Introduction: In comparison to conventional cardiac troponin (cTn), high sensitivity cardiac troponin (hs-cTn) assay is associated with improved detection of myocardial infarction (MI). From literature review, resource utilization seems... more
Introduction: In comparison to conventional cardiac troponin (cTn), high sensitivity cardiac troponin (hs-cTn) assay is associated with improved detection of myocardial infarction (MI). From literature review, resource utilization seems variable across institutions. This study sought to determine the effect of converting to hs-cTn on hospital resources. Hypothesis: hs-cTn is associated with overall decrease in resource utilization Methods: We performed a descriptive retrospective analysis of resource utilization at Rush University Medical Center (Chicago, IL) over the period of transition (July 6, 2021) from a cTn to hs-cTn assay using data extracted from the electronic health record. Inclusion criteria included Emergency Department (ED) encounters between January 1, 2021 and December 31, 2021 with chief complaints of “chest pain” or “dyspnea” with an associated troponin order. The primary endpoints were percentage of ED discharges. Secondary endpoints included the number of cardiac studies ordered including troponins, electrocardiograms (ECG), echocardiograms, stress tests, and coronary angiograms. Univariable comparisons of these endpoints were performed using Student’s t-test for continuous variables and Chi-square tests for binary/categorical variables. Results: A total of 5113 encounters were analyzed. hs-cTn was associated with an overall increased ED discharge in patients with negative troponin tests (44.1% vs. 29.9%, P<0.01). In terms of cardiac testing per encounter, hs-cTn compared to cTn was associated with a marginal increase in number of troponin tests (1.9 vs. 1.6, P<0.01), electrocardiograms (3.0 vs. 2.9, P=0.01), Echocardiograms (0.5 vs. 0.4, P<0.01). There was a decrease in the utilization of stress testing (0.21 vs 0.26, P<0.01). There was a trend towards increased coronary angiography per encounter (0.11 vs. 0.09, P=0.05) and an increase in total coronary angiography use during the hs-cTn period compared to cTn (227//2471 (9.2%) vs. 195/2642 (7.4%, P=0.02)) Conclusion: Transitioning from cTn to hs-cTn was associated with increased ED discharges, marginal increase in troponin tests, ECGs, echocardiograms. There was a decrease in stress testing but increase in total coronary angiography.
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Few studies have assessed the integrated psychosocial processes underlying acute pain. As observed with clinical pain conditions, women also appear to be disproportionately vulnerable to acute pain, which may be associated with their... more
Few studies have assessed the integrated psychosocial processes underlying acute pain. As observed with clinical pain conditions, women also appear to be disproportionately vulnerable to acute pain, which may be associated with their social landscape.We examined whether positive and negative social processes (i.e., social support and social undermining) are associated with acute pain, and if these processes are linked to pain by influencing negative cognitive appraisal and emotion (i.e., pain catastrophizing, hyperarousal, and anger). Psychosocial variables were assessed in inner-city women (N=375) presenting to an Emergency Department with acute pain. The latent cognitive-emotion variable fully mediated effects of social undermining and support on pain, with undermining showing greater impact. Results suggest that pain may potentially be alleviated by limiting negative social interactions, reducing catastrophizing, and addressing psychological distress, mitigating the risks of alternative pharmacological interventions.
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There has been considerable emphasis on the care of patients with ST-elevation myocardial infarction (STEMI) with the wide implementation of protocols to quickly identify and triage them from the emergency department (ED) to a cardiac... more
There has been considerable emphasis on the care of patients with ST-elevation myocardial infarction (STEMI) with the wide implementation of protocols to quickly identify and triage them from the emergency department (ED) to a cardiac catheterization laboratory for percutaneous coronary intervention. However, a small but important number of patients with STEMI develop ST-elevation while hospitalized for another medical problem. A single-center, retrospective chart review was performed on 172 consecutive patients with STEMI who underwent emergency percutaneous coronary intervention. One hundred thirty-seven patients presenting to the ED with STEMI and 35 patients who developed STEMI while hospitalized were compared. Hospitalized patients with STEMI had delayed reperfusion, longer hospitalization, greater rates of stent thrombosis, and greater 30-day and 1-year mortality compared with these in patients presenting with STEMI to the ED. Optimized clinical pathways for prevention, early diagnosis, and expedited reperfusion of inpatients with STEMI are urgently needed.
