Here is a quick look at three articles published in the February issue of Annals of Emergency Medicine. Visit www.annemergmed.com to read the full text.

Emptying the Corridors of Shame: Organizational Lessons From England’s 4-Hour Emergency Throughput Target

By E.J. Weber, et al.

Editor’s Capsule Summary

• What is already known on this topic: In 2005, England mandated that nearly all emergency department patients requiring admission receive an inpatient bed within 4 hours of arrival to combat delays and boarding.
• What question this study addressed: What does a sample of 27 English ED leaders think about the mandate?
• What this study adds to our knowledge: Using a semistructured, qualitative interview approach, the leaders surveyed noted that success required collaboration between ED directors and a cooperative hospital administration. Staff perceived more empowerment but still had concerns about patient care and safety when meeting this requirement.
• How this is relevant to clinical practice: Health care systems considering the implementation of similar rules should heed lessons learned in the English experience, embracing processes that optimize care rather than relying solely on rigid time intervals.

The Effect of Triage Diagnostic Standing Orders on Emergency Department Treatment Time

By R. Retezar, et al.

Editor’s Capsule Summary

• What is already known on this topic: Initiating laboratory testing at triage when an emergency department is full is one approach to improving flow, but it has an uncertain effect on overall care efficiency.
• What question this study addressed: Do triage standing orders decrease patient length of stay defined as room placement through disposition?
• What this study adds to our knowledge: In this retrospective study of more than 15,000 patients seen in one urban ED, use of triage orders for those with selected conditions decreased the time of in-room ED care by 16%.
• How this is relevant to clinical practice: Triage orders can speed the in-room portion of care when an ED is full; however, this study did not assess the costs or other downsides of unnecessary testing.

Ketamine With and Without Midazolam for Emergency Department Sedation in Adults: A Randomized Controlled Trial

By S. Sener, et al.

Editor’s Capsule Summary

• What is already known on this topic: Emergency physicians are often reluctant to sedate adults with ketamine, fearing unpleasant hallucinatory recovery reactions.
• What question this study addressed: Does co­administered midazolam decrease recovery agitation following emergency department ketamine sedation in adults?
• What this study adds to our knowledge: In this study of 182 subjects, coadministered midazolam decreased the incidence of recovery agitation of any severity by 17% (number needed to treat to benefit was 6).
• How this is relevant to clinical practice: Coadministered midazolam appears to reduce the incidence of recovery agitation following ketamine sedation in adults in the emergency department. However, this study does not clarify how many of the prevented occurrences were clinically important.