Krislyn M Boggs

Boston Children's Hospital · Heart Center

Objectives Pediatric readiness varies widely among emergency departments (EDs). The presence of a pediatric emergency care coordinator (PECC) has been associated with improved pediatric readiness and decreased mortality, but adoption of PECCs has been limited. Our objective was to understand factors associated with PECC implementation in general ED...

Objectives Prior research suggests that the presence of state-specific pediatric emergency medical facility recognition programs (PFRPs) is associated with high emergency department (ED) pediatric readiness. The PFRPs aim to improve the quality of pediatric emergency care, but individual state programs differ. We aimed to describe the variation in...

Background Telehealth has been proposed as one strategy to improve the quality of time‐sensitive sepsis care in rural emergency departments (EDs). The purpose of this study was to measure the association between telehealth‐supplemented ED (tele‐ED) care, healthcare costs, and clinical outcomes among patients with sepsis in rural EDs. Methods Cohor...

Background Infection prevention and control (IPC) is especially challenging in the emergency care setting due to ever-increasing emergency department (ED) crowding, boarding of patients, increasing rates of staff turnover, and other factors. Methods 2022 IPC practices in the ED setting were queried between January and April 2023 using the National...

Background: Prehospital obstetric events, including out-of-hospital deliveries and their complications, are a rare but high-risk event encountered by emergency medical services (EMS). Understanding the epidemiology of these encounters would help identify strategies to improve prehospital obstetric care. Our objective was to determine the character...

Objective: Telehealth capacity may be an important component of pandemic response infrastructure. We aimed to examine changes in the telehealth use by the US emergency departments (EDs) during COVID-19, and to determine whether existing telehealth infrastructure or increased system integration were associated with increased likelihood of use. Metho...

Objectives: In 2007, the US Institute of Medicine recommended that every emergency department (ED) appoint pediatric emergency care coordinators (PECCs). Despite this recommendation, our national surveys showed that few (17%) US EDs reported at least 1 PECC in 2015. This number increased slightly to 19% in 2016 and 20% in 2017. The current study o...

This cross-sectional study identifies US institutions sponsoring residency programs and examines whether Council of Teaching Hospitals and Health Systems membership is associated with institution characteristics.

Background: Despite the potential protective effect of a plant-based diet against chronic obstructive pulmonary disease (COPD), it remains unknown whether intake of different types of plant foods is beneficial for COPD. Our aims were to determine whether adherence to the healthful version of a plant-based diet (healthful Plant-based Diet Index (hP...

BACKGROUND The Region 1 Disaster Health Response System project is developing new telehealth capabilities to provide rapid, temporary access to clinical experts across US jurisdictions to support regional disaster health response. OBJECTIVE To guide future implementation, we identified hospital-level barriers, facilitators, and willingness to use...

Objective Trauma center certifications across the United States (U.S.) are not unified. Participation in the national trauma certification program established through the American College of Surgeons (ACS) is not universal, and many states maintain unique trauma certification systems with varying criteria. We investigated degree of similarity betwe...

Introduction Millions of people visit US national parks annually to engage in recreational wilderness activities, which can occasionally result in traumatic injuries that require timely, high-level care. However, no study to date has specifically examined timely access to trauma centers from national parks. This study aimed to examine the accessibi...

Objectives To describe first author gender differences and characteristics in 1) Society for Academic Emergency Medicine (SAEM) Annual Meeting abstracts and 2) resulting manuscript publications. Methods We performed cross-sectional evaluation of SAEM abstracts from 1990, 1995, 2000, 2005, 2010, 2015, and 2020, compiling and reviewing a random samp...

Objectives: Little is known about the recent usage of pediatric telehealth across all emergency departments (EDs) in the United States. Building upon our prior work, we aimed to characterize the usage of ED pediatric telehealth in the pre-COVID-19 era. Methods: The 2019 National ED Inventory-USA survey characterized all U.S. EDs open in 2019. Among...

Background: Pediatric hospital care is becoming increasingly regionalized, and previous data have suggested that insurance may be associated with transfer. The aims of the study are to describe regionalization of pediatric care and density of the interhospital transfer network and to determine whether these varied by insurance status. Methods: U...

Background Although primary percutaneous coronary intervention (pPCI) is the preferred intervention for ST-elevation myocardial infarction (STEMI), not all patients are admitted directly to an emergency department (ED) with 24/7/365 pPCI capabilities. This is partly due to a lack of a national system of known pPCI-capable EDs. Our objective was to...