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Medicine, Electrocardiography, Humans, Triage, Female, and 13 moreMale, Follow-up studies, Length of Stay, Aged, Cardiac Catheterization, Middle Aged, Percutaneous Coronary Intervention, Myocardial Infarction, Time Factors, Retrospective Studies, Inpatients, Early Diagnosis, and Emergency Department
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Introduction: Early recognition and rapid revascularization is associated with improved outcomes in patients with STEMI. Increasingly, prehospital providers acquire ECGs, transport patients to PCI-ready hospitals, and activate... more
Introduction: Early recognition and rapid revascularization is associated with improved outcomes in patients with STEMI. Increasingly, prehospital providers acquire ECGs, transport patients to PCI-ready hospitals, and activate interventional cardiology teams in advance of arrival (“door time”). Therefore, the time from first medical contact (FMC) with either EMS providers or the emergency department may be an important metric for overall system performance in the care of patients with STEMI. Hypothesis: A prehospital ECG transmission program will be associated with a decreased median FMC to revascularization device deployment time. Methods: A retrospective cohort study of Action Registry-GWTG data in Chicago was performed. The Chicago Fire Department implemented a 12-lead ECG program in 2012. Patients with confirmed STEMI from January through December 2013 were included. A baseline median FMC to device time was determined for the third quarter of 2012, at the start of the ECG program. Descriptive statistics were used for analysis. Results: Over the study period, 322 patients experiencing STEMI were treated in 9 hospitals. Patients were predominantly male (66%), and 50% arrived by ambulance. The average median FMC to device time during the study was 83 minutes, which decreased from an initial baseline of 104 minutes. The median time from FMC to door and from catheterization laboratory arrival to device remained constant over the study period (24 minutes and 22 minutes respectively), but the median time from door to catheterization laboratory decreased from 42 minutes to 33 minutes. Conclusions: Implementation of a prehospital ECG transmission program was associated with a decreased median FMC to device time in a large city, with FMC to device times consistently less than 90 minutes. The median door to device time for all patients regardless of arrival mode decreased too suggesting improved care processes for all patients with STEMI.
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Psychology and Sleep
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Management of acute myocardial infarction with ST elevation (STEMI) remains a challenge for academic institutions. There are numerous factors at play from the time electrocardiogram is obtained to the time the patient arrives to a... more
Management of acute myocardial infarction with ST elevation (STEMI) remains a challenge for academic institutions. There are numerous factors at play from the time electrocardiogram is obtained to the time the patient arrives to a catheterization laboratory and the balloon is inflated. Academic hospitals that are located in large urban centers have to deal with staff living long distances from the facility, and therefore, assembling the catheterization team after-hours and on the weekends becomes a difficult task to achieve. There are other factors that contribute to time delays, such as, administering electrocardiograms in timely fashion, having emergency physicians activate the catheterization team, instead of contacting the cardiologist to discuss the case, and other time-sensitive factors. All of the aforementioned issues contribute to the delay. Yet, primary percutaneous coronary intervention is clearly demonstrated as the modality of choice in treatment of STEMI, which improves patient's morbidity and mortality. Therefore, it is imperative that institutions do all they can to improve their protocols and meet the core measures in the treatment of STEMI patients, including the door-to-balloon time of less than 90 minutes. Our institution started a quality improvement program for STEMI care in 1993 and has showed progressive improvement in use of aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, and other medication, culminating in 95% to 100% use of these medications in 2003-2004, when we operated in accordance with the Get With The Guidelines program. Door-to-balloon time in less than 90 minutes became a new phase in our quality improvement process, and we achieved 100% compliance in the last 2 years.
