Unique Characteristics of Emergency Care Research: Scope, Populations, and Infrastructure

Abstract

The National Institutes of Health (NIH) Clinical and Translational Science Awards (CTSA) program and the 2006 Institute of Medicine (IOM) Report on the future of emergency care highlight the need for coordinated emergency care research (ECR) to improve the outcomes of acutely ill or injured patients. In response, the Society for Academic Emergency Medicine (SAEM) and the American College of Emergency Physicians (ACEP) sponsored the Emergency Care Research Network (ECRN) Conference in Washington, DC, on May 28, 2008. The conference objectives were to identify the unique nature of ECR and the infrastructure needed to support ECR networks and to understand the optimal role of emergency medicine (EM) and other acute care specialties in research networks. Prior to the conference, participants responded to questions addressing the relevant issues that would form the basis of breakout session discussions; two of these breakout questions are summarized in this report: 1) what makes EM research unique? and 2) what are the critical components needed to establish and maintain networked ECR? Emergency care research was defined as ''the systematic examination of patient care that is expected to be continuously available to diverse populations presenting with undifferentiated symptoms of acute illness, or acutely decompensated chronic illness, and whose outcomes depend on timely diagnosis and treatment.'' The chain of ECR may extend beyond the physical emergency department (ED) in both place and time and integrate prehospital care, as well as short-and long-term outcome determination. ECR may extend beyond individual patients and have as the focus of investigation the actual system of emergency care delivery itself and its effects on the community with respect to access to care, use of resources, and cost. Infrastructure determinants of research network success identified by conference participants included multidisciplinary collaboration, accurate long-term outcome determination, novel information technology, intellectual infrastructure, and wider network relationships that extend beyond the ED. Clinical research in the emergency care setting presents unique challenges, including the unscheduled and

Part 12: Cardiac Arrest in Special Situations

“…Challenges include the infrequency with which most specific conditions occur, the heterogeneity of presentation, and ethical challenges related to withholding established care from patients who are unable to provide informed consent because the patient has an altered mental status, the patient is suicidal, or there is a lack of time to explain treatment alternatives. 219 The majority of questions addressing cardiac arrest due to drug toxicity remain unanswered. Epidemiological studies are required to document the incidence rate of cardiac arrests secondary to drug toxicity and the safety and efficacy baseline rates for current therapeutic strategies.…”

Evaluating Emergency Care Research Networks: What Are the Right Metrics?

“…This is a particularly intriguing concept for emergency care research, which must contend with many disease and patient populations, sometimes available at low concentrations. 1 Given regional differences in practice and disease predominance, emergency care research networks (ECRNs) may be the optimal modality for answering important research questions via randomized clinical trials and other research methodologies. However, further investigation is required to determine the best methods of evaluating the effectiveness, efficacy, and infrastructure of research networks.…”

The 2008 Emergency Care Research Networks (ECRN) Conference: Design, Summary of Findings, and an Update

“…[1][2][3][4] In the first, Courtney et al suggest a consensus definition of emergency care research that acknowledges the diverse patient populations, undifferentiated presentations, and need for timely diagnosis and treatment as characteristics making emergency care research unique. The authors also suggest that growth of emergency care research must extend research endeavors and outcome determination beyond the physical emergency department with respect to time and place.…”

“…[1][2][3][4] The aim of this summary is to outline the structure and content of the conference, highlight key findings, and provide an update on events since the conference related to the federal support of, and focus on, emergency care research.…”