JessicaJiang

October24th,2015
Period1

AnnotatedSourceList

Baron,David,JosephGarbely,andRobertL.Boyd."EvaluationandManagementofSubstance
AbuseEmergencies."
PrimaryPsychiatry
16.9(2009):4147.
AcademicSearch
Complete
.Print.25Oct.2015.

Thisarticleisaboutthecorrectprocedureofclinicalevaluationandinitialtreatmentof
substanceabusingpatientswhocometotheemergencyroom.Analgorithmforemergencycare
physiciansandpsychiatristsontreatmentproceduresforpatientssufferingdrugintoxicationor
withdrawalisproposedinthearticle.Thesourcealsofocusesonthethreemainfederal
guidelinesfromtheCenterforSubstanceAbuseTreatmentforemergencyphysicianstreating
patientsthatareintoxicatedorexperiencingwithdrawal.Theguidelinesare,nevergive
medicationstopatientsandthenimmediatelydischargethem,donotdischargeintoxicated
patientstothestreets,andnotethedistinctionbetweenpatientsexperiencingsevereintoxication
andwithdrawal,anddeterminethepossibilityandpotentialofintentionalandunintentional
selfharm.
ProposinganalgorithmormethodfortreatmentproceduresforK2islikelyresearch
projectthus,thissourceisanexcellentmodelofwhatisnecessarytoincludeforthistypeof
proposal.However,thisarticleisalittleoutdated,asitwaspublished6yearsago,andsomeof
thedatagatheringtechniquesitutilizesareobsolete,asbettermethodshavebeendevelopedover
thepastseveralyears.Furthermore,althoughitprovidesadecentamountofbackgroundasto
whysuchastudyisnecessary,itisstillanexperimentalreport,soitismoretechnicalthan
conceptual,filledwithdata,figures,andscientificexplanations.Forexample,thearticleexplains
thehowbuprenorphine,adrugusedtoalleviatewithdrawalsymptoms,operateswithinthebrain.
Althoughinformationlikethisisinteresting,itisnotexactlyrelevantorsignificanttoanareaof
studyexaminingreasoningandfrequencyofdrugandalcoholrelatedemergencyroom
visitations.

Buss,TerryF.,RashidAbdu,andJamesR.Walker."Article:Alcohol,Drugs,andUrban
ViolenceinaSmallCityTraumaCenter."
JournalofSubstanceAbuseTreatment
12
(1995):7583.
Edselp
.Print.25Oct.2015.

Thisstudyusespatientinterviewsandmedicalrecordstogaininsightonwhetherornot
smallcitiesfacethesameproblemslargecitieswithmajoracademicmedicalcentersdo.
THroughtheinterviewsandrecordsexamined,theauthorsfoundthat70%ofalcoholanddrug
usingpatientswhohadexperiencedurbanviolencewereyoung,male,poor,and

AfricanAmerican.Thestudyproposesthatthebestwaytopredictcurrentsubstanceabusein
urbantraumapatientswastoexaminetheirmedicalhistoryforpastsubstanceabuse.Various
techniquestocombattheviolenceanddrugabusecircumstancesinthesesmallcitiesare
suggestedandsupported,includingadministeringtoxicologyscreensforalltraumavictims,
referringthemtosubstanceabuseprograms,targetingatriskpopulationsinordertoprevent
occurrence,andeliminatinganenvironmentthatbreedsviolenceanddrugabuse.
Thissourceisveryhelpfulinthatitgivesspecificreasonsforsuchfrequentemergency
roomvisitsduetosubstanceabuseandprovidesstatisticalproofthatsupportstheeffectiveness
ofvarioussolutionsitproposestodecreasethenumberofvisitations.However,themainissue
withthisstudyisthatitisfocusedspecificallyonsmallcitytraumacenters.Mercyisamajor
academicmedicalcenterslocatedinalargeurbanarea,thustheresultsofthisstudycannotbe
directlyappliedtoMercy.But,theinformationinthisstudycanbeusedtoarguethat,regardless
ofsizeofanurbancenter,manycityhospitalsexperiencesimilaritiesinregardstopatientswith
substanceabusehabitspatientsoftentimeshavebeeninvolvedorhaveexperiencedsomesortof
violence,andtypicallyfitthedemographicofbeingyounger,male,impoverished,and
AfricanAmerican.

Cederbaum,JulieA.,ErickG.Guerrero,KeyonR.Mitchell,andTinaKim."Utilizationof
EmergencyandHospitalServicesamongIndividualsinSubstanceAbuseTreatment."
SubstanceAbuseTreatment,Prevention&Policy
9.1(2014):2.
Edb
.Print.25Oct.2015.

Thisstudyexaminestheriskofusinghospitalservicesforracialandethnicminoritiesin
publiclyfundedsubstanceabusetreatmentcentersinLosAngeles,California.Datafrom
20062009wasanalyzedanditwasfoundthattherewasanincreasedamountofemergency
roomvisitationsamongpatientssufferingfrommentalhealthandsubstanceuserelatedissues,
whichsupportedthefindingsofnumerouspreviousstudies.Thearticleconcludesthatthe
findingsofthisstudyaresignificanttoconsiderinhealthcarepolicy.Duetosucha
concentrationofpatientsinthesubstanceabusecategory,itisimportanttoconsidertheneedfor
preventionservicesofdrugabusetoreducecostlyhospitalizationfeesforapopulationthat
frequentlycannotpaythem.
Akeyquestion,howtoreducethecriticalissueofemergencyroomcareoveruse,is
addressedinthisarticle,makingthissourceveryuseful.Mytopicofstudyisdirectlyrelatedto
theissuesdiscussedinthisstudy,and,mostimportantly,itprovidesstatisticalproofanddatato
supporttheassertionthatthegreatestamountofoveruseoruseingeneralofemergencycareis
concentratedamongsubstanceabuseandmentalhealthpatients.Furthermore,thedataprovided
isalsoveryspecific,splittingbetweenthevarioustypesofdrugs,alcohol,cocaine,heroin,
marijuana,ormethamphetamines,andtheageanddaysofprimarydruguse.Thistypeofdata
willproveinvaluableduringthewritingoftheresearchpaper.However,onedownsidetothis
sourceisthatthedatacompiledwasfrom20062009.Inrecentyears,drugusehasincreased
withtheintroductionofnewtypesofdrugs,suchasK2,amanmadesyntheticmarijuana.

Ideally,therewouldhavebeenasimilarstudyconductedmorerecently,but20062009isnot
incrediblyoutdated,andwillstillbeveryuseful.

Cherpitel,CherylJ."TrendsinAlcoholandDrugrelatedERandPrimaryCareVisits,
19952000:AreHealthyPeople2000ObjectivesMet?"
AmericanJournalonAddictions
14.3(2005):28190.
Psychology&BehavioralSciencesCollection
.Print.25Oct.2015.