Objectives: Since its founding in 1989, the Society for Academic Emergency Medicine (SAEM) has accepted thousands of abstracts for presentation at its Annual Meeting. We reviewed abstracts to characterize temporal changes in study design, abstract topics, quality scores, and proportion of abstracts published as manuscripts. Methods: In this seri...

Introduction: Although many emergency departments (EDs) receive telehealth services for psychiatry, or telepsychiatry, to manage acute psychiatric emergencies, national research on the usage of ED telepsychiatry is limited. To investigate ED telepsychiatry usage in the pre-COVID-19 era, we surveyed a sample of EDs receiving telepsychiatry in 2019,...

Background Telehealth for emergency stroke care delivery (telestroke) has had widespread adoption, enabling many hospitals to obtain stroke center certification. Telehealth for pediatric emergency care has been less widely adopted. Objective Our primary objective was to determine whether differences in policy or certification requirements contribut...

Aim: Sepsis is a top contributor to in-hospital mortality and, healthcare expenditures and telehealth have been shown to improve short-term sepsis care in rural hospitals. This study will evaluate the effect of provider-to-provider video telehealth in rural emergency departments (EDs) on healthcare costs and long-term outcomes for sepsis patients....

Background: Pediatric emergency care coordinators (PECCs) are associated with pediatric readiness of emergency departments (EDs). National organizations have called for PECCs in all EDs. Although the National Pediatric Readiness Program provides a list of suggested tasks for each PECC, little is known about implementation. Our objective was to des...

Objectives: Emergency department (ED) data are often used to address questions about access to and quality of emergency care. Our objective was to compare one of the most commonly used data sources for national ED information, the American Hospital Association (AHA) Annual Survey, with a criterion database: the National Emergency Department Invent...

Objectives: Stroke centers are essential for the optimal care of patients with acute stroke. However, there is no universally applied standard for stroke center certification/designation and no unified list of confirmed US stroke centers. Multiple national organizations, and some state governments, certify/designate hospitals as stroke centers of...

This cross-sectional study assesses US population access to emergency departments with acute stroke capabilities and telestroke capacity in 2019.

Background Optimal care for patients with stroke relies on timely recognition and rapid transport to appropriate treatment, often by emergency medical services (EMS). Our primary objective was to describe EMS time intervals for patients with suspected stroke in the United States. We also sought to quantify the variation in EMS time intervals by geo...

Introduction: Prehospital recognition and rapid transport of stroke patients by emergency medical services (EMS) is critical to optimize access to time-sensitive care. We aimed to describe EMS time intervals for suspected stroke patients in the U.S. and to quantify variation in EMS time intervals by geographic location and urbanicity. Methods: We c...

Backgound: In 2011, nearly 20% of Americans lacked timely access to alteplase-capable hospitals. We update this work by assessing access to stroke centers and emergency departments (EDs) with telestroke capacity. Our objectives are to identify all US EDs with acute stroke capabilities (i.e., in a confirmed stroke center or with telestroke capacity)...

Introduction: Telehealth is commonly used to connect emergency department (ED) patients with specialists or resources required for their care. Its infrastructure requires substantial upfront and ongoing investment from an ED or hospital and may be more difficult to implement in lower-resourced settings. Our aim was to examine for an association be...

Objective Physician assistant (PA) and nurse practitioner (NP) staffing is increasingly common in emergency departments (EDs), with variable physician supervision. We examined the feasibility of using publicly reported metrics as a measure of ED performance by staffing model. Methods We classified a convenience sample of 915 EDs by staffing model...

The care of severely burned patients comes with unique requirements for specialized burn centers. The American Burn Association sets guidelines for burn centers and provides a voluntary program to verify their quality of care. However, not all burn centers are verified, and it is unclear which nonverified centers have met requirements set by their...

BACKGROUND Telehealth for emergency stroke care delivery (telestroke) has had widespread adoption, enabling many hospitals to obtain stroke center certification. Telehealth for pediatric emergency care has been less widely adopted. OBJECTIVE Our primary objective was to determine whether differences in policy or certification requirements contribu...

Question Is there an association between a history of operating room (OR) employment, as proxy for exposure to inhaled agents such as surgical smoke and disinfectants, and incidence of chronic obstructive pulmonary disease among female nurses in the US? Findings In this cohort study of 75 011 US female nurses, nurses with 15 or more years of OR em...

Telepsychiatry has made psychiatric care more accessible to emergency department (ED) patients. To date, most telepsychiatry studies have focused on specific populations or small groups of EDs. This study sought to examine the potential role of telepsychiatry across a wider range of EDs by comparing visit dispositions for psychiatric visits in EDs...