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Quality Improvement, Medicine, Electrocardiography, Humans, Female, and 12 moreMale, Cardiac Catheterization, Middle Aged, Percutaneous Coronary Intervention, Medical Emergency, Myocardial Infarction, Patient Care Team, Time Factors, Disease Management, Clinical Protocols, Delayed Diagnosis, and Guideline Adherence
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Emergency Medicine, Treatment Outcome, Medicine, Electrocardiography, Humans, and 14 moreTriage, United States, Female, Male, Follow-up studies, Middle Aged, Percutaneous Coronary Intervention, Myocardial Infarction, Time Factors, Retrospective Studies, Emergency Department, Hospital design and construction, Cath Lab, and Cardiovascular medicine and haematology
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Introduction: Early recognition and rapid revascularization is associated with improved outcomes in patients with STEMI. Increasingly, prehospital emergency medical services (EMS) providers acquire prehospital ECGs, transport patients to... more
Introduction: Early recognition and rapid revascularization is associated with improved outcomes in patients with STEMI. Increasingly, prehospital emergency medical services (EMS) providers acquire prehospital ECGs, transport patients to PCI-ready hospitals, and activate interventional cardiology teams in advance of hospital arrival (“door time”). Therefore, the time from first medical contact (FMC) with either EMS providers or the emergency department may be an important metric for overall system performance in the care of patients with STEMI. Hypothesis: A prehospital ECG transmission program will be associated with a decreased median FMC to revascularization device deployment (“device”) time. Methods: A retrospective cohort study of Action Registry-GWTG data in Chicago was performed. The Chicago Fire Department implemented a 12-lead ECG transmission program in 2012. Patients with confirmed STEMI from January through December 2013 were included. A baseline median FMC to device time was determined for the third quarter of 2012, at the start of the ECG transmission program. Descriptive statistics were used for analysis. Results: Over the study period, 352 patients experiencing STEMI were treated in 9 hospitals. Patients were predominantly male (66%), and 50% arrived by ambulance. The average median FMC to device time over the study period was 83 minutes, which was decreased from a baseline of 104 minutes. The median time from FMC to door and median time from catheterization laboratory arrival to device remained constant over the study period (24 minutes and 22 minutes respectively), but the median time from door to catheterization laboratory decreased from 42 minutes to 33 minutes. Conclusions: Implementation of a prehospital ECG transmission program was associated with a decreased median FMC to device time in a large urban city, with FMC to device times consistently less than 90 minutes. The median door to device time for all patients regardless of arrival mode decreased over implementation, suggesting improved care processes for all patients with STEMI.
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BACKGROUND: The Centers for Disease Control (CDC) recommends universal human immunodeficiency virus (HIV) testing for patients aged 13-64 years in health care settings where the seroprevalence is>0.1%. Rapid HIV testing has several... more
BACKGROUND: The Centers for Disease Control (CDC) recommends universal human immunodeficiency virus (HIV) testing for patients aged 13-64 years in health care settings where the seroprevalence is>0.1%. Rapid HIV testing has several advantages; however, recent studies have raised concerns about false positives in populations with low seroprevalence. STUDY OBJECTIVES: To determine the seroprevalence of HIV in our Emergency Department (ED) population, understand patient preferences toward rapid testing in the ED, and evaluate the performance of a rapid oral HIV test. METHODS: A serosurvey offered oral rapid HIV 1/2 testing (OraQuick ADVANCE, Bethlehem, PA) to a convenience sample of 1348 ED patients beginning August 2008. Subjects declining participation were asked to complete an opt-out survey. RESULTS: 1000 patients were tested. Twelve had positive results (1.2%), including one who had newly diagnosed HIV infection; 988 patients tested negative. Of these, 335 (33.3%) had never bee...
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Screening for Acute Coronary Syndrome in chest pain patients can be initiated with a 12-lead electrocardiogram (ECG). Current American College of Cardiology/American Heart Association guidelines recommends getting an ECG performed and... more
Screening for Acute Coronary Syndrome in chest pain patients can be initiated with a 12-lead electrocardiogram (ECG). Current American College of Cardiology/American Heart Association guidelines recommends getting an ECG performed and reviewed within 10 minutes of the time these patients present to the Emergency Department (ED). One innovative method to improve door-to-ECG time is by placing a trained greeter in the triage section of the ED. This study was conducted over a 3-week period from September to October 2006, in a large urban academic medical center. The greeter was stationed in the triage area, and screened every patient entering the ED for the following symptoms/complaints: chest pain, shortness of breath, acute mental status changes in nursing home patients, dizziness, and nausea with or without vomiting in diabetic patients. The greeter obtained the ECG in the qualified patients, or alerted the triage. Data was collected on ECGs for all ED patients who presented with th...
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Management of acute myocardial infarction with ST elevation (STEMI) remains a challenge for academic institutions. There are numerous factors at play from the time electrocardiogram is obtained to the time the patient arrives to a... more
Management of acute myocardial infarction with ST elevation (STEMI) remains a challenge for academic institutions. There are numerous factors at play from the time electrocardiogram is obtained to the time the patient arrives to a catheterization laboratory and the balloon is inflated. Academic hospitals that are located in large urban centers have to deal with staff living long distances from the facility, and therefore, assembling the catheterization team after-hours and on the weekends becomes a difficult task to achieve. There are other factors that contribute to time delays, such as, administering electrocardiograms in timely fashion, having emergency physicians activate the catheterization team, instead of contacting the cardiologist to discuss the case, and other time-sensitive factors. All of the aforementioned issues contribute to the delay. Yet, primary percutaneous coronary intervention is clearly demonstrated as the modality of choice in treatment of STEMI, which improve...