ThisstudyisafollowupofaninitiativeknownastheHealthyPeople2000objective,in
whichactionsweretakentotryandreducetheamountofalcoholanddrugrelatedemergency
roomvisits.TheinitiativeattemptedtoreducedrugandalcoholrelatedERvisitationsbyatleast
20%.SurveysfromtheAlcoholResearchGroupsNationalAlcoholSurveysetwerecompared
between1995,withasamplesizeof4,925,and2000,withasamplesizeof7,612.Comparison
examinationresultedintheassertionthattheobjectiveswerenotmet.Thearticlehypothesizes
thatthiswasbecauseofanincreaseinpatientsseekingtreatmentfortheirabuseratherthanan
actualincreaseindruguseitself.Furthermore,theauthoralsoassertsthattheremayhavebeen
misleadingfiguresinthedatacollectedbecausethereisnouniversalsurveillancesystemofthe
amountofclientsvisitingduetoalcohol,resultinginanoverrepresentationofthesetypesof
patientsingeneralERclientpopulation.
Thisstudyisnotentirelyrelevanttomyresearchtopicbecauseitisaddressingaspecific
initiative.Furthermore,theHealthyPeople2000objectivewasfromover15yearsago,and,
althoughitisstillrelevant,theinformationanddataitprovidesisstillconsiderablyoutdated
comparedtomanyotherstudiesconductedinthe2010s.However,thesourcestilloffersvaluable
information.Forexample,themisleadingfiguresduetoalackofauniversalsurveillancesystem
isextremelynoteworthyandsomethingthatmustbeconsideredwhenexaminingothersources
documentingsimilardata.Anotherpositiveofthissourceisthat,eventhoughsomeofthe
contentisnotrelevant,ithasanextensivereferenceslistthatcontainsseveralmoreapplicable
sources,suchasa1992NationalHospitalAmbulatoryMedicalCareSurvey.

Constant,Aymery,AntoniaLeGruyer,CarolineLeLan,FrancoiseRiou,andRomainMoirand.
"PostdetoxificationFactorsPredictingAlcoholRelatedEmergencyRoomVisits12to24
MonthsAfterDischarge:ResultsfromaProspectiveStudyofPatientswithAlcohol
Dependence."
Alcoholism:Clinical&ExperimentalResearch
39.7(2015):1236.
Edb
.
Print.25Oct.2015.

Thisstudyexaminesthefactorsleadingtopatientreturn1224monthsafter
detoxification.Forthisexperiment,88patientsthathadbeenhospitalizedfordetoxificationin
theaddictiondepartmentofauniversityhospitalinRennes,Francewereused.Foreachofthese
88patients,alcoholconsumption,psychiatricsymptoms,andlifeeventswereinvestigatedby
addictionspecialistsduringthepatientshospitalizationandfora6monthperioddirectly
afterward.Afteranalyzingresults,thestudyfoundthatalmosthalf,47.7%ofthepatients,

returnedtotheER12to24monthsaftertheirinitialvisits.Resultsalsoindicatedthatpatients
livingwithfriendsandparentswithaggravatedpsychiatricsymptomshadahigherreturnrate
thanthosepatientswholivedwithchildrenandhadanimprovedmentalhealthstate.These
findingsledtotheconclusionthatmonitoringfamilylifeandpsychiatricsymptomsdirectlyafter
adetoxificationprogrammaybeveryhelpfulandeffectiveindeterminingwhichpatientsare
morevulnerabletoarelapse.Thearticleproposesthatearlysystematicscreeningsforthese
changescombinedwithappropriatetreatmentandestablishmentofasupportivesocialsystem
couldaidinavoidingfuturerelapsesandERvisitations.
Thisisanexcellentsourcethatprovidesuniqueinformation,asitexamineswhyapatient
willreturnafterdetoxification.Thisproblemisverycommoninmanyemergencycare
departments,especiallyfrommyexperiencethusfaratMercy.Othersourcesexaminedataof
howmanyERvisitationsaredrugandalcoholrelated,buttypicallydonotaccountforhow
manyofthesevisitsarebythesamepatient.Thissourceexaminesthatdatasetveryspecifically.
Althoughitisonlyasamplesizeof88,theresultswereveryinterestingandwillprovevery
useful.However,thestudywasconductedinanaddictiondepartmentofauniversityhospitalin
Rennes,France.Usingastudyconductedinaforeigncountryisnotideal,asdifferencesin
treatmentproceduresareunfamiliarandunaccountedfor.

Cohn,Meredith."ReducingEmergencyRoomUsebyTargeting'SuperUtilizers'"
TheBaltimore
Sun
.TheBaltimoreSun,29Sept.2015.Web.25Oct.2015.

Superutilizers,asdefinedbythearticle,arepatientswhooverusethecareprovidedby
theemergencydepartment.Onespecificexample,MatthewHardy,wenttotheemergencyroom
eighttimesoverafourmonthperiod.Thesetypesofpatients,rangingfromsubstanceabusersto
homelessveterans,visittheemergencyroomfrequentlyforsimpleneedssuchasfoodoreven
simplycompanyoftentimes,thesepeopleareverylonelyandevencalltheambulancejustto
askforfulfillmentoftrivialneeds,suchasreceivingapairofsocks.ThearticleexplainshowDr.
JeffreyBennerstartedtheRobertWoodJohnsonFoundationinordertocombatthisissue.By
providingmorelongtermcare,suchasdrugabusecounselingforfrequentdetoxpatients,they
havebeenabletoreducetheamountofsuperutilizersinemergencyroomsacrossthecity.
Furthermore,theyhavealsobeenabletostarttoreducetheimpactofsuperutilizersonthe
healthcarebudget.Havingpatientsthatvisitedsofrequentlydemandedmorespendinghowever,
bydecreasingtheamountofthesetypesofpatients,manyMarylandhospitalshavebeencoming
underbudget,andhavethusfurtherencouragedthemtokeeppeoplehealthyandoutofthe
hospital.
ThisarticleisuniqueandveryhelpfulinthatitconnectstwotopicsIhadthoughtabout
researching,drugandalcoholrelatedincidentsintheemergencyroomandthefrequencyof
nonurgentcasesintheER.Itshowsthatmanyofthesesubstanceabusevictimsare
superutilizersandcomeinfornonurgentcircumstances.Theirconstantdetoxrequestsand
visitsforthesamesymptomsrepeatedlyconnecttotheimpactofdrugrelatedemergencyroom

visitsonhealthcarespending.Atmymentorsite,Ihaveviewedthisproblemfirsthand.Often
timesapatientcomesinfordetox,andisdischarged,onlytoreturnafewhourslaterdrunkoron
drugsagain.Thisarticleprovidedgoodinsightonapossibleresolutiontothisproblemthatcould
bebroughtintotheMercyMedicalCenterinBaltimore,theRobertWoodJohnsonFoundation.
BysettingupaseparatedrugandalcoholabuserelatedsectionoftheERmanagedbyspecialists
andsubstanceabusecounselors,theemergencyphysicianswouldthenabletoattendtomore
urgentcases.

DrugAbuseWarningNetwork,2011:NationalEstimatesofDrugRelatedEmergency
DepartmentVisits
.Rep.Rockville:SubstanceAbuseandMentalHealthServices
Administration,2013.Web.18Oct.2015.

Thissourceisadatacompilationthatestimatestheamountofemergencyroomvisitsdue
todrugs.Thestudyfoundthat,withoverlapbetweenthecategories,about1.25millionEDvisits,
or51%,involvedillicitdrugs,1.24million,or51%,involvednonmedicaluseof
pharmaceuticals,andabout0.61million,or25%,involveddrugscombinedwithalcohol.The
documentincludesasummaryoftheresultsaswellasthedetailedindividualdatatables,which
notpatientdemographicandage,andgraphs,whichgiveholisticrepresentationsofthepatient
representationineachcategory.Thedataiscollectedbasedonthespecificreasonforthevisit,
rangingfromillicitsubstanceabuse,underagedrinking,suicideattempts,toaccidentalingestion.
Italsosummarizespasttrendsandfutureestimationsofthesedrugrelatedemergencyroom
visits.
Thedatagiveninthissourceisextremelydetailedandspecificaswellasextensive
(nearly100pagesofdata).Certainly,itisallreliableasitisfromagovernmentsponsored
agency,theSubstanceAbuseandMentalHealthServicesAdministration(SAMHSA),whichisa
branchoftheU.S.DepartmentofHealthandHumanServices.However,Iwillnotbeabletouse
andcompileallofthisdataeffectivelyintomyresearchpaper,Imayonlydrawfromcertaindata
groupsandfiguresratherthanfromthereportasawhole.Alongwithitsreliability,thissourceis
alsoveryuserfriendly,asitincludessummariesoffindingsanddata,sothereaderdoesnothave
toanalyzethelargeexpanseofdatawithoutaid.Thissourcewillproveveryusefulinproviding
statisticalproofformyresearchonthefrequencyofdrugandalcoholrelatedemergencyroom
visits.Furthermore,theshockingstatisticthatoverhalfofallERvisitsarerelatedtoalcoholand
druguseenforcesthesignificanceandurgencyofpursuingthistopicofresearch.