Objective Health services research on the differences in care between pediatric and general emergency departments (EDs) is limited by ambiguity regarding the definition of a pediatric ED. Our goal was to determine the proportion of EDs captured by commonly used definitions of pediatric ED. Methods We linked data for 2016 from two databases from Ne...

Importance Given the mortality disparities among children and adolescents in rural vs urban areas, the unique health care needs of pediatric patients, and the annual emergency department volume for this patient population, understanding the availability of pediatric emergency physicians (EPs) is important. Information regarding the available pediat...

Objective: The aim of this study was to describe our expansion of a Massachusetts grassroots initiative-to increase the appointment of pediatric emergency care coordinators (PECCs) in emergency departments (EDs)-to all 6 New England states. Methods: We conducted annual surveys of all EDs in New England from 2015 to 2020 regarding 2014 to 2019, r...

Background: Emergency care is an essential part of a health system. Ecuador has recognized emergency medicine as a specialty and has two emergency medicine residency training programs. However, little has been published about emergency department characteristics and capabilities in Ecuador. Objective: We described the characteristics and capabil...

Background: Most data on spoke emergency departments (EDs) using telestroke come from single academic hub-and-spoke networks. Our objective was to describe characteristics of EDs using telestroke in a national sample. Methods: We surveyed a convenience sample of 366 EDs among those who self-identified as using telestroke on the 2016 National ED Inv...

Objective To determine the availability of pediatric emergency care coordinators (PECCs) in U.S. EDs in 2015, and to determine the change in availability of PECCs in U.S. EDs from 2015-2017. Study design As part of the National ED Inventory-USA, we administered a survey to all 5,326 U.S. EDs open in 2015; all 5,431 in 2016; and all 5,489 in 2017....

Objectives Occupational use of disinfectants among healthcare workers has been associated with asthma. However, most studies are cross-sectional, and longitudinal studies are not entirely consistent. To limit the healthy worker effect, it is important to conduct studies among early- to mid-career workers. We investigated the prospective association...

Background Telemedicine is a valuable tool to improve access to specialty care in emergency departments (EDs), and states have passed telemedicine parity laws requiring insurers to reimburse for telemedicine visits. Our objective was to determine if there is an association between such laws and the use of telemedicine in an ED. Methods As part of...

Study objective: There has been increasing attention to screening for health-related social needs. However, little is known about the screening practices of emergency departments (EDs). Within New England, we seek to identify the prevalence of ED screening for health-related social needs, understand the factors associated with screening, and under...

Objective To determine whether frequency of interfacility transfer varied by insurance status among pediatric emergency department (ED) patients. Secondarily, we tested for an association between insurance status and odds of transfer with discharge from the second ED without observation or admission. Methods We used the 2016 New York State ED and...

Introduction: The American Hospital Association (AHA) has hospital-level data, while the Centers for Medicare & Medicaid Services (CMS) has patient-level data. Merging these with other distinct databases would permit analyses of hospital-based specialties, units, or departments, and patient outcomes. One distinct database is the National Emergency...

Objectives Our objective was to estimate the emergency medicine board‐certified emergency physician (EMBC EP) workforce supply and demand by U.S. state. Methods To estimate state demand, we applied the methodology from our 2005 analysis to calculate full‐time equivalent (FTE) EMBC EP demand for each emergency department (ED). The 2017 National Eme...

Study objective: The number of freestanding emergency departments (EDs) has increased rapidly in the United States, and there is concern that such entities are located near existing EDs rather than in areas lacking emergency care. In 2018, the Medicare Payment Advisory Commission recommended a reduction in Medicare reimbursement rates to freestand...

Objective Telemedicine is used by emergency departments (EDs) to connect patients with specialty consultation and resources not available locally. Despite its utility, uptake of telemedicine in EDs has varied. We studied characteristics associated with telemedicine adoption during a 4‐year period. Methods We analyzed data from the 2014 National Em...

Objective The U.S. opioid epidemic persists, yet it is unclear if opioid-related emergency department (ED) policies have changed. We investigated: 1) the prevalence of opioid use disorder (OUD) prevention and treatment policies in New England EDs in 2018, and 2) how these policies have changed since 2014. Methods Using the National Emergency Depar...

Objective Inter-hospital transfers are costly to patients and to the healthcare system. The use of telemedicine may enable more efficient systems by decreasing transfers or diverting transfers from crowded referral emergency departments (ED) to alternative appropriate facilities. Our primary objective was to describe the prevalence of telemedicine...