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The main objective of this pilot study was to measure the effectiveness of a 1-year comprehensive training program on the long-term cognitive competence in disaster preparedness among attending emergency physicians (EPs). Ten attending... more
The main objective of this pilot study was to measure the effectiveness of a 1-year comprehensive training program on the long-term cognitive competence in disaster preparedness among attending emergency physicians (EPs). Ten attending EPs participated in a year-long training program in disaster preparedness and management. A baseline pretraining test and self-evaluation questionnaire were administered to the participants. Post-training written test and self-evaluation questionnaire were repeated at 12 months after the completion of the program. The study took place at an urban tertiary care medical center from July 2007 to June 2008. The training program was divided into three main categories: didactic core topics, formally recognized courses, and a practicum (drill). Pretraining and posttraining test scores in addition to pretraining and posttraining self-assessments were compared for disaster preparedness in various areas. There was a statistically significant increase in the ove...
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Introduction: Early recognition and rapid revascularization is associated with improved outcomes in patients with STEMI. Increasingly, prehospital providers acquire ECGs, transport patients to PCI-ready hospitals, and activate... more
Introduction: Early recognition and rapid revascularization is associated with improved outcomes in patients with STEMI. Increasingly, prehospital providers acquire ECGs, transport patients to PCI-ready hospitals, and activate interventional cardiology teams in advance of arrival (“door time”). Therefore, the time from first medical contact (FMC) with either EMS providers or the emergency department may be an important metric for overall system performance in the care of patients with STEMI. Hypothesis: A prehospital ECG transmission program will be associated with a decreased median FMC to revascularization device deployment time. Methods: A retrospective cohort study of Action Registry-GWTG data in Chicago was performed. The Chicago Fire Department implemented a 12-lead ECG program in 2012. Patients with confirmed STEMI from January through December 2013 were included. A baseline median FMC to device time was determined for the third quarter of 2012, at the start of the ECG progra...
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INTRODUCTION: There are limitations to acute medical management of low back pain in the ED. Transcutaneous electrical nerve stimulation (TENS) provides a non-invasive, safe, accessible, and promising therapy. OBJECTIVES: To evaluate the... more
INTRODUCTION: There are limitations to acute medical management of low back pain in the ED. Transcutaneous electrical nerve stimulation (TENS) provides a non-invasive, safe, accessible, and promising therapy. OBJECTIVES: To evaluate the role of a TENS unit in managing low back pain in the ED, and to compare the average patient length of stay in the ED to conventional treatment. METHODS: 71 patients with a chief complaint of low back pain were enrolled in the active arm. Pain scores on a 0-10 scale were obtained before and after treatment with the TENS units. The control group included 70 historical cases with conventional treatment. T-test analysis was used to evaluate for any statistical difference in pain reduction. RESULTS: The pain scale before and after treatment was statistically significant between control and active arms: Before--controls 8.53 ± 1.52 and active arm 7.65 ± 1.81; after-controls 5.89 ± 2 and active arm (5.01 ± 2.65). The Delta score related variables were not s...
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Introduction: Early recognition and rapid revascularization is associated with improved outcomes in patients with STEMI. Increasingly, prehospital emergency medical services (EMS) providers acquire prehospital ECGs, transport patients to... more
Introduction: Early recognition and rapid revascularization is associated with improved outcomes in patients with STEMI. Increasingly, prehospital emergency medical services (EMS) providers acquire prehospital ECGs, transport patients to PCI-ready hospitals, and activate interventional cardiology teams in advance of hospital arrival (“door time”). Therefore, the time from first medical contact (FMC) with either EMS providers or the emergency department may be an important metric for overall system performance in the care of patients with STEMI. Hypothesis: A prehospital ECG transmission program will be associated with a decreased median FMC to revascularization device deployment (“device”) time. Methods: A retrospective cohort study of Action Registry-GWTG data in Chicago was performed. The Chicago Fire Department implemented a 12-lead ECG transmission program in 2012. Patients with confirmed STEMI from January through December 2013 were included. A baseline median FMC to device tim...