"DrugRelatedHospitalEmergencyRoomVisits."
DrugFacts
.NationalInstituteonDrugAbuse,
May2011.Web.17Oct.2015.

Thisarticlesummarizesthetrendsanddataindrugrelatedhospitalemergencyroom
visits.Itincludeshighlightsfromthe2009DrugAbuseWarningNetwork(DAWN)suchashow
therewerenearly4.6milliondrugrelatedERvisitsnationwidein2009.Italsosplitsthedata

basedonthedrugcausingthevisitation,includingillicitdrugs,alcoholandotherdrugs,and
nonmedicaluseofpharmaceuticals.ThearticledictatesthattheoveralltrendindrugrelatedER
visitsovertimehasincreaseddramatically,81%from2004to2009alone.Italsoincludestrends
forafewspecificdrugsandcategories,suchashowERvisitsduetononmedicalusesof
pharmaceuticalsincreased98.4%from2004to2009,andERvisitsinvolvingillicitdrugs,
ecstasyspecifically,increasedby123.2%.
Thedatasummarizedinthissourcehelpssupportthenecessityofpursuingatopiconthe
frequencyandreasoningfordrugandalcoholrelatedemergencyroomvisits.Becausethese
numbershaveincreasedsorapidlyoverashort5yearperiod,conductingdeeperresearchinto
thereasonsbehindthisinfluxisaworthwhilepursuit.Thesourcecompilesthedatainavery
userfriendly,easytoreadformat,unlikethecomplexchartstypicallyseeninmanyjournal
articles.Thissourceisalsoverybeneficialinthatitincludesotherdatasourcesandreferences
thatcouldwouldbehelpfultolookinto,includingreportsanddataonERvisitsfromtheDrug
AbuseWarningNetwork(DAWN)from2004to2009.

Ettner,SusanL.,etal."BenefitcostintheCaliforniaTreatmentOutcomeProject:Does
substanceabusetreatmentpayforitself?."
HealthServicesResearch
41.1(2006):
192213.Print.19Oct.2015

Thisstudyevaluatescostsandthemonetarybenefitsofsubstanceabusetreatment,using
theDrugAbuseTreatmentCostAnalysisPrograminstrumenttocollecttreatmentcostdatafrom
healthcareproviders.Fromasamplesizeof2,567clients,administrativedatabaseswereusedto
extractinformationonmedicalhospitalizations,emergencydepartmentvisits,earning,and
transferpaymentsfromaninitialinterviewandafollowup9monthslater.Theauthorfound
that,onaverage,asubstanceabusetreatmentcosts$1,583.Becauseofreducedcostsofcrime
andincreasedemploymentearnings,thetreatmentcostswereabletoreturnamonetarybenefitto
societyof$11,487,leadingtotheauthorsconclusionthatredistributingtaxpayerdollarsto
substanceabusetreatmentisawiseinvestment,evenwithouttheconsiderationthatallocating
morefundingtothistypeoftreatmentwouldcorrelatetoimprovedhealthandqualityoflifefor
drugabusingpatients.
Unlikemanyoftheothersourcesinvestigatingmonetarymattersinregardstothe
increaseofnonurgentordrugandalcoholrelatedERvisitations,thisstudyprovidesaunique
perspectiveonhowsubstanceabusetreatmentisnotasdetrimentaltothegovernmentbudgetas
onewouldthink.However,theoneissuewiththissourceisthataccesstothefulltextversionis
restricted.Inordertomaneuveraroundthisproblem,Icouldeithersimplypayforthesourceor
emailtheauthororsponsorofthesiteandseeifitispossibletogainfreeaccessasastudent.
AnotherwaytosolvethisissueistotryaccessingitfromtheUMBCdatabasesource.Thearticle
islocatedontheWileyOnlineLibrarydatabase,andUMBCpayssubscriptionfeestothis
database.Gainingfulltextaccesswouldbeverybeneficialasthissourceoffersveryrelevant
andusefulinformationinanewperspective.

Gill,J.M.,andA.W.Riley."NonurgentUseofHospitalEmergencyDepartments:Urgency
fromthePatient'sPerspective."
TheJournalofFamilyPractice
42.5(1996):49196.
EuropePubMedCentral
.Print.15Oct.2015.

Oftentimespatientscometotheemergencyroomwithtrivialissues,suchasarunny
nose,headache,fever,orthecommoncold.Whatisevenmoresurprising,however,isthatmany
ofthesepatientsdeemthemselvesurgentcasesintheemergencydepartmentwaitingroom.Upon
surveying268patientsinanurbanEDwaitingareadeemednonurgentbythetriagenurse,itwas
foundthat82%ofthesepatientsregardedtheirconditionasurgent.Despitethecommon
stereotypethatthewaitingtimeintheemergencyroomisextremelylong,themostcommon
reasonpatientsgaveforseekingemergencycarewasanexpectationofexpediency.Thearticle
concludedthatlackofaregularsourceofcare,primarycare,hadnoeffectoncomingtotheER
forproblemsthatpatientsdeemednonurgent,andthatprovidingasourceofregularcarewould
havenosignificanteffectinmanagingtheutilizationoftheemergencycaredepartment.
Thisarticleprovidesveryrelevantinformationthatisimportanttoconsider.Becauseit
comesfromadifferentpointofview,thatofthepatient,theinformationofferedinthisarticle
posesimplicationsthatareimperativetomentioninthefinalresearchpaper.Furthermore,this
articleprovidesinsightintherelationbetweennonurgentcasesanddrugandalcoholcasesinthe
emergencydepartment.Forexample,patientsseekingdetoxoralleviationfromwithdrawal
systemsareoftenlabeledasurgentdependingontheseverityofthesymptoms.However,these
typeofpatientsalsofrequentlyfitthedescriptionofsuperutilizersbecausetheyreturntheER
shortlyafterdetoxification,sometimesevenwithinthesameday.Thisarticleprovidesmore
informationintheotheraspectofnonurgentvisitations,whereanursedeemsapatientscase
nonurgentwhenthepatientbelievesitisurgent.However,oneimplicationofthisarticleisthat,
despitetheusefulandrelevantinformationitoffers,fulltextaccessisrestricted,andonlyan
abstractisviewable.Inordertoovercomethisissue,contactcouldbemadewiththeauthoror
thedatabaseitself,EuropePubMedCentral,toseeifitispossibletogainfreeaccessasastudent
tothisonearticle.Ifthisisunsuccessful,othermethodsofresolutioncouldbetopaythefeeto
gainfullaccessortosearchthroughtherelatedarticlestabonthepagetoseeifsimilararticles
existwithunrestrictedaccess.

