measure of dehydration.


Time to Diagnosis and Length of Stay for Emergency Department Pelvic Ultrasonography

Funding Agency: None

This randomized controlled trial compares the efficiency of pelvic ultrasounds performed by emergency medicine residents and attending physicians to ultrasound studies performed by the radiology department.


Barriers to Performing Emergency Ultrasound to Diagnose Intrauterine Pregnancy versus Ectopic Pregnancy in the Pediatric Emergency Department

Funding Agency: None

This survey will identify barriers for Pediatric Emergency Medicine Physicians and Fellows in performing emergency pelvic ultrasound to diagnose intrauterine pregnancy versus ectopic pregnancy.  The results from this study will help to inform the design of training programs in the future.


Clinical Predictors of False-Negative FAST Examinations in Pediatric Patients with Blunt Abdominal Trauma

Funding Agency: None

The goal of this study is to examine associations between patient and injury characteristics with false-negative FAST examinations in pediatric patients with blunt abdominal trauma.

Miscellaneous

Influence of PTSD Symptoms on Chronic Pain Development After Sexual Assault

Funding Agency: NIH

This is a multi-site project coordinated by the University of North Carolina Chapel Hill. The Denver Health SANE Program will be one of 8 sites across the US participating in this 5 year project examining the recovery process of female sexaul assault victims.

Increased Prescribing Compliance Among Emergency Department Providers Using a Smart Phone Application

Funding Agency: None

This project will investigate whether providing emergency department clinicians a bedside, handheld antibiotic application for their personal smart phone improves hospital specific prescribing habits.


Impact of Scribes on Resident Productivity in an Urban Safety Net Emergency Department

Funding Agency: None

This study examines the effects of implementing a scribe service to facilitate efficient patient documentation. Resident productivity in the emergency department at Denver Health will be the primary outcome.


Effects of Wrist Extension on Radial Artery Size

Funding Agency: None

This study examines the effects of wrist extension on radial artery size in adult and pediatric patients.  The project aims to determine an angle of wrist extension that optimizes radial artery size and may improve first attempt radial artery cannulation success in patients.


Surveillance for Argranulocytoisis/Vasculitis Caused by Cocaine Contaminated with Levamisole

Funding Agency: None

This study examines the integrated hospital system database that identifies cases of levamisole-cocaine-agranulocytoisis and vasculitis syndrome and initiates targeted provider education in near real time.


Outpatient Alcohol Withdrawal and Intoxication Treatment

Funding Agency: None

This study examines the treatment strategy of the Denver CARES facility.  Patient demographics and medications used to treat alcohol withdrawal are being collected to elucidate the patient population and treatment strategy employed by this colloborative system.


Adherence to Evidence-Based Guidelines: An Analysis of Knowledge Translation

Funding Agency: AHRQ

This study aims to assess the barriers and facilitators to implementation of evidence based medicine in the pediatric emergency department.