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PTSD symptoms and other negative psychosocial factors have been implicated in the transition from acute to persistent pain. Women (N = 375) who presented to an inner-city Emergency Department (ED) with complaints of acute pain were... more
PTSD symptoms and other negative psychosocial factors have been implicated in the transition from acute to persistent pain. Women (N = 375) who presented to an inner-city Emergency Department (ED) with complaints of acute pain were followed for 3 months. They completed a comprehensive battery of questionnaires at an initial visit, and provided ratings of pain intensity at the site of pain presented in the ED during 3 monthly phone calls. Latent class growth analyses were used to detect possible trajectories of change in pain intensity from initial visit to 3 months later. A 3-trajectory solution was found which identified three groups of participants. One group (early recovery; n = 93) had recovered to virtually no pain by the initial visit, whereas a second group (delayed recovery; n = 120) recovered to no pain only after one month. A third group (no recovery; n = 162) still reported elevated pain at 3-months post ED visit. The no recovery group reported significantly greater PTSD symptoms, anger and sleep disturbance, as well as lower social support, at initial visit than both the early recovery and delayed recovery groups. Results suggest that women with high levels of PTSD symptoms, anger, sleep disturbance and low social support who experience an acute pain episode serious enough to prompt an ED visit may maintain elevated pain at this pain site for at least three months. Such an array of factors may place women at increased risk of developing persistent pain following acute pain.
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Psychology and Sleep
Traditionally, authors will present a manuscript at a conference prior to submitting the subsequent manuscript for consideration in a journal. While peer-reviewed publications are typically considered to be the gold standard in research,1... more
Traditionally, authors will present a manuscript at a conference prior to submitting the subsequent manuscript for consideration in a journal. While peer-reviewed publications are typically considered to be the gold standard in research,1 presentation of abstracts at conferences have several distinct advantages. First, presentation of abstracts at a conference offers an opportunity for early feedback and review, which can help identify issues prior to submission. This can allow authors the ability to refine their study question or revise their study design prior to completion of the project.
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Previous research has shown that African Americans (AA) report higher pain intensity and pain interference than other racial/ethnic groups as well as greater levels of other risk factors related to worse pain outcomes, including PTSD... more
Previous research has shown that African Americans (AA) report higher pain intensity and pain interference than other racial/ethnic groups as well as greater levels of other risk factors related to worse pain outcomes, including PTSD symptoms, pain catastrophizing, and sleep disturbance. Within a Conservation of Resources theory framework, we tested the hypothesis that socioeconomic status (SES) factors (i.e., income, education, employment, perception of income meeting basic needs) largely account for these racial/ethnic differences. Participants were 435 women [AA, 59.1%; Hispanic/Latina (HL), 25.3%; Non-Hispanic/White (NHW), 15.6%] who presented to an Emergency Department (ED) with an acute pain-related complaint. Data were extracted from psychosocial questionnaires completed at the participants’ baseline interview. Structural equation modeling was used to examine whether racial/ethnic differences in pain intensity and pain interference were mediated by PTSD symptoms, pain catastrophizing, sleep quality, and sleep duration, and whether these mediation pathways were, in turn, accounted for by SES factors. Results indicated that SES factors accounted for the mediation relationships linking AA race to pain intensity via PTSD symptoms and the mediation relationships linking AA race to pain interference via PTSD symptoms, pain catastrophizing, and sleep quality. Results suggested that observed racial/ethnic differences in AA women’s pain intensity, pain interference, and common risk factors for elevated pain may be largely due to racial/ethnic differences in SES. These findings highlight the role of social inequality in persistent health disparities facing inner-city, AA women.
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BACKGROUND Since 2006, Centers for Disease Control and Prevention guidelines recommend routine opt-out human immunodeficiency virus (HIV) testing among sexually active 13- to 64-year-olds. Earlier diagnosis and treatment of HIV infection... more
BACKGROUND Since 2006, Centers for Disease Control and Prevention guidelines recommend routine opt-out human immunodeficiency virus (HIV) testing among sexually active 13- to 64-year-olds. Earlier diagnosis and treatment of HIV infection reduces morbidity and mortality and can limit transmission to others. OBJECTIVE Our aim was to increase HIV testing, diagnosis, and linkage to care in the emergency department (ED). METHODS Beginning May 4, 2015, we utilized our electronic health record (EHR) to enhance HIV testing in patients seen in the Rush University Medical Center emergency department in Chicago, IL, who were 13-64 years of age, did not have HIV listed on their problem list, and did not have an HIV antigen/antibody (Ag/Ab) test in the EHR within the past rolling 12-month period. Strategies included use of a "Best Practice Advisory" and later auto-order screening linked to a complete blood count order. RESULTS Our baseline HIV test rate was 2.5% of the target population by age (average of 93 tests per month). From May 4, 2015 to January 31, 2019, 137,749 patients of 240,091 ED visits met our test criteria and 23,588 (17.1% of the target population) HIV Ag/Ab tests were performed, resulting in 164 positive tests. We identified 18 acute seroconverters, 51 new chronically infected persons, and 95 known infected, many of who had not disclosed their status. Our positive test rate was 0.70%, which dropped to 0.29% if only newly diagnosed individuals were counted. CONCLUSIONS EHR enhancements in a large urban ED identifies both newly diagnosed acute and chronically HIV-infected persons. Identification of previously diagnosed patients offers an opportunity to relink them to care.