Gutherz,Cheryl,andShiraBaron."WhyPatientswithPrimaryCarePhysiciansUsethe
EmergencyDepartmentforNonurgentCare."
TheEinsteinQuarterlyJournalofBiology
andMedicine
18(2001):17176.Print.13Oct.2015.

Utilizationoftheemergencycaredepartmentfornonurgentcaseshassteadilyincreased
overthepast30years.Thearticleassertsthatgoingtotheemergencyroomforcareisnotas
beneficialasgoingtoaprimarycaredoctorbecausethereisnolongtermfollowupor
comprehensiveunderstandingofapatientspastmedicalhistory.Astudywasconductedwhere
30patientswhohadprimarycarephysiciansandhadnonurgentcasesattheemergency

departmentofalargeurbanmedicalcenterwereinterviewed.Thestudyfoundthatthemain
reasonbehindthedecisiontocometotheERdespitehavingprimarycarewasduetoaninability
toscheduleanappointmentduetotheprimarycarephysiciansschedule.Demographicfactors
andtrustintheirprimarycarephysicianswerenotfactorsinwhypatientschosetocometothe
ERinstead.Thearticleconcludesthat,inordertoreducetheamountofnonurgentcasesinthe
emergencydepartment,primarycarephysiciansshouldimprovetheirsystemofanswering
sickcallssopatientsaremoreinclinedtovisitthemratherthantheER.
ExaminingreasoningbehindnonurgentvisitationstotheEmergencydepartmentisavery
importantsidetomyresearch,asitisimportanttodefinetherelationshiptononurgentcasesand
casesofdrugandalcoholvisitsrepeatedlyafterdetoxification.Havingpatientsreturntimeand
timeagainfordetoxorwithdrawalsymptomsisinefficientandobstructsemergencycare
physiciansfromattendingtopatientswithmorediresymptoms.However,thesepatientscannot
bedeemednonurgent,whichposesthequestions,whatdowedowiththem?Howcantheybe
treatedmosteffectivelyandefficiently?Partofansweringthesequestionsistofirstunderstand
reasonsthatsimple,nonurgentclientscomeintotheER,andthisarticleaidsinthat
understanding.

HenryFordHealthSystem."MostEmergencyDepartment'superfrequentUsers'Havea
SubstanceAbuseAddiction."
EurekAlert!
HenryFordHospital,17May2014.Web.22
Oct.2015.

Thissourceassertsthatinordertodealwithsuperfrequentusersoftheemergency
room,theunderlyingproblemthatthemajorityofthesesuperfrequentusersaresubstance
abusersmustbedealtwithfirst.AccordingtothestudyconductedatHenryFordHospital,
amongfrequentpatients,77%hadasubstanceabuseaddiction,47%wereaddictedtopainrelief
narcotics,44%wereaddictedtootherillicitdrugs(cocaine,marijuana),and35%wereaddicted
toalcohol.ThearticlethensummarizesasolutiontheHenryFordHospitalimplementedtotry
andsolvethisissue.TheycreatedtheCommunityResourcesforEmergencyDepartment
Overuse(CREDO)totryandmoreeffectivelymanagetheincreasedamountoffrequentusersof
theERbycreatingindividualcareplans.Afterexaminingandcollectingdatafromtheelectronic
medicalrecordsofpatientswhoattendedpartookinCREDO,itwasindicatedthattheprogram
hadasignificanteffect.TherateofsuperfrequentuservisitstotheERdroppedfrom33visits
peryearto11.6.
Theinformationpresentedinthisarticlesupportstheassertionfoundinavarietyofother
sourcesthatthemajorityofsuperutilizersoftheERaresubstanceabusers.Furthermore,this
sourcegoesbeyondjustsupportingtheassertion,andformulatesandappliesaresolution.
ConsideringMercyexperiencesahighrateofreturningsubstanceabusepatients,perhaps
implementingasystemsimilartoCREDOwouldbeverybeneficialingivingboththesubstance
abusepatientsandotherpatientsmoreefficientandeffectivecare.Theinformationpresented

aboutCREDOisveryhelpfulinprovidingguidelinesifIweretakeontheimplementationofa
similarprogramatMercyasmyresearchproject.

Hensley,Scott."WhyNotStartAddictionTreatmentRightInTheER?"
NPR
.NPR,29Apr.
2015.Web.18Oct.2015.

Thisarticleprovidesdetailsonhowtoproperlytreatforaddictionordrugandalcohol
abuseinthemostbeneficialwaypossibletothepatients.Addictionshouldbetreatedasa
chronictreatmenttooffermoreeffectiveandefficienthelptopatients.Thisassertionwastested
byDr.Dr.GailDOnofrioatYaleNewHavenHospital.Theresultsindicatedthatover
threequartersofpeopletreatedwithacombinationofmedicinetoeasewithdrawal,abrief
counselingintervention,andtreatmentreferralactuallywenttotreatment30dayslater.By
comparison,only37%ofpatientsthatwereonlygivenmedicationforwithdrawalwenttoa
treatmentcenter30dayslater.Certainly,thearticleasserts,thisstudywouldneedtobe
replicatednumerousothertimesandindifferentlocationsacrossthenation,buttheresults
indicateaverybrightfutureinfindingabetter,moreefficienttreatmentofaddictedorsubstance
abusepatientsthatcoulddecreasetheamountofdrugabuserelatedvisitstotheemergency
room.
Thisarticleisveryhelpfulinthatitprovidesasolutiontoaproblemverycommonin
manyhospitalsacrossthenationandparticularlyatthehospitalIinternat.Unlikeotherarticles,
insteadofsimplyprovidingstrategiesandideasfortacticsonhowtodecreasetheamountofthis
typeofvisit,nonurgentdrugandalcoholrelatedones,thearticlegivesinformationonastudyin
whichoneofthesestrategiesisactuallyapplied.However,thearticledoesnotprovide
informationonhowtreatingaddictionlikeachronicdiseasewouldaffecttheamountof
nonurgentdrugandalcoholrelatedERvisits.Furthermore,ifanyonewantedtoreplicatethe
studythearticleexplains,thearticledoesnotprovidesufficientinformationtodoso.Itonly
brieflyoutlinestheexperiment,asitisnotascholarlyjournalarticlebutratheranewsarticle
meantforthepublicthusthedetailsoftheexperimentandhowitwasconductedarenot
included.

Hsu,Dr.SamuelS.Personalinterview.4Oct.2015.

Dr.SamuelS.Hsu,mymentor,hasbeenanemergencycarephysicianatMercyMedical
CenterindowntownBaltimoreforeighteenyears.Aftercompletinghisundergraduatedegreein
biomedicalengineering,Dr.HsuearnedhisM.D.attheUniversityofMarylandmedicalschool
inBaltimorein1993.In1994,hecompletedhisinternshipatUniversityofMarylandMedical
Systemandhisresidencythroughthesameprogramin1997.Beforebeginninghisresidencyas
anemergencycarephysician,Dr.Hsustartedasaresidentsurgeon.Afterrealizinghewasnotas
inclinedtowardssurgery,heswitchedtospecializeinemergencymedicine.Throughouthis
extensiveexperienceattheMercyMedicalcenter,Dr.Hsuhashelpedthehospitalearnarankof

thenumberonecommunityhospitalinMarylandforthe20152016year.Duringmytimewith
himthusfar,hehasgivenmenumerousideasondifferentresearchtopicsaswellasextremely
usefulsourcesIhaveutilizedtogathermoreinformationonthetopicshehassuggested.