Introduction: Despite the growing number of freestanding emergency departments (FSED) in the United States (US), FSED definitions differ across major US data sources of healthcare facilities and use. We compare these sources and propose a universal definition of FSED (and its two major types) to improve communications regarding these facilities an...

Objective: The receipt of telemedicine for the management of mental illness, also known as telepsychiatry, is being adopted in emergency departments (EDs), but little is known about this approach. This study investigated the prevalence and applications of telepsychiatry in general EDs in the United States. Methods: All 5,375 U.S. EDs were survey...

Background: Exposure to disinfectants among healthcare workers has been associated with respiratory health effects, in particular, asthma. However, most studies are cross-sectional and the role of disinfectant exposures in asthma development requires longitudinal studies. We investigated the association between occupational exposure to disinfectan...

Importance Exposure to disinfectants in health care workers has been associated with respiratory health outcomes, including asthma. Despite the biological plausibility of an association between disinfectants (irritant chemicals) and risk of chronic obstructive pulmonary disease (COPD), available data are sparse. Objective To investigate the associ...

Background: Processed meat intake may increase the risk of chronic obstructive pulmonary disease (COPD). However, the magnitude of this association may depend on smoking and unhealthy diet. Our aims were to determine whether processed meat intake increased the risk of COPD among middle-aged women, and to estimate the combined impact of high proces...

Study objective: Telemedicine has potential to add value to the delivery of emergency care in rural emergency departments (EDs); however, previous work suggests that it may be underused. We seek to understand barriers to telemedicine implementation in rural EDs, and to describe characteristics of rural EDs that do and do not use telemedicine. Met...

Background Awareness about food allergy and food-induced anaphylaxis (FIA) has increased dramatically over the past decade. It remains unclear, however, whether concordance with guidelines for FIA management has improved over time. Objective Our objective was to describe changes in emergency department (ED) concordance with guidelines for FIA mana...

Objective: Telemedicine has the potential to improve the delivery of emergency medical care: however, the extent of its adoption in United States (US) emergency departments is not known. Our objective was to characterise the prevalence of telemedicine use among all US emergency departments, describe clinical applications for which it is most commo...

Objectives While many U.S. emergency departments (ED) have a “pediatric ED,” there is, to our knowledge, no accepted criteria for this type of ED. We investigated the prevalence, distribution, staffing, and characteristics of self‐reported pediatric areas in U.S. general EDs. Methods We conducted a survey of all 5,273 U.S. EDs to characterize emer...

Objectives Appointment of a pediatric emergency care coordinator (PECC) is considered the single best intervention to improve pediatric emergency care, and has been recommended for all US general emergency departments (EDs) for more than a decade. Unfortunately, many EDs do not adhere with this recommendation. In 2017, we performed a grassroots int...

Introduction The receipt of remote clinical care for children via telecommunications (pediatric telemedicine) appears to improve access to and quality of care in U.S. emergency departments (EDs), but the actual prevalence and characteristics of pediatric telemedicine receipt remain unclear. We determined the prevalence and current applications of p...

Objectives To investigate the association between occupational exposure to disinfectants/antiseptics used for hand hygiene and asthma control in nurses. Methods In 2014, we invited female nurses with asthma drawn from the Nurses’ Health Study II to complete two supplemental questionnaires on their occupation and asthma (cross-sectional study, resp...

Background: Changes in emergency department (ED) concordance with guidelines for the management of stinging insect-induced anaphylaxis (SIIA) are not known. Objective: We describe temporal changes in ED concordance with guidelines for the management of SIIAs. Methods: We analyzed data from two multicenter retrospective studies of patients with...

Introduction Telemedicine connects emergency departments (ED) with resources necessary for patient care; its use has not been characterized nationally, or even regionally. Our primary objective was to describe the prevalence of telemedicine use in New England EDs and the clinical applications of use. Secondarily, we aimed to determine if telemedici...

Background: Disinfectant use among healthcare workers has been associated with respiratory disorders, especially asthma. We aimed to describe disinfectants used by U.S. nurses, and to investigate qualitative and quantitative differences according to workplace characteristics and region. Methods: Disinfectant use was assessed by questionnaire in...

Healthcare workers have a higher risk of work-related asthma, partly attributed to exposure to disinfectants used for surfaces and medical instrument cleaning. Hand hygiene practices also involve exposure to disinfectants. However, the potential respiratory risks associated with hand hygiene among healthcare workers are unknown. We investigated thi...