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Women may be disproportionately vulnerable to acute pain, potentially due to their social landscape. We examined whether positive and negative social processes (social support and social undermining) are associated with acute pain and if... more
Women may be disproportionately vulnerable to acute pain, potentially due to their social landscape. We examined whether positive and negative social processes (social support and social undermining) are associated with acute pain and if the processes are linked to pain via negative cognitive appraisal and emotion (pain catastrophizing, hyperarousal, anger). Psychosocial variables were assessed in inner-city women ( N = 375) presenting to an Emergency Department with acute pain. The latent cognitive-emotion variable fully mediated social undermining and support effects on pain, with undermining showing greater impact. Pain may be alleviated by limiting negative social interactions, mitigating risks of alternative pharmacological interventions.
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Given high levels of traumatic stress for low-income, inner-city women, investigating the link between PTSD and pain is especially important. Using the Conservation of Resources (COR) Theory, we investigated direct and indirect... more
Given high levels of traumatic stress for low-income, inner-city women, investigating the link between PTSD and pain is especially important. Using the Conservation of Resources (COR) Theory, we investigated direct and indirect relationships of PTSD symptoms, vulnerability factors (i.e., resource loss, depressive symptoms and social undermining), and resilience factors (i.e., optimism, engagement, and social support) to acute pain reports in a sample of low-income, inner-city women. Participants (N=341; M Age=28▒y; 58.0% African American) were recruited from an inner-city Emergency Department (ED) following presentation with an acute pain-related complaint. Study data were gathered from psychosocial questionnaires completed at a baseline interview. Structural Equation Modeling examined direct and indirect relationships among PTSD symptoms, vulnerability factors and resilience factors on self-reported pain intensity and pain interference. PTSD symptoms were directly related to higher...
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A wealth of literature [1,2] addresses the multifaceted problem posed by frequent, nonurgent emergency department (ED) use to the health care system (eg, costs) as well as patients (eg, disease management). As Medicaid patients visit the... more
A wealth of literature [1,2] addresses the multifaceted problem posed by frequent, nonurgent emergency department (ED) use to the health care system (eg, costs) as well as patients (eg, disease management). As Medicaid patients visit the ED more than those privately insured [3], numerous interventions [2,4,5] aim to decrease ED use among Medicaid patients. The State of Illinois developed the Medical Home Network (MHN) [6] in 2012 to address frequent, nonurgent ED use by Medicaid recipients living in Chicago. A recent retrospective analysis [7] found that MHN patients visited the ED more and arrived to the ED with lower acuity in comparison to non-MHN patients. Hence, more research and continued intervention development are needed to address the reduction of ED use among Medicaid patients. What providers and researchers know regarding frequent, nonurgent ED use among Medicaid recipients is largely based upon quantitative data sources [8] includingmedical records from the perspectives of providers and insurers [9]. The patient perspective remains limited; however, it is an important source of data for developing interventions [9]. Qualitative methods such as individual interviews provide in-depth examinations of the patient perspective [10]. While conducting qualitative research within an ED is less common than quantitative studies [10], it can produce important findings [10] used to modify and create interventions to reduce ED use. Regardless of patient population, most qualitative research regarding EDuse has been conducted outside of the ED.We conducted a qualitative study within a large, urban ED at an academicmedical center in Chicago. Participants were 50MHNpatients seeking carewithin the ED for a nonurgent issue. After completing the informed consent process, participants took part in 1-time, individual interviews lasting 1 hour or less during their downtime in the ED. Interviews occurred inside of private rooms. Participants were interviewed Monday through Sunday during the morning, afternoon, and evening. The goal of the interviews was to identify and understand MHN patient-identified facilitators of ED use. When conducting qualitative research within the ED, researchers must develop a partnership with an ED physician before conducting the study. The ED physician (1) informs the qualitative study design,