JunttiPatinen,Laura,TapioKuitunen,PerttiPere,andPerttiJ.Neuvonen."DrugRelatedVisits
toaDistrictHospitalEmergencyRoom."
Basic&ClinicalPharmacology&Toxicology
98.2(2006):21217.
AcademicSearchComplete
.Print.25Oct.2015.

ThisFinnishstudysuccessfullydeterminedtheincidenceofdrugrelatedERvisitstoa
districthospital.Thedataprovidedwasdividedbasedonpatientgroupsandthedrugsinvolved
patientsweregroupedbasedonageandgenderwhileseparatedatatablescontainedinformation
regardingthedrugtype.Thestudyfoundthatof7113evaluatedvisits,only2.3%were
certainlyorprobablydrugrelated,1.4%wererelatedtoadversedrugreactions(ADRs),and
0.9%wereduetointentionaloverdose.ThestudyconcludedthatADRsleadtoahigher
frequencyofhospitalization(51%)comparedtointentionaloverdose(35%),andthatthe
incidenceofcertainorprobabledrugrelatedvisitstotheERwasrelativelylow.
BecausethisstudywasconductedinFinland,itsresultsandvalidityarequestionable,
especiallybecauseitsresultsdonotmatchtheresultsofanyoftheothersourcesfoundona
similartopic,mostlikelybecausetheFinnishpopulationhasdifferentdrugusehabitsthanthe
Americanpopulation.Thisfactormakesthefindingsofthisstudyratherunusefultothepursued
researchtopic,astheresultsdonothelptheunderstandingoftheavailablepopulation.However,
itwouldbeusefultonotethesefindingsinthefinalresearchpaperasageneral
precaution/warningtoreadersofthepaperabouthowtheUnitedStatesperhapshassomeofthe
highestpercentagesofdrugusersworldwide.Perhapsthereasonbehindthelowrateofdrug
relatedvisitsattheFinnishdistricthospitalisthat,atthatlocation,veryfewpeopleusedrugs
andutilizetheemergencyroomcorrectlyforitsintendedpurpose.

Knezevich,Alison."Balto.Co.OfficialsSeekLocalBanonSyntheticMarijuana."
Baltimore
Sun
.BaltimoreSun,13Jan.2014.Web.28Sept.2015.

Thisarticleexplainstherecentriseintheuseofsyntheticmarijuana,commonlyknown
asK2orSpice,andhowpublicofficialsareattemptingtoinstateabroaderlawto
completelyoutlawtheuseofthisdrug.Thecurrentlawonlyillegalizescertainchemical
compoundsthatarecurrentlyfoundinthisdrughowever,becauseitissynthetic,therearea
multitudeofvariouscompoundsthatcanbesubstitutedinfortheillegalones.Thus,sellersare
abletoworktheirwayaroundthelaw.BaltimorecouncilwomanVickiAlmondwantstopassa
billthatdefinessyntheticmarijuanamuchmorebroadly,asanydrugthatmimicthe
intoxicatingeffectofmarijuanaTHC.Althoughthepassingoftheearlierlawandincreased
awarenessonthedangeroussideeffectsofthisdrughavedecreasedtheamountofincidents
involvingK2,thedrugisstillveryprominentthroughoutBaltimoreCounty.

Thisarticleismorehelpfulonthenonmedicalsideofthisissue,asitfocusesmoreon
thepoliciesandactionsthecountyistakingtowardsthespreadofthisdrug.Thiswouldprovide
agoodbackgroundorintroductiontomypaper,asmyideaforapossibletopicismorefocused
onthemedicalsideeffectsofsyntheticmarijuana.Thisarticledoesnotofferverymuchinthe
sciencebehindthedrug,suchaschemicalcompoundscommonlyfoundinthedrug,howit
mimicstheeffectofTHC,andwhyitisworsethannaturalmarijuana.Thearticledoesoffera
quicklistofcommonsideeffects,butthereareothersourcesthatwillgomoreindepthabout
eachone.However,thefactthatthearticleisratherrecent(2014),andisfromBaltimoreCounty
areverypromisingfactors,asmyinternshipislocatedinBaltimore.

"K2/Spice("SyntheticMarijuana")."
DrugFacts
.NIH:NationalInstituteonDrugAbuse,Dec.
2012.Web.27Sept.2015.

Thispagegivesanindepthanalysisofsyntheticmarijuana,includinghowitaffectsthe
brain,howitisabused,othersideeffects,aswellasitsriseinthepastfewyears.Theentry
emphasizeshowK2hasbecomeverypopularduetohowitisfalselyadvertisedasasafeand
legalalternativetonaturalmarijuana,when,inreality,chemicaladditivesinthedrugare
labelednotforhumanconsumption.
Thisarticleisveryuseful,asitgivesanexcellentandverydetailedanalysisofideally
whatmytopicwouldfocuson,themedicalsideeffectsofthedrugandhowitistreatedinthe
hospital.Theinformationitprovidesisveryhelpful,andalsoveryreliable,asitwasrecently
revisedin2012,mostlikelyduetotheriseinuseofK2aroundthattime,andbecauseitis
informationfromagovernmentassociation,theNationalInstitutesofHealth(NIH).Italso
provideslinkstoothersourcesthatcouldpotentiallybeverybeneficial,includinganarticlefrom
theNIDAaboutadditionalinformationontheuseofsyntheticcannabinoidsandadocument
abouttherisinguseofK2fromtheEuropeanMonitoringCentreforDrugsandDrugAddiction.

Macleod,JanaB.A.,andDanielW.Hungerford."AlcoholrelatedInjuryVisits:DoWeKnow
theTruePrevalenceinU.S.TraumaCentres?"
Injury
42(2011):92226.
Edselp
.Print.25
Oct.2015.

Inordertodeterminetheextenttowhichpresentliteratureanddataprovidesaproper
estimateoftheprevalenceofalcoholrelatedvisitstoUnitedStatestraumacenters,thisstudy
utilizedaMedlinesearchforallarticlesfrom1966to2007thatmightprovidedecentlyaccurate
estimates.Thesearchyielded836journalarticleshowever,thesearticleswereonlyonesin
whichtheprimaryorsecondarygoalofthepaperwastoestimatetheprevalenceofpositive
bloodalcoholconcentration(BAC)orsevereintoxication.Thearticleassertsthat,onceallthese
journalswerecompiled,theresultingdatawasstillnotsufficientenoughbecausethescopeof
thejournalswassonarrow.Thearticleconcludesthat,thusfar,nostudyhasconducteda
comprehensiveestimateofalltraumapatientshospitalized,treated,released,ordiedinalcohol

relatedcases,becausethereisalackofmethodologyinestimationefforts.Becauseofthis,itis
difficulttodeviseappropriatepoliciesonhowtraumacentersshouldapproachalcoholrelated
casesinavarietyofmedicalsettings.
Thisarticleprovidestremendousinsightonthevalidityofmanystudiesexaminingdrug
andparticularlyalcoholrelatedvisitstotheemergencyroom.Thenoteworthyobservationit
makesaboutalackofmethodologicalestimationandcalculationisveryimportanttokeepin
mindwhenexaminingallotherdatasetsregardingalcoholrelatedcasesattheER.However,
despitethepositivethatthisarticlewarnsofmisleadingdata,italsosaysthat,currently,no
comprehensive,proper,andreliabledatasetexiststhatcompilesallofthecircumstancesand
demographicsofpatientsthatusetheERforsubstanceabuse.Thisassertionleadstomany
implicationsinresearch,asitsaysthatnoneofthedatafoundisentirelyreliable.However,this
studywasdonein2011,anditispossiblethatinthepast4years,adatasethasbeencompiled
thatfitsthestandardsdictatedbythisarticleofaproperandreliabledataset.Furthermore,
becausesomanydatasetshavebeenobtained,itispossiblethatacombinationofallofthem
wouldproveworthyandreliableenoughbythestandardsofthisstudy.

