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SAEM 2019:Gun safety, over testing and more

May 15, 2019

ANN ARBOR, Mich. - Thousands of emergency medicine physicians gather this week at the Society for Academic Emergency Medicine Annual Meeting in Las Vegas, Nevada. According to SAEM, it is the largest forum for the presentation of original education and research in academic emergency medicine.

The emergency medicine team at Michigan Medicine is well represented at the conference. Here are some highlights:

Keynote address: Firearm injury

This year's keynote address was presented by Rebecca Cunningham, M.D., a professor of emergency medicine at Michigan Medicine and director of the Centers for Disease Control and Prevention-funded University of Michigan Injury Prevention Center.

Cunningham, along with Garen Wintemute, M.D., M.P.H., presented Firearm Injury: Facts, Myths, and a Public Health Path Forward.

"Firearm violence is a major public health problem," says Cunningham, associate vice president for research-health sciences at U-M. "In fact, firearm injuries are the second leading cause of death among children one to 18 years old and the leading cause of death among children 14 to 17 years old."

In April 2018, she received a $5 million grant from the National Institutes of Health to create the Firearm-safety Among children & Teens Consortium (FACTS). In November 2018, FACTS launched a new website with free access to data on the issue of gun violence, as well as training for health care providers and others.

The keynote address focused on gun safety, a term Cunningham hopes more people will start using.

"People always use the term gun control when talking about gun safety, but that's not what I'm talking about here," Cunningham says. "We're talking about an injury prevention issue. We want to prevent injury, while respecting Second Amendment rights."

Cunningham and Wintemute provided an overview of firearm violence, data on how firearm injuries compare to other forms of injury and death in patient populations, and ways for their fellow physicians to begin researching and screening for gun violence in their own clinical settings.

"Through research and science we were able to reduce the amount of children and teens dying in motor vehicle accidents, even though there are more cars on the road today," Cunningham says. "I believe we can apply the same scientific principles to firearm violence and reduce the number of children dying from guns."

Plenary session: Reducing over-testing in the emergency department

The meeting's plenary session includes the top six abstracts selected by the SAEM19 Program Committee.

One of this year's plenary session abstracts was research presented by Keith Kocher, M.D., M.P.H., an assistant professor of emergency medicine at Michigan Medicine.

The abstract, titled Emergency Care Quality Imaging Benchmarks in a Statewide Collaborative: Estimated Excess and Associated Spending, included other Michigan Medicine experts Benjamin Bassin, M.D., Michaelina Bolton, M.D., James Pribble, M.D., Nicole Sroufe, M.D., Bradley Uren, M.D., and Michele Nypaver, M.D.

In the study, the research team highlights opportunities to safely reduce over-testing in emergency departments using data from the Michigan Emergency Department Improvement Collaborative (MEDIC), a physician-led statewide quality network connecting a diverse set of unaffiliated emergency departments with the goal of improving quality and reducing low-value emergency care throughout the state of Michigan. Estimates of excess imaging were calculated based on Achievable Benchmark of Care, a method for determining quality improvement targets across a population.

"The emergency department is an essential care setting, treating over 145 million annual visits in the United States across a wide range of patient populations," says Kocher, a member of the University of Michigan Institute for Healthcare Policy and Innovation. "Therefore, the emergency department setting represents the ideal venue to implement practice improvement efforts to ensure high-quality care, informed by the best available evidence."

Across the collaborative, the team found substantial variation in amounts of performed imaging and the potential to avoid 1,519 head computed tomography (CT) scans for minor head injury, 3,308 chest x-rays for children with asthma, bronchiolitis or croup, and 4,254 CT scans for suspected pulmonary embolism in 2017 alone.

"The estimated spending on these excess tests ranged from $3.59 to $5.02 million," Kocher says. "We show that there is the opportunity to avoid low-value imaging in the emergency department and in turn, create significant health care savings."


In addition to giving the keynote address, Cunningham received this year's SAEM Excellence in Research Award.

According to SAEM, the award honors a SAEM member who has made outstanding contributions to emergency medicine through the creation and sharing of new knowledge. Recipients are chosen based on their research accomplishments, training and mentorship of other investigators, and recognition, such as peer review journal positions, awards they have received and more.

"I am humbled and honored to receive this award from the Society for Academic Emergency Medicine," says Cunningham, who will become interim vice president for research at U-M on June 1. "As an emergency medicine physician and academic researcher, my goals have consistently aligned with those of SAEM: we both strive to improve care for acutely ill and injured patients by advancing research and education.

"I look forward to partnering with organizations like SAEM as we continue our work to translate research that has the greatest impact on emergency care."

Patrick Carter, M.D., an assistant professor of emergency medicine at Michigan Medicine, was one of the recipients of this year's SAEM Young Investigator Award.

According to SAEM, the award recognizes those SAEM members who have demonstrated commitment and achievement in research during the early stage of their academic career. Recipients are chosen based on several criteria, but mainly their academic and research accomplishments, including grant awards.


Robert Huang, M.D., the associate director of clinical ultrasound and clinical ultrasound fellowship director at Michigan Medicine, is one of the lead organizers of SonoGames, an ultrasound educational event that takes place on the last day of the Annual Meeting.

According to SAEM, SonoGames is a national ultrasound competition in which residents demonstrate their skills and knowledge of point-of-care ultrasound in an exciting and educational format. They compete in front of hundreds of spectators in hopes of bringing home the SonoCup to their residency program.

"Typically about 80 teams from 80 different residency programs compete and faculty come to support and watch," Huang says. "We will have our own team of residents, Mitch Odom, Christ Hebert and Vivian Lam, competing this year."
To view more information on Michigan Medicine experts' involvement at this year's SAEM Annual Meeting, click here.

Michigan Medicine - University of Michigan

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