McGuinness,TeenaM.,andDonnaNewell."RiskyRecreation:SyntheticCannabinoidsHave
DangerousEffects."
JournalofPsychosocialNursingandMentalHealthServices
50.8
(2012):1618.
Healio
.Healio,1Aug.2012.Print.28Sept.2015.

Thisexcerptfromajournalexplainsthehistoryofsyntheticmarijuana,fromhowit
startedasaproductsoldlegallyinconveniencestoresandheadshopstobeingillegalizedand
soldsolelyontheInternet.Italsodocumentsthevariouspiecesofnewinformationthathave
emergedasdeeperresearchhasbeenconductedduetotherisingpopularityofthedrug,
includingaggressivebehavior,paranoia,hallucination,andshorttermmemorydeficits.Italso
includesanaccountbyapsychiatricnursepractitioneronaneighteenyearoldcollegefreshman
whoendedupintheemergencyroomafterusingthedrug.
Thisresourcewillbeveryhelpful,asitwillshowmehowotheremergencydepartments
otherthantheoneatMercyMedicalCenterhandlepatientsinneedofurgentcareduetothe
intakeofsyntheticmarijuana.ThisinformationfitsperfectlyintotheideaIhaveformytopic,
sinceitwillgivemealargerbreadthofknowledgeintreatmentproceduresforpatientssuffering
fromoverdoseorreactiontoK2.Furthermore,unlikenewsarticlesaboutthedrug,thisarticleis
fromamedicaljournal,whichprovidesveryspecificinformation,andevenusesmedical
terminologytooutlinevarioussideeffects.However,theonenegativesideofthissourceisthatI
canonlyviewanexcerpt,notthearticleortheeditionofthemedicaljournalinitsentirety.In
ordertocombatthis,Icanemailtheeditorofthissectionofthejournal,Dr.TeenaM.
McGuinnessaboutpossiblybeinggrantedaccesseithertothisarticleortheentirejournal.

MercyMedicalCenter.TheSistersofMercy,n.d.Web.04Oct.2015.

TheMercyMedicalCenterwebsitegivesanoverviewofthemedicalcenter,fromnews
andeventstotypesoftreatmentstheyoffer.Italsocoversthedifferentcentersanddepartments
withinthemedicalcenter,andprovidesalistofwhatservicesareprovidedwithineachand
contactinformationforeachdepartment.InthesectionaboutthevariouscentersMercy
comprisesof,includingtheCancerInstitute,WomensHealthCenter,Orthopedicscenter,and
theEndocrinologycenter,thewebsitegivesabriefsynopsisofvariousconditionsapatientmay
havethatincludesadescriptionofthecondition,thesymptomsanddiagnosticprocess,and
optionsfortreatment.Forexample,ontheOrthopedicscenterpage,onecanproceedtoapageon
theconditionsthecentertreats,andthentoaspecificcondition,suchasplantarfasciitis,in
whichtheligamentsconnectingtothetheundersideofthebackoftheheelareinflamedorhave
microscopictears,whichcausesasearingsensationontheundersideofthebackoftheheel,
especiallyintheearlymorningwhenonerises.Thesitealsoofferspatientservices,suchas
payinghospitalbillsandfindingaprimarycarephysicianatMercy.
Thissourceisextremelyhelpfultome,asitisthewebsiteofthemedicalcenterIintern
at.Notonlydoesithelpmegainagoodbackgroundandbetterunderstandingofthecenterand
theideologiesoftheSistersofMercythatsupportit,Ialsogainedanexcellentdatabaseof
reliableinformationandbackgroundofahugevarietyofdiseasesandconditions.Furthermore,it
alsogivesmetheinformationIneedtocontactspecialistinotherfieldsbesidesemergency
medicine,inthecasethatIchooseadifferentresearchtopicbesidestheeffectofK2.Mercyhas
arenownedprostheticdepartment,soifIchoosetoconductresearchonthattopic,Ihavean
entiredatabaseofpossiblesources,bothorthopedicphysiciansandsurgeons,thatImaypossibly
interview.

NonurgentUseofHospitalEmergencyDepartments
,U.S.SenateCong.,114(2011)(testimony
ofPeterCunningham).Print.

Thisstatementarguesfordivertingnonurgentmedicalcasesawayfromtheemergency
room,namely,substanceabusecases.Thisassertionissupportedbytheproofmanystudieshave
foundstatingthatsettingupaseparatetreatmentprogramorprocedureforsubstanceabuse
patientsnotonlyprovidesthemwithbetterandmoreeffectivecare,butisalsomoreeconomical.
Thespeaker,Cunningham,arguesthatcostsavingsfromsimplyreducingnonurgentERusewill
bemodest,butthecostsavingsfromuninsuredandMedicaidpatientsarelikelytobemuch
greater.However,Cunninghamconcludes,thevalueofthesemonetarysavingswillbe
overshadowedbytheinvaluablegainsincarequalityforthesesubstanceabusepatients.
Thisarticleisinaverydifferentmediumcomparedtoothersources.Asastatement
beforetheU.S.Senateonthenonurgentuseofhospitalemergencydepartments,itprovidesalot
moreconceptualreasoningbehindthistrendratherthanstatisticalproofasinmostothersources.
Furthermore,itisrelatedtoahearingonwhetherornotdivertingnonurgentemergencyroom

usecanprovidebettercareforlowercosts.Thefactthatsuchatopichasmadeleadwayintothe
discussionoftheSenatespeakstothevalidityofthisresearchtopicaswellasitsprominencein
current,moderndayaffairs.Also,becauseallofthisinformationispresentedinajudicial
testimony,itisallreliable,wellsupportedinformationthatisusableforthefinalresearchpaper.

Parker,Gary,DaneLibart,LindaFanning,TracyHiggs,andCathyDirickson."Takingon
SubstanceAbuseintheEmergencyRoom:OneHospitalsSBIRTStory."
International
JournalofMentalHealthandAddiction
(2012):n.pag.SpringerScienceandBusiness
Media,LLC,26July2012.Print.25Oct.2015.

ThisarticlespeaksdirectlyabouthowtheMercyHealthCenterinOklahomasuccessfully
implementedaScreening,BriefIntervention,ReferralandTreatment(SBIRT)programintheir
emergencyroom.Becausenearly2550%ofthetraumarelatedincidentsbroughttothehospital
involveuseofalcoholorillicitsubstances,theemergencydepartmentstaffmadeacollective
decisiontoimplementanSBIRTprogram.Thearticleexplainsthestudythehospitalconducted
inordertoconcludewhetherornotincludinganSBIRTprogramwouldbebeneficialinthe
futureinchangingpatientbehaviorregardingalcoholanddrugabuse.Ofabout2083screened
patientsthatcameseekingurgentcareoveran8monthperiod,1319returnednegativeresults,
372weredeemedmedicallyunstableandunabletoparticipate,27abstainedfromparticipating,
and365weredeemedtobeatriskorworseforsubstancemisuse.Thestudyconcludedthat
futureandformalimplementationofsuchaprograminmanyemergencydepartmentswouldbe
verybeneficialtopatientwelfare,althoughfurtherstudiesshouldbeconductedinhospitals
locatedinotherlessaffluentareastoobservehowthedatamaybeaffected.
ThisstudyisveryhelpfulinanothertopicIaminterestedinresearching,thefrequencyof
drugoralcoholrelatedvisitsintheemergencyroom.Thearticleprovidesspecificstatisticson
thistopicandproposesamechanismthatwouldbenefitpatientswithsubstanceabusehabits
moreefficiently,theSBIRTprogram.ThestudyalsowasconductedatabranchoftheSistersof
Mercy,theMercyHealthCenterinOklahoma,ausefulparallelbecauseIinternattheBaltimore
branchofMercy.ItispossiblethatIcoulddiscusstheresultsofthisstudywiththeemergency
departmentatMercyandseeifimplementationisapossibility,asmanyofthepatientswesee
sufferfromdrugandalcoholabuse.Thisstudycouldbealittlemorespecificwhenexplaining
theparametersofthestudyinordertomakeitmorereplicable.However,itwillstillbevery
helpfulwithfurtherresearchasitprovidesanextensivelistofreferencesthatcouldbepotential
othersources.

Parthasarathy,Sujaya,etal."Associationofoutpatientalcoholanddrugtreatmentwithhealth
careutilizationandcost:revisitingtheoffsethypothesis."
JournalofStudiesonAlcohol
62.1(2001):8997.

Astudywasconductedthatexaminedthehypothesisthattreatmentcanreducemedical
utilizationandcostoftreatmentforpatientswithsubstanceabuseproblems.Partneringthe
insurancecompanyKaiserPermanente,researchersexaminedthemedicalrecordsandcostsof
adultpatientsenteringanoutpatientchemicaldependencyprograminSacramentoovera2year
period.Thestudyfoundthatpatientswhowentintoaseparatetreatmentprogramresultedina
noticeabledecreaseintheamountofERvisitsfordrugandalcoholrelatedincidents.Thearticle
concludesthatinthecaseofpatientswithsubstanceabusedisordersthatenteredtreatment,there
wassignificantlylessinappropriateandinefficientutilizationandcostinthehospitalERduring
theposttreatmentperiod.
Thisarticleprovidesaverytechnicaldescriptionofthedataithascalculated.Becauseit
offersevidencethattreatmentreducesmedicalutilizationandcostofpatientsdealingwith
substanceuseproblems,itprovidesveryuniqueinformationthatotherarticlesfailto.
Furthermore,itsupportstheassertionmentionedinapreviousarticleabouthowsubstanceabuse
treatmentisnotascostlyanddestructiveofthehealthcarebudgetasresearchershadoriginally
thought.However,acriticismofthisarticlewouldbethataccesstothefulltextPDFis
restricted,andonlytheabstractisavailable.Althoughtheabstractitselfisveryextensiveand
coversalotofspecificinformations,suchassamplesizesofvarioustestgroups,accesstothe
fulljournalarticlewouldbemorebeneficial.Icouldeithercontacttheauthorordatabasein
whichthisarticleisstoredtoseeifIcouldgainfreeaccessasastudent.

RawlingsBlake,Stephanie.
BaltimoreCityHealthDepartment
.CityofBaltimore,2014.Web.
12Oct.2015.

ThesourcehighlightsvariouspublichealthissuesfoundinthecityofBaltimoreaswell
asresourcesforonlinepayments,311services,andaboutgovernmentactionsandupcoming
localevents.Thesubstanceabusepageofthesiteexplainsaprogramofpublichealth
intervention,knownastheStayingAliveDrugOverdosePreventionandResponsePlan.Started
in2004bytheformerhealthcommissioner,Dr.PeterBeilenson,theprogramhastrained12,365
individualsinrecognizingthesignsandsymptomsofopioid/heroinoverdoseandhowtorespond
correctlyinordertomaximizethepatientschanceofsurvival.
Thiswebsite,asuggestiongivenbymymentor,hasanextensivearchiveofinformation
thatisextremelyhelpfulbecauseitisallfoundlocallyinBaltimore.Furthermore,itisextremely
relevanttoMercyhospitalbecauseallofitsfindingscanbedirectlyobservedinthehospital
itself,particularlyintheemergencyroom.Thewebsitehasaspecificpageonsubstanceabuse
andhighlightssomeofprogramsandplansthecityofBaltimorewillundertake.Eventhough
thoseresultsarehealthpolicyrelatedratherthanemergencyroomrelated,itisnecessarytohave

articlespertainingtohealthpolicyforthefinalresearchpaperbecauseitwillunderscorewhat
thegovernmentandoutsideorganizationsotherthanthehospitalitselfcandotoresolve
nonurgentordrugandalcoholrelatedemergencyroomvisits.Thissourceisalsoveryhelpful
becauseitprovidesasmalldatabaseofdruguserelateddatasources,rangingfromlistsof
intoxicationdeathstodrugintoxicationdeaths.However,thesesourcesareslightlyoutdatedas
theyarefrom20072008.

Schrimpf,Natalie."ERsForcedtoCopewithRisingDrugCases."
Crain'sClevelandBusiness
17.41(1996):24.
RegionalBusinessNews
.Print.25Oct.2015.

Overthepastyears,datafromtheSubstanceAbuseandMentalHealthServices
Administration(SAMHSA),abranchoftheDepartmentofHealthandHumanServices,has
indicatedariseinillegaldrugrelatedvisitstotheER.Thisarticleexplainstheimplicationsand
effectsofthisfindinginthesettingofanactualhospital.Thestudyarticlenotesthat,alcohol
relatedincidentsespeciallyhaveincreasedatUniversityhospitalsinCleveland,increasingnearly
15%.Thearticlesummarizesmoreshockingstatisticsabouttheriseofdruguse,andrelatesitto
thelossofhumanpotential.
Thisarticletakesmuchofthedatacompiledovertheyearsandputsitintheperspective
ofhowithasaffectedhospitals.Thisnewperspectiveisveryvaluablebecauseitindicateswhat
shouldbeobservedinthehospitalthatisaccountedbythesenewstatistics.Specifically,the
increaseindrugandespeciallyalcoholrelatedcasesintheemergencyroomhasresultedinthe
increaseofsecurityatvariousUniversityhospitals(andinMercyaswell),inordertoprevent
anyintoxicatedpatientsfromharmingthemselvesorothers.Theinformationpresentedinthis
articleisveryuniqueandrelevanttothecurrentresearchbecauseitisbothsomethingtobe
includedinthepaperandtobeutilizedattheplacementsite.Itwouldbehelpfultoseekout
similararticlesregardingdifferenthospitalsites,asthisonepertainstothehospitalslocatedin
NortheastOhio.However,thearticledoesfailtoincludereasonsfortheriseindrugandalcohol
relatedvisitationsattheER,whichissomethingprospectivearticlesshouldinclude.

Spencer,Michelle,RyanPetteway,LaVedaBacetti,andOxirisBarbot.
HealthyBaltimore2015:
ACityWhereAllResidentsRealizeTheirFullHealthPotential
.Rep.N.p.:n.p.,n.d.
BaltimoreCityHealthDepartment,May2011.Web.22Oct.2015.

Thisreportpresentsinformationonawidevarietyoftopics,rangingfromreducing
alcoholanddrugabusetoencouragingtheearlydetectionofcancer.Thearticleexplainshow
alcoholanddrugrelatedincidentshaveextremelynegativeconsequencesonthelivesofthe
individualandthecityitself.Drugandalcoholabuseleadstobuildupofextremelyhighcosts,
lossofproductivity,familyandcommunitydisruption,crime,homelessness,andexpensive
healthcareutilization.Italsogivesthreedatasetsonthistopic,twodepictingtherateofhospital
dischargesofpatientswithalcoholordrugrelateddiagnosesbyrace,andthethirdofpercentof

highschoolstudentsreportingdruguseinthelastthirtydaysbygender.Thearticlenotesthatit
isimportantespeciallytodecreasedrugandalcoholuseintheyouthpopulationtoensurethe
possibilityofabrightandsuccessfulfuture.
BecausethisisalocalreportfromtheBaltimoreDepartmentofHealth,itisbothreliable
andaccessible.Furthermore,itsfindingsandtheinformationitprovidesaredirectlyverifiable,
asIcanobservefirsthandwhetherornottheirassertionsaretruebyobservingwhathappensat
myinternship.However,despitethesepositives,thesourcelacksindepthandbreadth.The
reportismultiplepageslong,butonlyonefocusesondrugandalcoholabuseinthecity.Even
thoughitisaveryrelevantandusefulsourcebecauseitisbasedlocallyinBaltimore,itdoesnot
providesufficientinformation.Itdoesnotfocusenoughontheemergencyroomaspectofdrug
andalcoholabuse,andinsteadfocusesmoreonitsfrequencyinthecitypopulation.

Torres,Dr.Mercedes.Personalinterview.24Oct.2015.

AsanemergencycarephysicianatMercyhospitalfornearlynineyears,Dr.Torreshas
hadalotofexperiencewiththemanydrugandalcoholrelatedcasesthatcomethroughthe
emergencydepartmentatMercy.Furthermore,asonewhocompletedherundergraduatedegree
atPrincetonUniversityandherdoctorateattheUniversityofPennsylvania,shealsohasalotof
insightinthearduoustaskandcompetitionofgettingintomedicalschool.Herexperienceshave
beeninvaluableinhelpingmeformulateamorespecificresearchtopicthatisveryfittingtomy
mentorshipplacementsiteandinhelpingmeunderstandthedifficultpathofbeingadoctor.

UnitedStatesofAmerica.DepartmentofHealthandHumanServices.CentersforMedicare&
MedicaidServices.
CMCSInformationalBulletin:ReducingNonurgentUseof
EmergencyDepartmentsandImprovingAppropriateCareinAppropriateSettings
.By
CindyMann.CentersforMedicaid&ChipServices,16Jan.2014.Print.13Oct.2015.

Thissourceissplitintotwosections,onedelineatingthreestrategiestoreduceuseofthe
ER,andtheotherexplainingthedistinctionbetweenemergencyandnonemergencyuseofthe
ER.ThestudyconcludesthatthebestandmostcosteffectivemethodofreducingERusage
whilestillprovidinghighqualitycareisthroughthethreestrategiesitdescribes,broadening
accesstoprimarycareservices,reducingthenumberofsuperutilizers,andtargetpatientswith
behavioralhealthissues,asmanyERfrequentersseektreatmentfortheirmentalhealthissuesor
substanceabuseproblems.Toconclude,thearticleemphasizestheimportanceofutilizingthe
threestrategiesinorderforhospitalstostaywithintheirbudgetsandhowcasebycase
evaluationisnotasefficientoreffective.
Asagovernmentpublication,thissourcepresentsverycredibleandreliableinformation.
Itprovidesinformationfromadifferentperspective,fromtheorganizationthatneedstofund
hospitals,ratherthanthehospitalsthemselves.Becauseofthis,muchoftheinformation
presentedisaimedtowardsaccountingforfinancialmatters,specificallytheinevitablespending

increaseduetotheAffordableCareActwhichwillcauseanincreaseintheamountofpatients,
asnowmorepeopleareabletoaffordhealthcare.But,thisdifferentperspectivealsomeans
indirecthospitalexperienceCMSisnotamedicalcenter,andmuchoftheinformationit
providesisnotfromfirsthandexperience.Thethreestrategiesitprovides,however,are
interestingtonoteandperhapsideasIcouldbringtomymentorsiteonhowtoreducethe
numerousnonurgentcases.Theparametersoftheinformationpresentedinthissourcefitvery
wellintomytopicandallofitisveryuseful.

UnitedStatesofAmerica.NationalInstitutesofHealth.
ALCOHOLRELATEDEMERGENCY
DEPARTMENTVISITSANDHOSPITALIZATIONSANDTHEIRCOOCCURRING
DRUGRELATED,MENTALHEALTH,ANDINJURYCONDITIONSINTHEUNITED
STATES:FINDINGSFROMTHE20062010NATIONWIDEEMERGENCY
DEPARTMENTSAMPLE(NEDS)ANDNATIONWIDEINPATIENTSAMPLE(NIS)
.
NationalInstitutesofHealth,Sept.2013.Print.12Oct.2015.

Thissourceisadatareferencemanualfeaturinganextensivecollectionofdataon
emergencydepartmentvisitsandhospitalizationsinvolvingalcoholuse.Thedocumentexplains
howthedatawascollectedandcalculatedandprovidesdetailedtablestodelineatethe
information.Specifically,thetablesshowdifferentagegroupsandwhatincidentthepatientwas
broughtinfor,suchasfallsormotorvehicleaccidents,andwhatpercentageofthoseincidents
weredrugrelated.
Thismanualharborsalotofdata,330pagesworthofit,andwillbeverydifficulttosort
through.Itwillbeuseful,however,ifIneedastatisticIcouldquicklylookupwhenwritingmy
researchpaper.However,anegativesideofthissourceisthatitisratheroutdatedthedatais
collectedfrom20062010.Fortunately,becausethissourceisdocumentingalcoholrelated
incidentsonlyandnotdrugrelatedones,itsantiquityisnotasinfluentialasitwouldbeonone
documentingdrugdata,astherehavebeenmanydevelopmentsinsubstanceabuseoverthepast
5yearsthantherehavebeenforalcohol.Alcoholhasbeenamorestaticcausetopatient
admittanceintotheERwhereasthetypesofdrugspatientsintheERusehavevariedgreatly
overthepastdecade.

Zed,PeterJ."DrugRelatedVisitstotheEmergencyDepartment."
JournalofPharmacyPractice
18.5(2005):32935.Print.20Oct.2015.

Thisarticlesummarizesthefindingsofmanycurrentpiecesontheimpactofdrugrelated
visitstotheemergencyroomonourcurrenthealthcaresystem.Itisimportanttonotethat,often
times,previousdatacollectedonpatientsintheERfordruguseonlydocumentpatientsadmitted
intothehospital,notthosewhoaresimplyseekingmedicalattention.Includingboththese
groupswouldcertainlyincreasethenumbersandindicateincreasedpressureonourhealthcare
system.Astimepasses,therehasbeenapositivecorrelationintheamountofdrugrelatedER

visits.ThisarticlesummarizesthecontentofvariousarticlespublishedontheimpactoftheseER
visitsinregardstoclassification,severity,preventability,andeconomicimpactofthese
drugrelatedvisits.
ThissourceepitomizesexactlywhatIamlookingforandexactlywhatthepurposeofmy
researchis.TheinformationitprovidesissomethingIwouldcertainlyincludeinmyfinal
researchpaper,alongwiththelargeexpanseofstatisticalevidenceprovidedinmyothersources.
Unlikeotherarticlesthataremoretechnicalandscientificinsummarizingdataandproviding
reasonsfortheERvisits,thisarticlegoesbeyondthatandprovidesinformationontheimpact,
makingthisanexcellentanduniquesourcethatfitsmytopicexactly.However,becauseit
parallelssoclosely,itisimportanttoremembernottodrawtoodirectlyfromthesourceandto
paraphraseandincorporateotherpartsofmyresearchwhenincludingthissourceinmypaper.